‘For me… it’s a miracle’: injecting beauty among kathoeis in a provincial Thai city

Abstract

Background

The Thai term kathoei refers to non-gender-normative females, males and intersexual individuals at different stages of the transitional spectrum with recognized social and cultural roles in society. Nevertheless, kathoeis are only tolerated in Thai society. Many kathoeis seek social acceptance through beauty and turn to the off-label injection of various ‘beauty drugs’.

Methods

The first author conducted an ethnographic study of injection parties at a wedding studio in a Central Thai provincial city between April and September 2011. Data were gathered through participant observation, focus group discussions and narrative interviews with six participants. All data were collected and analyzed in Thai, and later translated.

Findings

While injection parties provide opportunities for kathoeis to socialize, bond, and share experiential knowledge on chemically-assisted transformation, they also reproduce ideologies of gender, beauty and sexuality that reinforce the notion that if a kathoei is to maintain her beauty, she must use medicines more frequently and in higher doses.

Conclusion

Injection parties among Thai kathoeis feature drug use that is entirely reasonable in terms of their own lay knowledge. Empowering kathoeis, by providing accessible information on chemicals and health in a way that reflects the complexity and diversity of their practices, would be one way to reduce health risks. Society must give more long-term options to kathoeis to build their sense of self, based on things besides being beautiful.

INTRODUCTION

There is renewed interest in the human body among social scientists, an interest which departs from an established biomedical view by studying the human body as the site of socially constructed values and meanings (Morris 2000). Bodies are no longer seen as complete at birth, but as constantly changing to better reflect their owners’ desires and identities (Shilling 1993). Kathoeis (a Thai term for transgender women) are one such group who create their identities through the pursuit of beauty. Kathoeis is a broader term than its Western equivalent, and includes non-gender-normative females, males and intersexual individuals at different stages of the transitional spectrum (Jackson 2000, 2003, 2013) with recognized social and cultural roles in society. However, kathoeis are only tolerated in Thai society (Jackson 1999) and many thus seek social acceptance through beauty.

In Southeast Asia, use of off-label ‘beauty drugs’ by transgender women – usually estrogens, progestogens and anti-androgens – is commonplace. For example, a study among 507 transgender women in Malaysia found 63 per cent used hormones to enlarge their breasts and improve their skin (Teh 2001). Likewise, a study among 147 Filipina transgender women found that up to 70 per cent used hormones and of those 90 per cent had not sought medical advice about this (Winter, Rogando-Sasot and King 2007). In Lao PDR, Winter and Rogando-Sasot (2009) found 37 per cent of 214 transgender women used hormones, with a mean age of initiation at 16.8 years.

In Thailand, 89 per cent of 474 kathoeis were found to use hormones and of those 75 per cent relied on injections; as in other Southeast Asian countries, this was usually not advised or supervised by medical personnel (Guadamuz et al. 2011a).

Beauty is important for kathoeis. Thai society values those who are beautiful; there is an assumption that the ‘beautiful’ are also skillful. Using drugs to enable bodily transformation is thus the first stage in parting ways with masculinity (Boonyapisomparn, Samakkeekarom and Boonmongkon 2008). Technological advances are driving individualism by providing transgender people with more options to manage their own bodies and to become who they want to be (Webster 2002).

Previous studies of kathoeis have often focused on sexual practices that put them at risk of contracting HIV (Chariyalertsak et al. 2011; Guadamuz et al. 2011a; Guadamuz et al. 2011b; Nemoto et al. 2012; Prabawanti et al. 2011). Studies of kathoeis’ use of medicines have focused on their use of hormones, on the impact of hormones on their bodies, or on their access to information about medicines (Gooren, Sungkaew and Giltay 2013; Guadamuz et al. 2011a). But the chemically-assisted pursuit of beauty among kathoeis is more complex than just hormone use. As evidenced by the phenomenon of injection parties, kathoeis also consume chemicals to make their skin whiter and firmer, to enlarge their breasts, to make their hair softer, or to look younger.

Popular understandings of medicines tend to view injections favorably, particularly in Thailand. They are perceived as modern, capable of delivering results more rapidly and effectively than other forms of administration (Whyte and Van der Geest 1994). This study shows that Thai kathoeis consider medicines as laden with values and symbolic meanings; by turning to injections, kathoeis reproduce ideologies about gender, beauty and sexuality, whether or not they are aware of it. To understand the complex and dynamic phenomenon of the injection party, we explore the values and meanings kathoeis associate with beauty, how drugs are used to pursue this ideal, and the ‘sociality’ of administration in a provincial city in Central Thailand.

METHODS

The study reported here is an ethnographic investigation conducted by the first author in a Central Thai provincial city between April and September 2011. During this time, he was able to attend over 10 injection parties where he collected data through participant observation, focus group discussions and narrative interviews with six participants. Focus group discussions were often informal and emerged naturally. The ethnographer revealed to other party attendees that he identifies as a male, a pharmacist, and a doctoral student. The ethnographer was introduced to one of the six participants through a friend. Over time, he was able to gain access to these parties as he developed rapport and gained trust from party attendees. All data were collected and analyzed in Thai, and later translated.

