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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.

According to the Miss Tiffany's Universe website, the live broadcast attracts record of 15 million viewers.

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.

A significant number of Thais perceive kathoeys as belonging to a third gender, including many kathoeys themselves, while others see them as either a kind of man or a kind of woman.

Most transgender women in Thai society refer to themselves as phuying (Thai: ผู้หญิง "women"), with a minority referring to themselves as phuying praphet song (a "second kind of woman") and only very few referring to themselves as kathoey.

Kathoeys currently face many social and legal impediments.

As well as trans individuals, the term can refer to gay men, and was originally used to refer to intersex individuals.

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

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.

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