What is bottom surgery, and who is it for?
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Bottom surgery refers to gender-affirming surgical procedures that alter a person’s genitalia to align with their gender identity. It is commonly performed for transgender and non-binary individuals seeking gender affirmation.
Bottom surgery can be classified into:
An ideal candidate for bottom surgery meets the following criteria:
✅ Diagnosed with persistent gender dysphoria by a qualified professional.
✅ Has letters of recommendation from 2 mental health professionals.
✅ Has been living and presenting as their identified gender.
✅ Meets the minimum age requirement (usually 18 or 20 years old).
✅ Has completed at least 12 months of hormone therapy.
✅ Is in good physical health with no uncontrolled medical conditions.
✅ Any mental health or medical issues are under control.
✅ Maintains a positive outlook and realistic expectations about the results.
Why is Thailand a popular destination for bottom surgery?
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1️⃣ World’s leader in gender affirmation surgeries. According to Bloomberg, Thailand is the #1 choice for transgender patients seeking bottom surgery abroad. With over 100 gender-affirming surgeons, it attracts patients from countries like the US, Australia, and New Zealand, where waiting lists can be years long or specialists are scarce.
2️⃣ Experienced surgeons. Thai surgeons have decades of experience and international training. They are often members of prestigious organizations like the World Professional Association for Transgender Health (WPATH) and the International Society of Aesthetic Plastic Surgery (ISAPS). Doctors like Pichet Rodchareon have earned their place among the world’s most esteemed SRS surgeons.
3️⃣ Affordable prices. Bottom surgery in Thailand costs up to 70% less than in countries like the US or UK. For example, MTF procedures like vaginoplasty cost between $7,000 and $20,000 in Thailand compared to $25,000 to $50,000 in the US.
4️⃣ Modern technology and techniques. Thai clinics use both “gold standard” methods for gender reassignment surgery, such as penile inversion, and the latest approaches, like peritoneal vaginoplasty. Facilities have state-of-the-art technology, including 3D imaging for pre-surgical planning and minimally invasive techniques that reduce recovery time.
5️⃣ All-inclusive packages. Thai clinics offer all-inclusive packages that cover the initial consultation, sex change surgery, anesthesia, hospital stays, post-operative care, medications, follow-ups, and airport transfers. This makes the process easier for international patients and helps them cut costs. On the other hand, clinics in the US and Western Europe usually include only the SRS surgery itself in the price.
6️⃣ Short waiting times. Unlike countries like Australia or the UK, where waiting lists for gender reassignment surgery can range from 2 to 5 years, patients in Thailand typically schedule procedures within 1 to 3 months.
7️⃣ Fewer barriers to SRS surgery. Unlike Western countries, Thailand has fewer bureaucratic requirements for sex reassignment surgery. While assessments and recommendations are still required, the process is more streamlined compared to the extensive documentation, insurance approvals, and referrals needed in the US or UK.
8️⃣ LGBTQI+-friendly culture. In 2024, Thailand became the first country in Southeast Asia to grant same-sex couples equal rights, cementing its LGBTQI+-friendly reputation. Thailand has a visible, accepted transgender community and inclusive healthcare practices. The country’s open-minded culture creates a safe, welcoming environment for patients undergoing surgery.
9️⃣ Serene environment and affordable accommodation. Hotel stays in Thailand are 50% to 70% cheaper than in the US. Patients can book high-quality 4-star hotels for $40 to $70 per night or enjoy luxury 5-star accommodations for $100 to $150 per night, compared to $150 to $300 per night in the US. Additionally, Thailand’s reputation as a world-class tourist destination offers the ideal setting for recovery. Patients can relax in luxury resorts, beachfront villas, or wellness retreats in places like Phuket, Koh Samui, or Chiang Mai.
What are the long-term outcomes and benefits of bottom surgery?
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1️⃣ High satisfaction and minimal regret
According to the Journal of the American Society of Plastic Surgeons, 99.7% of patients report satisfaction with the surgical outcomes of gender confirmation surgery. This means regrets after such procedures are almost non-existent.
