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Each year, the number of international patients choosing to undergo sex change surgery in Thailand is a continuous increase. The affordable prices, the highly trained surgeons and the culture's open-mindedness towards the gender identity, make Thailand the Gender Reassignment Capital of the World. Gender identity is a very important characteristic for human beings and the change of sexual identity is one of the most, if not, the most important change that a human can experience. Some people feel they are physically a different sex than they are emotionally and mentally, so by the time they decide to have the surgery they have lived for a long time with a dissonant identity. Sexual reassignment surgery is mostly performed outside the US due to lower costs and less stringent laws regarding this procedure. It is really hard to know exactly how many people have this procedure in the US, but the Encyclopedia of Surgery says that "the number of gender reassignment procedures conducted in the United States each year is estimated at between 100 and 500" , compared to the number worldwide which is estimated to be up to five times larger. Thailand - The Gender Reassignment Capital of the World Thailand is known to have one of the largest transgender population in the world and it is one of the most accepting cultures, showing tolerance to a wide range of gender identity such as the kathoey, the effeminate men. The price for SRS in Thailand is about one-third the price of those performed in the U.S. Thailand capitalizes on decades of know-how, low-cost health care, and surgeons trained to perform the male-to-female procedure. Asia Cosmetic Clinic Thailand is one of the centers which performs the male to female sex change surgery. The clinic was founded by Dr. Tanongsak Panyawirunroj, who is one of the best plastic surgeons in the country. "The demand for SRS are increasing each year. More and more people are ready to come out of the closet and take the step to make this change thanks to the legal changes that prevent discrimination, the societal acceptance and the number of famous persons who decided to make this surgery. I have successfully performed numerous male to female sex change surgeries to patients coming from all over the world, but especially from Australia, China, and the Middle East," says Dr. Tanongsak Panyawirunroj.