No Retreat
From San Francisco Chronicle Magazine
In a trip of a lifetime, an ex-Marine from San Francisco
ventures to Thailand for a sex change operation
By Jason Gagliardi
My passenger giggles and shrieks as the jeep rattles down
a steep jungle pass through an afternoon storm. Her tattooed
arms flex as she picks at a chip in her nail polish. The road
is slick and treacherous, and it takes all my concentration
to carry on our conversation while peering through the maelstrom,
dodging the crazed speed-freaks and half-drunk holidaymakers
who have turned the Thai resort island of Phuket into something
resembling a demolition derby.
Our talk ranges over the bitchy antics of the
San Francisco goth scene, high-speed runs to Tijiuana to load
up on female hormones, and the ineffable oddity of knowing
you have just 16 hours left as a man.
When she wakes up tomorrow morning, Samantha
Hellstrom - former U.S. Marine, bodybuilder and security guard
from San Francisco - will be wheeled into the operating room
of the Phuket International Hospital, given a general anesthetic
and an epidural, and then during six grueling hours will have
her penis peeled apart and transformed into a passable-looking
and functional approximation of a vagina.
"Nervous? Sure, I'm a bit nervous about the surgery,
but not the end result," she says, as we pull into the leafy
surrounds of the hospital. We've just been for a walk along
Karon Beach, a quiet spot half an hour from the hospital and
just south of the sex-and-booze mayhem of Patong Beach. It
will be Samantha's last real chance to stretch her legs for
at least a week. "All I want is to be ass complete a woman
as medical science can make me at the present time. That's
all I can hope for."
Samantha is one of a growing number of transsexuals
from around the world opting to have their "gender reassignment
surgery" performed in Thailand. She has chosen Dr. Sanguan
Kunaporn, an affable, gangling young doctor who is fast coming
up on his 400th sex change operation and is challenging his
mentor and teacher, Bangkok-based Dr. Preecha Tiewtranon,
57, as the kingdom's top plastic and reconstructive surgeon.
The pair operate almost exclusively on patients from overseas.
They are rated among the best in the world, and certainly
the cheapest. Each will take on sex reassignment surgery for
around $5,000, which includes up to two weeks in the hospital.
Breast augmentations is another $2,000 or so. In the Western
world, expect to pay three or four times that, unless you
are prepared to risk the quacks. Cheap as these prices may
sound to those with hard currency, however, they are still
well out of range of most local katoeys (ladyboys), who must
make do with lesser surgeons and less-than-satisfactory results
or remain in the sexual netherworld of the shemale.
 Like
many others, Samantha was lured by the island's promise of
"sun, surf and surgery" and by Dr. Sanguan's growing reputation
among the transsexual community. "Welcome to Phuket, the most
famous holiday destination in the Southeast Asian region,"
gushes his Phuket Plastic Surgery Web site. "Our services
range from breast implants, tummy tucks, liposuction, face-lifts,
eyelid surgery to sex reassignment surgery." Of course, the
combination of sand, salt water and painfully raw and tender
nether regions may not hold the same appeal for all potential
patients.
"Medicine is a big business in Thailand now,"
acknowledges Dr. Sanguan. "We target people to come here for
plastic surgery and to stay for a holiday. Last week, I did
a face-lift for a 65-year-old American man, who said it was
cheaper here and he got to stay in paradise. We usually offer
a package. People want exact prices. So for example, if someone
comes for liposuction, they pay about $1,500 for surgery and
the hospital stay, then we can organize a hotel room, anything
from $15 to $100, in town or on the beach. I don't know if
in the future we will be a hub for cosmetic surgery in the
world, or in Asia. But I think there's a good chance."
This surgery-by-the-sea in Phuket is part of
a push that began three or four years ago, when dozens of
hospitals thrown up during the boom years suddenly found themselves
with world-class facilities and empty beds. The medical profession,
Thai Airways and the tourism authorities got together and
began marketing "medical vacations," where holidaymakers can
fit a full health check-up or a face-life into their stay
at less than a quarter of what it would cost in the United
States, Europe or Australia. This nip-and-tuck tourism has
now become a major earner for the Land of Smiles.
