Penile Skin Inversion

Frequently Asked Questions (FAQs)

Q: I like to inquire about the services of SRS for my nephew who lives in China. He is 21 years old and he was diagnosed with gender identity disorder a few years ago. After that, he started taking hormone and his psychological reports that he is suitable for sex reassignment surgery. Now he wants to find a suitable hospital for the surgery because he is not confident in his language skills.

A: We have interpreter for many languages such as Chinese, Italian, Japanese, Spanish, Russian, Turkish, and Iranian and on request. All staff and doctors here are fluent in English.

Q: If I have orchiectomy, Could I do SRS surgery

A: Yes.

Q: I am from the Philippines. I plan to have SRS soon and I want to ask how much is the total cost of the procedure in your clinic?

A: As medical law for cosmetic and reconstruction surgery 18+, we can’t provide surgery fees on line website as respectfully. Please kindly write questions direct email and we will answers all questions and schedule everything.

Q: I’m interested in receiving the MtF PSI SRS. I am a transgender woman, and have known about it since I was a little kid. Due to some societal pressure I was not able to go through the puberty I was supposed to have, but friends have been addressing me with the proper name since I was 9-10 years old. I came out in my 20s (am 29 now) and living openly and proud as myself in all areas of life. My current equipment has caused me a great deal of dysphoria throughout the years, and even though I have tried to come to terms with it there is no way that I can ever be okay with what I have now. I have been on hormones 4 years and I have spent a great deal of time considering if having the surgery is worth the risk. Ultimately I decided that I can’t go through life like this, even though HRT has been kind to me I feel like there is a part still missing. The dysphoria is present every single day, in ways like when I pee, how I get dressed, how I walk, how my body feels. I would like to be able to be sexually active after the surgery, but the most important part is being able to move through life without having that specific part of me tearing my mental health down. I do recognize that surgery is not a “fix-all”, but it will alleviate a lot of physical dysphoria for me.

A: Base on your personal information, this seems to be ready for transition srs penile skin inversion. So please kindly prepare your hormone therapist letter, fill out your medical form and then processes will be contact via email.

Q: I'm a transgender woman living in France I'm 37, 1m86 and 80kg I'm doing research since 2 years to choose the surgeon to do my vaginoplasty penile skin inversion. I would like to know the process, the cost estimate and the delay to be operated by doctor there. I would be pleased to give you all the information you need. Thank you very much for your help

A: In general, your Body Mass Index (BMI) is 23.12, which is in good bodyweight. So please remain your bodyweight at 23.12 or below 24.99 just on surgery date (this is just to avoid an extra charge on general anesthesia) For the process (pre-screening), we can exchange all information via email such as fill out a medical form, tentative surgery date and so on. All questions and answers are direct to each request doctors (Dr.Burin or Dr.Sutin).

Q: Hello. I’m curious to the cost of the srs program for mtf vaginoplasty for a girl coming from the United States ? California to be exact.

A: For MtF vaginoplasty , you should also provide us aging, bodyweight, height as well as your personal history such as how long you have been living as female, psychiatrist, hormone treatments, health conditions and fill out medical form. The doctor needs firstly to review and all questions with answers will be response by doctors via email.

Q: I have few questions about laser hair removal , I just start it on my genitals. How many sessions do you recommend and how much time before the surgery should I stop it ?

A: Laser hair removal is just an optional before coming to surgery. It’s not necessary because doctor will also scrape the root of hair from penile and scrotal skin during surgical times (hair follicle scraping). However, if you still consider before coming surgery. This can consider around two sections and all should be finished at least two weeks before arriving Bangkok.

Q: Is the surgery performed with the expectation that there will be a cosmetic revision in the future, as part of a two-step process? Or is it performed with the intention that this one surgery will result in a cosmetically satisfactory outcome (just one surgery rather than two). (Obviously this is regarding the intention of surgery, and the actual outcomes vary by individual)

A: Expectation should not come back for revision unless, you have had much sexual intercourse, which may need to come back for labia repairs. This is just normal to all.

