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Transgender Medical Tourism
Medical Tourism is the act of leaving one’s country in order to receive medical care. This sort of travel can be seen in transgendered groups primarily from the United States and the United Kingdom. Transgendered people usually use medical tourism in order to undergo a gender reassignment surgery, however there are many other operations being pursued, such as hormone therapy or breast augmentation. Those seeking these sorts of procedures travel across borders due to gender reassignment surgery costs, lack of doctors available to perform surgery, and the excessive wait time for the surgery. In response to the high demand for sex surgeries, professional medical travel companies have been created to assist patients in the entire process of medical tourism. The experience of medical tourism affects a patient’s self-image and overall well-being. However, in order to be a successful process, the patient must feel comfortable in his or her surroundings and a gender identity must be put in place.

Operations
•	Gender/Sex reassignment surgery

•	Hormone Therapy

•	Breast Augmentation

•	Facial Feminization Surgery

•	Orchiectomy

•	Psychotherapy

•	Voice feminization therapy

•	Other cosmetic surgeries

Gender Reassignment Surgical Tourism


Out of all the operations, gender reassignment surgery is most prevalent among transgendered patients (Lombardi). Financially, this surgery can be expensive especially because most insurance companies deem it as a cosmetic procedure and cannot pay for it. However, outside the United States and the United Kingdom costs for surgeries decrease dramatically. Many patients seek gender reassignment for personal reasons while others can be considered to suffer from certain psychological disorders; the most prevalent being gender identity disorder (GID), gender dysphoria, and gender nonconformity (Maguen). Since gender reassignment is a life-changing procedure, every patient is required to undergo a year of real-life experience. Real-life experience is the process in which a patient would live as the desired gender in all aspects of his or her life for an entire year. This helps distinguish between patients who are ready and those who are not (Bockting). Some places, such as Thailand, are known for body modification processes and have linked up with specific medical travel companies in order to invite patients from around the world (Aizura).

Medical Travel Companies and Satori World Medical
Satori World Medical is a professional medical travel company that guides patients through the process of gender reassignment. Satori World Medical is known for its over the phone service in which a patient plans an entire trip to a world destination. After planning the trip, Satori World Medical arranges all necessary transportation, overnight accommodations, clinical support, and any other specific needs. Hospitals affiliated with Satori World Medical are called “Centers of Excellence” and claim to give the highest rated care as well as “top-of-the-line medical professionals”. Thailand and Canada are the most visited by Satori World Medical patients, but one specific center in Thailand called Suporn Clinic, goes above and beyond to ensure quality care and activities throughout the day (Aizura).

Cultural Relevant Care
Not only is the necessary precautions taken into account, but where the surgery takes place is taken into account. Every place around the world incorporates its culture into the recovery of a surgery. Relevant care is necessary in order to successfully transform (Lombardi). Surveys have been done to report that global patients prefer centers with a strong sense of community and support. They prefer to have other patients going through the same thing as them, rather than be isolated in a hospital in their homeland. Culturally, the specialty centers allow patients to mingle and interact as part of therapy to gain support; as compared to the many hospitals in the United Stated and the United Kingdom that promote privacy (Maguen). No matter where the surgery takes place, it is very important for health care professionals to respect the patient’s own culture while also integrating new cultural ideas. Health professionals must be very cautious in consultation not to offend or use discriminating language. Many patients can get offended by the use of certain gendered pronouns, so it is important for the health care professional to promote open communication with the patient (ALGTIC Committee).

Gender, Race, and Beauty
Many patients who seek gender reassignment are looking to be feminized. There are many feminization processes that can be done such as facial feminization surgery, voice feminization therapy, hormone therapy, or breast augmentation; but not every culture has the same idea of femininity. In Bangkok, there are two separate views of femininity: “Orientalized” femininity and “Westernized” femininity. Orientalized femininity is considered to be a softer look whereas Westernized femininity is associated with a more prominent look. Both types of femininity value white skin as a sign of modernity and social status (Aizura). Many clinics in Bangkok offer a skin bleaching procedures as well as “Westernizing procedures”.

