Life-changing... 'Gender Confirmation Surgery' - a day that should be a right, not just about beauty.

It's a significant first step that has drawn attention to health and human rights once again. Dr. Chedtatam Thammathat-Aree, the Secretary-General of the National Health Security Office (NHSO), revealed plans to introduce a package covering gender confirmation surgeries for the LGBTQ+ community. This package not only includes surgical procedures but also counseling services and the use of various hormones.

Dr. Chedtatam mentioned that while gender confirmation surgeries have been included in the basic health insurance benefits since 2018, it was observed that hospitals only provided reimbursements for surgeries related to individuals who were born intersex. However, surgeries for the LGBTQ+ community were not covered.

This crucial first step is expected to have a significant impact on the lives of many Thais. Gender Affirmation Surgery, or Gender Confirmation Surgery, is a life-changing procedure for many individuals. It's not just about the privilege of beauty but about affirming one's body to align with their gender identity. Therefore, it is considered a right that everyone should have the option to choose for their own lives.

According to the criteria set by the Medical Council, individuals seeking gender confirmation surgery must have lived consistently in their desired gender for at least 24 hours a day for a minimum of 1 year. They must have undergone continuous hormone therapy for at least 1 year under medical supervision and must be certified by at least 2 psychiatrists.

This major decision is not taken lightly; rather, it involves careful consideration to initiate a fresh start in life.

 

 

However, despite Thailand being globally recognized and having individuals from various countries travel for gender confirmation surgeries, accessing such services within the country can still be a challenge. This is primarily due to the high associated costs. Even in government hospitals, the starting cost for gender confirmation surgery is in the hundreds of thousands, and waiting times can extend to several years. As a result, many people opt for private hospitals where the cost can range from 300,000 Baht upwards, depending on the type of surgery. Gender confirmation surgeries, especially those involving the creation of male genitalia, can cost between 500,000 to 600,000 Baht in government hospitals. These figures do not include chest surgeries or hormone therapy, which contribute to the overall high long-term expenses.

And as for the "rights" related to gender confirmation that the Thai population should have access to, Matichon Online has invited Dr. Jeerawan Thamthatchariya, Secretary-General of the National Health Security Office (NHSO), and Dr. Reena Janamnuaysook, Project Manager of the Trans Health Clinic at the Institute for HIV Research and Innovation (IHRI), a health clinic specifically for transgender individuals.

Reena raises the issue that although Thailand is globally recognized as a hub for gender confirmation surgeries, Thai transgender individuals themselves struggle to access these services due to the associated high costs. Even in government hospitals, the starting cost for gender confirmation surgery is in the hundreds of thousands, and the waiting times are long. Many opt for private hospitals, where costs start at 300,000 Baht, and for surgeries such as gender confirmation involving male genitalia, costs can reach 500,000 to 600,000 Baht in government hospitals. These figures do not include chest surgeries or hormone therapy, adding to the overall long-term expenses.

Reena also discusses the critical issue that transgender individuals face in accessing healthcare services. She emphasizes the need for comprehensive services that go beyond just surgeries, including counseling, sexual health care, and hormone therapy. Additionally, she mentions that the right to gender confirmation and surgery is not officially recognized in Thailand's healthcare system.

Dr. Jeerawan highlights the importance of the government addressing these issues and acknowledges that while Thailand is recognized globally for gender confirmation surgeries, Thai transgender individuals are unable to access these services easily. She discusses the NHSO's commitment to providing comprehensive support packages, including hormone therapy, mental health services, and counseling for transgender individuals. This move by the government is seen as positive, recognizing the importance of these rights in the overall healthcare system and responding to the demands of social organizations that raised these concerns with the NHSO two years ago.

The decision-making process for "gender confirmation surgery"

Rina mentioned that for Thai individuals undergoing gender confirmation surgery to create new sexual organs, a process must be followed. If you are Thai, two psychiatrists need to provide a diagnosis and issue a certificate confirming the gender identity. The individual must have lived consistently in the desired gender for at least one year, undergone at least one year of continuous cross-sex hormone therapy under medical supervision, and demonstrated readiness for the surgery. Medical professionals will assess if there are no co-existing medical conditions or other illnesses that may affect the planned surgery, considering potential side effects or pre-existing conditions. Gender confirmation surgery is a significant procedure, and once completed, it is not reversible. Thorough preparation is required, and individuals may seek specialized surgeons for various surgical techniques, including aesthetic and reconstructive procedures.

Rina emphasized that the decision to undergo gender confirmation surgery is a personal choice, a manifestation of an individual's commitment to being true to themselves. Seeking medical services is one way to affirm one's gender identity. The process involves multiple dimensions: medical, legal, and societal. The medical dimension includes hormone therapy and surgery. Legally, Thailand currently lacks laws recognizing gender identity, making it challenging for individuals to choose their gender on official documents. The societal dimension involves societal respect for an individual's choice of gender identity, including using appropriate names and pronouns. The three dimensions collectively contribute to affirming gender identity. Research indicates that supporting health services for the LGBTQ+ community, including hormone therapy and gender confirmation surgeries, improves the quality of life and mental well-being, allowing individuals to express their full potential. Rina emphasized the need for state support in providing these services.

 

 

Which types of surgeries are popular?

Currently, gender confirmation surgeries can be performed using various techniques. This includes surgeries to transform male to female by constructing organs from existing genitalia, using intestinal tissue, and surgeries using peritoneal lining, which is considered a newer technique in recent years.

