Why Dr. Suporn?
I have to say that this is a page I didn't initially intend to write. I did so largely because of what I learnt, and the realisation that it is 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 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 was able to learn, both from public sources and firsthand experience - and how it affected my decision.
I should also say that although I was 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 them...and although there are also many surgeons in mainland Europe I didn't investigate them either as it appeared that many would not accept patients from other states anyway.
While writing this I was acutely aware that many of us have very strong opinions on the capabilities or otherwise of various surgeons, and that there is 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 criteria while choosing a surgeon
We each have different priorities in the care we seek, and no more so than in the results we seek from something as life changing as 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.
While some seek only to alleviate the dysphoria they've suffered and rid themselves of the deformity they've had to bear throughout their life, I didn't feel quite like that - although the genitals I was born with felt wrong and didn't fit, just getting rid of them wasn't enough for me - I hoped that the genitalia that resulted from my surgery would both look and feel the way I'd always felt they should. That hope heavily influenced my decision.
In deciding where to seek my surgery, my main criteria were:
- I hoped for my clitoris to be sensate, and my genitalia to have a realistic appearance (including complete labia minora and a clitoral hood). I wanted 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 looked" in front of a new partner. The fact that I was then quite self conscious about my appearance generally also probably contributed to this need.
- Given that, you probably won't be surprised that it was 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 didn't necessarily guarantee that - it apparently can depends how much "donor material" is available and where the penis is located. Every surgeon differs in this regard.
In the event it turned out my penis was located significantly higher (i.e. further from the anus) than average, and to achieve a useable depth my surgery required the use of a skin graft in addition to all of the penile skin. Not all surgeons perform such skin grafts.
- I hoped for 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.
Which SRS/GRS Surgeons were available in the UK?
At the time I was transitioning I became aware of the following reassignment surgeons practicing in the UK:
James Dalrymple & Trevor Crofts
James Dalrymple and Trevor Crofts practiced privately at London Bridge Hospital as the "Dalrymple Crofts Partnership". I believe Trevor Crofts also did NHS work at Lothian University Hospitals NHS Trust in Glasgow.
I wasn't able to locate any photographs of vaginaplasty results performed by either surgeon, although several patient accounts were available for Dalrymple.
On their website they claimed to spend 4-5 hours on the surgery which suggested a high level of care and that perhaps the risk of complications may have been quite low. However, I had previously been informed by a friend that neither would construct a sensate clitoris and this was 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 at the time had surgery with Dalrymple. Her experience was very positive, and she was very happy with the results.
Were it not for the lack of a sensate clitoris and had information on patient results been more publicly available, I may well have been happy to look into Dalrymple further.
Both surgeons have since retired.
Until I saw the Channel 4 Documentary "Under the Knife With Miss Evans" I had never even heard of this surgeon. Having seen the documentary, I think her bedside manner alone would haved scared me off!
Add to that what looked 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 she was not for me I'm afraid. She has since retired from NHS Surgery.
I'd heard of her referred to as "The Dick Doctor" and "The Butcher of Rhyll", but I suspect the latter was partly a result of her forthright manner - her charitable work in Africa was at odds with the sort of person such a label suggests.
At least the programme was interesting - it was the first time I'd seen reassignment surgery shown close up.
I wasn't able to find much at all on this surgeon - and neither patient accounts or photographs of results - aside from the fact that he practiced privately at Huddersfield Nuffield Hospital and had a good reputation as a plastic surgeon. Apparently he did very few reassignment surgeries (which tends to suggest longer waiting times and a technique which was not evolving significantly over time) and was due to retire from NHS work.
Given that it shouldn't be particularly surprising that I never considered him for my surgery.
Michael Royle was 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 seemed not entirely at the time - he was still doing at least some private (and possibly NHS) work.
He has since retired.
For whatever reasons (I'm not about to speculate about why) Tim Terry became a controversial surgeon - if you hear anyone talking of "The Butcher of Leicester", it's him they are referring to.
I knew several trans women who were very happy with Tim Terry's work, and one who wasn't. The particular problem she had was by coincidence the same as that Anne Lawrence remarked on in this picture - leftover erectile tissue. Fortunately, that is a problem that can be corrected by relatively minor surgery if it happens - and I was sure Terry would be quite happy to do so, although for a private patient I suspect costs outside of the surgeon's control (i.e. involving the hospital etc.) would be incurred.
Although a handful of patient accounts and photographs of results were available for Tim Terry, what I'd read and seen of his work on the web with regard to cosmetic appearance (in particular this picture) and reports of issues with hair growth within the vagina discouraged me from seriously considering him.
