Most will stay in the US for the simple reason of convenience and fear but, there are quite a few with ethnocentric viewpoints thinking that US surgeons and US hospitals are far superior to any other. And, remember, Thailand is the sex change capital of the world and Thai surgeons are renowned for their skill. As my Thai surgeon told me, "American surgeons are busy writing papers and such to gain recognition, Thai surgeons are busy doing surgery"........which is why Thailand has such a high industry in medical tourism.
I used Dr. Saran and would not have traded him for anyone else, even if it was free. He certainly does not do it for the money because he has a thriving clinic and does many other procedures. His bedside manner is unparalleled as well as his skill. The whole time I was in Bangkok, I've never seen Dr. Saran with anything but a smile on his face.....he loves what he does and he has supreme care for his patients. When I look at the fees that US surgeons charge, I am left with no other opinion that they do it simply for the money and the demand.
When I had surgery, I had 3 procedures: vaginoplasty, switched out saline implants for silicone and a trachea shave. Including my airfare (which was elevated for summer travel), I still paid $6000 less than McGinn's vaginoplasty fee and $10000 less than Bowers vaginoplasty fee.....and I had 3 different procedures and better BA results than my previous US surgeon.
Just because a US surgeon is charging more it doesnt mean your getting a better end product by any means. I'd certainly compare my results to that of any US surgeon and still be more than satisfied. While I was in post op care, not only did I receive daily visits from Dr. Saran but I also received daily visits from his personal assistant and she often would bring me treats without me even asking.....fresh fruit, roses from the flower market, sweet snacks, traditional Thai food. The nursing staff at the hospital I was at were remarkable to say the least. If I hit my call bell, they were in my room within 30 seconds asking what I needed and attending to those needs or wants.
There is one thing that Thai surgeons (especially Dr. Saran) understands is that in addition to being a patient, you are a customer first........something that US surgeons have not grasped ahold of and certainly not any US hospital.
Based on my experience, save your money, use Dr. Saran, travel to Thailand and enjoy a different culture.......trust me, you wont regret it!