Introduction

I have to say that this is a page I didn't initially intend to write. I've done so largely because of what I've learnt, and the realisation that it's part of my story - putting it on the record here gives the background to my decision to undergo surgery with Dr. Suporn in Thailand.

Before I finally committed to that choice I tried to learn what I could about what options were available in the UK. This is my small attempt to share what I've been able to learn, both from public sites on the internet and firsthand experience, and how it affected my decision.

I should also say that although I'm aware of the capabilities of some of the more well known surgeons in the U.S. and Canada I didn't consider them as I doubted I'd be able to afford to go to them...and although there are also many surgeons in mainland Europe I didn't investigate them either (apparently many won't accept patients from other states anyway).

I'm acutely aware that many of us have very strong opinions on the capabilities or otherwise of various surgeons, and there's an awful lot of misinformation and rumour about. As a result the capabilities of different surgeons is an incredibly controversial subject to discuss, so please accept my apologies if you find anything I've written here disagreeable or upsetting - my intention is to give background to my own personal choice, and no more.

Your choice and opinions are your own, just as mine are, and whatever you decide, my blessings and prayers go with you.
 

My Personal Criteria in Choosing a Surgeon

We each have different priorities in the care we seek, and no more so than in the results we seek from reassignment surgery. It's a decision we only have one chance to get right, and if we don't we have to live with the results for life. That's a tough call to make.

Many transwomen seek only to alleviate the dysphoria they've suffered and rid themselves of the deformity they've had to bear throughout their life. In my case, although what I had was wrong and didn't fit, just getting rid of it wasn't enough - I wanted my genitalia to both look and feel the way I've always felt they should, and that's heavily influenced my decision.

In deciding where to seek my surgery, my main criteria were:

• I wanted my clitoris to be sensate, and my genitalia to have a realistic appearance (including complete labia minora and clitoral hood). I want to be able to enjoy my body, and I didn't want to risk feeling disappointed with the appearance of my genitalia after surgery or worry about "how I look" in front of a new partner. The fact that I'm quite self conscious about my appearance generally probably contributes to this need.
   
• Given that, you probably won't be surprised that it's also incredibly important to me that the vaginal opening be positioned in an anatomically correct position. That may seem obvious, but a conventional penile inversion operation doesn't necessarily guarantee that - it depends how much "donor material" is available and where the penis is located. Every surgeon differs in this regard.
  
  As it turned out my penis was located significantly higher (i.e. further from the anus) than average, and to achieve a useable depth required the use of a skin graft in addition to penile skin. Not all surgeons perform such skin grafts.
  

• I wanted adequate depth - preferably at least 5" (but 6" would be better!) to be able to enjoy intercourse without worries over whether my partner would "fit".
   
• The technique employed by the surgeon - including how much time is typically spent in theatre (which can be an indication of how much attention to detail each surgeon has and how complex their technique is - and by inference how cosmetically accurate the results are) and whether the surgeon performs a single or two-stage procedure. Personally, I prefer the single stage approach.
   
• Whether the surgeon performs hair removal in theatre from the penile and (if a scrotal skin graft is used) scrotal skin or whether this must be done by the patient beforehand.
   
• The likelihood of complications (and which are most likely for each surgeon, which will of course change over time as techniques evolve) or the need for follow-up work.
   
• The quality and availability of aftercare, both in the immediate period following discharge from hospital, and over the longer term.
   

What GRS Surgeons are available in the UK?

James Dalrymple & Trevor Crofts

James Dalrymple and Trevor Crofts practice privately at London Bridge Hospital as the "Dalrymple Crofts Partnership". I believe Trevor Crofts also does NHS work at Lothian University Hospitals NHS Trust in Glasgow.

I haven't been able to locate any photographs of vaginaplasty results performed by either surgeon, although several patient accounts are available for Dalrymple. I haven't found any for Crofts.

On their website they claim to spend 4-5 hours on the surgery which suggests a high level of care which suggests that the risk of complications may be quite low. However, I had previously been informed by a friend that neither would construct a sensate clitoris and this is confirmed by the following statement on their website:

"A cosmetic clitoris is constructed to closely resemble the female form but we do not construct a sensate clitoris as a number of complications relating to this technique have been described in the surgical literature."

Having said that, a friend of mine had surgery with Dalrymple. Her experience was very positive, and she is very happy with the results.

Were it not for the lack of a sensate clitoris and had patient results been more available, I may well have been happy to look into Dalrymple further.
 

Christine Evans

Until I saw the Channel 4 Documentary "Under the Knife With Miss Evans" I'd never even heard of this surgeon. Having seen the documentary, I think her bedside manner alone would scare me off!

Add to that what looks like a very basic surgical technique (she did construct a sensate clitoris, but it wasn't hooded and I couldn't see any evidence of labia minora) and...well not for me I'm afraid. As far as I know she's now retired from NHS Surgery anyway.

At least the programme was interesting - it's the first time I've seen them show reassignment surgery close up. There's a profile of her here which I found rather interesting. You'll also hear her referred to as "The Dick Doctor" and "The Butcher of Rhyll". I suspect the latter is partly a result of her forthright manner - her charitable work in Africa is at odds with the sort of person such a label suggests.
 

