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One must provide evidence of diagnosis of gender dysphoria from a psychologist/psychiatrist.Before going through gender reassignment surgery, one must be on hormones/antiandrogens for at least one year.It is most often rendered as ladyboy or lady boy in English conversation with Thais and this latter expression has become popular across Southeast Asia.Although kathoey is often translated as "transgender" in the English usage, this term is not used frequently in Thailand.

The phenomenon is not restricted to urban areas; there are kathoeys in most villages, and kathoey beauty contests are commonly held as part of local fairs.Using the notion of karma, some Thai 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.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 sex reassignment surgery.

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