As a note of caution, for those men for whom ladyboys do not appeal, please be sure to treat them with respect. There is one unique factor to consider, regarding ladyboys, that makes Westerners particularly attractive to them; it relates to a problem that is a serious concern for any Thai man who is dating a ladyboy i.e. Even if his parents are accepting of his preferences they will probably still pile on the pressure for him to eventually marry a woman in order that grandchildren can result.The issue of children takes on an extra importance in Thailand compared to the west and it shouldn’t be underestimated.The advice that I’ll offer has been gathered from: I hope and believe that it will be of some use to you.
Aside from surgery, virtually all ladyboys will be taking hormone replacement therapy and they will, in many cases, have been doing so from an early age.
The preference of the Ladyboys themselves will always be to resemble a female as far as possible, but they have to balance that desire against the possible negative effects of a bad surgical procedure (resulting in loss of sensation), the expense, and the loss of some interest from potential boyfriends.
Surgical operations that are much more common are breast and hip implants.
You can decide for yourself whether that makes them male or female, but in Thailand they are simply regarded as belonging to a third sex.
There are even some provisions made for children that identify with belonging to the third sex; some schools provide separate changing rooms and so on.