2️⃣ Improved mental health and reduced gender dysphoria
Bottom surgery is linked to a 42% reduction in psychological distress and a 44% reduction in suicidal thoughts. Studies have also noted a 35% decrease in tobacco smoking, suggesting improved coping mechanisms and overall well-being.
3️⃣ Enhanced self-confidence and body satisfaction
By achieving a body that aligns with their gender identity, patients experience higher self-esteem and comfort in their physical appearance. This improvement often translates into better relationships and social interactions.
4️⃣ Increased sexual satisfaction and functional improvements
- For MTF patients: After vaginoplasty, 91.4% report satisfaction with sexual intercourse.
- For FTM patients: While sensitivity can vary, up to 88.5% of transgender men achieve orgasm after phalloplasty. Patients who opt for metoidioplasty even experience a 30% increase in sexual satisfaction. Phalloplasty also allows trans men to urinate while standing, a functional improvement that significantly impacts comfort and confidence in daily life.
5️⃣ Social integration
With their physical body aligned with their gender identity, patients often feel more confident in public spaces and experience reduced stigma.
What types of bottom surgery are available in Thailand for trans women and men?
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For trans women (male-to-female sex reassignment surgery)
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Surgical technique
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Tissue source
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Key benefit
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Typical depth
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Penile inversion vaginoplasty
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Penile skin
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High sensitivity, natural clitoral function
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12-16 cm (4.7-6.3 inches)
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Peritoneal vaginoplasty
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Abdominal lining (peritoneum)
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Self-lubricating, deeper canal
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14-19 cm (5.5-7.5 inches)
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Colon vaginoplasty
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Segment of colon
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Long depth, self-lubricating
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17-25 cm (7-10 inches)
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1️⃣ Vaginoplasty
The most common procedure involves reshaping male genitalia to create a functional and aesthetically pleasing neovagina.
Popular surgical techniques:
- Penile inversion vaginoplasty. The “gold standard” in MTF genital reconstruction. Uses the penile skin to create the vaginal canal, with the glans used to form a sensitive clitoris.
- Non-penile inversion or peritoneal vaginoplasty. A newer technique that uses the patient’s abdominal lining (peritoneum) to create a deeper and self-lubricating vaginal cavity. It is often chosen by patients with insufficient penile tissue.
- Colon vaginoplasty. Uses a segment of the colon to construct the vaginal canal. The colon vaginoplasty technique provides natural lubrication. It is a good choice for patients with insufficient external tissue or those seeking longer vaginal depth.
2️⃣ Labiaplasty (optional)
Typically performed several months after vaginoplasty to refine the appearance of the external genitalia by creating labia majora and labia minora.
3️⃣ Orchiectomy (optional or as part of vaginoplasty)
The removal of the testicles, often done to reduce testosterone production and eliminate the need for hormone blockers.
👉 Learn more about how male-to-female bottom surgery works.
For trans men (female-to-male sex reassignment surgery)
Techniques
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Genital reconstruction technique
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Tissue source
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Key benefit
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Urination standing
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Sensitivity
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Possibility of penetration
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Penile size
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Surgical complexity
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Metoidioplasty
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Hormonally enlarged clitoris
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Preserves natural sensitivity, minimal scarring
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Possible with urethral lengthening
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High
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Rarely possible
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4-8 cm
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Less complex, shorter recovery period (2-4 weeks)
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Phalloplasty
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Forearm, thigh, or abdomen
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Larger, more realistic appearance
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Possible with urethral lengthening
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Moderate
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Possible with penile implants
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12.7-15.3 cm (5-6 inches)
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More complex, longer recovery period (4-6 weeks)
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1️⃣ Metoidioplasty
Utilizes the hormonally enlarged clitoris (through testosterone therapy) to transform female genitalia into a small, functional penis. The average length is 4-6 cm (1.6-2.4 inches). Metoidioplasty has a 99% satisfaction rate, allows for standing urination, and preserves sensitivity.