Thai Culture
Thailand has a history of transgenderism which allows an easy transition for gender reassignment patients. Out of all the medical tourism locations, Thailand is considered to be the best overall experience due to its cultural ideas and experience with gender variance. Thai culture values femininity as seen in cultural icons and rituals. Many patients in Thailand adopt certain feminization traditions and rituals to mark their completion in a new gender. One transgender woman from Austrailia reports a Buddhist ritual in which offered her removed testes to the Buddhist temple in order to mark the beginning of womanhood. Another transgendered woman marked the beginning of her womanhood by tattooing an Asian goddess, representing beauty and grace, on her body (Aizura).

Discrimination
Those who vary from their genders are commonly discriminated against by societal norms and sometimes, their own family and friends. They are often bullied and can become severely depressed (Lombardi). Many transgendered people lose their support systems when they “come out” to their friends and family about undergoing gender reassignment processes. In the United States, those who undergo operations can be let go from jobs and even lose their houses (Ainsworth). Although discrimination is prevalent around the world, transgendered people can undergo psychotherapy to build confidence and learn to deal with problems they may face in a new gender (Bockting).

Identifying with a Gender Identity


Gender identity is an aspect of one’s sense of self. Without a gender identity, a person does not fully understand oneself and can develop a psychological disorder (Nuttbrock). A widely believed theory of gender identity involves fourteen stages; beginning with confusion and ending at the final stage of pride for one’s gender identity (Maguen). Gender reassignment is not complete without a positive self-image. Studies have shown those who have undergone gender reassignment surgery have a better quality of life than those transgendered patients who do not. Quality of life was measured through mental health, physical health, social function, and emotional health (Ainsworth). However, those who cannot afford surgery and remain uncomfortable in their born genders can develop depression or other disorders. Gender dysphoria can develop when a person’s gender does not match their preferred gender. Those with gender dysphoria feel extreme stress or anxiety when acting in gender norms. Gender nonconformity is a term used to describe any differences in one’s gender in relation to gender norms (Maguen).

Importance of a Support System
Without a strong support system, transgendered patients can end up developing other issues. Depression, gender identity disorder, anxiety, suicidal thoughts and other psychological issues can result from rejection by family or friends (Ainsworth). In Association for Lesbian, Gay, Bisexual, and Transgender Issues Counseling Committee’s Competencies for Counseling with Transgender Clients, forming a gender identity can be a complete process and can repeatedly become a problem throughout life (ALGBTIC Committee).

Works Cited: Ainsworth, Tiffiny A., and Jeffrey H. Spiegel. "Quality of Life of Individuals with and without Facial Feminization Surgery or Gender Reassignment Surgery." Quality of Life Research 19.7 (2010): 1019-024. Print.

Aizura, Aren. "Feminine Transformations: Gender Reassignment Surgical Tourism in Thailand." Medical Anthropology 29.4 (2010): 424-43. Print. Aizura, Aren. "Where Health and Beauty Meet: Femininity and Racialisation in Thai Cosmetic Surgery Clinics." Asian Studies Review 33.3 (2009): 303-17. Web.

Association of Lesbian, Gay, Bisexual, and Transgender Issues in Counseling. (2009). Competencies for counseling with transgender clients. Alexandria, VA. Bockting, W. "Psychotherapy and the Real-life Experience: From Gender Dichotomy to Gender Diversity." Sexologies 17.4 (2008): 211-24. Print.

Gagne, Patricia, and Richard Tewksbury. "Conformity Pressures and Gender Resistance among Transgendered Individuals." Social Problems 45.1 (1998): 81-101. Print.

Lombardi, E. "Enhancing Transgender Health Care." American Journal of Public Health 91.6 (2001): 869-72. Print. Maguen, S., J. Shipherd, and H. Harris. "Providing Culturally Sensitive Care for Transgender Patients." Cognitive and Behavioral Practice 12.4 (2005): 479-90. Print.

Nuttbrock, Larry, Ph.D. "Transgender Identity Affirmation and Mental Health." The International Journal of Transgenderism 4th ser. 6 (2002): n. pag. Print.

Poling, Kevin. Medical Travel Programs Offer Hope For Transgender Patients Seeking Affordable Sexual Reassignment Surgery. San Diego Gay and Lesbian News, 26 Oct. 2009. Web. 11 Oct. 2012. .