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You won't see much about the negatives of Tibet travel on an agent's glossy brochure but there are some things that must be seriously considered:
Is there camping involved? If so, ask yourself: Do I like camping and, if so, how many days are my limit? Camping is not for everyone, and even when it is fun for a day or so, a week can make some people cry. No bath, rain and mud, sciatica pains, etc. They are real. Some people thrive, some get cranky. You just have to know yourself.
Group Travel: Pilgrimage is not the same without a group. The best part of my Tibet travel over the years is the friends I have made. I do find I like the group much more when I can get away and be alone in my own room some of the time. My preference is to always spend the extra money for a single supplement and I'm sure that comes from being an only child and a mindfulness meditator. Roommate problems are not that infrequent and a single supplement avoids the risk. (Most guides are happy to change rooms around if necessary) If you are tenting for a while, you might also appreciate having the tent to yourself. Many people have exact opposite feelings: They like having a roommate and hate to stay alone.
Tibet can be difficult because of the altitude and the bumpy dusty roads. Some people get very anxious when they are out of their element. The best way to deal with these personality quirks is to relax and realize that the trip is for a limited time. Give up your expectations and agendas. Don't play the pecking order game at all. Just go along for the ride and absorb the experience.
I have observed that there is a certain bond that develops in spiritual groups, probably due to their common interests. It does seem to me that if a group is too small, say 5-7 people, there may be less chance of finding those to whom you can relate.
Flexibility: If you are not able to tolerate other people's little quirks, if you can't take a little inconvenience, last minute changes in itineraries, physical adversity, well, don't go to Tibet. If you tend to complain a lot and expect accommodations to be totally comfortable, definitely do not go to Tibet. Westerners who are not flexible and adaptable should skip some trips, simple as that. Showers that don't work, planes that are late, food that is not what you are used to, bathrooms that are just not describable here. More? Potholes to fall into, signs that can fall on your head, marginal to no healthcare (try using a pantyhose on your broken leg when the local hospital has never even heard of a ACE bandage). Okay, you get the idea. For many people, all that is part of the fun, the learning experience. Others just don't do well with adversity.
Altitude and Itineraries: This is a major consideration because Tibet is high. And not everyone does well at higher altitudes. There is medication that works for most people but everyone is different. Ideally, if your itinerary takes you to extremely high altitudes, those high points will be near the end of the trip so you can acclimatize. Agents, needing to fit a trip into a two week time slot may have the group ascending too fast. That basically means that people get headachy, grumpy and unable to sleep. Altitude may be glossed over by some travel agents but in reality it is something to be taken very seriously. Check out the High Altitude Medicine Guide. And don't forget travel insurance that includes evacuation.
Modern Medicine: See a good travel clinic or doc before going to Asia. Hepatitis vaccine is a must. And you will need some medications to pack. As one who has traveled to Asia for years, I can remember the before- antibiotic days when it was not unusual for a person's trip to be totally ruined by vomiting and other unfortunate intestinal complaints. High altitude used to be another problem that was insurmountable for many. Now there are prescription medicines that can change a trip to the Hell realm to a trip in which you feel pretty good. There are always some anti-medicine people on these trips, but I say, "Hey, get over it." You spent $5000 plus for the trip; do you want to spend it in the bathroom of your hotel (or worse?) My own philosophy is to take the pills, and take them earlier rather than later.
What about Mt. Kailash? Sorry, I can't tell you. I have always avoided the Kailash trips. It is an important pilgrimage site for Buddhists, Jains, Hindus. But do not kid yourself: You are undertaking a very, very, high and difficult trip if you sign on for this one. Yes, people really do die there. They break their legs and have heart attacks and altitude sickness. Some people have endured it and loved it (or said they loved it) but I have heard too many horror stories for my comfort. IF you do go, do not look for the cheapest trip, and good luck! Bad food, low air pressure (think headache) and very little oxygen. All to see what is basically a mountain and lake? But that's just me…
My favorite destination in Tibet to date? Lake Namtso, hands down. It's high and you have to be ready for it but it fabulous in so many way. And you can descend to a small town in a couple hours.
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