FAQS About Female to Male SRS

Who is the candidate for sex change FTM surgery?

Patients must be diagnosed with at least one of the following disorders: gender identity disorder, gender dysphoria, or associated conditions (anxiety, depression).

What are the requirements to have sex change FTM surgery?

Patients are required to have continuous 12 months of hormone therapy and provide the written document from a doctor prescribing hormone.

Patients are required to have 12 months of successful continuous full time real-life experience in the cross gender role and provide the identification document from a licensed psychiatrist (MD).

Why do I need to have hormone therapy?

Hormonal treatment plays an important role in the gender transition process not only physically, but also psychologically. These are often medically necessary so patients are able to live as members of their preferred gender.

Why do I need to have 12 months of successful continuous full time real-life?

The real-lift experience is the act of fully adopting a new or evolving gender role or gender presentation in everyday life. This step is important in a person’s transition from one gender to the other. It is a major decision which involves not only the person, but also the immediate family, relatives, friends and colleagues. Because of the immediate personal and social repercussions, it is very important that there is an awareness of the familial, vocational, interpersonal, educational, economic, and legal consequences.

Are there any effects after taking testosterone treatment?

There are both desirable effects and side effects after taking testosterone treatment. The desirable effects of testosterone treatment are deepening of the voice, enlargement of the clitoris, mild decrease in breast size, increased facial and body hair, and male pattern baldness. The side effects of females, infertility, acne, emotional liability, increases in sexual desire, shift of lipid profiles to male patterns which increase the risk for cardiovascular disease, potential to develop benign or malignant liver tumors, and liver dysfunction are the possible negative side effects. Due to these side-effects, it is very important that patients should take hormone with the doctor’s advice.

After the surgery, can I have a child with my partner?

The penis of a transgender male is created from soft tissue of the forearm which is not composed of the same specialized tissue and testicle as in the genetic male's penis. Hence, the transgender male cannot have a child with his partner.

How long should I stay in Thailand for sex change surgery?

It is advisable that a patient should stay in Thailand at least 2-3 weeks for the first 2 stages and 1 month for the last stage for full recovery. Generally, a patient should stay in the hotel in the first night of arrival day in Thailand to take rest after a long flight and have a surgery on the next day. The hospitalization of sex reassignment surgery from female to male depends on which stage a patient is at.

What is the preparation tip prior to the surgery?

If you plan to have a surgery, please stop smoking tobacco products, consuming alcohol, taking any medications and vitamins at least 2 weeks before the date of the surgery. In addition, you must fast 8 hours before the surgery which means you should not eat anything on the day of the surgery.

How is surgery performed?

Sex change FTM surgery consists of 3 stages and each stage should be 3-6 months apart to allow proper healing:

Stage 1: Breast reduction and removal of uterus & ovaries:

Breast reduction (Subcutaneous mastectomy) surgery will reduce breast volume and provides the patient with masculine breast features.

Removal of uterus & ovaries (Hysterectomy) surgery will remove uterus and ovaries so that the patient does not face the problem with menstruation and on the other hand eliminate the hormone producing organ.

Hospitalization: 6 nights
Length of stay in Thailand: 2 weeks

Stage 2: Vaginal closure & urethral lengthening and Urethral prefabrication:

Vaginal closure and urethral lengthening is the step wherein the path of the urinary tract is altered and the vaginal closed. Since the direction of the female and male urinary tracts is positioned in different way, the surgeon has to alter the direction of the urinary tract and completely close the vagina. The length of the urethra is also made longer and prepared to join with the urethra at the forearm in the last step.

Urethral prefabrication is performed to prepare the urethra to a penis by using the forearm flap Phalloplasty. The skin, nerves and blood vessels from forearm are raised and transplanted. The healing process for this stage will be approximately 3 months till until the urethra constructed in the forearm is ready the next stage.

Hospitalization: 7 nights
Length of stay in Thailand: 2 weeks

Stage 3: Male genital organ construction (phalloplasty):

This stage is to construct the male genital organ by transferring the forearm flap and join the structures through microsurgical technique. The approximated length of new penis is 4-6 inches penis, depending on the length of the patient’s forearm can be obtained. The surgeon separates the blood vessels and nerves of the forearm to connect with the blood vessels and nerves in the pubic area then creates a scrotal sac from the tissues of the labia. This scrotal sac consists of fat and pigmented skin of the labia, but without testicles inside.

Hospitalization: 14 nights
Length of stay in Thailand: 1 month

What is the post-surgical care?

Like any other major surgery, after sex reassignment surgery, the patient should avoid strenuous activities 3-4 weeks and follow the surgeon’s post surgery guidelines.

What are the possible risks and complications?

Following the surgeon’s advice closely will reduce risks and complications. The main possible risks are swelling, bruising, bleeding, infection, scarring and numbness, or change in sensation.