30 Issues | If You Sought Gender Affirmation Surgery in Thailand...

It's known as the gender affirmation surgery capital of the world.

It's hard to put a number on how many surgeries are carried out every year in Thailand, but because of the combination of cheap services, well-trained doctors, and hospitality, the country is booming with all kinds of medical tourism.

But the deal isn't as sweet for Thai citizens. Despite universal healthcare, the government rarely, if ever, covers the medical costs of transitioning. This pushes gender-affirming surgeries into private clinics.

So here's what would happen, if you were a Thai transsexual person seeking gender affirmation surgery: your first step is to visit a psychiatrist to get a signed diagnosis of gender dysphoria.

Then, you'll begin hormone treatment. Hormones are available over-the-counter from a pharmacy - no prescriptions required. (Compare that to here in the states, where hormones can run you about $100 dollars a month.)

It'll be a long road before surgery, but down the line you could end up paying anywhere between $9,000 to $20,000 USD for a male-to-female surgery, or $12,000 to $20,000 for female-to-male.

That's about a third of the cost of similar surgeries in the United States.

In 2009 the Thai government changed the law and now requires Thais to provide psychological evaluations and wait at least one year before undergoing surgery. But for many medical tourists, these measures are glossed over.

Just a note: some people refer to this as gender reassignment surgery or gender confirmation surgery, but we're using the term "gender affirmation surgery" based on a recommendation from the LGBT Community Center in New York.

For comparison, here's what it's like to seek gender affirmation surgery in a few other countries...

America

The Human Rights Campaign, an LBGTQ advocacy group, estimates that trans-specific surgeries can cost anywhere between $25,000 and $75,000. Some phalloplasties can cost upwards of $100,000.

And that's not including the cost of hormones (typically around $100/month).

It's unclear how many health insurance plans cover gender-affirmation surgeries right now, but steps are being taken to expand access. In 2009, Aetna, one of the biggest health carriers in the country, became the first major health benefits company to cover gender affirming surgeries.

And in September of 2015, the Obama administration proposed a new regulation to require all insurers to cover gender affirming treatments for transgender people. That regulation has yet to be approved.

Iran

After Thailand, Iran performs more gender affirmation surgeries than any other country in the world.

But this practice is intertwined with policies that forbid homosexuality.

Reports say these medical procedures were first sanctioned in the 1980s, when the Ayatollah Khomeini was moved by a meeting with a transsexual woman who described her feelings of being trapped in a man's body. He declared a religious decree allowing gender-affirming surgeries.

Now, the Iranian government subsidizes the entire cost of gender affirmation surgery, and provides health and housing aid for transsexual Iranians. 

However, the surgery is seen as a correction for what the government considers an abnormality. Homosexuality is punishable by death in Iran, and if found by the government, gay and lesbian Iranians are given the option to undergo gender affirmation surgery free of charge or face a death sentence.

Serbia

All citizens in Serbia have access to health care in a system based on universal health coverage.

Starting in 2012, the Serbian government began subsidizing gender affirmation surgeries for Serbs. This makes the cost of the surgery itself close to free, but it doesn't cover the costs of hormone therapy or certain specific procedures, including mammoplasty.

Still, the 2012 decision marks a step forward. Prior to this, gender affirmation surgeries were only available in private clinics and could cost around 200,000 Serbian dinars (that's $1,838 USD).

For foreigners traveling to Serbia (an increasingly popular trip, for those seeking this surgery), the total cost comes to about $12,000 USD.

We'll continue to examine other healthcare scenarios all week, as part of our "30 Issues in 30 Weeks" elections series. And if you like knowing tidbits like these, sign up for our newsletter! It'll be a once-a-week digest of what we learned while preparing our series segments, Brian's insights, and fun facts that didn't make it to the air.