Aug. 5 (Bloomberg) -- Paiboon Marvin started wearing dresses and makeup before he became a teenager. Now 16, he wants to be castrated as the next step toward becoming a woman.
Until recently, that wouldn't have been a problem: Boys of any age in Thailand could have their testicles removed for as little as 5,000 Baht ($150) with no questions asked. Now Paiboon may have to wait two years because the procedure will be outlawed for those under 18, after pressure from gay rights activists who say youngsters may follow a trend and regret it later.
``I don't think I'm too young to do it,'' says Paiboon, wearing a green-ribboned top, shorts, mascara and pink lipstick. ``I know I won't change my mind. I've known since I was a kid that I'm not male.''
The business school student has support from doctors who perform more than 1,000 castrations and sex-change operations annually in the Buddhist kingdom, which has one of the world's largest transsexual communities. They argue many minors seeking castration have gender identity disorder and surgery is an essential treatment.
``We should respect their decisions and age shouldn't be a fixed requirement,'' says Aurchat Kanjanapitak, president of the Medical Association of Thailand, which represents 4,500 doctors. ``If someone happens to have a woman's heart in a man's body and doesn't want to keep his testicles, the change should be allowed.''
The Ministry of Public Health in April suspended all castrations, except to treat life-threatening conditions, while the Medical Council of Thailand draws up the first regulations governing the nation's sex-change industry.
The rules, due by year-end, will forbid the castration of boys under 18, while those under 21 will need parental approval and psychoanalysis before undergoing the procedure, says the council's secretary-general, Amnaj Kussalanan.
``Sometimes kids may make decisions carelessly because it is fashionable, or because they have insufficient information or a herd mentality,'' Amnaj says.
There are about 180,000 transgender people in the country of 66 million, according to Sam Winter, a psychologist at the University of Hong Kong who studies transgender issues in Asia. Castration is often a precursor to full sex-reassignment surgery.
Buddhist teachings hold that people can be reincarnated as males or females, which makes Thais tolerant of gender swapping, says Robert Thurman, a professor of Indo-Tibetan Studies at Columbia University, New York.
``The hysteria about sex is something special to the West,'' he says.
Kathoeys, a Thai term meaning ``ladyboys'' that applies to men who live as women, are a common sight in Thailand. Often dressed in high heels, with fake eyelashes and polished nails, they work as makeup sales staff, waitresses and hotel receptionists. Some end up in the sex trade.
Transsexual beauty pageants are popular, including the largest, ``Miss Tiffany's Universe,'' which is broadcast live on television. The Kampang School in northeastern Thailand built separate unisex toilets after a survey showed 200 of its 2,600 secondary-level students were transsexual.
``Sexual preferences can change as you grow older,'' says Natee Teerarojjanapongs, the Bangkok-based coordinator of the Sexual Diversity Group, who led the campaign to regulate the sex- change industry after he met boys as young as 15 who wanted to go under the knife. ``You can't change it back.''
Noon, a receptionist at a Bangkok hotel who asked to be identified by her nickname, became depressed after her sex change at 19.
``Right after the operation, I started feeling that maybe it was wrong,'' says Noon, 28. ``I wasn't ready for the surgery.''
Noon cut her hair short at 21 and tried dressing as a man again. ``I wasn't successful,'' she says. ``There should be some control on sex-change and castration operations.''
Thailand's regulation vacuum means some clinics fall short of international recommendations on standards of care from the Minneapolis-based World Professional Association for Transgender Health Inc., which advises against surgery on those under 18.
``It is extremely unusual for anyone aged under 18 to be offered surgery anywhere in the world,'' according to guidelines published by the U.K.'s Department of Health, titled ``Medical Care for Gender Variant Children and Young People.''
Even so, some doctors in Thailand are unhappy with the proposed age rule.
Boys should be allowed to ``express their feeling,'' says Thep Vechavisit, 55, who has castrated patients as young as 17 with parental consent and is preparing a lawsuit to challenge the new guidelines.
``They're in a very stressful situation, psychologically and socially,'' says Thep, who charges 5,000 baht for a castration at his Pratunam Polyclinic in central Bangkok.
Paiboon, who first had to overcome opposition from his mother, can't wait. He's turned to the Internet to find a surgeon prepared to operate in secret.
``It's my own money, my own body,'' he says. ``It's nobody else's business.''