As a general rule, we tend only to schedule patients for surgery where they require sufficient surgical procedures to warrant a full hospital operation under general anesthetic. This may be either SRS, a full FFS surgery, or by combining minor FFS procedures (decided on a patient-by-patient basis) at the same time as the patient is undertaking SRS and/or AM. Because of the time that would be needed under general anesthetic and consequent risk to the patient Dr Suporn will not perform full FFS on a patient in the same operation as SRS. In this context, "full FFS" means undertaking
more than one of the 4 main group surgical packages outlined under "ffs procedures".
For a guideline to the time required for the surgery, and the recovery time spent in hospital please see our scheduling table
Due to the
long duration under which patients are under general anesthesia, all patients are advised to have a full medical check-up to confirm that they are physically fit, of healthy weight, and are strong enough to be under general anesthesia for a period upwards of
about 5-1/2 hours for SRS. In our experience, Dr Suporn's patients require about twice the duration of total recovery period (3 to 4 months) compared with having SRS elsewhere. All SRS patients must stay at least 24 days and preferably 30 days in Thailand to ensure proper recovery under the care of the Clinic staff.
Minimum Psychosocial requirements for Patients Scheduling SRS:
It is not Dr. Suporn's policy to deny SRS surgery to any patient he believes to be medically and psychologically fit to undergo it. As far as is considered reasonable, The Suporn Clinic follows the guidelines of the Harry Benjamin Gender Identity Disorder Standards of Care (HBGIDSOC). Additionally, we always comply with the Medical standards of Thailand. We require patients to provide written evidence that they meet the following criteria:
With effect from 29 November 2009,
new regulations issued by the Thai Medical Council regarding SRS
patients come into force.
ALL patients undergoing SRS MUST
provide an original, signed document from a qualified psychiatrist or
psychosexual specialist, confirming as a minimum that:
They have been diagnosed with
Gender Identity Dysphoria.
SRS is indicated in their case,
and is the recommended treatment.
Ideally, the referral should also
They have been living full time
as a woman for at least 12 months prior to surgery or - if not -
gives an explanation as to why that has not been possible in their
case. It is accepted that RLT is not a practical possibility in
They have been undertaking a
course of female hormone replacement therapy (HRT) unless there
are medical reasons (to be indicated) that such a course is not
advised in their case.
The letter must show the name, address and telephone number of the
signee, for possible verification
In order to ensure that there are no difficulties with the documentation
that you have, please make sure that you scan the letter and
send it to me
as an email attachment for review, to make sure it meets the necessary
requirements. It is essential that you bring the original with you when
you come for surgery (or that the original is sent to us direct). It will
not be possible to go ahead with the SRS operation without such a suitable
There are no exceptions to this requirement. Any patient who arrives
without this evidence will not be permitted to undergo surgery. If you
have difficulty with providing such evidence, please contact the
Clinic, so we can discuss possible ways of meeting this requirement.
Additionally, if the referral letter from the psychosexual specialist does
not specify as in items (3) and (4) above, we require you separately to
provide evidence that you:
have had treatment with
feminizing hormones (HRT) and/or anti-androgens for a minimum
period of 12 months, unless there is a medical reason why to do so
would not be advised in your case.
have lived full time in your
acquired gender for a period of at least 12 months, evidenced by
at least 2 original documents ( ** ), unless there are clearly
given and acceptable reasons why this is not possible, or not practical
in your case. Some easement of this requirement might be
permitted, subject to the contents of the referral letter.
( ** ) Documentary evidence needs only to be sufficient
to show the patient's acquired (female) name, and bear a date at least 12
months prior to surgery. Suitable examples would be - but are not restricted
to - passport, driver's licence, official ID card, household utility bill,
There is no specific format for a SRS Referral letter.
Dr Suporn does not expect a long report or detailed diagnosis, but he does
expect it to contain certain minimum criteria. We would expect the doctor to
mention how many times he has seen the patient, and since when. The doctor
or practitioner does not have to specifically recommend that the patient
should undergo SRS, nor do they have to
specifically refer the patient to Dr Suporn ( a qualifying referral
previously addressed to another surgeon is acceptable ). However, we would expect to see that the doctor or
therapist considers that the patient:
has been diagnosed with gender
dysphoria as the conclusion of a number of personal communication sessions. Confirmation of diagnosis in accordance to DSM IV Code
302.85 and/or ICD10 code F64.0 (or as otherwise appropriate) must
shows no evidence of co-morbidity
or substance abuse.
is demonstrably living full time
as a woman for at least 12 months, or shows evidence of commitment
to do so, or has satisfactory reasons as to why she is not yet
doing so. There might, for example, be legal reasons in any
particular country preventing this.
is not suffering from any
psychological or psychiatric disorders (****) that might be
adversely influencing her decision or desire to undergo SRS.
has been taking female hormones
(for a specified period - usually a minimum of 6 months), unless
it is considered medically unsafe to do so.
is fully adjusted to living in
society as a woman or – if not yet living as a woman – must have a
satisfactory explanation as to why this is the case.
is fully aware of the
consequences, cost, details, complications and surgical and
non-surgical options available to treat her gender dysphoria.
is aware that SRS is
is considered suitable by him /
her to undergo SRS insofar as he/she offers no reason why you
should NOT undergo SRS and that SRS is necessary for the patient’s
If the letter has all (or most
of) those "ingredients", and the doctor is competent to write and
sign it by virtue of his / her qualifications and credentials, Dr
Suporn will accept that as suitable referral.
