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Families (and especially fathers) are typically disappointed if a child becomes a kathoey, and kathoeys often have to face the prospect of coming out.
The phenomenon is not restricted to urban areas; there are kathoeys in most villages, and kathoey beauty contests are commonly held as part of local fairs.
Australian scholar of sexual politics in Thailand Peter Jackson claims that the term "kathoey" was used in pre-modern times to refer to intersex people, and that the usage changed in the middle of the twentieth century to cover cross-dressing males.
The term can refer to males who exhibit varying degrees of femininity.
Beginning in 1998, the pageant takes place every year in Pattaya, Thailand during May.
With over 100 applicants, all across Thailand, the pageant is considered to be one of the most popular transgender pageants in the world.
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").