2️⃣ Phalloplasty
Creates a larger, more realistic penis—12.7-15.3 cm (5-6 inches). Phalloplasty uses tissue grafts from donor sites, such as the forearm, thigh, or abdomen. Patients may also undergo urethral lengthening for standing urination and can receive penile implants for penetrative sex.
3️⃣ Scrotoplasty with testicular implants
Creation of a scrotum using skin from the labia majora. Doctors can also insert silicone testicular implants for a more natural appearance.
👉 Find out more about female-to-male bottom surgery.
What is the cost of bottom surgery in Thailand compared to other countries?
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In Thailand, bottom surgery is 60%–80% cheaper than in the US, UK, Australia, and New Zealand.
Male-to-female surgery in Thailand costs between $8,000 and $20,000, with an average of around $10,000. In comparison, costs in the USA usually start around $25,000 and average at $50,000.
Female-to-male surgery in Thailand ranges from $12,000 to $22,000. Phalloplasty costs around $15,000, while metoidioplasty ranges between $5,400 and $12,000. In contrast, female-to-male gender reassignment surgery can cost $30,000 for metoidioplasty in the USA and can reach up to $134,000 for a multi-stage phalloplasty.
You can compare average prices for bottom surgery in the table below.
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Country
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Male-to-female surgery cost
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Female-to-male surgery cost
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Thailand
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$8,000–$20,000
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$12,000–$22,000
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United States
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$25,000–$50,000
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$30,000–$134,000
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United Kingdom
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$15,000–$43,000
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$50,000–$88,000
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Australia
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$20,000–$30,000
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$50,000–$80,000
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New Zealand
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$54,000
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$219,000
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New Zealand presents a uniquely challenging case. Patients needing FTM surgeries can face costs of up to $219,000 due to a lack of surgeons and domestic options. At the current rate, it would take 50 years to clear the waiting list for gender reassignment surgery in New Zealand.
💰 Check out Bookimed’s comprehensive guide to the cost of transgender surgery.
Does health insurance cover bottom surgery in Thailand?
Most major insurance providers in the US offer plans that cover sex reassignment procedures like bottom surgery. However, coverage for sex change surgery performed abroad is often limited or unavailable. It’s best to contact your insurance provider directly and ask about your policy inclusions and limitations. Patients can also explore medical travel insurance and financing options provided by Thai clinics.
What are the top clinics for gender reassignment surgery in Thailand?
According to Bookimed’s research, the following are the top 3 clinics in Thailand for gender reassignment surgery. They stand out for their surgical expertise, comprehensive service packages, and high patient satisfaction.
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Clinic
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Highlights
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Included services
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Cost
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Patient rating
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Bangkok Plastic Surgery
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- Dr. Pichet Rodchareon, Thailand’s #1 gender-affirming surgeon
- Over 3,000 successful surgical procedures
- Memberships in WPATH, ISAPS, and ASPS
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- 4-star hotel stay
- General anesthesia
- Pre-op tests and follow-ups
- Medications
- Transfers and language assistance
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$9,500–$10,000
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⭐ 5.0
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Wansiri Hospital
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- 99% success rate for male-to-female surgeries
- High-tech hospital with “Clean Room” standards and advanced air filtration
- Famous male-to-female surgery patient: Fuschia Anne Ravena (Miss International Queen 2022)
- Handles 2,000+ patients annually from across the world
- Offers a variety of surgical techniques
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- Variety of techniques: penile peritoneal vaginoplasty, colon vaginoplasty, penile inversion
- Full hospital stay (meals included)
- Pre-op exams, anesthesia, and post-operative care
- Hotel stay post-surgery
- Transfers
- Vaginal dilators, wound dressing, and medications
- A dinner cruise
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$10,000–$21,000
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⭐ 4.7
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Asia Cosmetic Hospital
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- ISO and JCI-accredited facility
- Dr. Akkrasash Vongjirad, 25+ years of experience
- Personalized VIP services with English-speaking support
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- Comprehensive pre-op exams (blood tests, X-rays, EKG)
- General anesthesia and VIP nursing care
- Medications and a 6-month post-op follow-up
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$6,900–$12,500
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⭐ 4
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Who are the best sex reassignment surgeons in Thailand?
