Susan's Place Transgender Resources

Hi everyone,

I'm going to be in Thailand in October and in that region for up to six months.

A few of you will know that I had a problem with self-meds a few months back and I was intending to see a doctor in Thailand to get re-started on HRT. I'm currently on AA's and thinking about resumption of oestrogen soon, but only after seeing an endo.

However, I've got a better plan: I'm thinking of having my balls chopped off instead :)

OK, what I'd like is the kind of orchie that enables the option further down the line of full SRS. I'm not that fussed about doing a full SRS right now for all sorts of reasons that I'd ask you to respect. What I really want is to kick my transition back into proper form by cutting off my male-ness at its source which means I can switch off AA's to a low dose of oestrogen. That is to me the biggest and best reason for having an orchie. Alongside it, I don't really want big invasive surgery right now as I've got a lot of travelling to do round Asia for my work, including treks into the jungle. But the massive motivation for me is that I hate the idea of pumping my body full of dodgy medicines for the next decades. OK, hate is too strong (I hate being 'male') but the meds worry me. Some of them aren't designed for what we use them for e.g. spiro and I do worry about the effects on my liver, kidney, heart etc.

So, any thoughts and advice would be massively welcomed. I guess the first and foremost are:

1. Who to go to for an orchie in Thailand?
2. Do you know whether I need paperwork for an orchie from abroad?

The way I'm thinking of doing this is to go for a consultation first time out, then return a few weeks later if there's a slot to have the surgery.

I actually cannot wait!

While I have no relevant knowledge of Thailand's best bet, I share your desire for a simple orchiectomy.  Trying to regulate my HRT medications has occasionally been a nightmare with spironolactone as a diuretic my electrolytes get out of whack and my estradiol patches come unglued.  These medications are powerful and put us at further risk as my signed three pages of complications acknowledged.

As a female person my testes are vestigial, impair my functioning and are unnecessary.  The dysphoria is just another challenge until they are gone with the wind ;D  Less nuts = less risky medication!

Good luck abroad.

Thanks Tessa and I'm with you 100%. Actually spiro really threw me a bad curve-ball. That was just me, I'm sure, but it wasn't great so it's such a strong reason for me to have an ochiectomy. I think you can even lower dose on estro too after an orchie with the same effects. Anything that is safer in terms of medication is a huge pull for me. x

You might think about one of the srs surgeons.
You might ask them, some use part of a payment for an orchi towards a srs. So a srs might be cheaper then.
You might also ask all of their opinions... how long to wait for srs... how the results might be... etc...


hugs

Thanks Laura,

Great idea! I've just emailed Drs Suporn and Chettawut. Are there any others I should contact that are safe and above board? The last thing I want is a back-street clinic.

Chen x

You could have a look here concerning the two:
https://www.susans.org/forums/index.php/topic,193067.msg1721458.html#msg1721458

Well concerning others... there are others, each has their advantages and disadvantages...
you might have a closer look there...
what kind of technique... one or two step process... what kind of hospital... what customers say...


hugs

I think Suporn and Chettawut prefer it if you don't have an orchiectomy. It causes the scrotal skin to atrophy which means there's less available to line the inside of the neovagina. If you live in a country with a health system, you could possibly have it performed free. From what I understand, its a quick simple cheap operation, comparatively speaking.

Hi, yes I've heard you can stretch the skin with some exercises although I guess it still atrophies. I'm not sure what to think about that side of it. I'm not certain I'd go ahead with full SRS but maybe I would want to further down the line. I do have a large scrotum actually (the other part is normal) so maybe a little shrinkage won't matter too much.

I've just had a reply from Dr Sarang who quotes me $4500 USD. This strikes me as quite steep?

In the UK I'd probably have to wait years for an NHS orchie I reckon. If the prices I've seen quoted by others on here are right i..e c. $1500 then I think I'd just go ahead with it.

I may be wrong but, if you're intersexed like your avatar says, I don't think the same rules apply when it comes to getting letters for genital surgery. Again, I might be wrong.  In so far as "full" SRS, I'm not sure an orchietomy would count as SRS. As far as I'm aware there's not really "partial SRS" or "full SRS". There's just "SRS" Sure there's different methods but they all share the same goal which is converting genital tissue from one arrangement to approximate the arrangement of the target sex.
And yes 4500$ usd sounds bananas. You could probably get it done at home for that or less (depending on where home is)

Thanks Isabelle. Maybe I should change my avatar ;) It's a transition at the moment so what I want to be and what I am aren't yet in sync :)

Home is UK, but I travel all over although not the US (just happened that way, not for any particular reason).

