Over-The-Counter Estradiol: 7 Reasons Trans People Should Visit Thailand (and 7 Reasons Why I'm Not Moving There Yet)

My primary partner and I just finished a 3-week trip to Thailand! I originally booked the trip while digging an anxiety rabbit-hole back in June - I decided I wanted to be outside the US for the 2024 Election Day. This turned out to be a FANTASTIC decision, getting bad news while touring Buddhist temples and meditating on the temporary nature of existence was way better than the obligatory mutually-escalating-concern bar conversations in Portland would have been. After the election news, I decided to scope out Thailand as a backup location should the situation in the US get all... Hitler-y. In case these notes are helpful to another trans person (or really any person with similar concerns) I decided to write up my plan as a blog post, as well as my reasons not to start implementing it yet.

I realize that many trans people don't have the means to flee the country if things get bad, and I'm sure that my own preparations come across as out-of-touch and elitist to trans people who are actively struggling to get out of terrible situations in red states right now. I don't really have a defense against that - taking a 3-week international vacation is by definition elitist and out-of-touch. I'm going to try to be as transparent as possible about the financials that went into this trip, in the event that someone else wants to follow my plan I want them to have a clear sense of how much it costs.

Also I won't have too many personal pictures in this post, I plan to put some on my instagram (@via_unnamed_roads) once I have time.


The Good:

1. Over-The-Counter Hormones

I had heard this as a rumor but wanted to confirm it myself - I was able to find at least one pharmacy in Bangkok that offers over-the-counter hormones! I followed this Reddit post's advice and was able to find Over-the-Counter Estradiol and Progesterone. I didn't directly check for Testosterone, other Reddit posts indicate that it's possible to find.


In case those details are hard to read, the drugs on the counter are:
  • Estradiol Valerate
    • 3x28 Count (84 total)
    • 2 mg
    • 590 Baht ($17.10)
  • Micronized Progesterone
    • 15 Tablets
    • 200 mg
    • 420 Baht ($12.18)

Obtained at:

Southeast Pharmacy
(207 209 Sukhumvit Rd,
Khlong Toei Nuea,
Watthana, Bangkok 10110)

Some notes however:

  • I checked prices but didn't actually purchase these medications. That turned out to be a good decision, US customs specifically asked if I had bought any prescription drugs overseas.
  • If you ask about prescription drugs pharmacies can't help you, when I first asked about obtaining these for a US prescription I was told to get a doctors' note from a local hospital
  • I tried two smaller pharmacies in Phuket and was told to get a doctors' note before they could put in the order, the supply/regulation of these drugs seems a bit hit-or-miss.
  • The pharmacy did not have any alternative dosages available and only had pills; they did not have any injectable varieties when I asked.
  • Just from a safety standpoint - you probably shouldn't self-administer hormones without bloodwork. It's cool that these exist over the counter but it's healthier to use a gender-care clinic (ESPECIALLY if you're just starting hormones)

2. Pronouns in the language

Thai has a really cool linguistic quirk - you gender yourself. 

Lots of common phrases including "Hello" and "Thank You" are pronounced differently based on your gender identity - in every interaction you give your pronouns by default as part of your greeting.

While I was still called "Sir" a few times (mostly in airports by international staff members), this helped a ton to feel welcome throughout the country. Possibly as a result of this linguistic quirk...

3. Thailand is relatively accepting of trans people

One of the first things I saw on entering Thailand was this sign:


Is it a cynical cash grab for LGBTQ+ tourists? Maybe. Does it make me feel more welcome in the country. ABSO-FUCKING-LUTELY.