Q: What if I haven't yet chosen the technique for which I want to perform the operation (PSI or PSI with scrotal graft? Can it be solved on the spot, in your clinic?

A: Yes. You and the doctor need to finalize here direct consultation. Everything needs to finalize here together during direct consultation here in clinic PAI.

Q: Can the patient have a companion? And how many companions can the patient have? And how much is the cost for the companion per night?

A: Companion is allowing in hospital for one person. The hospital will provide pillow, blankets and able to sleep on sofa bed (free of charge). If more than one adult person, we are recommend to stay in hotel and able to use a taxi to come to see her while in hospital. The cost of a taxi meter from hotel to hospital is less than $5.

Q: If they (the patient and companion) are going to stay in hospital, are they served with food? If yes, how much must be paid for serving food?

A: While in hospital private room, patient meals are included within a package surgery fee. But companion can order room services or just walk to 1st floor hospital. There are many international foods, local foods there. Restaurants, cafeterias are charge as a standard cost. They won’t double charge.

Q: Are there hospital, hotel or clinic free internet WIFI?

A: Yes. All places.

Q: Must the cost be paid in dollars or another currency? (It is very important)

A: Surgery fee can be pay by cash CNY, HKD, SGD, AUD, USD, EURO, and YEN, GBP or credit cards (VISA and Master card). But credit card is an extra charge 3% from surgery fee. Hotel, living expenses can use credit cards without an extra charge. Most of them prefer VISA or Master card.

Q: I am also considering a zero depth SRS. I thought we had discussed this in past emails but cannot find them. Please could you tell me if you carry out zero depth SRS and can I have the price too, thank you.

A: Yes. But you must provide clarify letter from your psychiatrist or hormone therapist that you are just request a zero depth SRS or minimal depth for SRS.

Q: As said in my previous email i have already undergone a chest x-ray and extensive blood test in preparation for surgery. Do you require any other tests?

A: You still have to do medical health exams here with us. But within a package surgery fee. No need to pay extra. But if there’s any indicate sign need to recheck some specific, an extra charge maybe applied.

Q: Could you please tell me if you require psychiatrist (Thai psychiatrist) to undergo surgery at PAI?

A: Yes. This is a requirement because we are follow WPATH, Asia PATH and medical law Thailand. All Gender affirming surgery are required Thai’s psychiatrist. We will refer to hospital. This is 1,800 THB. It’s requirement for international patient. Your local psychiatrist or hormone therapist's letter is also best supportive.

Q: I hope it's okay for me to ask, but what is the absolute cheapest hotel near PAI that you would recommend?

A: The best budget hotel nearby PAI is 1,800 THB/net include breakfast (studio room).

Q: Can I just request Sex Reassignment Surgery for Male to Female, especially for No-depth and PSI because I do not really care much on the depth of vagina?

A: Yes, you can. But you must provide proof of psychiatrist or hormone therapist to qualified SRS and in the letter, your psychiatrist or therapist must written the patient is request zero depth or minimum depth for surgery in English.

Q: I have had trouble with my gender since 2017 because I cannot accept my current biological sex. I've always felt strongly that my gender should be a woman. When I was in 2022, I told my family about my troubles and started hormone therapy. At the beginning of 2023, I went to a psychiatric hospital in China, where the doctors endorsed my thoughts. I think undergoing gender reassignment surgery may be my last resort! So, I chose to go to Thailand for gender reassignment surgery. I don't do surgery in China because the pre-surgery preparation process in China is very troublesome. The operation process in Thailand is relatively qualified, and has rich surgical experience. I am 19 years old. Please tell be the general process for patient who want to go for SRS under 20 years old.

A: For patient who under 20 years old. But must be fully 18 years old. 1. Psychiatrist evaluation written in English. This can be one letter. 2. Endocrinologist to explain and how long you have been taking hormone. 3. Parent must come with you to sign a permission (consent form) allowing surgery. This can be father or mother. 4. Must be in good health. Pre-screen labs and questions will be communicate via email.

