This blog documents my journey, literally and figuratively, from New Zealand to Thailand to undertake Gender Affirming / Reassignment Surgery to medically transition from Assigned Male at Birth, to Female.
I hope you enjoy it.
To navigate this blog, at the bottom of each entry, click the "older" post or right facing arrow (if on mobile). To jump direct to a page, select the links on the left .
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Hi, my name is Maddie, I am a 53 year old transgender woman living in New Zealand. My transition journey started in 2018 when, after years of feeling I was not being true to myself, after surviving a few health scares, experiencing the loss of family and pets I took the first steps to understanding why I felt this way and worked with therapists to get over the shame I had about wanting to be a woman.
I had cross-dressed since about 10 years old, married at 21, my wife, Fran, was aware of my feelings and was always of the opinion that I should do what makes me feel good, but she was not sure of her feelings should I actually transition, and I thank her for taking this stance and being there for me - she really is one in a million. My job was professional, often stressful and I suffered from imposter syndrome on many occasions, scared that I would be uncovered as a fraud and even worse, that someone would find out I like to dress in women's clothing, which I used to do quite often at the end of the day at home or in a motel if away for work, and it just felt right.
I started hormone replacement therapy in 2019 and came out to the world in March 2020. Most people had no idea. I had no idea I hid it so well.
I legally changed my name and presented as female from that day forward, and haven't looked back to be honest.
In 2022 I underwent Gender Reassignment Surgery (GRS) at Phuket Plastic Surgery Institute. Fran and I had separated, but remain very much in each other's lives, and she accompanied me as my support person on this trip. To be honest I wouldn't have had anyone else with me to be the voice of reason, understand what makes me work and be my voice when I wasn't sure what I wanted.
This blog will detail the experience and provide some background as to how I arranged this surgery.
Feel free to comment, ask any questions or email me, I'm very open to questions!
If you want to jump to the video overview of this entire blog then it's the last post, or click here
I made contact in April 2021 with a beautiful woman named Savannah that had gender reassignment surgery in 2016 by Dr Sanguan Kunaporn. I struck up a friendship with her and she was incredibly open and willing to share her experience with me. She couldn't sing the praises of Dr Sanguan enough, and was very happy with her result.
I found that a company online called Beautiful You Holidays (BYH) offered surgery in Phuket at the Phuket Plastic Surgery Institute (PPSI), where Dr Sanguan was based. The company had representatives in New Zealand and so I sent off an online enquiry in May 2021. Whilst I could deal direct with PPSI, I wanted the security of dealing with someone local and having my transfers and accommodation arranged with an organisation that could recommend options.
Paula Vernon from BYH responded to my enquiry the same day, and we conversed by email, on the phone and zoom video chat regularly while I completed the required forms, sent photos and obtained readiness for surgery documentation and medical sign-offs over the following months. Paula's colleague and Trans specialist, Nikki Carlson, also had her surgery with Dr Sanguan, in 2015, and was very positive about her result and experience.
We agreed on the procedures and costs and in July 2021 I booked to have surgery in Phuket on 6 July 2022. BYH arranged a hotel in Patong for 3 weeks, I was going to be in hospital for the first 2 weeks but Fran, as my support person, would need somewhere for the full 3 weeks. We chose Patong as a place to stay as it was near the coast, had plenty to do, and the rate was good.
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| Nikki and Paula were incredible and have become close friends |
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| Taken during a video interview when we were documenting my journey and discussing the Thai covid entry requirements |
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| Savannah and I in Queenstown August 2021 |
I've been a long time Air New Zealand customer and booked flights in March 2022 amongst the uncertainty over border closures and vaccination requirements. Thailand had a Covid pass system and Covid insurance requirements in place that needed to be adhered to. I hadn't contracted Covid and was anxious about how catching it or even having a cold would create all sorts of problems.
The Thai Covid pass requirements were dropped 2 weeks before we left, but by then we had all the documentation anyway, and we had stayed Covid free. The flight went to plan, we left Auckland just after midnight on 4 July, flying to Singapore for an hour, then onto Phuket on a Singapore Airlines plane. We arrived in Phuket at 9.30am on 4 July.
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| Auckland Airport was deserted |
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| The route |
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| Singapore during our 1 hour transit stop |
We were met at Phuket International Airport by a hospital taxi van driver who drove us the 30 kms to our hotel in Patong in an air conditioned van. It was very humid, pouring with rain and the cool van was fantastic.
We arrived at the Andakira Hotel in Patong, and were pleased to have a large top floor unit, where we unpacked and decided to take a walk around Patong, which was wet and a bit overwhelming but helped us get our bearings. Later that afternoon we met with Nuya, our Phuket Beautiful You Holidays contact person, who drove us around to familiarise us with the area and gave us so much information.
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| Welcome to Phuket |
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| Trip to hotel from airport |
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| Patong was wet! |
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| Meeting and lunch with Nuya, our Phuket contact |
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| The view from the hotel (on a nice day, taken when I was back there two weeks after surgery) |
My consultation with Dr Sanguan was booked for 11am 5 July, the taxi collected us at the arranged time and we were at Phuket Plastic Surgery Institute with plenty of time to spare.