My overall experience was that Thai folks were pretty accommodating to my partner and I, although  some of that may have been foreigner/passing privilege - we got asked by our hostel manager in Phuket "are you two sisters? You kind of look alike". I decided to take the partial win and give the time-honored "oh, we're... friends" (🙄 history shall record that they were roommates and good friends who lived together for years and adopted several cats together). My (also transfem, also 6-foot-tall, also goth/alt-styled) partner and I had a good laugh about it while I was railing her incoherent later that night. I don't get the sense that nonbinary translates well in Thai culture though, as I understand it Thai Kathoey is a social category for more-or-less binary trans women but other varieties of gender-expansive may not be as well known.

Also it would be remiss of me not to mention the Surgeons - Thailand is famous for cheap, reliable transgender surgeons. I don't plan to take this option myself (while reading up on FFS I found a US doctors' commentary on some of the shadier practices these clinics may or may not use, especially with Oregon's mandatory trans care insurance coverage I decided that US options were better for my case). Still, proximity to world-class trans surgeons is always a plus.

Finally, I saw a few other queer couples around Bangkok. I don't know enough Thai or Mandarin to say for sure but I think I rode the SkyTrain behind a Chinese gay male couple - Bangkok setting itself up as a hub for international queer tourism would definitely make sense in the context of the much more conservative/authoritarian countries around it.

4. It's so cheap

Like.... SO. CHEAP. This Hostel sign has some common prices for alcohol, food and Hostel beds (in Thai Baht). We went a little bit fancier with a private room, but the cheapest options are in the 400-500 Baht per night range ($10-$15) for a dorm bed.


(Also I highly recommend this hostel, the vibe was great!)

This restaurant in Bangkok posted prices for pretty-good restaurant food, this is roughly comparable to delivery prices:

Generally Pad Thai/Fried Rice in Chiang Mai or Bangkok was about 40-60 Baht per plate ($1.75), more in touristy areas.

While touristy stuff and airline tickets were a little more than that, living like a local and sleeping in a hostel dorm you could easily get by on $20/day. I added a complete breakdown of our trip itinerary/costs to the end of this blog, even with touristy stuff and nicer private rooms we still found the country VERY affordable.

A surprisingly large number of US retirees and digital nomads choose to live in Southeast Asia because of the cost - if you're able to work a remote US tech job and make a US tech salary but pay Thai prices, you could conceivably save enough money to retire (at least to Thai living standards) in a few years.

5. It's much more approachable than many developing-world countries

I've traveled through at least a dozen countries that would be considered "developing world". Thailand is one of the easiest ones as an American citizen, for a few reasons:

a. Visas are (relatively) easy

Some countries are VERY defensive about visas granted to foreigners - India and Kenya come to mind. Both countries really crack down on foreigners working in the country, trying to reserve jobs for locals. Thailand takes a different approach, really making it easy to get started as a foreigner through a number of official and unofficial-but-accepted options:

b. Telecoms are easy

I used Google Fi for the trip, but I don't recommend it - in theory Google Fi would work well for this kind of travel, but my experience has been that it's much more expensive than a local SIM and harder to setup than Mint Mobile. My partner used Mint mobile's 10-day data packs (10 days/10 GBs data for $20 each). If you're staying long-term a local SIM would help, but honestly the Mint data packs made everything pretty easy. 

c. Thai is hard but English is everywhere

Most street signs had Thai and English variants. With the exception of Mandarin, some scattered French/Spanish in Chiang Mai and occasional Russian in Phuket, generally English seemed to be the de-facto tourist language. Google Translate made it pretty easy to decipher anything that didn't have English on the packaging/signage.

d. Customs isn't super high-pressure

Kenyan Customs can be INTENSE - taxes on electronic devices are pretty high in many African countries, leading to unexpected fines/taxes due on arrival in Kenya. My experience with Thai customs was pretty relaxed in comparison, I felt like it was well explained and not as ruthlessly extractive as countries where the police are more corrupt.

e. Outlets work with American devices

Outlet voltages are 220V so you can't bring a fan/hairdryer from the US, but the plug shape works pretty well with any device. This doesn't seem like a big deal but it can be really nice to not have to swap through adapters all the time.