🏨 Hospital: Bangkok Plastic Surgery, Bangkok
Dr. Pichet is one of Thailand’s top gender-affirming surgeons. He has performed over 3,000 successful surgeries, including bottom and facial feminization surgeries.
Memberships:
- World Professional Association for Transgender Health (WPATH)
- International Society of Aesthetic Plastic Surgery (ISAPS)
- American Society of Plastic Surgeons (ASPS)
- Society of Plastic and Reconstructive Surgeons of Thailand
- Society of Aesthetic Plastic Surgeons of Thailand
🏨 Hospital: Wansiri Hospital
A renowned plastic surgeon with 30 years of experience, Dr. Saran specializes in complex gender affirmation surgeries, including penile inversion, peritoneal, and colon vaginoplasty. He was trained under Dr. Preecha Tiewtranon, Thailand’s first SRS surgeon.
Leadership and international training:
- East Virginia Medical School (EVIMS), USA
- World Congress of Cosmetic Surgery, Aesthetic and Anti-Aging Medicine
- Extensive training with the International Academy of Cosmetic Surgery, Japan
Memberships:
- Royal College of Surgeons of Thailand
- Society of Plastic Aesthetic Surgeons of Thailand
- International College of Surgeons
- Oriental Society of Aesthetic Plastic Surgery (OSAPS)
What are the requirements for bottom surgery in Thailand?
The requirements for bottom surgery in Thailand vary from clinic to clinic, but many follow the guidelines set by the World Professional Association for Transgender Health (WPATH), considered the gold standard for transgender healthcare. Here are common eligibility criteria:
✅ Letter(s) from a psychologist. Most clinics require 1 or 2 letters from a mental health professional. They should confirm that you’re mentally prepared for sex change surgery and that it is expected to alleviate gender dysphoria.
✅ Optional reference letter. From a family member, friend, or employer (not always required).
✅ Hormone replacement therapy (HRT). Proof of at least 1 year on hormone therapy.
✅ Pre-surgery lab tests: Chest X-ray, electrocardiogram (EKG), and blood tests.
How to prepare for bottom surgery in Thailand?
To prepare for gender reassignment surgery, you should:
- Get lab tests and a medical evaluation to ensure you’re fit for surgery.
- Obtain letters of recommendation from qualified therapists.
- Take prescribed medications or adjust your current medications as advised by your doctor.
- Stop smoking at least 2-4 weeks before transgender surgery to promote healing.
- Avoid aspirin, anti-inflammatory drugs, and herbal supplements to reduce the risk of bleeding.
How long do patients typically need to stay in Thailand for bottom surgery and recovery?
Patients usually need to stay in Thailand for 3 to 4 weeks:
- Hospital stay. 3-7 days under close monitoring by the surgical team.
- Post-hospital recovery. 2-3 weeks nearby for follow-up appointments, wound care, and initial recovery.
Your clinic will provide specific guidelines based on your surgical procedure and individual progress.
How long does the recovery process take, and what does it involve?
For trans women (male-to-female)
Initial recovery takes about 6-8 weeks, but complete healing may take up to 1 year.
What it involves:
- Regular dilation to maintain vaginal depth and prevent narrowing.
- Daily wound cleaning to prevent infection.
- Pain management through prescribed medications.
- Avoiding strenuous activities, including exercise and heavy lifting, for at least 6 weeks.
- Attending follow-up appointments to monitor healing.
For trans men (female-to-male)
- Metoidioplasty: Initial recovery takes 2-4 weeks, with full healing in 6 weeks.
- Phalloplasty: Initial recovery takes 4-6 weeks. Due to multiple stages, complete healing occurs over 4-12 months.
What it involves:
- Proper wound care and hygiene, especially around graft and incision sites.
- Managing pain, swelling, and initial discomfort.
- Limiting physical activity to avoid complications or delayed healing.
- Monitoring for potential issues like fistulas or urethral complications (for phalloplasty).