I was welcomed warmly at reception and given some forms to fill in, followed by an EKG test, full Covid test, XRay, blood pressure, blood draw and weight / height measurements.
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Then I went into a side room where I undressed and my chest was photographed from different angles whilst standing against a wall. Dr Sanguan pinched and prodded my skin and I tried on some implants in a bra to determine my cup size. He was concerned that my skin was very tight and thick and said that he probably couldn't go to the size I wanted, which was 450cc, that would produce around an E cup, which on my frame would be reasonable.
I then lay on a bed and he inspected my genitals, and it was then that he said I did not have enough scrotal skin to achieve any depth past 3 - 4". He pinched my abdomen skin and thigh skin and said that I would need a skin graft and this could come from my upper thighs. I was not overly happy with this but had suspected all along that I wouldn't have enough scrotal skin due to things shrinking down there over the past years of HRT.
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| Breast implant discussion |
After that we went back to his desk, he showed me the different breast implant shapes and agreed that a teardrop with a wide base would be the best for me. He would go as big as he can but said it wouldn't be any larger than 400cc. We then discussed the skin graft, his technique is to make an oval shaped cut and to join the sides, basically a thigh lift.
I had some specific questions about how my genitals were re-purposed and moved and Dr Sanguan did a drawing to show what went where. It was really nice to spend time with him and no questions were bad questions.
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| Explaining how my vulva would be made |
After that I paid for the surgery and hospital stay - this was done using a credit card, which I had deposited funds into and I was admitted to the ward.
The room was really nice, a comfy chair and extra bed for Fran, a good bathroom and toilet, television and free wifi. I was issued with a hospital robe, that tied up at the front (so no bare ass issues), a pair of crocs (which were really comfy, I may be swayed and buy some) and the room had water, tea and coffee along with a fridge, jug and cups.
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| The TV wasn't smart but there were several English speaking channels, I mainly left it on Al Jazeera for background noise. |
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| Two of the menu pages |
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| The ward |
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| View of an outdoor garden, I never saw anyone there but it was nice to look at during walks around the ward. |
5 July 2022
Soon after being admitted I was told that I would be given a Poo Poo Machine. The nurse used hand signals to indicate fluids shooting out of her bottom, saying "poo come out quick" I was a bit worried and expected her to wheel in a device with a hose to connect to my anus and it suck out the poo from me.
Turn out that "machine" is my interpretation of "medicine" in muffled Thai/English said through a mask!!! Medicine, not MACHINE! This is something I struggled with, I am not good with accents, and adding a mask into the mix made for some interesting interpretations and confusion. Thank God Fran was there to decipher for me.
I was then given a foul tasting liquid laxative to drink in 30 minutes and a bowl of soup broth to drink. Not long after getting through that I became close friends with the toilet and spent the next few hours basically cleaning out what was in my bowels.
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| Prepped - taken just before surgery |
The following has been taken from an information document provided by PPSI. In my situation I had a skin graft from the top of my thighs.
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STAGE 1
Dr. Sanguan has improved MTF GRS techniques by using all of the sensitive skin from the corona ridge of Glans penis and prepuce skin cuff, with blood supply and nerves intact, to fashion the clitoris, clitoris hood and labia minora. By this process, the top of the glans becomes the neo-clitoris, and the underside forms the inner section of the labia minora – all preserved as one piece of skin. The color of the new labia minora will match that of the former prepuce skin. This new procedure significantly improves the external appearance of the new genitalia, as well as enhancing sensitivity.
STAGE 2 (after approx. 7 days)
Although many GRS surgeons discard excess scrotal skin, Dr. Sanguan has found it to graft
successfully in the majority of cases, thus making additional skin grafts unnecessary. After the scrotal
skin is removed during the first stage of surgery, it is safely refrigerated at 4 degrees Celsius
(approximately 39 degrees Fahrenheit), where it will remain healthy for up to 2-3 weeks, far longer than necessary.
Before grafting, Dr. Sanguan carefully scrapes the scrotal tissue to remove hair follicles, thus preventing hair growth inside the vagina. This technique means patients do not require expensive and sometimes painful scrotal electrolysis prior to GRS.
The average vaginal depth will be 4-5 inches when grafted from the available penile and scrotal skin. If, however, Dr. Sanguan concludes that the penile and scrotal skin is not sufficient to construct a
functional or sufficiently deep vagina, he will recommend a full thickness skin graft. Excess or loose skin from the tummy, hip area or groin is added to the penile and scrotal skin. The donor site for the graft will leave a linear or horizontal scar. This is the best, and least invasive, choice.
A new technique of Dr. Sanguan is Free Small Intestinal Jejunal Graft Vaginoplasty, moist vaginal
lining, more lubricated than scrotal skin but lesser than colon flap. Penile skin is used for Labiaplasty,
scrotal skin is used for construction of the vaginal opening only and not inside the canal, so there is no
hair growth inside neo-vaginal canal. With this technique, it can achieve 6 inches vaginal depth.
