T*********rism is not an American thing regardless of how you view it.

It is a COURAGEOUS Decision to seek inner peace with one’s body.


Mindanao, Philippines and Bangkok, Thailand —


By 8:30am on April 27, 2023, the Pratunam Polyclinic in Bangkok was already full. Women sitting in rows of plastic chairs occupied most of the already cramped reception area. An empty fish tank with dirty water stood in one corner of the room and a receptionist snapped instructions in broken English in the other.

It is here, according to the owner of the clinic, that hundreds of t*********r women, from across Asia and further afield, come every year, hoping to get an anatomy that better reflects their g****r identity – at a fraction of what it costs elsewhere.

On that Thursday, 29-year-old Bianca Balala from the Philippines was one of them. After years of “being trapped in a wrong body,” and working to save up the money for a g****r affirming vaginoplasty, Balala finally took what she called the “longest journey of my life.”

The 12-hour trip started when she took a bus from her rural hometown in southern Philippines to Pagadian City, where she caught a flight to Manila. The next day, she boarded another plane to Bangkok. Balala checked into a hostel once she arrived, and four days later, she walked a short distance to the Pratunam Polyclinic, feeling nervous but determined.

A staff member handed her a dressing gown and gestured for her to get changed in an adjacent room with yellowed newspaper clippings of women in lingerie and before-and-after breast surgery pictures were taped to the walls. Then she was led up three flights of narrow stairs to a windowless operating room. After she lay down on an old operating table, her arms were strapped by the wrists to a narrow wooden plank placed horizontally under her upper back.



Listen to this woman who says she risked it all for g****r affirming surgery
The small operating room was stuffed with random items, including a VCR, and empty boxes of breast implants were stacked up to the ceiling, Balala told CNN. The sight “shocked” her because it didn’t look like anything like an operating room.

Despite being told to leave all her belongings at the reception desk, she said she snuck in a pink rosary in her dressing gown pocket. Her mother had pressed it into her hands as they waited for the bus that would take her on a trip that would mark the end of one chapter of her life and the beginning of another.

“My heartbeat was so fast,” Balala told CNN. “I was just thinking, what if bad things happen to me?” Balala began to pray.


The reception area of Pratunam Polyclinic, Bangkok, in July 2023. Watsamon Tri-yasakda for CNN

Pratunam Polyclinic, opened in 1988 by Dr. Thep Vechavisit, has built a reputation, according to media reports, as a low-cost destination for g****r affirming and cosmetic procedures including breast augmentation, nose jobs, and vaginoplasty, which involves rearranging g*****l tissue to create a vagina and vulva.

Balala told CNN that she was quoted $7,300 for a vaginoplasty by a clinic in the Philippines. In Thailand, few clinics publicly disclose their pricing. But one plastic surgeon in Bangkok charges between $6,500 and $12,000, depending on the surgical technique, according to his website. Another clinic in the Thai capital says the cost can vary from $10,000 to $17,000. But Pratunam Polyclinic offers vaginoplasty using the penile inversion technique for just $2,065.

Dr. Thep, as everyone calls him, said he performs roughly 350 vaginoplasties every year. Most of his patients are from Thailand but about 20% travel to the clinic from other Asian countries, including: India, China, Indonesia, Malaysia and the Philippines. They come despite the discrimination they face and the lack of healthcare support for t*********r people in their home countries.


“People come to see me for my sk**ls, not because of what my clinic looks like,” said Dr. Thep Vechavisit, 71, who founded and runs Pratunam Polyclinic. Watsamon Tri-yasakda for CNN

In the case of the Philippines, the national health insurance program, PhilHealth, does not currently cover g****r affirmation surgeries for t*********r people, said Dr. Albert Domingo, deputy spokesperson for the Philippine Department of Health.

Balala had known about the Pratunam Polyclinic’s low-cost surgeries for some time but said she had initially been reluctant to go to Dr. Thep. She told CNN that she’d heard mixed reviews. Some of his patients had been happy with their operations, but others said they’d experienced medical complications or been unhappy with the results of their surgeries, because they weren’t aesthetically pleasing. There were also complaints about the rudeness of the clinic’s staff.

But Balala would soon change her mind.

“I risked everything to go”
Balala was assigned male at birth. When she was around five years old, she remembers wrapping a handkerchief around her head to mimic long hair and telling her grandmother, “This is my hair. I am a woman.”

Her mother, Juhanna Balala, told CNN that she let Balala be. “She has always been my daughter.” Despite their strong Catholic faith, family members helped Balala accept her g****r identity as she grew up.


Having heard mixed reviews about Dr.Thep, Balala held on to her faith as she underwent surgery at his clinic in Bangkok. Mailee Osten-Tan for CNN

As a teenager, she started to participate in local t***s beauty pageants. Exposure to older t***s beauty queens, who had undergone surgical t***sitions, made Balala think about getting g****r affirming surgeries herself. “I wanted to have the surgery to become more confident in my body. It was really hard for me to have the male part.”

Not all people who identify as t***s or non-binary feel they need surgery, but for some, the g****r dysphoria or discomfort caused by the incongruence between their physical bodies and g****r identity, can take a heavy mental and emotional toll. Globally, according to a 2023 review and meta-analysis of 65 selected studies, the prevalence of suicidal thoughts and attempted suicide among t*********r people over their lifetime was 50%, and 29% respectively, and nearly half of the t*********r people who had suicidal thoughts did end up taking their own lives.

Despite the distress Balala’s body caused her, the cost of a vaginoplasty was much more than she could afford. She said a clinic in Manila had quoted her $7,300 for the procedure.

But Balala lives hundreds of miles away in the southern Philippines, where the incidence of poverty among families in the province was estimated at around 44% in the first part of 2023, according to official government statistics. Most people in her rural hometown support themselves through farming or run small businesses. Balala sold husky puppies and, occasionally, sex online. “I h**e to say it but it’s part of survival,” she told CNN.