Q: IS THERE ANY PROBLEM FOR SRS (MtF) ? If I have done voice surgery a long ago.

A: It is importance to double check with your voice surgeon or written in the letter. Please inform your voice surgeon that we (PAI), general anesthesia will using tube size 6.5-7 or a little bigger. No smaller size. Is there any side effect ? If not, sex reassignment surgery can be perform.

Q: Can you compare PPV and PSI's technique in general ?

A: The standard technique is Penile Skin Inversion (PSI). By PSI, this is most qualified long researchers (in house researchers and international public researchers) reliable accepted technique - compare with Penile Peritoneal Vaginoplasty (PPV) technique.

Q: How will the whole process work, like on day one when we arrive do we rest in hotel for one day than have a consultation the next day or how does the whole plan work ?

A: That’s right. Start on arrival date at the airport: - (Day 0) PAI’s driver will pick you up at the airport anytime. - (Day 0) Check in hotel for rest. - (Day 1) In the next morning, PAI’s driver will pick you up from hotel to PAI’s clinic. Direct consultation is set in the morning and then medical health exams. - (Day 2) Other preparation before surgery (labs, if need) - (Day 3) Surgery date (check out hotel, if need) - (Day 3 to Day 8) Stay in hospital for recovery. - (Day 8) Discharge from hospital after doctor visit. This is normally discharge at noon. - (Day 8) Check in hotel. - (Day 8 to Day 17) Stay in hotel for recovery period and come to PAI’s clinic by appointments. PAI’s driver will pick you up from hotel to PAI’s clinic. - (Day 18) Check out hotel in the afternoon. - (Day 18) You are able to fly home after day 18 or plan to be in Bangkok with us at least eighteen days all together for SRS (Penile Skin Inversion)

Q: Also what is the bowel prep for penile inversion vaginoplasty because in UK it’s normal eating and they just do enema before the surgery and are you admitted on the day of surgery. Also after surgery what is the diet when can you eat and what about bowel movements after surgery how is that dealt with ?

A: Bowel prep for penile skin inversion (SRS), this will be preparation after direct consultation here in Bangkok. About after surgery, you can eat normal meals well cooked. But avoid any spices and alcohol at least 2 weeks, after surgery date.

Q: I would also like to know if I need to have any consultation session(s) beforehand. If yes, can it be done via email or online meeting?

A: Yes. You can consult with doctor beforehand via email and then finalize can be choose during direct consultation.

Q: Does my friend who will accompany me need to book a room in a hotel for the 5 days I am in the hospital, or can he stay with me there?

A: Your friend is welcome with you and able to stay with you in hospital too. The hospital will provide pillow and blankets with sofa bed for your friend. There are many local and international restaurants inside hospital. Your friend will enjoys. But for you, we have meals included with surgery fee while in hospital. Otherwise, your friend can wait in hotel to see you after discharge from hospital. If prefer to wait at the hotel and he is able to take a taxi to visit you in hospital too. A taxi meter from hotel to hospital is around 6 USD/trip.

Q: I am a transgender woman who is interested in penile skin + scrotal graft bottom surgery. I have been hormonally transitioning since June of 2019 and have been living full time in my work and social life as a woman since early 2022. I have a psychiatric specialist who will be able to provide a letter of recommendation and believe I meet all other medical criteria.

A: All related to SRS (MtF surgery), please direct email by consult@pai.co.th

Q: I am also curious as to hair removal necessity. With a scrotal graft is that a pre requisite or not.

A: Electrolysis hair removal from (SRS) Penile Skin Inversion or with Scrotal Skin Graft, these are optional. The surgeon will also scrape the root of hair from penile and scrotal skin during surgical times (hair follicle scraping). Indeed, still comfortable with electrolysis hair removal ahead of times before arriving to be surgery. We are recommend at least two sessions and should be finished at least four weeks before arrival Bangkok. The area should be considered for electrolysis hair removal at middle part of scrotum.