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Bumrungrad Hospital in Bangkok is the apotheosis
of the trend, boasting vast rooms that look more like hotel
suits, with hot and cold running nurses, cable and Internet
access, and even Starbucks and McDonalds in the lobby. The
staff treated more than 160,000 foreign patients last year.
The hospital now refers to play down its role in sex reassignment
surgery, despite the fact that Dr. Preecha has done more than
1,200 of the operations there. Transsexuals don't quite jibe
with the new jet-set image, despite the fact that sex changes
still fill a big part of the coffers. "It's not something
we want to talk to you about," said a hospital spokeswoman.
Dr. Sanguan and Phuket International have no such
qualms, perhaps hoping publicity will boost the hospital's
profile. Foreigners are greeted by Pim Solasachinda, a briskly
efficient PR type who speaks seven languages. "Ah, you're
here to see Samantha," she says, and leads us to her room.
Having become accustomed to seeing the petite
frames of Asian ladyboys after nine years in this part of
the world, it's a bit of a shock when Samantha opens the door.
She's nudging 6 feet, has an inky riot of dragons and such
winding their way over most of both arms and her chest, and
bulging, vein-bisected biceps. She's wearing a black dress
and black Reeboks, matching her nail polish. Her hair is receding
slightly and cut in a wavy bob, and while her face is far
from unattractive, there is an undeniably masculine cast to
her makeup-free features.
"Come in," she trills. Samantha, like her surgeon,
is 41. She'd prefer not to mention her previous name. She
was born in Chicago and raised in the Bay Area, where she
still resides. She works in a building downtown, where she
has toiled for 18? years, after seven years in the Marines.
She previously sported a full and bushy beard and tipped the
scales at 209 pounds during her serious bodybuilding days,
when she often worked as a security guard at rock concerts.
She still lifts weights, but these days she's down to a slinky
size 12. Her breasts look to be about a B-cup. "That's all
from hormones," she says proudly. "I've never had implants.
Some of the younger trannies worry about their breasts and
Adam's apples (the surgeons can shave the cartilage for a
small extra fee) but I'm pretty comfortable now with who I
am. That's not so important to me."
Samantha just got back in touch with her dad after
20 years, and says he's shocked to learn of his son's transformation
but is struggling to understand. She doesn't talk to her mom
much but dotes on her two sisters. She crosses her legs and
sighs. "I've done many different things in my life. I was
a very different person during my repression years. I realized
I was meant to be a woman when I was still a young kid but
I didn't start actually living as a woman until 2? years ago.
I started taking hormones about a year before that, and I
was into the transsexual community, going around as a woman
part time. It got to the point where I couldn't stand living
two lives anymore. I was fed up with trying to be macho, trying
to be a man. So one day I went to work looking like this,
and it's been fine ever since. O f course, a lot of people
were shocked, but most of them got over it."
She says she'd love to get rid of her tattoos.
"But it's too expensive. I don't want to have my entire arms
lasered. I have my facial hair lasered and that's bad enough."
But she feels, on the whole, like the woman she believes she
is destined to be. "I'm still basically developing. Even after
surgery, it will take another year or so for feminization
to take its full effect. It will accelerate after surgery,
when my body is not fighting the testosterone the whole time.
I'm still growing and changing."
As if to accentuate the point, she pulls out a picture
of when she was 17 and had just been inducted into the Marines.
She looks like a recruitment poster. Dress blues and white
hat, smooth olive skin, square jaw and wide-set-eyes. I can't
help thinking she was a much better looking man than she is
a woman. Another picture, this time of someone who looks like
Marilyn Manson's big sister. "This is me at one of the goth
clubs I go to in San Francisco. It's a club where you can
be what you want and no more cares. I don't really hang out
in the transsexual scene anymore."
She did for years, however, and has her share
of horror stories. Lots of friends drifted into the dark web
of porn to raise money for operations, and found it hard to
leave the easy money and the drugs. "You know, all the shemale
Web sites. Chicks with d-ks, all that stuff. I've never considered
myself a shemale and I don't like the term. But at least it's
coming out into the open more. It was all so under the table
before. There were transsexual bars where you could buy hormones.