Oliver Fenton

I haven't been able to find much at all out about this surgeon (I couldn't locate any patient accounts or photographs of results), aside from the fact that he practices privately at Huddersfield Nuffield Hospital and has a good reputation as a plastic surgeon. Apparently he does very few reassignment surgeries (which tends to suggest long waiting times and a technique which isn't evolving over time) and is due to retire from NHS work soon.

Given that it shouldn't be particularly surprising that I never considered him for my surgery.
 

Michael Royle

Michael Royle is one of the pioneers of GRS surgery in the UK, and trained both James Bellringer and Phil Thomas. I had thought he'd retired, but it seems not entirely - he's still doing at least some private (and possibly NHS) work.

Given how long he's been practicing, I doubt his surgical techniques are up to current standards (in particular with regard to sensitivity), and I never considered him for my surgery.
 

Tim Terry

For whatever reasons (I'm not about to speculate about why) Tim Terry has become a controversial surgeon - if you hear anyone talking of "The Butcher of Leicester", it's him they're referring to.

I know several girls who are very happy with Tim Terry's work, and one who isn't. The particular problem she has is by coincidence the same as that Anne Lawrence remarks on in this picture - leftover erectile tissue. Fortunately, that's a problem that can be corrected by relatively minor surgery if it happens - and I'm sure Terry is quite happy to do so, although for a private patient I suspect costs outside of his control (i.e. involving the hospital etc.) may be involved.

Although a handful of patient accounts and photographs of results are available for Tim Terry, the what I've read and seen of his work on the web with regard to cosmetic appearance (in particular this picture) discouraged me from seriously considering him.

According to this account (from August 2000) he was at the time unaware for the need for prior hair removal in the genital area. I don't know what he recommends now, but it you're planning to go to him it's worth being aware of the possible need, and planning ahead accordingly.

On the plus side his patients tend to be not only sensate but orgasmic (a big plus!) and for private work he's very cheap by UK standards - £7,300 or so for the first stage operation - although I suspect if you want a clitoral hood (as I did) it may cost you more. By comparison the 2004 price for GRS with Dr. Suporn (to which you must of course add flight and hotel costs) is about £6,000 - - which makes Terry a cheaper option overall.

Considering everything - and despite the reassurances of those I know who're very happy with his results - I didn't feel I could consider him for my own surgery.
 

James Bellringer

James Bellringer is the primary surgeon at Charing Cross GIC (although Phil Thomas performs some surgeries there too, and apparently they work together on occasion), and as such, I feel he's in a position of great responsibility - most patients who attend that clinic will have their surgery with him - and that's a lot of patients.

I was unable to locate any independent accounts of surgery with him or photos of results, although there are a couple of photos on his own website. On the site he also gives advice regarding prior hair removal.

A friend of mine had NHS surgery with him in early 2003 (which apparently cost her Primary Care Trust about £12,000), and I both met him and was able to see the results he achieved with her. While her results may of course not be typical (remember that no two natal women look the same), what I saw immediately convinced me that he most definitely wasn't the right choice for me. Although he does construct a sensate clitoris, in her case I could see no evidence of labia minora and the vaginal opening was positioned far too high, resulting in an unnatural dilation angle to get past the pubic bone. There were several other things I felt uneasy about too.

Bellringer has a reputation for rushing surgery (I wouldn't have mentioned this had I not heard it from several sources - including within the medical profession). My friend's surgery took 2¼ hours, which is far faster than any other GRS surgeon I've come across. That also made me rather uneasy.
 

Phil Thomas

Phil Thomas practices both at Charing Cross and Brighton. I believe that surgery costs around £9,500 with him at Brighton...but the costs at Charing Cross may well be comparable to those of Bellringer.

Given that both he and Bellringer were trained by Michael Royle, their techniques are not likely to be all that different. Details aside, the one thing that does seem to separate them is reputation.

A friend of mine had her surgery with Thomas, and she's very happy with the result - which is very reassuring. Of course, whether I'd have been is open to question - I'm a fussy cow I know!

There's an account of surgery with him here. The one thing that puts me off somewhat is the cosmetic appearance of the results. Of course, this picture may not be representative - but without others to compare against it's difficult to know.
 

What I could and couldn't find available in the UK

From a personal perspective, I found that the lack of information on the techniques of UK surgeons and (more importantly) detailed patient accounts hindered me in my quest for information on what options were available to me.

So few of us publicly document (even anonymously) our own experiences in detail - particularly within the UK. To an extent that's understandable, as we all want to move on with our lives and this is such a personal experience that many wish to put it behind them. No doubt the British character contributes to the silence too.

What I did manage to figure out was:

• Although most of the UK surgeons will perform single stage operations with a sensate clitoris, I haven't found any indication that any of them would be able to give me genitalia with the cosmetic appearance I've always hoped for (comparable to those from respected US surgeons such as Meltzer or Schrang for example - Lynne Conway's article Vaginoplasty: Male to Female Sex Reassignment Surgery shows what's possible with modern techniques).
  

