Caught napping (part 1)

Tough action awaits any back-alley medical clinics which continue removing the testicles of young Thai men who are under-age.

They are likely to lose their operating licence, and the owner could be fined up to B20,000 baht and/or jailed for a year.

A craze among young Thai kathoey (boys who want to be girls) to get their testicles removed came to light when gay activists revealed that parents of teens who had undergone the procedure contacted them to complain.

Back-alley clinics have advertised on the internet claiming that castration is a cheaper and effective alternative to gender re-assignment surgery for young teen males who want to become women. Most teens who get their testicles removed are just 15 or 16.

The gay activists called on the Medical Council yesterday to demand it stop clinics performing the procedure. Under law, someone must be 18 before he can undergo surgery without his parents' consent.

Thai gay activist Natee Teerarojjanapong, who led a delegation of 10 activists to present their demands to the Medical Council yesterday, believes that as many as eight out of 10 kathoey may have had the procedure done.

He says the procedure can potentially destroy lives, as it is irreversible, and can lead to premature senility and even mental retardation. He decided to come forward after worried parents in Chiang Mai contacted him.

Their son was pressuring them to consent to the procedure - though many other under-age kathoey had undergone castration without telling anyone.

Quack surgeons offering the service do not bother to inform their young patients about the potential consequences. Now do they do not ask if they have their parents' consent.

They offer the service for as little as B5-7000 baht, compared to the B100,000 needed for gender re-assignment surgery. No wonder it is seen as an appealing alternative to full surgery.

The Medical Registration Division of the Ministry of Public Health, which inspects clinics once a year to make sure they comply with the terms of their operating licence, says it does not know how many clinics perform castration on demand for under-age teens. Some clinics which advertise the service on websites leave just a contact number.

It had never received any complaints from the public, as the teens who usually seek out the service do so furtively.

Supachai Kunarattanpreuk, Medical Services Support Department director-general, said hospitals and clinics had been warned not to perform castration unless a medical condition requires it.

The furore could also have repercussions for the way gender re-assignment surgery is done. The Medical Council is working on tougher regulations covering gender re-assignment surgery and castration. It has invited the gay activists to supply them with information about the castration trend among young teens.

now, see part 2

In the name of progress (2, final)

Thai Rath newspaper carried a lengthy story about Natee's plea to the Medical Council on page 1 today. Kom Chad Leuk newspaper, another Thai-language daily, spoke to teens who have had the operation done.

'Bird', 19, said he knew youngsters aged 12 to 16 who had expressed an interest in getting their testicles removed, as they believed they would end up with tapering arms and legs like a woman. They saw it as a much cheaper alternative to gender re-assignment surgery, which most could not afford.

'Word is spreading among kathoey who enter beauty pageants in the North. They believe that if they get their testicles removed, then take female hormones on top of that, they will end up looking beautiful,' he said.

The newspaper also spoke to kathoey 'Sukat', 15, who like Bird had undergone the procedure. He went to a clinic close to home and told the surgeon that he wanted his testicles removed. The surgeon consented, without asking about his medical history, or making any inquiries about his psychological state. He simply made an appointment with him to come back and get the procedure done.

Sukat's testicles were removed a little over a year ago.

He describes in graphic detail what happened. The surgeon gave him an injection in his arm to make him drowsy. Then he inserted a knife about 15cm deep in the gap between his testicles, and removed them. The surgeon told him to rest for three hours, after which he was free to return home.

Thai psychologist Wallop Piyamanotham said that in the absence of legal penalties, doctors could perform gender re-assignment surgery or castration without having to check on a patent's psychological condition first.

Unscrupulous surgeons were exploiting loopholes in the law to make money. They started on patients early, by removing their testicles, then invited them back later to perform full gender re-assignment surgery. The two should be performed together, if they are performed at all, but patients were seldom told.

In the name of progress (1)

The craze among teen kathoey males to get their testicles removed started gathering pace after the government changed the law allowing men who had undergone gender re-assignment surgery to use the word 'Miss' or 'Mrs' in front of their name, says gay activist Natee Teerarojjanapong.

After that law was passed, increasing numbers of kathoey - boys who want to be girls - decided they would like to be women, and turned to this low-cost procedure as a way to achieve it.

'I believe that if you asked 100 kathoey now if they had undergone the procedure to remove their testicles, 80 would say yes,' he told Kom Chad Leuk newspaper.

One Chiang Mai clinic said that on average, four kathoey came to the clinic asking to have their testicles removed every day.

The law change last year by the National Legislative Assembly allowed men who had become women to use the honorific. It was sought in the name of equality and progress, but led to unforseen consequences, he said.

Natee Teerarojjanapong and nine other gay activists today paid a visit to the Medical Council to demand that it stop clinics offering castration surgery to kathoey teens.

In the kathoey community, a clinic in Pratunam of Bangkok, was well-known for offering the procedure. However, Natee had also heard of clinics and hospitals offering the 15-minute procedure in Chiang Mai, Phuket, and Chon Buri.

His gay coalition had received complaints from custodians of kathoey guys aged 16, who had pressured them to consent to their undergoing the surgery. Some kathoey were aged 14 and 15 were joining the waiting list at clinics for the chance to get their testicles removed when they 'come of age' at 16.

Natee says that when he was 16, he thought he would like to change his sex. When he grew older he realised he was merely gay, and that it was not necessary to take such a step.

Emboldened by the law change, many young kathoey were going ahead with the operation, which could have drastic consequences for the rest of their lives. 'If we do not act now, we could end up with many people who are crippled and maligned for life,' he said.

'I don't want surgeons to feed off young people in this way. These clinics need a code of moral conduct. Patients should be examined by a psychologist, and given more information.