- Regular follow-ups with the surgical team to assess progress and address concerns.
What are the common risks and complications associated with bottom surgery?
Although gender reassignment surgery is safe in the hands of experienced surgeons, it has certain risks, like any surgical procedure. These include:
- infection and bleeding;
- scarring or delayed wound healing;
- nerve damage leading to reduced sensitivity;
- urethral complications (e.g., fistulas or strictures);
- implant rejection (for phalloplasty).
If these complications arise, they can be successfully resolved by an experienced medical team. That’s why it’s crucial to carefully select a qualified clinic and surgeon. Bookimed works only with verified clinics and can connect you with top surgeons specializing in gender-affirming surgery.
What are other gender affirmation surgeries available in Thailand?
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Some patients choose to combine several surgeries during their stay in Thailand to achieve a complete gender transition. In addition to bottom surgery, Thailand offers the following gender-affirming medical procedures:
1️⃣ Top surgery (chest surgery)
- Mastectomy (FTM). Removes breast tissue to create a masculine chest contour.
- Breast augmentation (MTF). Enhances breast size using implants.
2️⃣ Facial surgery
- Facial feminization surgery (MTF). Includes procedures like rhinoplasty, jaw contouring, brow lift, and tracheal shave to soften masculine features.
- Facial masculinization surgery (FTM). Involves procedures like cheekbone reduction, jaw augmentation, and forehead reshaping for a more masculine appearance.
3️⃣ Body contouring
Liposuction and fat grafting to create a more feminine or masculine body shape.
4️⃣ Voice modification surgery
Voice feminization (glottoplasty) or masculinization procedures to alter pitch and resonance.
How to get started with bottom surgery in Thailand?
💚 Submit a request. Fill out a form on the Bookimed website with details about your sex reassignment surgery goals.
💚 Consult with a medical coordinator. A dedicated Bookimed coordinator will contact you to discuss your preferences, answer questions, and present you with the best options.
💚 Choose the right clinic. With the help of your coordinator, select a top clinic in Thailand that meets your medical needs and budget.
💚 Receive a personalized quote. Once you choose a clinic, you’ll get a complete cost estimate with no hidden expenses.
💚 Plan your trip. Bookimed will help you arrange appointments, transfers, and accommodations to make your gender transition stress-free.
Resources
- Plastic and Reconstructive Surgery. (2023). Regret after Gender-Affirming Surgery: A Multidisciplinary Approach to a Multifaceted Patient Experience. https://pubmed.ncbi.nlm.nih.gov/36727823/
- Harvard T.H. Chan School of Public Health. (2021).Mental health benefits associated with gender-affirming surgery. https://hsph.harvard.edu/news/mental-health-benefits-associated-with-gender-affirming-surgery/
- International Journal of Transgender Health. (2020). Patient-reported satisfaction and quality of life after trans male gender affirming surgery. https://pmc.ncbi.nlm.nih.gov/articles/PMC8726650/
- Cureus. (2022). Sexual Satisfaction After Gender Affirmation Surgery in Transgender Individuals. https://pmc.ncbi.nlm.nih.gov/articles/PMC9417774/
- Sexual Medicine. (2021). How Sensitive Is the Neophallus? Postphalloplasty Experienced and Objective Sensitivity in Transmasculine Persons. https://pmc.ncbi.nlm.nih.gov/articles/PMC8498953/
- Medical News Today. (2021). What transgender men can expect after gender-affirming surgery. https://www.medicalnewstoday.com/articles/transgender-men-after-surgery
- Frontiers in Endocrinology. (2021). Metoidioplasty: Surgical Options and Outcomes in 813 Cases. https://pmc.ncbi.nlm.nih.gov/articles/PMC8548780/
- Australian Broadcasting Corporation. (2023). Transgender Australians waiting years for gender-affirming surgery, as Medicare bid looms. https://www.abc.net.au/news/2023-08-25/transgender-affirming-surgery-barriers-waiting-lists-costs/102473890
- BBC. (2024). Life on an NHS transgender waiting list. https://www.bbc.com/news/uk-england-68588724