: The identity is a spectrum. While some ladyboys live entirely as women and undergo medical procedures like hormone therapy or surgery, others may identify as effeminate gay men or occupy a distinct "third gender" space that is neither strictly male nor female. Personal Experiences and Visibility
In Thailand, the visibility of ladyboys is deeply rooted in local tradition and religious beliefs. ladyboy may crush
: Within Thai Buddhism, some believe that being born kathoey is a result of "karmic debt" from sexual transgressions in a previous life. This belief often leads to social tolerance rather than outright rejection, though it can also carry a sense of pity. : The identity is a spectrum