Fringe Medical Practices in Thailand
by Isaac Olson

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2 December 2010

Thailand has become a global hub of medical tourism which has in turn continued to bolster the standing of medical practices in the kingdom. World class facilities offering a wide range of medical treatments are now located within the country.  As a result, a number of medical faculties offer what can be called fringe medical procedures.  When many people hear the words “fringe medical,” they often think of scientifically questionable practices.  This does not have to be the case,

rather, fringe medical can be defined as simply taking place outside of mainstream medical practice. This could be due to the fact that the procedure may not yet be fully tested by scientific scrutiny or it may simply be that the conditions which are being treated are rare.

Thai medical institutes offer a number of fringe medical procedures and fund research.  Since some fringe medical practices can raise ethical questions, the Thai government has stepped in to regulate or outright ban some practices.  This article will address gender reassignment surgery, stem cell therapy and research, cloning, face transplants, and cancer treatment and research.

Gender Reassignment Surgery

Thailand is famous for its Khatoey or ladyboys, and many private hospitals and clinics offer gender reassignment surgery.   This type of surgery has truly moved from the fringe since most major private hospitals and many more clinics offer a variety of treatments for patients wishing to change their gender.  Far and away the most common type of change is from male to female.  There are several ways the male female sex change is accomplished.  The most common of which essentially involves turning the penis inside out.    Skin grafts or parts of the scrotum are then used to create an aesthetically similar vagina.¹  The surgery takes little time and is often done with only localized anesthesia.²  However, patients say it is quite painful for the first month after the surgery. 

Other smaller procedures are also available.  Some of the most popular are breast implants, facial feminization, phonosurgery to create a feminine voice, and thyroid chondroplasty to shave the adam's apple.³  Many foreign clients come to Thailand for these procedures, and many Thais also opt to physically become a woman.

Standards of Care for gender identity disorders are set by the World Professional Association for Transgender Health (WPATH) which was formerly known as the Harry Benjamin International Gender Dysphoria Association (HBIGDA).⁴   The WPATH lays out five ways professionals can be involved with patients.  These are: “diagnostic assessment, psychotherapy, real-life experience, hormone therapy, and surgical therapy.”  To be considered a true transsexual, the organization stipulates that a person show a true wish to live as a member of the opposite sex which usually involves wanting to physically change through hormone therapy and/or surgery.  Furthermore, a person should have had a transsexual identity for at least two years and the transsexualism can not be due to another mental disorder or chromosomal abnormality.  Mental health professionals are encouraged to determine the eligibility of a person for gender reassignment surgery.  One way for a transsexual man to meet eligibility is to live for at least one year as a woman.  The Standards of Care also stipulate one letter from a mental health professional for hormone therapy or breast surgery and two letters for genital surgery.  Also to be eligible for genital surgery, a patient must be of legal age, have received hormonal therapy for one year, have lived full time as their opposite gender for one year, and have knowledge of surgical costs and complications.⁵

The WPATH Standards of Care have no legal binding in Thailand but are guidelines for professionals, although Thai regulations of sex change operations have been heavily influenced by the WPATH standards.  This is most apparent from looking at the regulations that the Medical Council of Thailand implemented in 2009.  These regulations made it so doctors performing sex change operations had to be registered with the Medical Council.  Additionally, doctors must check for and give treatment for any post-operative complications.  Before an operation can begin, a transgendered person must live as the opposite sex for a year while under hormone therapy.  To even receive the hormone therapy, one has to consult a psychiatrist.  Before a doctor can operate, two psychiatrists must give letters of approval for a transgendered person to receive gender reassignment surgery. 

Operations under the age of eighteen are prohibited, and from the ages of eighteen to twenty, parental consent must be sought.  The Medical Council stated that it wanted to increase the quality of sex change surgeries.⁶  Much of this was in response to castrations that doctors had performed on under age boys.  This prompted the organization Transgendered Women of Thailand to call for greater regulation of sex change operations.⁷  Despite the new rules, transgendered people still can not change their gender on national ID cards nor official documents which has been a goal of transgendered Thais since the creation of the last constitution.⁸  On top of this, some transgendered people feel the new rules violate their right to choose.⁹ In the foreseeable future, it might be possible to see a rise in lawsuits regarding medical malpractice in Thailand alongside the rise in activism for transgender rights in Thailand.

Stem Cell Research and Therapy

cells.  Stem cells also have the ability to divide without limit over long periods of time and replace other cells which helps repair damaged tissue.  They can even become cells for organs but only under the right conditions.  Due to these properties it is hoped that stem cells will some day be effective in treating diseases such as diabetes and heart disease, but the use of stem cells on these and many other diseases is still experimental.  The effects of injecting stem cells into organs and tissues to facilitate repair is likewise still under study.¹¹

On the global level, the International Society for Stem Cell Research (ISSCR) has made guidelines for the use of stem cells in therapy and research.  The ISSCR calls for independent review and approval as well as oversight bodies to regulate how stem cells are used.¹²  Furthermore, the ISSCR has a consumer based program to help people identify fraudulent stem cell use.¹³

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