According to Reena, there are new techniques in gender confirmation surgeries. The use of intestinal tissue to extend and create depth for the genitalia is one such method. This technique involves using the intestines as an extension to provide depth to the genitalia, and it has the advantage of not requiring the use of dilators or lubricants. However, it comes with a higher cost, posing a barrier for many individuals to access these services.

Reena emphasizes that the current policies and high costs result in limited accessibility for many individuals. Some resort to working in informal sectors, leading to challenges in accessing quality healthcare. Reena suggests that if such policies are implemented, the government needs to regulate and standardize gender confirmation surgeries to mitigate the various associated challenges. She also highlights the importance of addressing the quality of life for individuals who may choose not to undergo surgery or face limitations due to pre-existing health conditions.

Reena also discusses the situation at the Transcend Health Clinic, which caters to the transgender community. The clinic serves around 6,000 individuals and is considered the largest transgender health clinic in Asia. Reena mentions that only about 20% of those receiving services at the clinic undergo gender confirmation surgeries, while the rest may wish to undergo surgery but face financial barriers. Additionally, some individuals prefer to live without surgery or have pre-existing health conditions that make surgery impractical.

The cost of services at government hospitals is more accessible compared to private facilities, but long waiting times and queues are common. Some individuals may wait for up to two years, while others may find the waiting period impractical and seek private alternatives. However, the high costs associated with private facilities create additional challenges for many individuals. Reena stresses the importance of addressing these challenges to ensure that gender confirmation surgeries are more accessible and affordable for everyone.

What rights should LGBTQ+ people have?

Being one of the driving groups and has experience in the health of the LGBTQ+ group and has participated in meetings to propose health plans with NHSO this time, Reena explained various rights that should be received, starting from:

• Providing counseling services not only to LGBTQ+ individuals but also to parents, guardians, and family members on how to support and accept each other is crucial. Some individuals may be aware of their gender identity for a long time but may struggle to make decisions or express their identity due to societal pressures. Counseling services should address issues such as domestic violence, egg and sperm banking, pregnancy termination, and the overall health during hormone therapy.
• Health check-ups include monitoring hormone levels, liver function, kidney function, prolactin levels, bone density, chromosomes, and fertility testing before starting hormone therapy. At the Transgender Clinic at Tangerine Community Health Center, we are the first to offer hormone therapy services, with blood tests to confirm gender identity for both male-to-female and female-to-male individuals.
• Surgical procedures extend beyond gender confirmation surgeries. Procedures such as facial feminization surgery, chest surgeries, testicular implants, vocal training, and hip augmentation for feminization, or breast removal surgeries and phalloplasty for masculinization require expertise. Psychological care is also essential, as individuals undergo emotional adjustments during physical transformations.
• Post-surgery care involves wound management, continuous medication, and maintaining hormone balance to prevent bone density loss. Sexual pleasure is another aspect that should be discussed, as some individuals may face challenges in this area. Having resources and support for corrective surgeries is crucial, especially when complications arise.
• While hospital fees in state-run hospitals are more accessible, long waiting times may lead some individuals to seek private clinics. Many face financial constraints, and some choose to work outside the formal system, engaging in occupations that lack recognition. Comprehensive post-surgery care, addressing issues like pain management, proper wound care, and information on sexual health, is necessary for a better quality of life.

"All of this constitutes a comprehensive package that we and our network have provided information to the National Health Security Office (NHSO). They will discuss it with the committee, viewing it as a positive signal from the government recognizing the right to affirm one's gender identity as a human right. The World Health Organization (WHO) has previously declared that being transgender or LGBTQ+ is not a mental disorder, but medical services are still necessary and fall under the category of health care. We are not sick; we just want to be true to ourselves."

 

 

Which countries have such rights?

Rina provided information that currently, several countries allow access to hormones and surgeries as part of their rights. Some examples include the United States, where certain states include these procedures in health insurance plans. Additionally, countries such as the Netherlands, the United Kingdom, and several European countries, including Switzerland, provide such services, albeit with the challenge of long waiting lists. This situation leads many individuals to travel to Thailand for these services and then have the expenses covered by insurance. For instance, in the Netherlands, where 60% of gender confirmation surgeries are covered, if the cost is 1 million, the state covers 600,000, and the individual covers the remaining 400,000.

Rina expressed that if the National Health Security Office (NHSO) develops in this area, it may need to train additional medical personnel and establish referral systems from hospitals that do not currently have specialized staff. In the long run, the goal should be to provide these services in every district hospital.

Transgenderism is a right, clearly stated, people are equal.

Rina mentioned that following the news about granting healthcare rights, including hormones and gender confirmation surgeries, to the LGBTQ+ community, there has been online opposition. Some argue why the government doesn't prioritize other health issues first. However, she emphasized that if viewed as a human right, everyone should receive the necessary care, just like with conditions such as diabetes. Not everyone within the LGBTQ+ community desires surgery, and services should be comprehensive, equal, and tailored to individual needs.

The project manager at Tangerine Clinic added that society needs to be more open-minded and accepting. Some individuals are content with hormone therapy or chest surgery, and the community's diversity should be acknowledged. Society should not perceive these procedures solely as cosmetic surgeries but as essential components of healthcare that can improve the quality of life. He emphasized the importance of a broad mindset, stating that the community deserves equal opportunities and the chance to excel in various fields. Acceptance should extend beyond personal disclosure and manifest legally to ensure equal rights in all aspects of life, not just health.

Rina concluded by expressing the need for international recognition, stating that it goes beyond personal identity and disclosure. The government should legally acknowledge and accept LGBTQ+ individuals, as their health is just one aspect, and societal acceptance has been long-awaited.

 

refer: Matichon Online