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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.
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.
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).
Because of this confusion in translation, the English translation of kathoey is usually "ladyboy" (or variants of the term).
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.