I never paid attention when I lived in the US..gender issues were not on my radar.
After I moved to Thailand, however, I was contacted by an old high school buddy who was trying to transition to female, and who outed me as "male."
This surprised me, so I read a number of Kindle trans autobiographies and was surprised to find myself reading my own story. I'm only about 60% transmale, but that had been enough to torpedo areas of my life, for most of my life.
There are many transgender people in Thailand, but they are in the mainstream, most without hormones or surgery, and it can be startling to see a man with a beard in a dress, wearing makeup, or a female-figured person dressed exactly like man, down to wingtips, playing a male role.
Transgender Thai don't seem to "transition" with operations and documents, or even try to officially become a member of the opposite gender, just seemingly dress how they feel comfortable, go about their business, and people don't even remark on it.