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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.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.

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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.

The winner of the pageant receives a tiara, sash, car, grand price of 100,000 baht (US$3,000), equivalent to a yearly wage for a Thai factory worker.

In 1993, Thailand's teacher training colleges implemented a semi-formal ban on allowing homosexual (which included kathoey) students enrolling in courses leading to qualification for positions in kindergartens and primary schools.

One must provide evidence of diagnosis of gender dysphoria from a psychologist or psychiatrist.

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

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.

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.

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