I even did some runs down to Tijuana myself to get some. There
was a lot of very bad information around, not like now with
the Internet. There was a nurse who would come and if you
wanted silicone injected anywhere, she'd do it for a thousand
dollars a shot. People got it in the hips, the boobs. One
girl had to have her legs cut open to get the stuff out when
they got infected."
She gets her share of hassle, but San Francisco
is more tolerant than most places. "You do get people coming
on the weekends from out of town, and they're not tolerant
at all. They throw things at me when I'm walking back from
a club, or yell things. I've had the urge to punch people.
I've Maced people. They've come up to hassle me and I've just
emptied a can of Mace in their face. I know people stare a
lot, because I'm fairly big and muscular compared to most
transgendered people. But I'm comfortable with that."
Samantha says she is now "going with" a guy, but
the relationship is not sexual. She dated men and women occasionally
before, but never seriously. "There was never anything really
sexual, I was so repressed I couldn't get into a relationship.
I never felt like a gay man. I guess I just felt like me."
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She says there are plenty of "straight"
men who go after transsexuals for a walk on the wild side,
but she's not interested in those relationships. "They want
to control you and keep that part of their life secret. When
I have my life back, when the operation's healed, I'll start
worrying about things like sex."
Why Phuket? And why Dr. Sanguan? "I know a lot
of people in San Francisco's transgendered community, and
many of them are from Southeast Asia. So I knew all about
the surgeons in Thailand. I got the best reports from people
about Sanguan, and I did a lot of research over the Internet
once I began my transition."
Three weeks earlier, I meet Dr. Sanguan for the
first time. He introduces me to Rebecca Steen, an erstwhile
310-pound, bearded Methodist priest and father of three, who
had her sex change a year ago. She's down to a trim 165 pounds
and looks like your average suburban mom, apart from her big
hands. "I'm here to have a tummy tuck because I've lost so
much weight," she says. "I overate before to run away from
who I was. Now I know I am the person I was born to be." She
speaks like a woman, with none of the usual ladyboy's high-pitch
whine, courtesy of larynx surgery and vocal coaching.
Dr. Sanguan believes he's getting better at his
work all the time, and there is no shortage of glowing testimonials
on his Web site. He began sex reassignment surgery more than
a decade ago, under the watchful eye of Dr. Preecha, before
going for further training with the best in the United States.
He's had patients as old as 72 and as young as 19. He's done
doctors, lawyers, pilots, politicians.
"There are cowboys here, but people shouldn't
be worried if they come to a reputable surgeon," he says.
"We have our own Society of Plastic and Reconstructive Surgery
and a board to control the quality." He has horror stories,
too, however, like the butcher who preyed on naive katoeys
in Pattaya about five years ago, stuffing their chests with
silicone-filled condoms which became horribly infected. He
was called on to undo the damage on several occasions.
He says almost 100 percent of his patients are
foreigners, usually from the United States, Europe, Australia,
Japan, New Zealand, Taiwan and Canada. Western transsexuals
differ greatly in their physical makeup from Asians, he says.
"But it's not true to say all Westerners have bigger penises.
In fact, many of them are circumcised, which makes the surgery
more difficult as there is less tissue for reconstruction.
It varies from individual to individual."
In clinical terms, the standard operation involves
the removal of the testicles (orchidectomy), creation of a
vaginal tunnel (vaginoplasty), construction of a clitoris
using the sensitive tissue from the head of the penis, which
is kept attached to its main nerve (sensate clitoroplasty),
construction of labia majora (limited labiaplasty), removal
of the penis (penectomy) and construction of a new urethral
opening (urethroplasty). Five to seven days later, a scrotal
skin graft is performed inside the vaginal tunnel using skin
kept refrigerated from the first operation. Most patients
are up and walking within two weeks, and can have sex after
two months. Many report achieving orgasm. One recent patient
from England healed so fast she was riding an elephant after
a week.
The operation sounds eye-watering, but Dr. Sanguan
says the pain from breast augmentation is usually worse. His
method, which includes the separate skin graft and entails
five or six days of bed rest so the graft will take, has its
critics. Some doctors say that's too long to spend immobile
because of the risk of clotting.
