Despite their visibility and general social tolerance, the community faces significant hurdles:

: In many Southeast Asian cultures, ladyboys are often viewed as a "third gender"—neither strictly male nor female. This identity is tied to historical and religious beliefs, such as the Thai Buddhist concept that being born kathoey is a result of karmic debt.

: Research into the wellbeing of ladyboys in Thailand shows high levels of occupational satisfaction, particularly in performance and service industries, though they still face social challenges like a lack of protective legal policies.