Q: What tissue will the labia minora be constructed from?

A: From penile skin and prepuce.

Q: Whether to manage to preserve the glans tissues as much as possible, where will they be used?

A: Reconstruction clitoris and the less will be place in the area between clitoris and size of urethra.

Q: Whether Bulbourethral glands will manage to be kept?

A: Bulbourethral glands, these are keep.

Q: Do I have any routine check after finished my gender affirmation surgery (when back to my country) ?

A: No you don't. However, we encourage you to follow up with any primary physician care such as gynecologist in your home town.

Q: Does PAI provide identification letter after SRS ?

A: Yes. We will issue the letter after gender reassignment surgery. You may consider updating your name and identification in your country.

Q: Appointment and Reservation: What is the procedure for scheduling an appointment for gender confirmation surgery?

A: If you live oversea. We can forward all information on line (email) and able to arrange everything include pre-screen ahead of time.

Q: Duration of Stay: How many days is it typically recommended for transgender women to stay in Thailand post-surgery?

A: Mostly, we are recommend transgender women to stay in Bangkok at least fourteen days (14 days) for post surgery.

Q: When would it be feasible for me to return to my home country after the surgery?

A: You should be in Bangkok at least 14 days after surgery date or 18 days included before and after surgery.

Q: Are there specific documents or materials I need to prepare before the surgery? Is a consultation with a psychological professional required in advance of the surgery, and if so, how can I schedule this?

A: Yes. Specific documents such as fill out a medical form and referral letter (psychiatrist or hormone therapist) written in English. Psychological consultation can also refer after direct consultation at Preecha Aesthetic Institute (PAI). We will refer to consult with Thai’s psychiatrists. All speak in English. This is a part of WPATH/AsiaPATH as well as follow Thailand Medical Law for transition surgery.

Q: Postoperative Recovery: After the surgery, what is the estimated recovery time before I can safely get out of bed and resume normal activities?

A: Let’s say able to walk slowly in hospital) after 3 nights surgery. To resume normal activities, this is require at least eighteen days (18 days) after surgery date. But avoid heavy lifting for 3 months after surgery date.

Q: Assistance and Translation: Is it necessary to have a local intermediary accompany me during the process? Will translation assistance be provided during consultations and throughout the postoperative care?

A: We speak English. Mostly, our patients (90%) are traveling alone for transition surgery. But able to bring anyone to accompany. This is free of charge.

Q: Do I need have electrolysis or laser hair removal on the genital area before having Sexual Reassignment Surgery?

A: Laser hair removal or Electrolysis hair removal on genital area before having sex reassignment surgery, this is just an option. During surgical, the surgeon will also scrape the root of hair from penile and scrotal skin (hair follicle scraping). However, if you are too worried. Laser hair removal or electrolysis hair removal should be finished at least a month before surgery date.

Q: My psychologist letter was also 2018. Do i need a update letter for GRS?

A: Please keep your psychologist letter to Bangkok. No problem if year 2018 (not an update yet). However, you still have to direct consultation with Thai's psychiatrists (2 doctors) here again in Bangkok. We will refer to see Thai's psychiatrist and interview by English, Italian, Chinese, French, German, Japanese, Turkish, Spanish. So your 2018 psychologist letter is one of the best supportive document. Note: As Thailand Medical, all patients who coming for SRS must also approved by Thailand Medical LAW as well as follow by WPATH, AsiaPATH.

Q: Would you organize Thai psychiatrists the consultations for GRS or to which hospital do I have to go?

A: We will organize Thai psychiatrists after direct consultation at Preecha Aesthetic Institute (PAI). We will take you to hospitals to see Thai’s psychiatrist consultation.

Q: requesting to setup a consultation for gender affirming sex reassignment surgery and was wondering, if I could request to speak to someone who speaks English (sadly) as I do not understand Thai yet.

A: We are all fluent in English and able to provide all major interpreters any language such as Chinese, French Italian, German, Spanish, Japanese, Turkish or upon requests.