( **** ) Although it is sometimes referred to as such, in this
respect, we do not consider Gender Identity Disorder (GID), Gender
Dysphoria or transsexualism to be a psychiatric or psychological
Under Thai medical regulations,
patients under the age of 20 are unable to undergo surgery without
the written approval of their parents, legal guardians, a direct
blood relative, or an individual who has legal Power of Attorney
over your affairs. The signee must, himself or herself, be aged
over 20. The signed document giving approval for you to undergo
SRS must also be accompanied by an originally signed photocopy of
a photo-ID which bears the same signature. If the family name of
the signee is different from your own family name, copies of
suitable evidence must be given to link the signee with having the
authority to sign on your behalf.
If you are able to obtain this approval, Dr Suporn would be quite
happy to proceed with surgery - providing you are able to meet the
other criteria of our protocol, particularly in respect of having
been diagnosed gender dysphoric, and having psychotherapeutic
agreement to undergo the surgery. If you do not provide this
approval, in original format, at the time of the operation, Dr
Suporn will not proceed.
Dr Suporn is unable to undertake SRS on patients aged less than 18
Dr Suporn no longer accepts
patients aged 65 and over for SRS or substantial FFS operations.
To amplify the meaning of "substantial", please contact the Clinic
to discuss specific circumstances.
Pre-Operative Medical Requirements and Surgical Considerations
Patients will only be operated on if they are medically fit for surgery. While a full medical check-up is provided at the hospital prior to surgery, all patients with known medical conditions are strongly advised to undergo a full medical check-up by their own medical practitioner prior to confirming their surgery booking. They should obtain and submit along with other documentation a report from their medical practitioner certifying that detailing date of birth, height, weight, medical history, medical conditions, and a recommendation that the patient is physically fit to undergo major surgery under general anesthesia.
All patients are screened with an electronic questionnaire prior to scheduling for surgery.
Final medical clearance for surgery depends on satisfactory results of the medical admission tests, and consent of the anesthesiologist at Aikchol hospital
Bilateral orchiectomy is not recommended prior to SRS,
but is permitted. If the scrotal sac has been removed, the applicant must seek elsewhere to undergo SRS.
Prior genital electrolysis is not required.
Permanent genital depilation is unnecessary, expensive and
uncomfortable. All hair follicles are manually excised (cut) from the scrotal skin during surgery,
and will not grow subsequently. A hair-free vaginal lining is
guaranteed. Prior electrolysis of the scrotal area may result in scarring and thickening of the skin which
could reduce its elasticity and vaginal depth. If desired, only the perineal region (perineum) between the anus to the scrotum should be cleared (which can also be cleared after SRS)
For all surgery, no blood transfusions are used (no need for patients to bring their own blood supply)
Major surgery - particularly SRS - carries the potential risk of incurring Deep Vein Thrombosis. Dr Suporn and his team take every precaution possible to minimize the risk of DVT. However, much of the responsibility for risk avoidance of DVT rests with the patient, not with the surgeon. Patients are recommended to reduce weight to acceptable (non-obese) levels, to remain actively fit, and to take adequate exercise during any long-haul flight. In addition:
All anti androgen/hormone injections must be stopped 4 weeks before traveling, and anti androgen/hormone oral tablets, gels, patches, and aspirin must be stopped 1 week before traveling to Thailand
must be stopped at least 1 month before traveling to Thailand.
Patients who fail to stop taking hormones or/and smoking before surgery will have their surgery cancelled.
Patients who smoke must make every effort not to resume until at least one month after surgery. FFS patients - in particular - should be aware of the that has on post-operative recovery and results.
After surgery, hormone treatment can be resumed 2 weeks after surgery (in the case of SRS resumption of anti androgens is not necessary unless prescribed to the contrary by your medical practitioner)
Dr Suporn does not undertake elective surgery on HIV+ (positive) patients.
Patients who have any doubts about being HIV- (negative) should have the test before coming to Thailand. Patients who fail to disclose any serious medical conditions, including clinical obesity, may have their surgery cancelled upon arrival to Thailand, and forfeit all payments made for surgery.
for undergoing FFS
Dr Suporn considers FFS to be purely elective surgery,
and as such does not expect any patient to meet any specific criteria other
than being physically fit to undergo the operation. In general, however, he
considers FFS likely to be unnecessary and unadvisable for any patient below
18 years of age, assuming she is following a course of feminising HRT,
unless she has unusually dominant male characteristics.
There is no requirement for any patient to have started
feminising HRT prior to undergoing FFS. HRT in general will have no effect
on the underlying bone structure of the face, but might have some feminising
benefit by altering the facial skin texture and facial fat distribution,
which can have a softening effect. HRT is more likely to be effective in
this respect for a younger client, than for a more mature individual.