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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 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.
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.
Australian scholar of sexual politics in Thailand Peter Jackson claims that the term kathoey was used in antiquity to refer to intersex people, and that the connotation changed in the mid-20th century to cover cross-dressing males.
The term can refer to males who exhibit varying degrees of femininity.
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.
Two months prior to the surgery, patients are required to see a psychiatrist in Thailand to confirm eligibility for gender-affirming 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).Kathoeys are more visible and more accepted in Thai culture than transsexuals are in other countries in the world.As well as transgender people, the term can refer to gay men, and was originally used to refer to intersex people.Because of this confusion in translation, the English translation of kathoey is usually 'ladyboy' (or variants of the term).