The underlying psychology

Miss Gad

The most common reason for SRS, Dr Sanguan says, is that patients simply can’t accept having male genitalia attached to their bodies. They all share a common emotion: they feel like women trapped in a man’s body. For them to have to look at and, worse, to carry the extra inches around, is tough. They want to be complete, to be women. That’s why they turn to a specialist like him for help.

“I have a lot of sympathy for my patients. I treat them with respect. SRS is not all about business; it can’t be, because it’s not a routine surgical procedure. You are dealing with someone’s life,” Dr Sanguan explains.

Miss Gad, a Thai transsexual who had SRS performed by Dr Sanguan a few years ago, told Phuket.com that she waited until she was 30, when she knew for sure that SRS was the answer for her. But she also stressed that SRS is not the solution for all gay men. Making that decision, she said, was a life-and-death matter. “It must be the hardest decision one can make. When it’s done, it’s done. You can’t just bring it back, if you know what I mean.”

No turning back

Beautiful

Before undergoing SRS, a patient must go through counselling by a psychiatrist and then try to live life as a woman for a specified period of time. This is essential because SRS is an irreversible operation. The run-up to the surgery varies from country to country but generally has the same aim – to ensure the patient is certain.

“Of all the cases I’ve handled, only two have asked that I change them back. I can’t help them on that, of course,” says Dr Sanguan. The reasons the two gave were financial; at work, their bosses disliked their choice and now both were stuck in the same old work without chance of promotion.

Dr Sanguan notes that, in the US, the average age of men opting for SRS used to be 50, though that average is now falling. In Thailand SRS patients are usually much younger – around 29 years old.

Denial denied

Patong Gay Festival Parade

Although he admits that, not being a geneticist, he cannot be 100% sure, Dr Sanguan firmly believes that being gay is a question of nature, not nurture. It’s hardwired into a person’s DNA, and environmental factors have nothing to do with it. “I’m speaking from my experience working with patients from all over the world and from all kinds of backgrounds. They may be taxi drivers or politicians, school teachers or policemen. Some patients tried to force themselves to be men by choosing to work in a tough career, such as the police, or by playing tough sports. But they still couldn’t get rid of that very real feeling that they were women. Some even try to hide their true identity by getting married to women.” As with the main characters in the movie Brokeback Mountain the outcome in real life is still the same: marriage is not a solution.

To back his theory, Dr Sanguan cites the case of twin brothers who are both gay. They lived separately but both eventually - and individually - came to him for SRS.

It’s not that simple

Fun at the Patong Gay Festival

But some of Dr Sanguan’s insights make one sit bolt upright. For example, one might think that gay men undergo SRS so that they can live life as a woman, and have a better relationship with a man.

But Dr Sanguan says he has had patients who had SRS so that they could be sexually active with a woman. One couple have been living together as lesbians since the man’s sex change. The gay issue is not as black and white as people might believe.

Stress? What stress?

Dr Sanguan Kunaporn

Away from the operating theatre, Dr Sanguan stays busy. “I used to cycle a lot but I had to stop because of my bad knees. But I still go sailing from time to time,” he says. He is also an active Rotarian, helping those less fortunate, such as tsunami victims and students from poor homes.

One can’t help thinking, when looking at his work, that it might be a rather depressing occupation. But Dr Sanguan does not see it that way at all. “I feel happy every time I perform SRS because I know that I’m helping the patient to be a happier person and to achieve peace of mind,” he says. “I also study Dhamma [the teachings of the Buddha] a lot and maybe - who knows - maybe Dhamma has helped me to become the person I am today. Let’s just say that I’m not a stressful person.”