In March this year, Laura Hodges of Sheffield, England,
died during sex reassignment surgery in Neenah, Wis. The death
has caused an uproar in transgendered circles. Six days after
Dr. Eugene Schrang performed the secondary skin graft, Hodges
got out of bed for the first time, collapsed and died from
a massive pulmonary embolism - the so-called Economy Class
Syndrome.
Dr. Sanguan acknowledges the controversy but
says the risks are small if the patient is properly cared
for and that the advantages of his method outweigh the risks.
"All surgery has risks," he says, "and of course the most
serious complication is always death. Fortunately in Thailand,
no one has ever died during sex reassignment."
Some U.S. surgeons also criticize the gung-ho approach
of their Thai counterparts, some of whom are happy to operate
on short notice if the patient has the money, even if they
have not undergone extensive counseling and psychological
evaluation. "They have to have been under female hormone therapy
for at least six months before I consider them as a candidate
for reassignment surgery," says Dr. Sanguan.
He says overseas patients must be referred by their
therapist in their home country. Thai transsexuals, he says,
are a different matter. "In Thailand, transsexuals show themselves
up in social life when they are still teenagers usually, and
everyone accepts and knows that they are women. They live
as women, dress as women, have female friends, they never
have sex with women. So we do reassignment surgery for these
people without psychological examinations because we know
they are good candidates. In the West it's different. People
fight it, hide it, get married, have kids, divorce, marry
again."
And of course it's financiallly rewarding. Dr. Sanguan
drives a new BMW but is cagey about the rewards of his profession.
"If you have a million, then someone else has 10 million.
So how do you define rich?" He says he got into sex reassignment
because it changes people's lives. "Many of them thank me,
say I've given them a chance to be happy."
Friday morning, 10 a.m., and Samantha is waiting
on a gurney in the operating room. She looks amazingly peachful,
considering the ordeal to come. "I didn't sleep much, but
then I never do," she says. "I'm a night person." The anesthetist
bustles about preparing syringes, from the tiny to the truly
fearsome. Then the mask comes down, she goes out, and Dr.
Sanguan arrives, looking almost frail in his hospital greens.
An epidural is poked into her spine, a tube stuck
down her throat, and the nurses drape sterile sheets over
her body, concealing her face behind a curtain. Her arms rest
to the sides, the black nail polish incongruous in these scrubbed
surrounds, and her legs are hoisted into stirrups. Samantha
is exceptionally well-endowed, and the nurses point and giggle
as they swab her groin down with betadine. The only other
sound is the ummphhh-hiss of the respirator until one of the
nurses slips "Music For The Operating Theatre" into the CD
player. Chicago, Air Supply and other anodyne stuff.
"Have you ever watch surgery before?" asks Dr. Sanguan,
as I shake my head. "OK, you stand back here." He puts a chair
behind me. "If you feel faint, sit down and breathe deeply."
And indeed I'm feeling curiously light-headed as the reality
of what I'm about to witness sinks in. Which is, basically,
every man's worst nightmare.
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The doctor takes a "before" shot with a digital
camera, turns to me and says, "You know, after the operation,
some girls go out and buy a new bikini. It's the first time
they can wear one without embarrassment."
Then he pulls on his gloves.snap,snap.sits on
a stool between Samantha's legs and with a kind of inked bush
marks out his first incisions. It's just like in the movies,
but he doesn't shout "scalpel." The nurses have done plenty
of these operations and know what he needs. Except it's not
like in the movies at all, because I'm less then two yards
away, and there's blood and glistening flesh and the room
feels very small and my breaths are coming in short little
gasps and now the room is spinning.
Get a grip, I tell myself. You're a professional.
It wouldn't do to keel over. Cover the story, as Hunter S.Thompson
would say. Indeed. The doctor's slicing away, swapping scalpel
for a little yellow wand called an electric cautery, which
closes the cuts with a puff of smoke and a reek of singed
flesh.