6. Culture

Thai culture is famously friendly and picturesque; plenty of other bloggers have already covered this in detail, so I'll only talk about the things that I personally liked.

a. Food

Thai food is awesome. Cheap Thai food is even better. I fucking love Pad See Ew and Mango Sticky Rice.

b. Temples

I'm a practicing Buddhist so I found the temples especially cool, but really any tourist will like them - they're beautiful. I highly recommend touring temples, especially in Chiang Mai/Chiang Rai.

(Wat Rong Khun, aka The White Temple in Chiang Rai)

c. Beaches

I don't like beaches very much but many people do ¯\_(ツ)_/¯. Thailand has good ones, they're just kinda overrun by tourists (more detail later).

d. Intoxicants

Marijuana was an open secret for years in Thailand, now it's just open knowledge. I don't smoke anymore but weed shops are everywhere, I know this is important to a lot of Trans folk.

e. Little Tokyo

Our most fun/unexpected find in Bangkok was a shopping mall I'm calling "Little Akihabara" - it's really similar to the Otaku district in Tokyo, featuring everything from obvious knockoffs:


to truly stunning pop-culture sculptures:


All arrayed in floor-after-floor shops of plushes, minifigs and miscellaneous other Otaku gear.


Truly unexpected, really cool, and a much lower-budget way to get (some of) the experience of visiting Tokyo. I noticed that this mall had some card tables set up, it looked like they did pretty frequent Trading Card Game tournaments.


All of this was at:

Mega Plaza

(900 Maha Chai Rd,Wang Burapha Phirom,Phra Nakhon, Bangkok 10200)

We spent a day touring just the one building, there were a lot more in the area - I ABSOLUTELY plan to go back!

f. Noticeably friendly

Thailand has a reputation for friendliness, even compared to the Pacific Northwest it felt very friendly for my partner and I. People went out of their way to say hi to us, my partner got a TON of compliments on her hair color.

7. Infrastructure, Transportation and Booking

Overall Thailand felt very safe, certainly safer than Nairobi and better than a lot of US cities. The main ride-sharing/food-delivery/grocery delivery app is called Grab - some of the Thai language can be hard to read but it's so similar to Uber/Uber Eats that we came to rely on it almost immediately (especially when we lost a bottle of contact solution to Manila airport security and had to find an emergency replacement in order to sleep in Bangkok on Day 1). Thai Pharmacies had comparable skin-care products/over-the-counter pills as US pharmacies. Overall public transit was pretty good, in the future I'd like to explore more of the bus/train options - airplanes, Grab and the Bangkok subway/SkyTrain metro system worked really well for us.

The Bad:

1. Other Expats/Tourists

I didn't like Phuket very much - the beach town is famous for its turquoise beaches but it was absolutely overrun with other tourists, to the point where it didn't seem like there was much of a city left for the locals. Many of these tourists were Russian, while I can't say anything for sure I got some weird vibes off a group of Russian 20-ish frat-bro types that gave me pause. Complaining about other Tourists is classic Hipster Tourist behavior so I can't say much, but based on my experience in Phuket I don't have a lot of interest in returning to Thai beaches.

2. Harder to build LGBT Community

The main reason I don't plan to move to Thailand immediately is the difficulty of building community there. My experience with expat/tourist types (admittedly pre-transition) was largely one of very temporary communities forming and rapidly dissolving. Especially in towns with high turnover of tourists, building long-lasting community can be incredibly difficult. I did see some Gay/Lesbian bars in Chiang Mai that showed promise, but haven't visited them personally so I can't say for sure:

Sapphic Riot, Chiang Mai
56 1 Singharat Rd,
Si Phum, Mueng, Chiang Mai 50200

Ram Bar Chiang Mai
Charoen Prathet Rd,
Chang Khlan Sub-district,
เมือง Chiang Mai 50100,

I didn't see as many queer events posted in Bangkok as I'd expect for a city that size; my guess is that most of them are organized through Whatsapp groups, not publicly-posted events. While I'm sure there's a queer scene it seems harder to break into than the Portland one.

