• Patient must be at least age 18 years of age. Patients will require permission from parents if under 20 years old.
• Patients must be diagnosed with at least one of the following disorders: Gender identity disorder, gender dysphoria, or associated conditions (anxiety, depression).
• Patients must have undergone at least one year of antiandrogens or/and hormones.
• Patients are required to have lived full-time in the cross-gender role for at least 1 year (supported by Identification Documents).
• Patients must have approval from a psychiatrist (MD), psychiatric social worker (PhD), or clinical psychologist (PhD).

•  CBC,
• HIV Electrolytes
• FBS
• Creatinine Urinalysis
• Alkaline Phosphatase
• Chest X-ray
• SGOT
• LDH
• EKG

Patients must discontinue hormone treatment at least fourteen days prior to surgery. Hormones should be halted to reduce the risk of thrombosis (blood clots). Oral tablets should be halted two weeks prior to surgery and injectables should be halted four weeks prior to surgery. Oral antiandrogens can be halted three days before surgery (four weeks if injectables). Aspirin and smoking should be halted two weeks before surgery.

Letter of Recommendation
Two letters are required from foreign patients. One letter must be from either a medical doctor or a psychologist states that the person is a candidate for SRS. The other letter may be from any doctor, showing proof of having been on hormones for at least one year.

• Infections; Infections are usually only minor and do not cause pulmonary or systemic infections.
• Short Vagina; Depth usually reaches six inches and will continue to extend after 6-12 months due to the maturation of scar tissue. In case of very short vagina, the second operation can be done after 6 months by using the sigmoid colon procedure .
• Rectovagina Fistula; A very serious complication of SRS, where a hole develops between the colon and the vagina.There are 3 out of 1000 + cases all were well taken care of.
• Other complications such as urethra vaginal fistula, Pulmonary thromboembolism, extensive bleeding.

• Wound disruptsions. There will be strong tension in the area around the fourchet of the new vagina perineum. Wound care will be required, but will heal within one month.
• Unable to urinate. Urination difficulty sometimes occurs after the urine catheter is removed, due to the swollen stump at the opening of the shortened urethra. In such cases, the urine catheter should be retained for several more days. Eventually urination will return to normal.
• Bleeding. You may experience oozing blood around the gauze dressing after the first day after surgery due to bleeding through the stump of the urethral opening. This may require repacking or suturing.

1. Dilating is the most important thing you can do to ensure the success of your surgery. If the patient does not dialate responsibly, this can result in the shortening of depth and width of the newly made vagina because of the scar contracture.
2. Failure to dilate properly can result in serious injury. You will be instructed to gently dilate into the right direction after the vaginal packing is removed.
3. Dilation can be painful for the first weeks, but is essential for developing maximum depth and ensuring post operative functioning of the neovagina.

During the recovery period, after each dilation session: The wound should be washed gently with Hibiscrub (pink colour) in the shower followed by douching while seated in the toilet:

1. douche proportion = 5-10 ml (cc) of Betadine solution mixed with bottled water until container is full;
2. insert the douche to full depth, squeeze, and hold tightly the container;
3. while holding tightly the container, extract the douche;
4. keep the wound dry and apply Betadine solution with cotton balls; and
5. apply Kemicitine ointment with a cotton applicator. If there is some bleeding, press or apply pressure with a dry cotton ball to the site for 15 minutes. During the first weeks after surgery, feminine napkins (tampons) should be changed several times per day due to normal vaginal bleeding during recovery.

After one month of SRS operation you will be required to start applying Premarin cream to your neovagina. Apply two times a day to soften your neovagina. This would generally takes around six months.

Patient can return to female hormones as before surgery after two weeks. You should consult your endocrinologist to re-adjust the dosage. A sudden change in hormone levels, for some individuals, may result in the fluctuation of emotion.

"You are required to send a Photograph of your face frontal and sideways to the surgeon for the initial consideration and approval. Without the photographs Surgeons will not approve and schedule the consultation appointment."

All the costs quoted by the Hospital / Surgeon includes the following

• Pre-Surgery Consultation
• Doctors Fee
• Surgery fee
• Hospital room charges
• Nursing fee
• All medications required
• Post-Operative Follow Up

In addition to the cost of the surgery, you will need to be prepared for the following additional costs.

Stay
For this procedure you are required to stay in Bangkok for at least 15 days of which you will be spending the first night at the hospital, and then you can choose whether to stay in the serviced apartment at the hospital or a hotel outside until the post surgery follow up appointment 7 days after the surgery. Surgeon will allow you to fly only after the follow up appointment, and therefore you need to plan accordingly.

Serviced apartment at the Hospital : Piyavate hospital provides a serviced apartment manned 24/7 by registered Nurses within the hospital complex, with prices ranging from US$ 45 -  US$ 195 / night depending on the type of room you choose. 

Hotel: If you wish to stay in a Hotel outside the hospital it could cost you anywhere between US$ 40 - 300 / night depending on the hotel you choose. There are many Quality / Clean entry level hotels that offer rooms for as little as US$ 40 in the near vicinity of the hospital and the Up market hotels near the Sukhumvit (10 mins in taxi) or Silom (25 mins in taxi) Shopping districts, the rate could go as high as USD 300 / night. 

BMT Concierge Service : If you wish to have us arrange you received at the airport and arrange the round trip airport transfer, and Transfer to all of your appointments and the surgery by one of our patient co-coordinators, there will be an additional Fee of US$ 169 which is to be paid after you confirm the surgery plan.  This fees only applies if you choose our Concierge service. There are no additional fee if you choose only the  Surgery planning service.

All the fees due for the surgery has to be paid directly to the surgeon or the hospital before undergoing the procedure.  There are no fees to be paid to us apart from the fee for the Concierge service if you wish to have us arrange all of your transportation.

If you are HIV+ve, there will be an additional 60% fee will be levied to cover the cost of additional equipment and personnel expenses.

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