The bloody swabs pile up, and the two nurses
perched on stools either side of Samantha are working as hard
as the doctor. Chris Isaak is wailing about a wicked game
as the first testicle is cut free and plopped unceremoniously
in a kidney-shaped steel dish. It's soon joined by its mate,
and I can't help but feel and uncomfortable tingle. Later,
when they are joined by other raw and bloodied excess flesh,
a nurse will scoop the lot into a jars labeled Samantha and
place it in a box with eight other jars, also labeled with
patients' names. It's an ignominious end for organs treasured
so highly by most men.
Dr. Sanguan starts hollowing out the vaginal
canal. By this time, Samantha's groin is splayed open and
resembles roadkill. It's hard to watch, but by this point
I'm fascinated. It occurs to me that this is about as close
as you can get to playing god, transmuting man to woman -short,
perhaps, of neurosurgery or genetic tomfoolery.
He makes hundreds of tiny sutures with a minute
needle. His hands are a blur, and it's clear the doctor is
the zone, hearing that fine high sound great artists hear
when the creative process is peaking. By 11:30, we're on to
a collection of dirge-like Thai love songs. Scalpels and forceps
are put into the autoclave, which pops and crackles, adding
a weird, syncopated beat.
Time flies and then crawls. By 1 p.m., we're
way past the point of no return. All that remains of the penis
is a kind of mangled pulp. Blood, cautery, suture, snip. It's
hypnotic. One of the nurses looms up from the next room with
a pair of surgical scissors. "Snip snip," she laughs as I
shrink back.
Toward the end of the procedure, at least five
hour in, there's a tense moment. A slight slip by a nurse
and a jet of blood misses the unprotected eye of her opposite
number by an inch. She looks furious, but doesn't miss a beat,
calling for another colleague to wipe her face. Earlier, the
doctor told me it is up to the patients to get AIDS tests,
but that he treats all patients as potentially infected.
Suddenly, after five hours, it all starts to come
together. The doctor still hasn't missed a beat or had a rest,
and he's still stitching furiously. At 4:15 p.m., he's finished.
He snaps off his gloves and takes a long look at his handiwork,
which looks pretty close to the real article.
"Keep breathing, keep breathing,," shouts the anesthetist,
as Samantha chokes and gurgles and come out of her slumber.
She is stabilized and wheeled off to the Intensive Care Unit.
When the pain starts to kick in, she'll be pumped full of
morphine. She won't be making much sense for days.
Dr. Sanguan heads for the coffee room and sticks
a plate of fried rice in the microwave. "My God, you must
be exhausted," I stammer, still in a kind of tongue-numbed
shock. "Was it a success?"
"Yes, a very normal case. No complications," he
says. In 15 minutes, he's due back in the operating room to
make adjustment to a breast job gone awry.
Later the same night, we venture into the heart
of Phuket's darkness Bangkla Road, which bisects Patong Beach,
is a monument to sin in all its shapes and forms; a lurid
carnival of beer and lust and neon that makes Bangkok's Patpong
Road look like the Avenue of the Americas.
About halfway along and off to the left as you
head away from the beach is the infamous Soi Katoey (Ladyboy
Street). A few years ago it was one bar with a handful of
dubious-looking shemales who made a killing when the Navy
come to town; sailors too drunk or naive to realize or care
that they weren't being dragged off to be shagged and probably
robbed by natural-born women.
Now the ladyboys are thick on the ground. They've
taken over at least six bars, they number in their hundreds,
and the flash of strobes on sequins and silver lame can cause
permanent eye damage. They take turns gyrating on a raised
stage, gazing out over the audience with vacant amphetamine
stares. Here, for 100 baht, or for nothing if they think you're
rich or cute, katoeys will flash you a glimpse of Dr. Sanguan's
handiwork.
The crowd is equal parts bemused tourists - goggle-eyed
European couples and redfaced, red-shouldered moms and dads
who have put the kids to bed and snuck out for a peek at the
wildlife - and genuinely sleazy types who have a taste for
this kind of thing.
We buy some Singha beers for Nancy, who looks
sad, pouts convincingly and has perfectly conical breasts.
