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Families (and especially fathers) are typically disappointed if a child becomes a kathoey, and kathoeys often have to face the prospect of coming out.

However, kathoey generally have greater acceptance in Thailand than most other Asian countries.

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.

Before going through gender reassignment surgery, one must be on hormones/antiandrogens for at least one year.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.Beginning in 1998, the pageant takes place every year in Pattaya, Thailand during May.With over 100 applicants, the pageant is considered to be one of the most popular transgender pageants in the world.

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