The process will be a delay graft approximately 3-6 days after the GRS. Dr. Sanguan always delay the graft procedure 3-6 days to ensure that there is no bleeding inside the neovaginal canal when he inserts the small intestinal Jejunal graft. If the insertion is done simultaneously during the GRS, there would be a risk of bleeding that will cause blood clot or hematoma between the neo-vaginal canal and Jejunal graft that can lead to graft necrosis or failure.
Dr. Sanguan will then pack the neo-vaginal canal with Polyurethane foam connecting to negative
pressure device (Vacuum assisted closure device) for 3 days, and if there is still some oozing of blood,
he will change the Polyurethane foam packing one more time and keep it for another 3 days, then it will
be ready for the graft.
During the vaginal packing or delay period, the patient is allowed to walk, no need to be in bed all the time. After the second operation graft and neo-vaginal packing with Vaseline gauze, the patient must be restricted in bed. Then 3-4 days after graft is performed, it is now ready to remove the packing at bedside and start vaginal dilation immediately or the next day. The vaginal dilation will be carried on 3 times a day for 6 months to ensure that there is no vaginal stenosis. However, the patient can have vaginal sexual intercourse normally 2 months after surgery.
After 6 months, the patient might dilate neo-vagina 2-3 times per week, not every day.
6 July 2022
My journey from the ward to the theatre consisted of a transfer from the bed to a trolley in a quarantine area, questioned on two occasions by staff as to my name, date of birth and what procedure I was having and then being wheeled into the operating theatre and transferred onto the operating table.
The medical staff in the room were in good spirits, quiet music was playing, the room was bright, clean and full of technology. The anesthetist introduced himself and again asked what I was here for, and then described the process that I would undergo whilst in his care.
Dr Sanguan entered the room and stood next to me on the table, asking if I had any questions, and saying that after I wake up I would be back in the ward. I just asked him to fit the biggest size implants he could in and he laughed, and agreed.
I was strapped to the table by my arms, which were extended outwards either side on platforms that were swiveled out from alongside the table. An oxygen mask was placed over my face and I took some deep breaths and as I drifted into unconsciousness I was overcome with calmness and a real feeling of peace.
As detailed in the previous post, this first stage involved creating a vaginal canal and the vulva. Before this procedure my breast surgery was carried out.
I understand that the surgery was around 9 hours in total, and I woke back in the ward, wondering if it went to plan as I felt no pain whatsoever. My shoulders and arms ached, and when I went to roll over I felt tightness across the top of my chest. The arms were aching due to being extended for so long and the pain across my chest was where the implants had been inserted under the muscle at the top of my chest.
I had bandages across my chest and two pipes coming from the bandaged area between my legs. I could feel sensation 'down there' when I did a pelvic floor contraction and was so happy that I had feeling!
I basically snoozed on and off all afternoon, Fran stayed with me that night in the room.
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| Fran and I after waking up and sitting up later in the day following the Stage 1 surgery |
7 July
This was a day of lying around, snoozing, reading and on social media. Nurses came in regularly to check on my blood pressure, which was stable.
I have two tubes attached to my body, one is a catheter, the other is the blood and fluid drain. I wasn't in pain, just really tired and happy to just lie down and take it easy.
The suction pipe that drained the vaginal canal wasn't working too well, so they changed over the wall mounted pump and didn't seem worried about it but I was!
Not too much more report for today
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| This angel was with me all day x |
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| Trying to see what my boobs looked like |
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| The surgery site and tubes |
8 July 2022
Dr Sanguan visited and checked me over and gave me the okay to get out of bed. The crocs were presented at the foot of the bed and he showed me how to disconnect the suction pipe from the wall pump and how to hang my catheter bag on the gown waist strap.
I then stood up and was steady enough on my feet to walk easily. I had a few walks up and down the ward and then spent most of the day sitting up, watching Netflix, talking to Fran listening to music and watching TV.
I will be nil by mouth tomorrow morning from 8am as I am back in theatre sometime in the afternoon to check the packing.
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| Crocs! |
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| Sitting up |
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| Fashion queen |
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| Noise cancelling headphones are a good idea |
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| Catheter bag hanging from my gown waist strap |
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| The ward |
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| View from window at end of ward |
10 July
The next few days were spent resting, reading, watching Netflix, browsing the net, doing some professional development online (gained a qualification!), eating and basically waiting for Stage 2. Oh and taking selfies.
I was in no pain in my groin area, my chest was a bit sore and tight but just felt like I had over-exerted myself doing push-ups, that sort of tightness.
Dr Sanguan came in and unwrapped and checked my breasts, was happy with the result and said that I could wear a crop top exercise bra if I wanted as he wanted the breasts to drop a bit more, they were sitting quite high.
Dr Sanguan said my Stage 2 surgery would probably be next Tues 12, Weds 13 or Thurs 14 July as he really wants to made sure that the canal is ready for the graft and to ensure a successful result.
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| Selfie pastime served me well |
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| Thumb censored nipple, very firm and high. They have dropped nicely since. |
The food was good. A wide selection, warm and cooked well, and very well priced.
Here are the menus and some of the meals. The order is placed by phone and it arrives 10 - 20 minutes later, I did not run out of my food allowance for the 2 weeks of 5000THB (NZD $225).
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