'Patients who have their testicles removed have to take hormones for the rest of their lives. Do they have the money?'

Kathoey had also read chatter on webboards which said the procedure would make them look more beautiful. At some webboards, clinics were offering such services openly.

'That's wrong. In fact, they could end up being intellectually retarded instead.'

Few young men could find the B100,000 needed for gender re-assignment surgery. By comparison, the B4000-5000 needed to get their testicles removed looked cheap and affordable.

now, see part 2

Retarded growth

Natee

Teen males as young as 14 are seeking out medical clinics to get their testicles removed, in the belief it will stop them becoming men, says gay activist Natee Teerarojjanapong (pictured).

A coalition of gay groups led by Natee will call on the Medical Council today, to insist that it cracks down on errant surgeons who are allowing youngsters below the legal age to undertake such drastic surgery.

No law prohibits surgeons from offering castration surgery to under-age youngsters, the Health Ministry admits. It has vowed to crack down on the practice, which Natee and his gay coalition says has become an internet-fuelled craze.

Natee says he himself has a younger sibling, a kathoey aged 16, who has undergone the procedure. She has two friends, aged 14 and 15, who are in the process of going through it.

Natee is gathering together parents of youngsters who have undergone the procedure, to speak to the media today. He says young kathoey (boys who want to change their sex) believe the operation will result in their getting finer skin, like a girl; that they will not have to put up with an Adam's apple, broad chest, body hair, or deep voice like a man. It is particularly popular among a group he calls dek toot (เด็กตุ๊ด), aged 14 to 16.

The procedure is readily available from small private medical clinics in many provinces nationwide, though he has also heard of the operation being performed at big hospitals, in Chiang Mai and Phuket.

Kathoey teens have left messages on webboards in which they talk about the operation as all in fun.

Natee wants to know whether surgeons have asked their patients whether they are young kathoey, committed to looking like girls, or whether they are just ordinary gays, who may later regret the decision.

In any event, he says it is wrong to perform the procedure on under-age patients. They should leave it until they are at least 20 - by which time, surgeons say, there is little point in proceeding anyway.

The operation costs just B4-5000, which is much cheaper than gender re-assignment surgery. However, it can have big impacts on a youngster's health.

Sittiporn Srinualnad, from the Department of Surgery at Siriraj Hospital, said the ideal age for gender change surgery was 13 or 14, before a young male's body has developed. By 16, his body is already grown. That said, surgeons only recommended castration surgery be performed to treat disease.

Castration at the age of 13, before the body had fully developed, could result in the patient growing up short, bald, fat, and with increased risk of memory disorders such as Alzheimer's disease, at a younger age than his peers. Because 80% of male hormones come from the testes, losing them can also affect sexual drive.

Sirachai Jindarak, a plastic surgeon at Chulalongkorn Hospital, said castration surgery would make gender re-assignment surgery harder to perform, because the skin surrounding the testicular sack shrinks.

Dr Somsak Lolekha, president of the Medical Council of Thailand, said the council was drawing up regulations on gender re-assignment surgery and cosmetic surgery, for surgeons to follow.

He had heard of surgeons performing castration surgery on youngsters who were under-age, but he did not know which clinics performed it.

Public Health Minister Chaiya Sasomsap said he would ask the the Medical Registration Division of the Ministry of Public Health to crack down on clinics offering surgery to under-age youngsters.

The doctor's out

I went to see the doctor to get more sleeping pills, at a medical clinic hidden in the middle of the Klong Toey fresh market in Bangkok.

The clinic is staffed by one doctor, who visits from a big hospital in town. He or she sees patients there just a few hours a day, in the morning and evening.

I have been several times before, and each time spoken to a new doctor.

That is the way it's done, at least in Bangkok. A patient rarely gets to see the same doctor twice.

Usually I visit a hospital, and see a doctor in outpatient's. Even there I have rarely seen the same doctor twice.

I have now started visiting the clinic instead, which is cheaper, and close to work.

It reminds me of a medical outreach centre, the type you might find in remote spots such as the bush, or the desert.

The doctor sits in one room, with a frosted glass door. In contains a bed and a desk.

It is so small that, from where I sit in the waiting room, I can hear what doctor and patient are saying.

Klong Toey is known for its large slum community. No one here has much money, and they aren't fussed about appearances.

The folk at the clinic keep my medical history on a little card, which the doctor makes notes on every time I visit.

One woman wanted me to address the causes of my sleeplessness, by seeing a psychiatrist at Chulalongkorn Hospital.

A second doctor, a young man, focused on treating the symptoms. He asked me to try a new pill in combination with the one I normally get.

A third doctor, another man, just gave me what I wanted.

The other night when I paid a visit, I went too early. The doctor had not yet arrived, and would not be there for another hour. Meanwhile, I was due at work in 30 minutes.

'What's your condition?' the nurse asked, from behind a counter.

'I can't sleep,' I said.

'The doctor is not here,' she said.

Two minutes later, as we discussed whether I should come back, another patient turned up.

'What's your condition?' the nurse asked.

''Whatever it is, he's not here,' I volunteered.

'Is your condition stable?' the nurse asked, turning back to me.

'Yes.'

I will give you the pills, then,' she said, reaching for a large white bottle she keeps on the medicine shelf behind her.

She counted 12 sleeping pills, and put them in a small, clear, unmarked plastic sachet.

She charged me for the drugs alone, without the consultation fee, which I normally have to pay.

This way is best. I no longer have to speak to Dr Cause, or Dr Symptoms. I can get my supply direct from the nurse, with no - or maybe just a few - questions asked.