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Mailee Osten-Tan
Mailee Osten-Tan is a multimedia journalist based in Bangkok, Thailand. Her reporting has been commissioned by Longreads, Al Jazeera, the United Nations, the Southeast Asia Globe, Thai Enquirer, China Dialogue, SOPA Images, and elsewhere. A graduate of the University of Oxford and the Salt Institute for Documentary Studies, Mailee’s visual and written work often explores social exclusion, gender discrimination, and resilience.

Finding a Path in a Broken System

Woman behind a curtain, looking out a window
Amy, who flew from the U.K. to Thailand for gender confirmation surgery, gazes out the window of a hotel room in Bangkok. All photographs in this story by Mailee Osten-Tan.

Mailee Osten-Tan | Longreads | June 2022 | 7,449 words (27 minutes)


CW: This story mentions depression, suicide, and isolation, and discusses different types of gender confirmation surgery and recovery procedures in graphic detail.

Go behind the scenes of this story in our Q&A with Mailee Osten-Tan.

As Amy (not her real name) walks toward the immigration hall in Bangkok’s Suvarnabhumi Airport, she is visibly nervous. The long glass corridors, rows of fluorescent lights reflecting off plastic face shields, and sound of crinkling white protective suits make her feel like she’s entered a science fiction film. She is presented with a small number tag and guided toward neatly spaced plastic seats where she waits for her documents to be inspected. The airport is almost completely empty: echoey, eerie.

It is July 3, 2021, and there are reports of 6,230 new cases of COVID-19 in Thailand today. But Amy’s anxiety is not the result of an 18-hour flight in the middle of a pandemic to a country — and a part of the world — she has never visited before. Being denied entry would create yet another stumbling block, another frustrating barrier, to what has already felt like a never-ending process. She is here to receive gender confirmation surgery (GCS), a procedure she has been dreaming about since childhood and for which she has been planning for six long years. Like an object on a conveyor belt, she has already passed through four different airport checkpoints — each time she scrutinizes the memory of her own documentation for one typo, one incorrectly filled form. When an immigration officer finally stamps her passport, she feels a cold wave of relief.

* Osten-Tan spoke to 15 trans women for this story. Among this group, one person had surgery in the U.K. through the NHS, two opted for surgery in the U.S., and another did not have GCS.

Amy is not alone. Since the first operation in 1975, Thailand has gained a reputation as the global expert in this niche field: Foreigners made up 90% of GCS patients between 2010 and 2012. But what is driving this thriving industry in the country goes well beyond the comparatively low cost of care. Over a period of six months, I spoke to a group of trans women* to better understand why many would rather fly halfway across the world than receive GCS at home. Coming from the U.S., the U.K., Norway, Bulgaria, Israel, Canada, and Australia, and facing different personal and social circumstances, they were united in their conviction that their home countries had not presented them with good options and that they had to take matters into their own hands. Read more…