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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.Many dress as women and undergo "feminising" medical procedures such as breast implants, hormones, silicone injections, or Adam's apple reductions.

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Before going through gender reassignment surgery, one must be on hormones/antiandrogens for at least one year.

Legal recognition of kathoeys and transgender individuals is non-existent in Thailand: even if trans people have had genital reassignment surgery, they are not allowed to change their legal sex. Problems can also arise in regards to access to amenities and gender allocation; for example, a kathoey and a transgender person who has undergone sexual reassignment surgery would still have to stay in an all-male prison.

Kathoeys began to gain prominence in the cinema of Thailand during the late 1980s.

Use of the term "kathoey" suggests that the person self-identifies as a type of male, in contrast to sao praphet song (which, like "trans woman", suggests a "female" (sao) gender identity), and in contrast to phet thi sam (which means "third gender").

The term phu ying praphet song, which can be translated as "second-type female", is also used to refer to kathoey.

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