Gotcha, well just so you know "intersexed" isn't really an identity you can adopt..
Its "a variation in sex characteristics including chromosomes, gonads, or genitals that do not allow an individual to be distinctly identified as male or female"

Is 'identity' only defined as 'male' or 'female' then?

See, this is where I have a slight issue. I've seen a tendency for people to be black and white about gender: you're either male 'or' female but this seems to me to fall into the very trap that transgender people want to avoid. I can understand it, if you're born into what you're sure is the wrong body you might be pretty evangelical about the transition: hence, especially if you look back at posts ten years ago, people could be adamant and strong that SRS was the only way to go, that anything less was a betrayal. I don't think most people do think like that anymore, certainly not on this forum. To me just as black and white are misleading terms: there are a thousand times a thousand shades of colour, so there are a thousand times a thousand varieties of gender. We're not defined by whether or not something dangles down below, to put it crudely.

Incidentally, since I used the colour analogy this is also a pitfall that those who want to categorise themselves (for understandable historical reasons) can fall into. The reality, in my view, is that the world is kaleidoscopic, and I resist boxing, labels and categories which are often just means to control, or for people to help self-identify (for good reasons).

Having said that, I may change my avatar setting. I feel I'm female in a male body :D

Identity is up to the individual. You can claim to be intersexed if you like. I was just giving you a heads up.

No that's cool and I appreciate it, I just don't understand the bit where you said 'it's not an identity you can adopt.' I don't know what that means? Are you referring to legal status then?

Crikey, just had a reply from Dr Chet and he wants as many checks and letters as full SRS. As well as preferring not to do it, which I understand for SRS reasons, he would perform an orchie under full general anaesthetic and the fee would be c. $2500 USD (100,000 Thai Baht).

I'm kind of hoping to get a more positive response soon but I do understand that they prefer an all out SRS in one go.

Yes, here in the US i am required to go thru the whole pre surgical process, with letters and such, for an orchiectomy as people do for GCS/SRS.  Sadly that US cost is not surprising to me and I had a career in that system.  Glad you are doing this research and sharing it here.  Thank you.

Quote from: Tessa James on August 26, 2015, 11:21:22 AM
Yes, here in the US i am required to go thru the whole pre surgical process, with letters and such, for an orchiectomy as people do for GCS/SRS.

Have you seen this?
Finally had a penectomy
https://www.susans.org/forums/index.php?topic=186475.0

Quote from: Monika1223 on April 13, 2015, 01:49:54 PM
I had an orchiectomy almost 2 years ago and I had the penectomy this Saturday 4/11/2015.  It still feels so unreal. I love looking down there and seeing it's not down there anymore.
But I want to share for anybody who is thinking of doing the same or just wants to read about my experience.

  It was done by Dr. Arnkoff(well mostly by an intern). He really is an angel who made my dreams come true 2 times. First with the orchie now with this. He did not require a therapist letter or hormone therapy.

He's in Detroit, right?

It sounds like it would be a hell of a lot cheaper and simpler to fly there than faffing around in Thailand for something they don't really want to do! I can get a very cheap flight from the UK. Hmmm ....

Thanks for the heads-up :)

Chen
xx

I don't know where he is apart from those posts, but google is good. It just goes to show that things don't work the way you'd think they do. I doubt you'd have much trouble getting an orchi in Thailand if you put your mind to it. I spent far too much time investigating this stuff.

Okay another update this time from Dr Suporn. He will not perform an orchiectomy at all without doing it as part of an SRS. He will do SRS on someone who has had an orchie from another surgeon.

I have to say that the email from Sophie seemed very slightly, well, grumpy if I'm honest. I mean, she put things like 'he's away the whole of October anyway,' when I had clearly stated that I will be out there for six months. Ah well, probably just lost in translation and all that.

So at the moment that leaves Drs Chet and Sarang at $2800 and $4500 respectively. Both clinics were perfectly friendly. Dr Sarang's states a requirement for one letter only, whilst Dr Chet asks for two. Having said that there was a rather nice (I thought) message from Dr Chet:

"However, Dr. Chettawut understands that some patients chooses to undertake
the orchiectomy first to reduce the testosterone source and avoid taking
anti-androgens which has some undesirable effects to the major organs of the
body like kidneys and liver. If this is the case, Dr. Chettawut is flexible
to accept doing the orchiectomy only"

As that sums me up at the moment, I thought that was pretty cute.

Quote from: Richenda on August 26, 2015, 02:37:59 AM

Hi, yes I've heard you can stretch the skin with some exercises although I guess it still atrophies. I'm not sure what to think about that side of it. I'm not certain I'd go ahead with full SRS but maybe I would want to further down the line. I do have a large scrotum actually (the other part is normal) so maybe a little shrinkage won't matter too much.