On the plus side his patients tended to be not only sensate but orgasmic (a big plus!) and for private work he was very low cost by UK standards - £7,300 or so for the first stage operation - although I suspect if you wanted a clitoral hood (as I did) it may have cost more. By comparison the 2004 price for reassignment surgery with Dr. Suporn (to which you must of course add flight and hotel costs) was about £6,000 - - which made Terry a cheaper option overall.
Considering everything - and despite the reassurances of those I knew who were very happy with their results from him - I didn't feel I could consider him for my own surgery.
He has since retired.
James Bellringer is the primary surgeon at Charing Cross GIC (although Phil Thomas performed some surgeries there too, and apparently they have worked 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.
At the time I was unable to locate any independent accounts of surgery with him or photos of results, although there were a couple of photos on his own website. On the site he also gave advice regarding prior hair removal.
A friend of mine had NHS surgery with him in early 2003 (which apparently cost her NHS 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 the genitalia of no two cisgender women ever look the same), what I saw immediately convinced me that he 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.
When I was transitioning Bellringer had 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 just 2½ hours, which wass far faster than any other GRS surgeon I've come across. That also made me rather uneasy.
Phil Thomas practiced both at Charing Cross Hospital and the Brighton Nuffield Hospital in Woodingdean. At the time I believe that surgery cost around £9,500 with him at Brighton...but the costs at Charing Cross would probably have been comparable to those of Bellringer.
Given that both he and Bellringer were trained by Michael Royle, I surmised that their techniques were likely to be similar. Details aside, the one thing that does seem to separate them is reputation.
A friend of mine had her surgery with Thomas, and she was very happy with the result - which was reassuring.
At the time I would one account of surgery with him. The one thing that put me off somewhat though was the only photo I could then find of the cosmetic appearance of his results. Of course, the photo I found (which is no longer available as far as I can tell) may not be representative - but without others to compare against it was difficult to know at the time.
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.
Back then so few of us publicly documented (even anonymously) our own experiences in detail - particularly within the UK. To an extent that is 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 would perform single stage operations with a sensate clitoris, I didn't find any indication that any of them would be able to give me genitalia with the cosmetic appearance I'd 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 was possible with modern techniques even at the beginning of the 21st century).
- As far as was aware, all of the of the UK surgeons used a conventional penile inversion technique (although James Bellringer also offered the peno-scrotal flap technique pioneered by Michael Royle). However, I had not seen any indication that any of them would 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 undergone some laser treatment in that area, it wasn't all cleared by the time of my surgery.
- As far as I was aware, once patients undergoing surgery in the UK were discharged from hospital (typically 7 days after surgery) the follow-up care available was likely to be limited and anything specialist (although I'd love to be corrected on this point!) would require travel back to the hospital where the operation was performed.
From where I lived in the South East, the only surgeons which were close by were in London and Brighton...which I felt restricted my choice of surgeons still further.
- Conversely, if you undergo surgery in the UK you are less likely to have problems in obtaining corrective surgery within the UK. If corrective surgery is required after undergoing surgery abroad, the NHS may be unlikely to be willing to perform it.
Why I chose Dr Suporn
After being unable to identify a UK surgeon who would be able to offer the sort of results I hoped for - and being unable to afford the US surgeons who may be able to do so - I had been keeping an eye on the techniques and results offered by Dr. Suporn since I first became aware of him in late 2001. Between 2001 and 2003 he had continued to significantly develop his techniques to the point where they seemed to offer everything I was looking for.
- He performed a single stage procedure.
- He not only constructed a sensate clitoris but labia minora (including a clitoral hood) with a realistic appearance. The inside of the labia minora were formed from foreskin material (where available) and therefore have the pink colour you'll see on the labia of most cisgender women. Cosmetically, his results are at least comparable to those of Meltzer or Schrang.
- He attemped to preserve virtually all of the glans tissue (with nerves intact) which offers the patient a lot more sensitivity than results from most surgeons.
- He positioned the vaginal opening in an anatomically correct position. Most of the penile skin (in my case all but 1") was 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 was necessary).
- Once a patient was discharged from Aikchol Hospital (where he performed surgery) she was transferred to a hotel (the Mercure - since renamed the Chon Inter) very close to the Clinic, and with whom the Clinic had negotiated a substantial discount for patients. While there (until about 4 weeks post-op), members of the clinic team monitored 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 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, and can become 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 is absolutely amazing what he can do!
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 are unlikely to come to any sort of 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 ideally hoped for. 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 Primary Care Trust had been since March 2002, I may well have got an NHS referral. Who knows? All in all, I'm happy with the choice I made and the results it led to. Truly, that's all that matters for each of us.
If you are trying to choose a surgeon, I hope that whatever you decide proves to be the right choice for you. Good luck!