Buddhism teaches tolerance, and transvestites and transsexuals are more open about it in Thailand than in the West. Beneath the surface though there may be more prejudice than appears on the surface but laws were passed in 1997 to make everyone equal. This still doesn't prevent discrimination. Kathoey are portrayed in the media as figures of fun - while this may seem harmless, it means that they are not taken seriously. Kathoey are sometimes referred to as the third sex.

Thailand is a popular place for sex change operations as the hospitals in Bangkok are very good and it is cheaper than in the West. There are many clinics which specialize in gender realignment surgery. Men can have breast implants and both sexes can be given new genitals. Hormones have to be taken first. Surgery is more effective if done earlier rather than later as otherwise transsexuals still have to live with some of the effects of puberty. For instance men to women transsexuals will still have a deeper voice, larger hands and feet, and more facial hair than most women. Many transgenders feel from an early age that they were born the wrong gender but usually do not undertake surgery until they are older. Some lady-boys can not afford to have the sex change operations required and continue with male physical attributes, but dress and portray themselves as women. Some kathoey have surgery in stages as they can afford it so they may have breast implants but still have male genitals. Thais who change sex have the right to change their title as well, ie the equivalent of changing from Mr to Miss.

Lady-boys are very hard to spot. Some clues are: the height - bear in mind that Thai women are very petite so a lady-boy may be the same height as a Western woman rather than a Western man; signs of an adam's apple; shape and size of hands.