3. Weather

I'm fine with 90+ degree weather (30+ Celsius) but my partner was NOT. AC is present in most hostels/hotels (ABSOLUTELY check for AC if you're booking something - if it's not advertised, go elsewhere), but not always effective in older/draftier structures. Thailand is relatively hot even during the "good" season (November - January), but I've heard that it can become unbearable at other times. Chiang Mai has both a smoky season and a rainy season - recent flooding caused disruption and displacement across the region. 

4. Health/Safety

If you visit Thailand (or really any developing country) you WILL get sick. Not a matter of if, it's a matter of when. If you're older or immunocompromised this can get pretty bad. While Malaria rates are low in tourist areas, food poisoning is a regular occurrence and cold/flu exposure is a regular part of travel. While I enjoyed the trip, I dealt with two colds and some nasty food poisoning during the three weeks I was there. 

Even if they're not dangerous, insects and unexpected animals are just a part of life. Luckily most of the unexpected hotel wildlife we encountered was pretty cute - my partner fell in love with the lizard who randomly popped out of the dresser on day 2 of the trip. Unexpected snakes wouldn't have been nearly as fun.

Not being able to drink the water safely causes a number of logistical headaches. Internet opinions are divided on this, we opted for the most-paranoid approach (bottled/filtered water only). Luckily bottled water is cheap and many hostels provide filtered water for guests.

Finally, construction is everywhere and sidewalks can be annoyingly nonexistent (even in major pedestrian areas).

5. Cultural downsides

Thailand is a Constitutional Monarchy. As a tourist this is more of an interesting fact than a major impediment, but it does impact how the country runs. Despite Thailand's reputation as a cheap "anything-goes party country", the culture is fairly conservative when it comes to things like alcohol sales (only allowed from 11 AM - 2 PM, then 5 PM - midnight), sex toys (officially banned even though this doesn't seem to be enforced too well) and standards of dress (I got a LOT of disapproving stares from older women and was once denied temple entry for wearing clothes that exposed my knees - welcome to femininity I guess ¯\_(ツ)_/¯ ).

6. Leaving the States is HARD

I've done this before (digital nomad, not fully changing my citizenship) so I know how difficult it is logistically to leave the US. There's a fair amount of annoyances and paperwork, including:

a. Your address in the states

If you're not paying rent you'll need to have mail delivered to a friend/relative/remote PO box. Registering a business is harder, many PO box companies cannot do this. Being fully-remote from the US isn't really possible, snail mail needs a physical address.

b. 2FA

You'll need a phone number for 2FA that works overseas - luckily those Mint datapacks work for a short trip, but long-term this can get tricky. 2FA for international numbers is rather spotty, my solution was to use Google Voice for 2FA (kinda bypassing the point of 2FA and making my personal security a bit weaker, although it's harder to Smish me now).

c. Health Insurance

Aetna has some international plans but these are really hard to get working overseas, mostly they're designed to prevent a trip back to the States for emergency care from bankrupting you. 

d. Taxes

You still have to file taxes if you're living outside the states, depending on how you get paid this could result in weird situations (look up double-taxation and foreign-earned income exceptions).

e. Health Care/Medications

This is tricky, health-care coverage is very tied to a physical address. Especially for ADHD medications doctors are reluctant to provide more than a 30-day supply, leading to frequent (and expensive) trips back to the states to resupply pills.

7. Coming back to the States is ALSO hard

When I returned to the US in 2022 after a 5-year absence, I had to file paperwork in what felt like a dozen different ways in order to re-establish myself as a legitimate citizen. On top of finding a place to rent and changing my address, I had to go through all the same logistics as leaving (Health Insurance, Finding a Doctor, Setting up Taxes, etc.).

