The modern world is increasingly liberalized and favoring greater rights for transgender people, but the crux of their health, both physical and mental, is only discussed in a limited circle, if at all. The feeling of being “someone else” in one’s own body is a subject only for certain groups of interest. Several topics such as innate gender identity that is inconsistent with current gender, a woman in a man’s body, or vice versa, are all brushed off as personal identity issues, and not in the public’s interest. A dedicated health clinic for transgender people is therefore crucial in today’s society.
From the above problem, King Chulalongkorn Memorial Hospital has founded a “Gender Health Clinic” in collaboration with faculty members from the Gender Medicine and Menopause, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University to provide a comprehensive health clinic to underline the importance of transgender people in Thai society today. In addition, this Gender Health Clinic is also a specialized learning center for doctors, medical students, and interested medical personnel. It is also an international research center on transgender health in conjunction with the Center of Excellence in Transgender Health (CETH).
“The establishment of a Gender Health Clinic is meant to provide medical services specifically for transgender patients who previously could find no specialized clinics in this field. Patients use hormones, self-inject hormones, or take birth control pills haphazardly or wrongly do what their friends do. Some people go to underground clinics and are not treated by specialists which is even more dangerous,” Associate Professor Krasian Panyakhamlert, M.D., Head of Gender Medicine and Menopause, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and founder of Gender Health Clinic elaborated about the rationale behind the Clinic which provides safe and standardized healthcare under the supervision of the Faculty of Medicine’s professors who are experienced and specialized in various fields, e.g. gender reassignment surgery, Integrative Adolescent Health Clinic.
Personalized service for various needs
Transgender people have different and diverse needs. Consulting physicians must therefore focus on giving personalized services.
Dr. Thanapob Bampenkiatkul, MD. Special Lecturer in Gender Medicine and Menopause, Department of Obstetrics and Gynecology, Faculty of Medicine, and a specialist at the Gender Health Clinic explained that “consultation depends on the way an individual patient wants to change his/her body to feel good. We provide information on the safest and most appropriate ways to become the person he/she wants to be.
For some, just to behave in the manner of their desired gender, such as cross-dressing, using pronouns, breast compression, or augmentation, can make them satisfied and happy without having to undergo hormone replacement therapy or sex reassignment surgery. Some may be content with just getting hormone pills without sex reassignment surgery. Even among patients who undergo sex reassignment surgery, they are satisfied with different things too.
The danger of hormone replacement
Hormone replacement therapy for a sex change is a popular method used by transgender people to transform their physique into their desired gender. Many people use it without consulting a doctor because they are unaware of the danger, especially from birth control pills. Using the wrong types and/or doses can adversely affect the cardiovascular system, one of the most common causes of death among transgenders.
Amarin Suwan, M.D., a lecturer of Gender Medicine and Menopause, Department of Obstetrics and Gynecology, Faculty of Medicine, and a specialist at the Gender Health Clinic, opined that “every person’s body is different and requires different drugs/doses to suit the body. Some people are better suited for pills taken orally, while others are better with topical drugs, or they may get the same drug but at different dosages, which the doctor will recommend the best.”
Most importantly, hormone replacement therapy is not for everyone. People with breast cancer, myocardial infarction, coronary artery disease (CAD), coagulopathy, polycythemia vera, or patients with abnormal liver or lipid profiles, etc. are barred from hormone therapy.
Gender Reassignment Surgery
Dr. Thanapob said, “transgenders have diverse needs. For instance, most trans men want their ovaries and uterus gone because they don’t belong to their body, while some people don’t mind them as much. Some may want to get pregnant or have vaginal sex, so they don’t have a hysterectomy, while only 3-4 percent of all trans men worldwide undergo penile reconstruction surgery. So, to each his own.”
The Gender Health Clinic offers gender reassignment surgery services for both transgender men and women, by working with a transgender surgery clinic. There are three types of surgical procedures:
1. Top Surgery consisting of breast reduction and breast enlargement.
2. Bottom Surgery consisting of hysterectomy, removal of ovaries, and fallopian tubes , penile and vaginal reconstruction, as well as castration.
3. Other surgeries including hips augmentation, Adam’s apple sharpening, jaw sharpening, face shape change.
Patients are carefully considered in detail in accordance with Thailand’s standards before they undergo each type of surgery. Initially, they must undergo psychiatric evaluation and be cleared by a psychiatrist that they really wish to undergo the operation and it’s not just a passing whim, because the surgery can only be done once and is irreversible. Without endorsement from a psychiatrist, surgery cannot be performed. This is forbidden at the Clinic. In addition, they may need to have been living a transgender lifestyle for at least one year. People who are allergic to anesthetics or unable to undergo surgery will not receive the service either.
The importance of psychiatric evaluation before sex reassignment surgery
To receive sex reassignment services, everyone must always receive a psychiatric evaluation. Many people mistakenly believe that seeing a psychiatrist implies a mental disorder. This is far from the truth. The psychiatrist is there to determine that the client is true to his/her will and will not regret it later, or the will is not caused by the confusion that might occur with schizophrenia patients who are delusional about their desire to be transgender, have personality problems or are sexually happy from cross-dressing only.
“There is nothing wrong with people who want to love and spend their lives with a same-sex partner, and current medical textbooks are going write transgenders off of Mental Health problems list, and classify them under the Sexual Health category, because wanting to live as another gender is not being mentally dysfunctional,” Assoc. Prof. Doctor Krasian said.
At what age can I undergo a sex-change operation?
There is no clearly specified age that is appropriate for sex reassignment surgery. It depends mainly on the needs of the service recipients because some people want to be transgender in their teens, others may come out in their 40s. Only those who are 18-20 years of age must always have the consent of their parents or legal guardians. Based on the Medical Council of Thailand’s Regulations on the Ethics of Medical Professionals Regarding the Criteria for Gender Reassignment treatment, B.E. 2552 (2009), the Gender Health Clinic will primarily care for adult patients.
Adolescents under 18 years of age are treated on a case-by-case basis. The clinic has specialized endocrinologists and child and adolescent psychiatrists from the Integrative Adolescent Health Clinic. All of this is for service recipients to have a better quality of life and mental health.
Among other services, the Gender Health Clinic also offers counseling services for gender-related health problems, such as menopause, vaginal dryness, endocrinological disorders related to sex hormones, and the consequential unsatisfying sex, such as lack of sex drive, pain from sexual intercourse, etc.
Gender Health Clinic opens for service every Monday from 13.00-15.30 hrs. To make an appointment for a consultation with specialists, call Tel 0-2256-5286 and 0-2256-5298, or follow the Facebook page: “Gender Health Clinic Chulalongkorn Hospital” – https://www.facebook.com/KCMHCMG/.
Published : June 24, 2021