1.) Legal age of maturity age in the patient's nation.
2.) Psychology certificate stating that you are a suitable candidate for sex reassignment surgery by a psychiatrist or clinical psychologist who is a professionally qualified specialist in the field of gender dysphoria.
3.) Hormone therapy certificate stating that you have been on hormone for at least 1 year.
Where can I take hormone treatment?
A patient should see an obstetrician-gynecologist to ask for a hormone prescription. Side effects can be bad if there is over dosage. It is not advisable to take hormone on your own since you should be monitored for side effects while taking it.
Where can I get the psychology certificate?
A patient of sex change surgery should see a psychiatrist or clinical psychologist who is a professionally qualified specialist in the field of gender dysphoria.
What are the effects of testosterone treatment ?
The effects of testosterone treatment on genetic females include deepening of the voice, enlargement of the clitoris, mild decrease in breast size, increased facial and body hair, and male pattern baldness. These changes may be irreversible. Reversible changes are increased upper body strength, weight gain, increased social and sexual interest and arousability, and decreased hip fat.
How is the sexual life after the surgery?
The penis of a genetic male is made up of specialized blood vessels which fill-up with blood during sexual arousal thus causing erection. In sex reassignment FTM surgery, the penis is created from soft tissue of the arm which is not composed of the same specialized tissue in the genetic male's penis. Therefore, it cannot achieve erection. In order for sex reassignment patients to be able to achieve penetration during sexual intercourse, silicone prosthesis will have to be inserted in a separate surgical procedure.
How long should I stay in Thailand for sex change surgery?
In order for a patient to have sex reassignment surgery, the patient should stay in Thailand at least 2-3 weeks to complete a whole process and allow the proper healing. On an arrival day in Thailand, a patient should stay in a hotel to relax from a long flight and have a surgery on the following day. The hospitalization of sex reassignment surgery from female to male depends on which stage a patient is at.
How is surgery performed? Stage 1:
1.1 Subcutaneous mastectomy
This surgery is the reduction of breast volume to provide the patient with masculine breast features. A semi circular U-shape incision located at the junction of the normal skin and areola skin is made. The incision leaves minimal scarring, easily hidden upon recovery, as the skin pigment will blend with the color of the areola. The procedure is Approximately 2 hours, after the surgery the surgeon will place a tube for two days to drain the blood and prevent accumulation. Stitches will be removed after 1-2 weeks.
1.2 Total removal of uterus and ovaries
Males do not have uterus and ovaries therefore it is very important that uterus and ovaries are removed for this group of patients so that they do not face the problem with menstruation and on the other hand eliminate the hormone producing organ. This is done by a gynecologist and can be done together with Subcutaneous Mastectomy. After the first and second procedure, when the wound in the breast as well as the internal and external abdominal wound is totally healed after Approximately three months, there will be a follow-up check with the surgeon to evaluate the condition of the wound and tissue to prepare for the second stage procedures.
2.1 Vaginal closure and urethral lengthening
This is the step wherein the path of the urinary tract is altered and the vaginal closed. It is because the direction of the female urinary tract is facing downward while the male urinary tract is in front. Therefore the surgeon is required to alter the direction of the urinary tract and completely close the vagina. The length of the urethra is also made longer and prepared to join with the urethra at the forearm in the last step.
The surgeon will lop off the wall of the vagina and fold it back outward (vaginal mucosa reflection) and lop off the tissues in the vagina and to closed it completely. When this procedure is completed the patient will not have a vaginal opening and the patient can urinate at the front direction, like that of a male but without the penis yet. The healing process take about 2-3 weeks: the patient is required to stay in the hospital for 2 days. A catheter will be inserted for about 7-10 days: it will be removed after the urinary tract is healed.
2.2 Urethral prefabrication
Urethral prefabrication is the preparation of the urethra to a penis (using the forearm flap Phalloplasty). In creating the penis at Yanhee International Hospital, the surgeon uses the forearm fascia; skin, nerves and blood vessels are raised and transplanted by microsurgical technique. To reduce the percentage of urine leakage the surgeon will create a urethra by wrapping the catheter with glutei skin and bury into the forearm. After the grafted skin is healed, the result is a sturdy urethral tube, and when used to create the penis, percentage of urine leakage is minimal. The surgery is only one hour and the patient is required to stay in the hospital for 2 days. After the surgery, the patient will have a catheter in the forearm and will be on a regular check-up by the surgeon along with self-care procedures for 3 months until the urethra constructed in the forearm is ready the next stage.
The last stage involves construction of the male genital organ. When the patient has reached this stage, external physical features of the patient are almost those of a male; flat chest, no ovaries, no uterus, able to void at standing position but without the male organ to control the direction and flow of urine. Hence, the surgeon will create the male organ by transferring the forearm flap and join the structures through microsurgical technique. 4-6 inches penis, depending on the length of the patient’s forearm can be obtained. On average, penis length is about five inches. The surgeon separates the blood vessels and nerves of the forearm to connect with the blood vessels and nerves in the pubic area then creates a scrotal sac from the tissues of the labia. This scrotal sac consists of fat and pigmented skin of the labia, but without testicles inside.
External appearance is similar to the male scrotal sac. All patients that complete these stages have a successfully reconstructed penis and all the physical changes from female to male without any residual female sex organs. No serious complications such as flap failure, infection, serious wound complications and urination leakage has been found. Patients all recover from the surgery fast because each stage consumes short time period without the need to correct the serious complication. All of the patients can urinate through the end of the neo-penis and the external appearance is similar to that of the genetic male sexual organ and also sensate.
What is the post-surgical care?
After sex reassignment surgery, the patient will be under the surgeon’s close supervision and he will inform you of everything you need to know. A sex reassignment patient will avoid strenuous activities 3-4 weeks.
What are the possible risks and complications?
The possible main risks are swelling, bruising, bleeding, infection, scarring and numbness, or change in sensation. Following the surgeon’s advice will reduce risks and complications.