One of the main considerations for any trans person looking to leave the US, especially if you already live in a "Sanctuary" state - you might be shooting yourself in the foot by leaving behind a clinic that's already prescribing hormones/has you on surgical waitlists. I expect that these clinics will get more and more overloaded over the next few years, my current clinic is already experiencing 10+ year wait times for trans surgeries. Leaving the States could result in some nightmarish bureaucracy to re-establish care in a Gender Clinic when you return.

My Plan:

After the trip to Thailand I like to have it as a backup option, but the situation in the US would have to deteriorate pretty substantially before I'd consider it. For me, the risk of losing my community/access to my US gender care clinic weighs more heavily than the gain of being able to save money while living further from Republicans. I'm currently thinking through some "lines in the sand" situations where I'd want to immediately book a ticket out of the US (like the President openly executing a political opponent); I won't write all of them here because it stresses me out to think too hard about them. 

Addendum:

Trans People - DON'T VISIT OR TRANSIT THROUGH INDIA. Specifically, don't fly to India. India uses gender-segregated airport security lines, which led to me being grilled about my gender by a security guard in New Delhi during this trip. Not a pleasant experience, I'd recommend avoiding India unless you pass really well.

Appendixes:

In case anyone is looking to recreate my trip, here's the full itinerary we followed. Note that I spent a week in India for a work visit while my partner was in Chiang Mai, I'm leaving the work travel out because I don't recommend visiting India.

1. My itinerary

I structured the trip around a relatively cheap flight ticket I found from SEATAC to Bangkok. While a bit inconvenient, taking an Amtrak to Tukwila Station then using public transit to get to SEATAC saved several hundred dollars from the trip (we used FlixBus to return from SEATAC, this was a bit more convenient than Amtrak). I typically use Google Flights for Flight bookings and Booking.com/Hostelworld for Hotel/Hostel bookings (my preference is to get a private room in a hostel for a more "personal" feel than a hotel - see my old blog post for details). Within Thailand, we visited:

  • Bangkok outskirts near the airport (2 nights initial jetlag recovery)
  • Chiang Mai
    • Stay North Gate Hostel (5 nights)
    • Chanapat Hotel (6 nights)
    • Temples around Chiang Mai 
    • Restaurants in Chiang Mai
      • Sunday Baker
      • Copacabana Rooftop diner
      • Into the Woods Cafe
      • Charmm Bistro
    • Day-Trip of Chiang Rai (White Temple)
  • Phuket
    • iNest Poshtel (4 nights)
    • Restaurants
      • Sabai Corner
      • Laem Sai Cup Cafe
      • Moon Terrace Lounge
      • Sawasdee Thai Cuisine
  • Bangkok downtown
    • Home16 Hostel (3 nights - we should have done more!)
    • Bangkok Aquarium
    • Restaurants
      • Clover SkyBar
      • Lazy Daisy Brunch

All of these places were well-rated and I don't have any complaints, we specifically avoided the notorious Thai party spots (like Khao San road in Bangkok) and any hostels that described themselves as "party hostels". Your mileage may vary, we wanted a relaxing trip but I still want to visit Khao San at least once in my life.

2. My packing list

Most of this is repeated from my previous post.

Essentials

  • Medications
  • Passport
  • Passport Wallet
  • Emergency Paper Money (USD + Baht)
  • Credit Cards
  • Covid Vaccination Card (no one checked, but I still want it)
  • Paper copy of passport/covid card
  • Phone/Charger Cables
  • Advil/Tylenol (for the flight)

Useful

  • Charged power bank
  • Headphones
  • Laptop/Charger/Mouse
  • Travel Luggage Scale
  • Neck Pillow
  • Immodium
  • Water Bottle
  • Earplugs
  • 5x days clothing
  • Safety pins
  • White Noise App/Music on Phone
  • Books/Offline media for the flight
  • Liquid IV
  • Folding Duffel Bag for the Return Trip
  • Ziplocks
  • Pens
  • Travel Duct Tape
  • First aid kit (including neosporin)
  • Chapstick
  • Eye Drops
  • Sunscreen
  • Hand Sanitizer
  • Umbrella
  • Laundry Bag

