When I can have the vaginoplasty surgery done? I have taken estradiol since April 2018 and had orchiectomy done.

Question

I am a male. 60 years old. I am healthy No allergies I am 5 feet 4 inches tall My weight is 206 lbs. My skin is light brown

Phatwira Pattarajierpan, MD · Answer

On timing, you are in a good position. You have been on estradiol since April 2018 and have already had an orchiectomy, so more than enough time has passed on hormone therapy for you to be considered for vaginoplasty. From that standpoint, you technically qualify today.
There is one procedural requirement worth knowing about in advance. Thai law requires two independent psychiatric evaluations before gender affirming genital surgery can be performed, and both must confirm a diagnosis of gender dysphoria. These can be completed either online or in person, so they do not require an additional trip, but they do need to be completed before surgery rather than alongside it.
I want to raise one point here carefully, because I do not want to make assumptions about you. You describe yourself as male. Some patients use that to refer to their sex assigned at birth while identifying and living as a woman, and in those cases the evaluations tend to be uncomplicated. For patients who do not identify as a transgender woman, the outcome is harder to predict, since everything turns on whether both psychiatrists independently confirm gender dysphoria. Without knowing more about how you identify and where you are with any social transition, I honestly cannot tell you how this step would go for you. If there is any uncertainty on your side, patients in that position often choose to complete the two evaluations first, as a standalone step, before committing to a surgical booking.
The one thing I would flag is your BMI. At 5 feet 4 inches and 206 pounds, your BMI is approximately 35.4. In my practice in Thailand we only admit patients with a BMI below 30 to the operating room, and that threshold exists for good reason. A higher BMI increases the risks associated with general anesthesia, raises the likelihood of wound healing complications and infection, and can make the surgery itself technically more difficult, all of which matter a great deal in a procedure of this complexity.
So my honest recommendation is that weight management before surgery would go a long way here. Reaching a BMI under 30 would mean getting to roughly 175 pounds, so around 30 pounds of loss. That is a meaningful goal but a very achievable one with time and the right support, and I would encourage you to approach it with your own physician so it is done safely and sustainably rather than quickly. Beyond meeting the surgical threshold, it would genuinely improve the safety of your vaginoplasty, or of any surgery you might have, as well as your recovery afterward.
Everything else you describe, your general health and the absence of allergies, is encouraging. Once your weight is in range, a full pre-operative assessment would be the next step to confirm you are cleared to proceed.

Kamol Pansritum, MD · Answer

I'm sorry for not getting back to you sooner. You can do vaginoplasty if 1. you are in good health2. BMI less than 27, now your BMI is 35.43. NO HIV hep B and CYou take hormones for a long time, and you can have surgery, but we suggest you make weight loss. around to be 160 pounds. You will have a good result and recover from

Christopher McClung, MD · Answer

It sounds like you've thought this through and are ready to go. You should find a surgeon and start talking with him/her about next steps. The surgeon will probably want to meet with you in the clinic a few times to make sure you are ready and check the status of your progression. Most reputable surgeons will ask you to provide letters from mental health professionals and may require hair removal before your surgery. Hair removal can take around 6 months. Additionally you should get a physical and stop smoking (if you smoke) to make sure your body can handle the shock of a major surgery. Your weight puts you at a BMI of 35, which is at the upper end at which most providers will perform surgery. What is more important than the actual number of your BMI, is where you hold your weight. This can be determined by an exam in the office by the surgeon that you choose. You should make sure that you have a social network in place to support you during your recovery. 
Your medical history is also important. We need to make certain that you are at peak health at the time of surgery. More information would be need to determine your candidacy for surgery, but the age is not an issue. We have performed vaginoplasties on patients that are older than you. 
I hope this is helpful. Good luck!

Praful Ramineni, MD · Answer

Generally most insurances just require that you've been transitioned for at least 12 months and that you have 2 letters of support from your therapists.

Baris Nuhoglu, MD - Account Suspended · Answer

You can have surgery after using estradiol treatment for two years. However, treatment should be discontinued 2 weeks before surgery.

When I can have the vaginoplasty surgery done? I have taken estradiol since April 2018 and had orchiectomy done.

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