Birthday Suits Altered While You Wait
or
"Do you dress right or left, Madam?"

First appeared in Salon Magazine as Bangkok's got a brand new bag.

Bangkok’s old-timers recall that in the 1970s — before someone clued the owners on the proper spelling — many tailoring establishments were emblazoned with signs reading "Man Chop". In retrospect, the signs seem far ahead of their time. Visitors still shop Bangkok for inexpensive, well-tailored suits but the city is rapidly gaining renown for a new type of alteration. In gay and lesbian circles, the city is known as a "gender reassignment center." Translated into plain English, it means "sex change operations." On returning home from this vacation, your friends will exclaim "My, your holiday did wonders for you; you look completely different" and mean it.

This is not a shady back-alley business. The operations are performed by some of the city's best plastic surgeons, and in aseptic private clinics, hospitals, or university medical centers. Little wonder that Bangkok has become a magnet for transsexuals from Europe, Asia, and the U.S. who, in a somewhat perverted Buddhist sense, undergo reincarnation beneath the knives of eminent surgeons.

It seems highly fitting that Bangkok should enjoy its present fame. It is a town where nothing is ever quite as it seems, and one can assume a new persona by sheer will. In this City of Angels, one can rent a gorgeous woman for the night and discover too late that the "lady" has handles and faucets. For a little cash, the gender challenged can match a psychic disguise with a physical transformation.

Transsexuals flock to Bangkok for gender reassignment because it is regarded as safe and inexpensive. "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 performs 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 taking place within. Even Dr. Preecha’s mien is deceptive. A 60-year-old avuncular man in horn-rimmed glasses, he looks less like a medical doctor and more like a bureaucrat.

His waiting room is filled primarily with Thais who seem quite happy with their gender assignment but who want to enhance what nature gave them. Facial alterations. Breast augmentation. Among them, however, are several "lady boys", transvestites employed in gay bars who have decided to move beyond the mere illusion of femininity. Increasingly, they are joined by foreigners of both sexes, drawn by the doctor’s fame; to date Dr. Preecha has transformed more than 600 Asian, Americans, and Europeans.

"Foreigners come here because the laws in their countries are very strict and the waiting period for governmental approval for the operations can often be three years,” claims Dr Preecha. “Here in Thailand, doctor are supposed to wait two years to see if the patient is mentally prepared for the life that comes after the operation." What he doesn't say but everyone knows is that laws are lax and if the doctor and patient feel the time is right, then the operation is performed.

The relaxed attitude stems in part from Thailand’s social acceptance of gays of any persuasion, local or foreign. Gays play a major role in Thai social life. 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. At the moment, a "katoey" (transvestite) professional "muay Thai" (Thai kick-boxing) boxer enters the ring wearing make-up. It is not a gimmick but a statement; once the fists and feet begin pummeling you know he is in deadly earnest…and deadly effective. Nor is his ferocity a reaction to ill-treatment; the idea of "gay-bashing" prevalent in temperate climates, is an alien concept in the Land of Smiles.

Gender orientation or re-orientation 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, Dr. 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 it will be safe to operate. The doctor must 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. The technique was abandoned because the grafts left unsightly scars and the resultant organ was not supple. "Penal skin is very elastic so we use that skin to line the inner walls of the vagina," said Dr. Preecha. The resultant vagina is remarkably realistic and the penis head is shaped into a small clitoris that is sensitive to touch.

Foreign patients also note the superior hospital care as a key reason for undergoing male-to-female operations in Bangkok. Clinics are hygienic, employ advanced equipment, and enjoy 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.

Complications are low, a good thing, because malpractice suits are rare in Thailand. One reason is that patients are required to sign consent waviers absolving the surgeon of all responsibility for slip-ups.

While he is adept at male-to-female operations, Dr. Preecha balks at female-to-male transformations. "It is a very difficult operation and foreign patient expectations are generally too high. They want everything to come out 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 live here for the two years it usually takes. And very few have the money to fly here time and again for the next procedure," he claims. "For these reasons, I don't do these types of operations any more."

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.