
Usually in those cultures they just acknowledge what they were born as, especially in Buddhist cultures. Thailand is a great example, many of the trans people there may take hrt to look more like women but don’t identify as women some even identify as feminine men. While us Americans we identify as women when we start taking hrt, in America transitioning is about changing and almost switching from one person to another while in Thailand it’s about growing, you’re still the same person you just l
look different. Also they don't feel the need to change everything about their identity like we do here in the states, I heard some stories about trans women in Thailand still having "Male" on their ID's and their male name still on their ID as well. While in America we change everything, our name and our legal sex when we transition.