• As far as I'm aware, all of the of the UK surgeons use a conventional penile inversion technique (although James Bellringer also offers the peno-scrotal flap technique pioneered by Michael Royle).
  
  However, I've not seen any indication that any of them will use skin grafts if necessary to make up for deficiencies in the amount of penile material available. In my case, this proved to be an extremely important consideration given my prior anatomy.
   
• I'm not aware of any UK surgeons performing hair removal in theatre. I had significant hair growth at the base of the penile shaft, and although I had some laser treatment in that area, it wasn't cleared by the time of my surgery.
   
• As far as I'm aware, once patients undergoing surgery in the UK are discharged from hospital (typically 7 days after surgery) the follow up care available is likely to be limited and (although I'd love to be corrected on this point!) require travel back to the hospital where the operation was performed.
  
  From where I live in the South East, the only surgeons within what I consider to be a reasonable distance (50 to 60 miles) are in London and Brighton...which I felt restricted my choice of surgeons still further.
   
• Conversely, if you undergo surgery in the UK you're less likely to have problems in obtaining corrective surgery within the UK. If corrective surgery is required after undergoing surgery abroad, the NHS is pretty unlikely to be willing to perform it.
   

Why I chose Dr Suporn

Having failed to identify a UK surgeon who would be able to offer me the results I sought and unable to afford the US surgeons who may do so, I've been keeping an eye on the techniques and results offered by Dr. Suporn since I first became aware of him in late 2001. Since then, he has continued to significantly develop his techniques to the point where they seemed to offer everything I ever dreamed of (save my ultimate dream of carrying a child).

In summary:

• He performs a single stage procedure.
  
  
• He not only constructs a sensate clitoris but labia minora (including a clitoral hood) with a realistic appearance. The inside of the labia minora are formed from foreskin material (if available) and therefore have the pink colour you'll see on most natal females. Cosmetically, his results are at least comparable to those of Meltzer or Schrang.
  
  
• He preserves virtually all of the glans tissue (with nerves intact) which gives a lot more sensitivity than most surgeons...indeed he claims that his recent patients have as much (or even more) sensitivity than natal females. Although that claim is very difficult to verify, given his personality I'm inclined to believe him - and it is rather compelling, although arguably such sensitivity is not essential!
  
  
• He positions the vaginal opening in an anatomically correct position. Most of the penile skin (in my case all but 1") is used in achieving this, with the rest of the neo-vagina formed from a scrotal skin graft (as does Meltzer) from which the hair follicles are removed in theatre (so no prior hair removal is necessary).
   
• Once a patient is discharged from Aikchol Hospital (where the surgery is performed) she is transferred to a hotel either in Chonburi or Pattaya with whom the Clinic have negotiated a discount for patients. While there (until about 4 weeks post-op), members of the clinic team monitor the patient's progress on a daily basis (normally excluding Sundays, although in my case they came out to me one Sunday following a panic attack the previous night).
  
  In my case, I don't know how I'd have coped without that follow up care, since I suffered a haematoma which set me back several weeks in my recovery.
   

There are of course disadvantages to his techniques:

• His surgical technique is very complex by comparison with most surgeons, and therefore can be expected to take a significant time in theatre (typically 6 to 9 hours), and is significantly more invasive.
  
  As a result, the recovery time is significantly greater (3-4 months) than most other surgeons and the dilatation regime much more stringent (two 2 hour sessions daily until roughly 6 months post-op, reducing to 10 minutes per day or so at 1 year post-op). Not everyone can cope with such trauma or manage to fit such a dilation regime into their day to day life.
   
• As I've mentioned previously, should any complications arise after returning to the UK they are most unlikely to be dealt with under the NHS. It becomes solely the problem of the patient.
   
• For me the flight back was a big concern too, but as it's delayed until nearly 4 weeks post-op it actually proved to be nowhere near as uncomfortable as I feared. Booking a wheelchair gets you through customs and passport control damn quick too!

Overall, I felt that the advantages strongly outweighed the disadvantages and I made my choice accordingly. Dr. Suporn was the right choice for me, but I would never claim that he's right for everyone - far from it!

You can get an idea of what his results are like from the SRS Results page on his clinic's website. Believe me, having seen them firsthand and been through that experience myself it's absolutely amazing what he can do!
 

Finally...

As I've said previously, reassignment surgery is an intensely personal experience and as such discussions of "who's best" are bound to be heated and not likely to come to any consensus. That's not surprising from those of us who've already made our choices, as there's an enormous amount of self-justification involved too.

Had I not had the choice of private treatment abroad, I'd probably have sought an NHS referral to Phil Thomas in Brighton - despite his techniques not offering what I sought. I may have considered Dalrymple if he routinely offered patients a sensate clitoris - but without seeing results I can't be certain.

Given how supportive my PCT has been since March, I may well have got an NHS referral. Who knows? All in all, I'm happy with the choice I've made and the results. Truly, that's all that matters for each of us.

If you're trying to choose a surgeon, I hope that whatever you decide proves to be the right choice for you. Good luck.