Surgery Protocols
General
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 any 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 unprecedented 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 7 to 10 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:
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Patients must be at least 16 years old, and under age 20
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Must not be undergoing treatment for any psychiatric or psychological disorder other than gender identity disorder (GID), Gender Dysphoria or transsexualism
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Have had treatment with anti-androgens and/or feminizing hormones (HRT) for a minimum period of 6 months
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Have lived full time in their acquired gender for a period of at least 6 months, evidenced by at least 2 documents **
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Have a written referral for SRS by a doctor, psychiatrist, psychiatric social worker, clinical psychologist, or endocrinologist/sexologist who is a professionally qualified specialist in the field of gender dysphoria
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Have written consent from legal guardians (usually parents)
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Patients must be considered - legally - to be adults under the law of their originating country, and be under the age of 40
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Must not be undergoing treatment for any psychiatric or psychological disorder other than gender identity disorder (GID), Gender Dysphoria or transsexualism
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Have had treatment with anti-androgens and/or feminizing hormones (HRT) for a minimum period of 6 months
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Have lived full time in their acquired gender for a period of at least 6 months, evidenced by at least 2 original documents **
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Have a written referral for SRS by a doctor, psychiatrist, psychiatric social worker, clinical psychologist, or endocrinologist/sexologist who is a professionally qualified specialist in the field of gender dysphoria
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Patients must be at least 40 years old, and under age 65
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Must not be undergoing treatment for any psychiatric or psychological disorder other than gender identity disorder (GID), Gender Dysphoria or transsexualism
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Have had treatment with anti-androgens and/or feminizing hormones (HRT) for a minimum period of 6 months
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Must :
** Documentary evidence needs only to be sufficient to show the patient's acquired (female) name, and bear a date at least 6 months prior to surgery. Suitable examples would be - but are not restricted to - passport, driver's licence, official ID card, household utility bill, bank statement...etc.
For exceptional cases where suitable evidence cannot be provided in the form above (for whatever reason, and as determined on a case-by-case basis) - and for patients aged over 65 - Dr Suporn will consider undertaking surgery providing the patient is able to provide firm, clear and written evidence to their suitability (both psychologically and physically) for surgery. This evidence will take the form of a full written description of the patient's gender dysphoria (as written by the patient) along with personal screening of the patient. Dr Suporn reserves the right not to schedule surgery if he considers an individual patient to be unsuitable for surgery.
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. If the scrotal sac has been removed, the applicant must seek elsewhere to undergo SRS
Prior genital electrolysis is not recommended as there would be no hair-bearing skin in the scrotal skin graft; hair follicles are manually excised (cut) from the scrotal skin during surgery. Prior electrolysis of the scrotal area would result in scarring and thickening of the skin which would 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:
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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
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must be stopped at least 1 month before traveling to Thailand.
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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, anti androgens and hormones 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.
Aesthetic Correction of Surgeries Undertaken by Other Surgeons
Corrective surgery cases are evaluated on a case-by-case basis, and the decision to proceed or otherwise is solely Dr Suporn's. As a guideline, factors considered will be:
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The surgery previously undertaken, the technique involved, the time elapsed since the surgery was done, and the surgeon who did the surgery, and the country in which the surgery was performed. In general, standard cases performed in Thailand are more easy to correct than are complex cases where the surgery was performed in Europe or North America
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The current expectations of the patient for the outcome of any corrective surgery
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The time that will be required to perform the correction
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No guarantee can be given that a correction can be achieved in one surgical operation
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Dr Suporn is not prepared to perform surgery to increase depth in a corrective post-operative SRS patient, nor to undertake surgery that would involve rectosigmoid colonvaginoplasty
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