There is a procedure that can be used that will stretch skin. The surgeon inserts an inflatable device inside the scrotum 3 months before your SRS and that will stretch the skin and give you more. Mr Bellringer told me he'd used it successfully for an SRS patient although it is normally something used for breast surgery I believe.

Hugs

Sorcha  ;D

Tissue expansion is used in reconstructive surgery but in SRS there is always option for additional grafts harvested from other site than the scrotum so I don't think this would ever be needed because there is always skin available 

Thanks for that so much: it sounds very true and I'm sure that if I want to go ahead to full SRS I can pursue the stretching options mentioned.

I'm currently researching other good surgeries in Thailand on the grounds that because it isn't full SRS, and is actually widely performed (I'm learning that a lot of kathoey do have this done), there must be other, good, surgeons who do it fairly routinely under local. The key though is not going backstreet. Don't worry folks ;) x

Another update.

Dr Pichet at Bangkoksplasticsurgery would do the bilateral orchiectomy under either general or local, depending which I prefer, for $2000 USD with one supporting letter.

Plastisurgerythailand (not actually sure who they are) won't do orchiectomies for SRS, only for other medical conditions.

I'm just putting the above to keep the thread updated as a reference for anyone going down this path. I would very much advise anyone coming back to this thread to use the forum search tools for the relevant doctors.

Further update:

Dr Preecha at P.A.I. Bangkok quotes $3900 USD which includes blood tests and everything.

At the moment Dr Chet looks the most competitive on cost at $2800 and since I very much like what I read about him and the Chet girls (;)) I might be heading to join the ranks  :angel:

much love to all

Chen xx

p.s. if I get any further useful responses I'll put them on here so anyone following this step can get a heads up. I'll also post updates on my journey.

http://www.tsroadmap.com/physical/orchiectomy/timothy-terry.html (http://www.tsroadmap.com/physical/orchiectomy/timothy-terry.html)

I found this for you, he's in the UK and does the procedure you're after. I don't know if he's still around though...

Also this, a first hand account of seeing this surgeon
http://www.looking-glass.greenend.org.uk/orchi.htm (http://www.looking-glass.greenend.org.uk/orchi.htm)

Thanks Isabelle. Yes he's been on my radar but he stopped doing it where he was based as well as becoming pricey and some other issues to do with referral systems.

Ohhhh, bugger. Well, it's such a quick operation, it's a day surgery I think, you walk in and walk out a few hours later, there's got to be someone out there doing it for a reasonable price.

Another update.

Dr Chet's liaison official, Som, says that he prefers to perform an orchiectomy under general as 'the surgery can be very painful and uncomfortable.' Mr Som is also pushing quite hard about the referral letters, mentioning that they must be originals with original handwritten signatures. This is fine of course.

Meanwhile, Dr Somboon at Bangkok Hospital is happy to do it and his clinic writes: 'it is a very simple procedure. Normally, we do under local anesthesia as an out-patient procedure.' They mention one psychiatric referral letter.

So there we have two contrasting views about the nature of orchiectomies. My surmise is that the SRS surgeons don't perform many standalone orchiectomies and are used to major invasive surgery under general anaesthetic which costs a lot of money. That's their metier and I don't think they perform many orchiectomies. The urologists and non-SRS specialists, and indeed vetinarians (!), know it's a relatively simple, non-invasive, procedure that can be done under local, and they perform it fairly regularly. Remind me of this comment when I'm howling with pain  ;D


Chen xx

Perhaps look into urologists? Apparently that's the type of specialist that usually performs the operation. There's no reason why you need to go to a specialist cosmetic surgeon for it is there?

That's my view completely, Isabelle. The Bangkok Hospital surgeon is a urologist. I'm pressing them on price but I suspect it's going to be waaaaaay lower than the SRS ones from what they've said so far. I just need to ensure it's done from groin incision not scrotum (for future vaginoplasty).

Did you notice my identity? ;)

Chen xx

Nope I didn't till you told me

If you're interested in intersex conditions, have a look here.
http://www.isna.org/faq

Ah, okay, it's anatomical. Now I get why you meant it's not an 'identity' one can assume. Gotcha.

Okay well I've just booked my consultation with Dr Somboon at Bangkok Hospital Urology Department.

I don't actually have the cost of the procedure yet, but chatting to the receptionist, who was really really lovely, it doesn't sound like it's going to be expensive. It's done in the urology department and it's performed as an outpatient.

