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A significant number of Thais perceive kathoey as belonging to a third sex, including some transgender women themselves.Most trans women in Thai society refer to themselves as phuying (Thai 'women'), with a minority referring to themselves as phuying praphet song ('second kind of woman') and only very few referring to themselves as kathoey.It most often rendered as "ladyboy" in English conversation with Thais, an expression that has become popular across Southeast Asia.Although kathoey is often translated as 'transgender woman' in English, this term is not correct in Thailand.Patients must have a note from the psychiatrist or clinical psychologist.Two months prior to the surgery, patients are required to see a psychiatrist in Thailand to confirm eligibility for gender-affirming surgery.

The ban was quietly rescinded later in the year, following the replacement of the Minister of Education., satree lek), later portrayed in two Thai movies, won the Thai national championship.

Many kathoey work in predominately female occupations, such as in shops, restaurants, and beauty salons, but also in factories (a reflection of Thailand's high proportion of female industrial workers).

Kathoeys are more visible and more accepted in Thai culture than transsexuals are in other countries in the world.

Using the notion of karma, some Thais believe that being a kathoey is the result of transgressions in past lives, concluding that kathoey deserve pity rather than blame.

Kathoeys currently face many social and legal impediments.

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Through beauty pageants, Thailand has been able to promote the country's cosmetic surgery industry, which has had a massive increase in medical tourism for sex reassignment surgery.

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