Nice-to-Have/Easy to Find Locally

  • Headlamp
  • HDMI Cable/Converter
  • Instant Coffee Packets
  • Tea Library (lots of hotels have tea kettles)
  • Tissue Packs
  • KN-95 Masks
  • Toiletries (toothbrush, shave kit, shampoo, etc.)
  • Small notebook/some index cards


3. My full trip costs

I think this is everything (at least the major items), we could definitely have reduced costs by moving around less/eating out at fewer fancy restaurants. Note that these costs were for my half of a 2-person split on rooms/food (for example, Orchid hotel cost $90 for 3 days but my half was $45).

  • Main Flight Ticket (SEATAC to Bangkok): $857
  • Transit To/From SEATAC: $85
  • Flight Tickets/Bag Fees inside Thailand: $189
  • Taxis in Thailand: $56
  • Hotels:
    • Orchid Hotel: $25
    • Stay North Gate Hotel: $82
    • Chanapat Hotel: $85
    • iNest Poshtel: $94
    • Home16: $45
  • Tourism: $69
  • Souvenirs: $30
  • Groceries/Food: $370
  • Pharmacy: $20
Total Cost: $2007 (for 22 days)


4. Shoestring budget trip costs

While this would be much less fun than the trip we had, if you just wanted to spend a full 60-day visa in Thailand without moving around/doing much touristy your potential cost breakdown would be something like:

  • Main Flight Ticket (SEATAC to Bangkok): $857
  • Transit To/From SEATAC: $85
  • Grab Taxi to/from Bangkok Airport to Hostel: $25 (less by public transit)
  • Home16 hostel (or comparable) Dorm Bed: $13.34 / night ($800 total)
  • Local Food Options/Groceries: $10 / day ($600 total)
  • Intoxicants/Pharmacy Costs - depends on your situation
Total Cost: $2367 (for 60 days)









 

Comments

  1. Great stuff, super helpful!
    One clarification: Many SEA nationals will use "Sir" and only "Sir" as a sign of respect. It seems the feminine form "Ma'am" was not globalized.
    A couple of recommendations to sprinkle in for some more LGBTQIA+ friendly fun.
    1. Cabbages & Condoms in Bangkok: this is both a restaurant and an institution to collect funding for sex worker health and safety. Richly decorated in actual condom with a finer dining setting (at an accessible price).
    2. Zoe in Yellow in Chiang Mai: nightly indoor/outdoor night club with live music and adjoining bars with a vibe suitable for everyone.
    3. Free Bird Cafe in Chiang Mai: great vegan options, another social enterprise benefitting Burmese refugees. Donated clothing sold on site and remnants turned into usefu, crafts for sale. The owner is American and she holds a monthly women's networking lunch for expats to get in olved.
    4. Try a Thai massage! You can also get a visa to learn this very interactive technique. Prices are so low at 24/7 parlors and you can show up with a group without any prior notice. Many locals treat it like a trip to the movie theater.
    Some tips:
    1. Sickness: The Thai healthcare system is well regarded in the region. Pharmacies are very well equipped with many US prescription medicines available OTC for a fraction their US label. Many run 24/7 and the pharmacist is trained to diagnose and treat common issues. That said, it is very common to incur intestinal issues. Thank goodness for bum guns!
    2. Water: Yes, do as the locals do, which is do NOT drink unfiltered/untreated water. The plumbing infrastructure is good, but very contaminated as evidenced by poor sanitation infrastructure. Most Thais do not cook at home either, so it is mainly used for washing and flushing. Large water jugs can be found at the nearest 7/11 which is a great detour on your way to check in to a hotel or guesthouse to save some hassle/cost.
    Enjoy your trip to the "Land of Smiles"!

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