I guess as I've mentioned previously, for me this is the end of 'maleness.' It's also the end of the need for high drug toxicities, so it's a no-brainer. Whether I go on to full vaginoplasty further down the line is another issue but right now I'm cool to be turning female, which is what this will do. Without balls even low dosage oestrogen will be very effective.

I'm super excited!! Whoop whoop.

Quote from: Richenda on August 29, 2015, 06:04:06 AM
Okay well I've just booked my consultation with Dr Somboon at Bangkok Hospital Urology Department.

I don't actually have the cost of the procedure yet, but chatting to the receptionist, who was really really lovely, it doesn't sound like it's going to be expensive. It's done in the urology department and it's performed as an outpatient.

I guess as I've mentioned previously, for me this is the end of 'maleness.' It's also the end of the need for high drug toxicities, so it's a no-brainer. Whether I go on to full vaginoplasty further down the line is another issue but right now I'm cool to be turning female, which is what this will do. Without balls even low dosage oestrogen will be very effective.

I'm super excited!! Whoop whoop.

You could have a look here for hints on estro etc:
https://www.susans.org/forums/index.php/topic,190296.msg1695059.html#msg1695059

Adding bioidentical progesterone might help...
some people even take a very small dose of testo, for example in gel form... if its necessary to help with overall drive...
but if its necessary should be seen after a few weeks or months after the orchi...
levels should drop till then  :)

here are a few hints that might help also:
https://www.susans.org/forums/index.php/topic,190515.msg1697107.html#msg1697107


hugs

If you do this, remember to take care of your bones. You'll loose bone density quicker than normal if you don't have the right amount of calcium and hormones to help replace what gets depleted as you age.

Update.

Dr Somboon's price at Bangkok Hospital is $2200 USD. That's more than I was expecting for a local anaesthetic urology department, if I'm honest. So, pulling this together I have:

Dr Pichet     Local or General     $2000   
Dr Somboon Local      $2200
Dr Chettawung General $2800
Dr Preecha General $3900
Dr Sarang General $4500
Dr Suporn: will not do the operation

All things considered I'm now leaning heavily Dr Chet's way again. For the sake of a few hundred $ I'd be in the hands of the same person I'd probably go to for the SRS. Plus they have been really friendly and helpful. It's still a heck of a lot of money though for what it is :/

So you're sure there's nowhere in The UK that will perform this privately and save the trip to Thailand. My orchie took little more than an hour with a general so the cost can't be that high surely?

Hope you find the right surgeon

Hugs

Sorcha  ;D

Hi Sorcha - it's worth exploring isn't it? Trouble is, I'm hardly in the UK over the next six months. Most of the time I'll be in Asia. I'll look into that though.
If I go private in Britain I'm not sure I'd beat it down below £1500 anyway?

Chen xx

Quote from: Richenda on August 31, 2015, 01:46:26 AM
Update.

Dr Somboon's price at Bangkok Hospital is $2200 USD. That's more than I was expecting for a local anaesthetic urology department, if I'm honest. So, pulling this together I have:

Dr Pichet     Local or General     $2000   
Dr Somboon Local      $2200
Dr Chettawung General $2800
Dr Preecha General $3900
Dr Sarang General $4500
Dr Suporn: will not do the operation

All things considered I'm now leaning heavily Dr Chet's way again. For the sake of a few hundred $ I'd be in the hands of the same person I'd probably go to for the SRS. Plus they have been really friendly and helpful. It's still a heck of a lot of money though for what it is :/

You might ask them if part of it would count towards an srs.
With some surgeons it does, reducing fees for an srs somewhat.

There are one or two us surgeons who state this on their list.

True and good point Laura. I think Dr Chet might be biddable on that actually. I must say that his team have been really friendly without going OTT. He made clear he prefers to do full SRS not a staged one with interim orchiectomy, but then went on to say he will do it. He will also know about going in via the groin not scrotum (for future SRS sake). If money was no consideration he has won me over and given that he's not much more than the cheapest it's a clear choice now. My only caveat is that it's still a lot of money. As you say, if it counts towards SRS then that's a big factor. xx

Is this not possible on the NHS here in the UK?

I'm on the waiting list for the gender clinic in Scotland and I'll be extremely pi$$ed off if they won't sanction an orchie for me.

Julie x

Hi Julie,

I don't know is my answer. My GP's are pretty useless and how long is the NHS waiting list for that? I can just see 2 years rolling by ... ? x

Hi Richenda,

I was told the wait was 11 months, I've got about 6 to go.

I just think that we pay enough into the system, it will be nice to get something back.

I do agree though, it would be nice to have it done sooner, rather than later.

Have you made any inquiries?

Julie xx

No but maybe I should try again. You're right about paying in and getting something back.