For people who believe they were born the wrong gender, the sex change they're yearning for can easily be found in the crowded Thai capital.
The surgery is so common that it's advertised in bold print in newspaper classifieds.
Kate Monroe-Gillibrand, 50, was married for 20 years. She was Andrew then, and fathered two children. Now in her hospital bed, days after surgery, she opens her pink satin nightgown and displays a flat bandage with a catheter.
Her 73-year-old mother and her partner stand proudly at her side. "This is a completion. This is where life begins," she says. "I'm going to stop being in a lie now."
Operations are cheap and easy compared to the United States and Europe, and the city boasts some of the world's most renowned surgeons.
Dr Preecha Tiewtranon has performed more than 3,000 male-to-female reassignment surgeries over nearly three decades.
Most patients have travelled around the world for the treatment, having decided years ago, like Monroe-Gillibrand, that they just couldn't live with the sex organs they were born with.
To qualify for treatment at the Aesthetic Institute, inside Bangkok's prestigious BNH Hospital applicants must already have been living and dressing as a woman full time.
They must also provide at least one recommendation letter from a psychiatrist. Patients typically book appointments in advance from their home countries and are already women in every sense, except anatomically, Preecha said.
The majority of foreign patients come from the United States, followed by Europe and Australia.
For many, it's their first trip abroad and most travel alone. Preecha performs up to 200 surgeries a year himself and estimates roughly 1,500 procedures occur annually in Thailand at his clinic and elsewhere with his students.
"The patients are so desperate to have this kind of operation," Preecha said. "The reason they come, No 1 is because they can get good results, and No 2 the price is low and they can afford it."
The most expensive genital reconstruction at Preecha's clinic costs $9,500, a fraction of what doctors charge in the US.
At the Pratunam Polyclinic, another facility said to have been visited by Karr, sex-change surgery is offered for just $1,625.
Sex-change surgery can be risky. The procedure for men becoming women takes about three hours.
Thai clinics including in Bangkok and the resort island of Phuket actively market such services on the internet, said Jamison Green, a transsexual man on the board of the Harry Benjamin International Gender Dysphoria Association.
"I think Asia is still one of the popular places for transgender people to seek surgery," she said by telephone. "Thailand's surgeons are readily available and they have less red tape. It's cheaper, even including air fare and hotel stay."
"If people want to go outside the system to get whatever they want, they can do it," Green said in a telephone interview from San Mateo, California.
