Pooh, a 27-year-old professional, had been saving up $6,000 for a one-week trip to Bangkok, Thailand in September 2023. For Pooh, who only used his first name for this story due to safety concerns, this trip was not simply a vacation. Born in the mountainous, multiethnic Sơn La province in Vietnam and assigned female at birth, Pooh was embarking on a life-changing journey: gender affirmation surgery. He hoped, as a result, to permanently change his current Vietnamese ID card, which lists his gender as female.
In many countries across Southeast Asia, bodily medical interventions, which typically include gender reassignment surgeries, are required by various national legal systems for individuals to officially change their gender—if gender change is legalized at all. Legal procedures associated with the change are often costly, complex, confusing, and cumbersome. Despite the associated health risks, pervasive discrimination, and substantial expenses, some individuals choose to undergo one or more surgeries of their own volition.
The Surgery Requirement
The right to change gender (upon medical intervention) was officially legalized in Vietnam after the National Assembly passed an amendment to the Civil Code in 2015.
As a member of the United Nations Human Rights Council (UNHRC), the Vietnamese government supported a 2016 UN resolution on protection against violence and discrimination based on sexual orientation and gender identity. In 2019, Bình Dân Hospital in Ho Chi Minh City opened a new clinic to serve the LGBTQ+ community, marking Vietnam’s first public medical facility to provide such services.
In 2023, a draft law was proposed by Vietnam’s National Assembly to allow legal gender recognition without requiring surgery. Pooh hoped that the draft law would be approved, marking a milestone for an estimated 400,000 to 500,000 self-identified trans people out of approximately 100 million people in Vietnam.
For years, Pooh had saved up for his life-changing surgery. His girlfriend even flew to Bangkok last September to take care of him during his medical stay abroad. Pooh does not plan further surgeries, for health reasons, hopeful that the new gender law in Vietnam would no longer require him to undergo additional surgeries for his gender to be recognized.
Yet, such a hope for many trans people was dashed. The draft Gender Transition Law was to be presented for the National Assembly’s discussions in October 2024, but was withdrawn, postponing the chance of approval for trans people.
The issue is not highly visible to the majority of the population in Vietnam, but it holds great significance for the people most affected. “That several trans celebrities appear on official TV channels does not mean that they have successfully had their ID [gender] changed,” according to an independent gender activist, who spoke to NPQ on condition of anonymity.
Pooh is concerned with his personal needs and resources. But after his surgery he also feels hopeful about the future. “I can go to the male bathroom now,” he said.
The Absence of Legal Recognition
Khimmy, from Laos, was assigned male at birth, and requested to use only her first name for safety. In 2009, the Lao government legalized changing gender but does not recognize nonbinary people. Khimmy, currently living in Vientiane, told NPQ she received wholehearted support from her family to become the person she wanted to be.
“I started growing my hair when I was 17,” said Khimmy, who is now 21.
While afraid of the pain or other possible health consequences of medical intervention, Khimmy said she is determined to undergo surgery, feeling it’s “very necessary and important” for herself and for trans people, “because it will give us more confidence in our lives and going out in public.”
“In Laos, there is little access to medical care. And another barrier is that the price of hormones is very expensive.”
Pooh also had a similar experience, feeling ashamed when swimming with his girlfriend prior to the surgery. “I felt embarrassed about my then-female body,” he said.
In Taiwan, where he has been living for the past six years, Pooh decided to adopt an English name to feel “more masculine,” in lieu of his original typically female Vietnamese name, which still appears on his official identity documents.
Pooh’s much-awaited top surgery was successful. As he told NPQ in an interview, “Now I can walk upright.” Pooh said proudly about his now completely flat chest: “I do not have to use my hands to hide my breasts anymore. Previously, whenever walking on the streets, I had to hunch my back so people wouldn’t see my chest.”
For her part, Khimmy told NPQ, “I feel confident now. But if I do it [undergo gender-affirming surgery], it will give me more confidence. In Laos, there is little access to medical care. And another barrier is that the price of hormones is very expensive.”
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Matt Yutthaworakool, a gender researcher based in Bangkok and cofounder of social-tech startup Himalaya Innovate, told NPQ that though Thailand is widely known as an international destination for gender affirming surgery due to the country’s openness and acceptance of gender diversity, changing gender markers on legal documents is far from a reality.
“When people think about Thailand, they will think of three Ts: temples, Thai food, and transgender,” Yutthaworakool said. “However, transgender people in Thailand continue to encounter the absence of legal recognition. In other words, they cannot be entitled to the legal title change. Moreover, every time when they demand their rights, transgender communities often face discrimination and are called ‘fake’ women or men.”
Yutthaworakool added, “Although recently there have been attempts from the members of parliament in amending the existing oppressive law, progress remains slow, compared to the same-sex marriage bill.” Same-sex marriage was legalized in Thailand in January 2025.
“Transgender people in Thailand continue to encounter the absence of legal recognition.”
Trans Health Disparities
In addition to varying perceptions toward queer communities, studies have shown disparities of LGBTQ+ healthcare across Southeast Asia, especially between rural and urban areas.
According to Lia Wulandari, a gender researcher and lecturer at Universitas Pembangunan Nasional Veteran Jakarta, transgender health is a relatively sensitive topic in the context of the Muslim-majority Indonesia.
“LGBT or transgender people are excluded from their families or run away from their family and home without any ID…so they cannot access any healthcare program or other social program,” Wulandari said in an interview.
Even for those who have access to care, things are not easy in Southeast Asia.
In Malaysia, the second-worst country for trans people’s rights according to the travel site Asher and Lyric’s Global Trans Rights Index, trans people are seen as high risk. This excludes them from various activities and rights, including donating blood in healthcare institutions.
Megan Steven, a Malaysian activist who was assigned male at birth, recalled an emotional moment when she was able to donate blood for the first time. But this was in Germany, where she was visiting.
“For years in my [own] country, I have not been allowed to donate blood and organs due to being categorized as high risk for contracting HIV,” Steven told NPQ.
In Malaysia…trans people are seen as high risk.
Manun Wongmasoh is a Muslim Thai assigned male at birth who identifies as a woman, despite her family’s disapproval. For over 12 years until 2019, Wongmasoh could not afford to pay a doctor. She bought her hormones online on her own, which can be both expensive and dangerous. The Thai government does not provide any hormone-related support and her medical insurance would not cover hormones for trans people, either.
Since 2020, thanks to a better-paying job, she has been able to afford hormones under a doctor’s guidance and felt that her health has significantly improved. Wongmasoh said that surgery is definitely on her to-do list as well.
“I have to make money first,” she said, but she feels unafraid of the pain of future surgeries. “I want to transform myself into a real woman’s body.”
