In her book The Agony, The Ecstasy and The Buddha: One Woman’s Month in Thailand Having a Sex Change, author Rachel Eliason offers more than a memoir. She offers a map, not just of Bangkok or the labyrinthine corridors of PAI Clinic, but of a journey deeply internal, vulnerable, and hard-won.
The book is equal parts travelogue and personal odyssey, a journal of physical and spiritual transformation set against the backdrop of one of the world’s most renowned destinations for gender-affirming surgery. It is a vivid, clear-eyed, and emotionally intelligent narrative from a woman who had already done the hard work of transition, and had one final milestone left. When Rachel Eliason boarded her plane to Thailand in 2010, she had already been living full-time as a woman for two years. She had legally transitioned, socially integrated, and was building the kind of life she had always dreamed of. Yet, as she candidly describes in her 2017 interview with The Heroines blog, there was still something unfinished. “I loved my life and I loved my body, mostly. But there was one part I didn’t love, and it was fixable.” That honesty sets the tone for the book: unflinching, thoughtful, and suffused with a quiet humor that only someone who’s been through fire can offer.
The Agony, The Ecstasy and The Buddha is structured like a daily travel journal. Each chapter covers another day of Rachel’s month-long stay in Thailand, from her arrival in the bustling streets of Bangkok to the serene, Buddha-watched recovery at her hotel. The diary format lends a raw immediacy to the narrative. We experience the mundane details, the challenges of jet lag, the difficulty of finding soy milk, the tiny quirks of her hotel room, right alongside the monumental: her pre-operative consultation, the moments before surgery, and the physical pain and emotional complexity of recovery. Rachel doesn’t romanticize the experience, nor does she sensationalize it. There’s no melodrama here. Instead, she presents gender-affirming surgery as what it is: a deeply meaningful medical procedure, full of both anxiety and anticipation. She is not afraid to share her moments of doubt, her physical discomfort, or the surreal loneliness that can accompany such a journey in a foreign country. But neither does she shy away from the joy, the spiritual lightness, the moment of waking up post-surgery and realizing: “It’s done.” Thailand is not merely the setting for this memoir, it is a character in its own right.
Rachel’s reflections on Thai culture, cuisine, and Buddhism offer a rich counterpoint to her internal journey. She explores markets, temples, and street corners with the curiosity of both a tourist and a woman in transition. “The Buddha is everywhere here,” she writes, and that presence becomes symbolic. In a place where transformation is woven into both spiritual and medical practices, Rachel finds comfort, inspiration, and insight. She also touches on the practicalities of seeking surgery abroad. Through her thoughtful, often humorous prose, we learn the realities that many transgender women face: the expense and bureaucracy of surgery in the United States, the reputation of Thai surgeons like Dr. Preecha and his colleagues, and the peculiar but reassuring ecosystem of Western trans women traveling to Thailand to reclaim ownership of their bodies. Her experience mirrors that of thousands who make the same journey, but Rachel has the gift of making hers feel utterly unique.
One of the most compelling features of The Agony, The Ecstasy and The Buddha is Rachel’s voice. She writes as if talking to a close friend, warm, confessional, witty, and never self-pitying. When asked in her interview why she chose to write the book, she said, “I wanted to demystify the process, to give an honest picture of what it’s like.” And she does just that. There’s humor even in the hospital bed. There’s clarity even when her body is swelling with pain. There’s grace in her description of vulnerability, both physical and emotional. What emerges is a story not just of genital surgery, but of healing. Not just of gender affirmation, but of self-acceptance. Rachel is clear that the surgery didn’t make her a woman, she already was. But it helped her feel whole, and her account serves as a powerful reminder that wholeness can look different for everyone.
In the landscape of trans memoirs, The Agony, The Ecstasy and The Buddha occupies a special place. It is not a story of struggle against transphobia or coming out, though Rachel has written elsewhere about those things. Instead, this is a story about what comes after: when you’ve come out, when you’ve transitioned socially, when you’ve claimed your space, and you still need one more thing. It’s a powerful message for many in the trans community who are often told, explicitly or implicitly, that wanting surgery is somehow superficial or unnecessary. Rachel’s narrative reclaims the right to want, to choose, and to heal, not because someone else demands it, but because your own inner voice leads you there. In her own words from the Heroines interview: “Transitioning isn’t about becoming someone else. It’s about becoming yourself.” The Agony, The Ecstasy and The Buddha is a record of that becoming, as honest as a mirror, as personal as a prayer, and as quietly radical as any story that dares to say: I am whole, I am here, and this is how I did it.
Available via Amazon
Photo via The Heroines of My Life
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