Bangkok's got a brand new bag

Karl Vetas describes a new aspect of Bangkok's allure: as the sex change capital of the world.

Published September 10, 1998 7:00PM (EDT)

Old-timers recall that in the 1970s -- before someone clued the owners on the proper spelling -- tailoring establishments were emblazoned with signs reading "Man Chop." In retrospect, the signs were either far ahead of their time or were on the wrong shops.

Visitors still shop Bangkok for inexpensive, well-tailored suits, and stores along Sukhumvit Road's side streets still advertise "suit, three shirts, vest, safari suit, two extra pairs of pants, only $100." And as in the past, it isn't until you get into the shop that you discover the $100 covers only the tailoring; you pay extra -- a lot extra -- for the cloth.

It is only appropriate, then, that Bangkok is rapidly gaining recognition for a new type of alteration. In gay and lesbian circles, the city is known as a "gender reassignment center." Translated into plain English, this means sex change operations. This is a vacation where on your return home friends can exclaim, "My, your holiday did wonders for you; you look completely different," and mean it.

This is not a shady back-alley business but one performed by some of the city's best plastic surgeons, in their own clinics, in hospitals or in university medical centers. As a result, Bangkok has become a magnet for transsexuals from Europe, Asia and the United States

It seems highly fitting that Bangkok should enjoy its present fame. It is a town where nothing is quite as it seems, where one can assume a new identify, a new persona. It is a city where the Khon, the masked dance/drama, is considered the supreme art form. In the City of Angels (as its Thai name "Krung Thep" translates) one can rent a gorgeous woman for the night and discover in the hotel room that the "lady" has handles and faucets. Little wonder that it is possible to assume more than a psychic disguise; for a little cash, one can match it with a physical alteration.

But the more salient reasons for the massive influx of transsexuals have to do with professional skill, cost and ease in getting approval for the operation. Already known for their skills in reshaping faces, Thailand's plastic surgeons have had more than 20 years to gain their considerable expertise in "gender reassignment" surgery. And they offer it at a price far lower than in a patient's own country.

"In Bangkok, you can change sex from male to female for only $7,000; it would cost at least $15,000 at home," says Dr. Preecha Tiewtranon, one of the art's foremost practitioners. He does two male-to-female operations each week at Bangkok's prestigious Chulalongkorn University Hospital, "for demonstration purposes to medical students." In addition, he performs 20 operations per month at his Chollada Clinic in the city's heart. The clinic sits down Soi 1 off busy Sukhumvit Road in a modest townhouse that gives little hint of the activities that take place within. It is presided over by an avuncular man nearing 60 who, with his horn-rimmed glasses, looks less like a medical doctor and more like a bureaucrat.

Preecha's main line of work is facial adjustments and breast augmentation. His waiting room is filled primarily with Thais who seem quite happy with their natural gender assignment, although a few await transformation from males to "lady boys" and will find employment in gay bars. But he also has more than 600 male-to-female transformations to his credit, with most of his patients coming from the United States, Europe and the elsewhere in Asia.

"Most of my clients are foreigners," he says. "They come here because the laws in their countries are very strict and the waiting period for approving the operations can often be three years. Here in Thailand, there's a protocol that says one needs to spend two years to see if the operation will be appropriate." What he doesn't say -- but what everyone knows -- is that Thai laws are lax; there is no waiting period if the doctor and patient feel the time is right.

The laxity of the laws stems in part from a social acceptance of gays of any persuasion, local or foreign. Gays play a major role in Thai social life, many of them presiding over soirees at large hotels. At one major hotel, the British general manager takes off his suit each day at 5 p.m. and dons a wig and a gown for an evening on the town.

In the past 25 years, the nation has had two reputedly gay prime ministers. And at the moment, a "katoey" (transvestite) professional "muay Thai" (Thai kick-boxing) boxer is famous for entering the ring wearing make-up. This is not a gimmick but a statement; once the fists and feet begin pummeling, you know that he is in deadly earnest. Nor is his ferocity a reaction to ill treatment: Gays have always been accepted in Thailand; the idea of "gay-bashing" is an alien concept in the Land of Smiles.

Gender orientation or reorientation is even recognized in the nation's bill of rights. The newly promulgated constitution allows those who have undergone sex alterations to change their gender on certain legal documents.

Although Thai laws are applied liberally, Preecha lays down strict guidelines for those seeking to change their gender.

"My advice is that if a male wants to be a female, he should A) dress like one for a year, B) take hormones for six months to reduce the male features and hair, and C) undergo an assessment by a urologist/gynecologist to see if the operation is right. This doctor must also explain to the patient everything that is involved. Unfortunately, most patients don't want to wait; they want it done now."

Using the latest techniques, Thai surgeons normally complete the operation in 90 minutes. In the past, the skin used to create the new vagina was taken from the inner thigh, but this technique was abandoned because the grafts left unsightly scars and the skin proved not to be very flexible. "Penal skin is very elastic, so we use that skin to line the inner walls of the vagina," says Preecha. The resultant vagina is remarkably realistic and the penis head shaped into a small clitoris is sensitive to touch.

Foreign patients also note the level of care as a key reason for undergoing male-to-female operations in Bangkok. Clinics are antiseptic and have the latest equipment and a high caregiver-to-patient ratio. A typical operating team includes the doctor, an anesthetist and five nurses. In the university demonstrations (which cost less because the subject -- called a "service patient" -- serves as a teaching tool) the doctor may be assisted by several interns.

As a result, complications are low. Not that it would matter; there are no malpractice suits because patients are required to sign consent waivers absolving the surgeon of all responsibility for slip-ups.

While he is adept at male-to-female operations, Preecha balks at female-to-male transformations. "It is a very difficult operation and foreign patients generally have too high expectations. They want everything to be as it is in nature -- but this just isn't possible."

Foreigners, he says, arrive thinking they can simply walk into the clinic a woman and come out a man. "It takes at least four operations to re-shape the female genitalia and create a penis from the skin covering the abdomen. You can't do them a week apart; sometimes you have to wait six months for the previous operation to heal.

"And they are expensive, nearly $100,000. Most foreigners don't have the money or the time to stay here for the two years it usually takes. They also don't have the money to come back time and again for the next procedure," he claims. "For these reasons, I don't do these types of operations anymore."

Many female-to-male operations fail because they involve use of a small $3,000 pump that allows the patient to erect his new penis. The pumps are notoriously unreliable, with a high failure rate. Even if it does work, the patient can satisfy his partner but not himself.

Yet foreigners continue to flood into Thailand, seeking both types of operations. In "Amazing Thailand," as the tourism authorities are billing the country this year, they can purchase new genders as easily as they once bought suits. Except that with this alteration, the customer supplies the fabric.

By Karl Vetas

Karl Vetas writes about Asia for a variety of publications.

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