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

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

It most often rendered as "ladyboy" in English conversation with Thais, an expression that has become popular across Southeast Asia.

Although kathoey is often translated as 'transgender woman' in English, this term is not correct in Thailand.

Legal recognition of kathoeys and transsexuals is nonexistent in Thailand: even if transsexuals 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 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.

Australian scholar of sexual politics in Thailand Peter Jackson claims that the term kathoey was used in antiquity to refer to intersex people, and that the connotation changed in the mid-20th century to cover cross-dressing males.

The term can refer to males who exhibit varying degrees of femininity.In January 1997, the Rajabhat Institutes (the governing body of the colleges) announced it would formalize the ban, which would extend to all campuses at the start of the 1997 academic year.The ban was quietly rescinded later in the year, following the replacement of the Minister of Education., satree lek), later portrayed in two Thai movies, won the Thai national championship.Beginning in 1998, the pageant takes place every year in Pattaya, Thailand during May.With over 100 applicants, the pageant is considered to be one of the most popular transsexual pageants in the world.One must provide evidence of diagnosis of gender dysphoria from a psychologist or psychiatrist.