"I had my operation five years ago," she says lifting her
skirt. "Do you want to see?" We demur and ask who the surgeon
was. "Dr. Sanguan. He wasn't so expensive before."
Does she feel like a woman? She pouts. "Eighty percent
I feel I'm a woman. I get sad sometimes. It's boring coming
down here, but what else can I do? Sometimes the guys are
nice. Others jump on you like monkeys."
She smiles, but not with her eyes, "But you know
the worst thing? Every night I dream that I'm pregnant. That
I'm going to have a baby. And I wake up and cry because I
never will."
Samantha's Post-Op Diary
Because this story was originally written in Thailand, we
asked Samantha for an update on her life in San Francisco.
Here is her e-mail correspondence:
July 5, Phuket
Well, my surgery and everything went absolutely
great. They took great care of me. I am extremely satisfied
with the results. My post-operative feelings in a nutshell
are: I feel great. Most of the pain was gone by the second
day. I did call for morphine. Kept it to a minimum, though.
Only had a couple of shots after my skin graft on Tuesday.
Most of the week was just spent eating and watching
TV and missing my Boy Friend Bobby. I just e-mailed him, And
I'm going to log on with AIM and see if he's on-line. It's
Goth hours in S.F. about now. I'm really kinda homesick and
want to go home soon.
When they did my skin graft (a few days later),
they numbed me from the waist down. Then, I'm assuming they
whacked me with a hefty dose of Demerol. I was humming and
laughing and giggling all the while Dr. Sanguan was preparing
my skin graft. I held the arm of one of the nurses and I may
have even called her Bobby.
After they were done, I was giggling and singing
all the way back to my room. The guys taking me back were
laughing to death. I was waving my arms all over the place
to some unknown tune. I came down off of cloud nine about
15 minutes after getting back to my room.
July 12, San Francisco
I'm feeling great! I came home earlier than I
had originally planned. Mainly because I was getting homesick.
As soon as I got home (around 8 p.m. S.F. time) I said to
myself "Hell, I'm not tired, time to go dancing."
And I did, at The Cafe on Market and Castro. My regular nightclubs
were not open last Sunday. Tonight, I am going to go to one
of my main clubs that I don't get to go to too much, Assimilate,
and tomorrow night I'll go to Shrine of Lilith.
Monday, I got a new shorty bob-cut hairstyle, went
to my job and got a great reception from everyone. I'm currently
off work till Aug. 20. But I don't feel like sitting on me
arse and doing nothing, So, I started to slowly workout again
for new pics on my website and walking all over the city as
was my usual weekend activity before surgery when I was by
myself.
Everything is going great. I have my dream. And
now all I'm getting ready to do for the time being is celebrate
at the clubs and enjoy being the real "me." As for today,
I'm off to get a new tattoo.
July 13, San Francisco
All my friends are dying to see the article about
me in Hong Kong. Nip and tuck tourism-I love it. Before I
left, I told everyone I was going to the chop shop to get
an "innie" instead of an "outtie."
I did get my tattoo yesterday. A Celtic shield with
spiral "triskele" and a sword crossing it, with Norse and
Celtic runes. It's on my upper left chest. It's a contrast
to the military tattoo on my upper right chest.
July 20, San Francisco
Things are cool here.. Usually. While I was in
Phuket, everyone treat me so great. I come back to S.F., I
go to Tower Records a couple days later to buy a video. And
some guy calls me a "faggot a-" as he walks by with his wife.
I was using the computer to look up something at the time.
I just turned and said "F-you retard" (I can be a meanie sometimes;
usually I ignore these types of jerks), I was feeling so great
and this guy has to walk by and say that. He didn't reply
to my quip; just kept walking . It makes me wonder why Americans
think they're so civilized most of the time. And in S.F.,
no less. Oh well, no biggie. I feel too good to even given
it too much notice.
Went to my club and danced to near death last night.
Saw all my club friends and they were trippin' cuz they figgur'd
I should be resting or just watching. Hehe, No way, I feel
great. Didn't drink too much, Just 5 Jackie Ds. It was great.
I suppose I'll rest for this week and slowly start working
on my new web sites. I feel reborn. This is really the start
of my life.
Samantha
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