I know of two doctors that will do surgery in Thailand without SRS letters. However, they do require that you show proof that you have lived as a woman for more than 2 years such has a drivers license with F stamp as gender or birth certificate with female gender or some other legal documents that states you lived as a female for more than 2 years.
I do not have SRS letters and I don't plan on getting SRS letters. I feel I shouldn't have to prove to anyone that I'm a woman. I have lived as a woman for 13 years now. No letter is going to attest to the fact that I look, behave and act as a woman. My medical records say I'm a woman, my doctors know I'm a woman and my employers know me as a woman, I am not 100% male because I have partial AIS (Androgen Insensitivity Syndrome) and to function as a female, I need vaginoplasty.
So, the surgeon that I chose, ask me to just send proof. So, I sent him court documents, medical records, my drivers license which says I'm female and have been since 1995, my pharmacy records since 2003 to show that I am on HRT, paystubs that go back to 1999-2008 with my name to prove that I've worked as female and some other documents. He told me that I had more than enough information to prove that I was a canidate for vaginoplasty.
If you have a medical condition that prevents you from meeting the HBSOC, then you need to make a strong case why you are a canidate. Simply saying that I cannot live the RLT because my grandparents or parents or whatever other reason is not good enough. However, I'm sure if you email a few doctors in Thailand you will find one that just might do the operation. Yet, you put yourself at risk for regret latter in life. Studies say regret appears within 7-10 years after having vaginoplasty. Understand, you cannot go back and put things the way they are now. Make sure this is what you really want to do. This is why the RLT is so...so...so...soooooo...important. The longer the RLT, the better the chances are that you will not have regrets.
One last thing, RLT isn't living part-time. The real live test, thus the initials RLT, means you live as a woman fully 24/7, 365 days of the year. There's no, "I'll be a woman all times except for when I visit friends, family, co-workers or whomever." If you cannot do the RLT at this point, my advice is to don't have surgery right now.
Best of luck to you.
-JasmineG