The Thorong La Pass Trek is graded moderate to strenuous, and altitude is the central challenge. The route climbs from Chame at 2,710 m to the pass at 5,416 m over five days, spending two nights above 3,500 m in Manang and one night at Thorong Phedi at 4,420 m before the crossing. Acute mountain sickness is a real risk at these elevations, and the itinerary builds in a full rest and acclimatisation day at Manang (3,519 m).
The pass day from Thorong Phedi starts before dawn, gains around 1,000 m to the prayer-flag-draped top, then drops more than 1,700 m to Muktinath at 3,710 m, covering 15 to 17 km in 7 to 8 hours. There is no technical climbing, but the high altitude, cold temperatures and physical length of the day make it serious. Anyone with a respiratory or cardiac condition should have a medical check before booking. Swotah guides carry a pulse oximeter and first-aid kit, and the descent option to Manang is available if altitude symptoms appear before the pass.