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Two months prior to the surgery, patients are required to see a psychiatrist in Thailand to confirm eligibility for sex reassignment surgery.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).
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.
Kathoeys are more visible and more accepted in Thai culture than transgender people are in other countries in the world.
Several popular Thai models, singers and movie stars are kathoeys, and Thai newspapers often print photographs of the winners of female and kathoey beauty contests side by side.
The term can refer to males who exhibit varying degrees of femininity.
Many kathoeys dress as women and undergo "feminising" medical procedures such as breast implants, hormones, silicone injections, or Adam's apple reductions.
Patients must be at least 18 years old and permission from parents if under 20 years old.
One must provide evidence of diagnosis of gender dysphoria from a psychologist/psychiatrist.Others may wear makeup and use feminine pronouns, but dress as men, and are closer to the Western category of effeminate gay man than transgender.The term "kathoey" may be considered pejorative, especially in the form "kathoey-saloey".However, kathoey generally have greater acceptance in Thailand than most other Asian countries.Legal recognition of kathoeys and transgender individuals is non-existent in Thailand: even if trans people have had genital reassignment surgery, they are not allowed to change their legal sex. Problems can also arise in regards to access to amenities and gender allocation; for example, a kathoey and a transgender person who has undergone sexual reassignment surgery would still have to stay in an all-male prison.Because of this confusion in translation, the English translation of kathoey is usually "ladyboy" (or variants of the term).