Setting

The primary setting for the study was a wedding studio. In Thailand, as in many other countries in Southeast Asia, wedding studios provide services to facilitate all aspects of the ceremony and preparations leading up to it, including shooting pre-wedding photos, renting various kinds of dresses/suits/tuxedos, as well as hair styling and make-up services for all occasions. Several transgender women worked in this particular wedding studio, which had become a magnet for transgender women in this city. This does not mean, however, that all wedding studios in Thailand are similar. Instead, it serves as an example of a transgender space where social activities, including injection parties, take place.

Participants

The full-time staff of the wedding studio included three transgender women (henceforth referred to as kathoeis) and three gay/bisexual men. The three kathoei sisters were co-owners of the studio and included Sand (30 years old) and the twins, Namdaeng and Som (29 years old). Namdaeng was the main investor and had the largest share in the studio; she handled all money-related matters. The gay-identified men were Nok (24) and Aee (24), the studio’s hair and makeup stylists. The bisexual man, Jeng (30), took care of cleaning, merchandise delivery and manual labor-related tasks. Additionally, a group of young kathoeis – Gaei (22), Pim (17) and Mai (18) – worked as apprentices; they received small stipends and enjoyed free room and board at the studio. Everyone respected Sand, Namdaeng and Som and regarded them as kathoei sisters/mothers.

Two more kathoeis regularly frequented the studio but did not work there: Aae (24) and Ribbon (30). Aae’s relationship with the studio began as a customer who needed specialty clothes, makeup and hair styling when preparing for a well-known national transgender pageant. Since that time, Aae had been coming to the studio from Bangkok (a two-hour drive) two to three times a week, sometimes staying for several nights. Ribbon had known the three sisters since she started transitioning 15 years ago in tenth grade. She would receive hormones, styling and beauty tips from Namdaeng and Som, including advice on traveling to Hong Kong to provide sexual services. Each time Ribbon returned to Thailand, she would stop by the studio to socialize with the other kathoeis. The wedding studio is a social space for kathoeis and other sexual/gender minorities in the area. Since the studio was large, enjoyed privacy, and was surrounded by things that promoted ‘beauty’ (different types of feminine dresses, quality accessories and makeup products), it was a magnet that drew in kathoeis from the community.

The injection parties emerged at the wedding studio through Aae, regarded as the most beautiful in the group and one of the most experienced in Bangkok in the injecting of chemicals. She introduced ideas of ‘beauty through injections’ to the group. At each party, the full-time public health nurse Phi Jup (48), who attended in her free time, administered the injections (Phi means an elder sibling, usually as an honorific, intimate and yet respectful salutation). As an older female, others at the wedding studio regarded Phi Jup as knowledgeable, wise and kind. Sand met her through volunteering (providing makeup and hair styling) at health promotion/public health events. Sand eventually brought some chemicals from Bangkok and asked Phi Jup to inject her with them. Since then, Phi Jup had not only provided injecting services to Sand and the kathoei group at the wedding studio but also brought various chemicals and samples to the party, even offering layaway plans where kathoeis could inject now and pay later in installments.

FINDINGS

Kathoeis’ world revolves around beauty

As there is no specific word to describe good looks for a kathoei, the word suai or ‘beauty’ has been appropriated from mainstream gender discourse. Ideals of womanly beauty unavoidably influence kathoeis when femininity is the defining characteristic of beauty, be it beauty of a womanly figure, or beauty of the skin, hair, breasts or even vaginas. For body shape, the key criteria of feminine beauty are slimness and the absence of masculine-looking features (e.g. muscles). Kathoeis who have big muscles are sometimes abusively called ‘buffalo kathoeis’, whereas those who are very slim and tall may be branded ‘pret kathoeis’ (pret are tall ghosts with needles as mouths in Thai folklore). For hair, the desired characteristics are thickness, softness, and shine. How the beauty of skin is defined is more complicated, with all the following characteristics playing a part: whiteness, fairness, brightness, aura, glow, firmness, elasticity, hydration, a healthy flushed look, smoothness, softness, evenness and the absence of wrinkles, blemishes, freckles and spots.

Not all kathoeis desire large breasts, but prefer a size that looks appropriate to their body. Many have learnt that having small breasts can in fact be an advantage as it helps them look more like Thai women, or like very young Thai women. Kathoeis in this study gave breasts a symbolic meaning that goes beyond sexual attractiveness: having feminine breasts signifies that one has already passed the transformation from a kathoei child to a grown-up, or in other words, from a feminine-being-in-the-making to a complete one. One reason for this is that gaining beautiful breasts through surgery is something only well-off, financially independent kathoeis are able to do. On the matter of primary sexual organs, kathoeis are divided between (1) kathoeis with a ‘snake’ – in other words, a penis – who believe that it is something to be proud of and a source of sexual pleasure; and (2) kathoeis who believe that obtaining a vagina through genital surgery gives them confidence and is another step to becoming a ‘complete’ woman. For some in the latter group, having a vagina also means access to considerable extra income from sex work. Aae, for example, feels happy and proud every time a man is satisfied enough to return to ‘eat her pussy’. Ribbon uses her vagina as part of sex work to improve her quality of life.

Among Thai kathoeis, beauty is a basic necessity and a requirement for becoming complete. Constructing one’s beauty means building one’s self-confidence as kathoeis who are not considered beautiful are frequently looked down upon and gossiped about, by both outsiders and by other kathoeis. Their social roles are limited to comedic figures, sometimes referred to as ‘buffalo kathoeis’ (a type of kathoei, one that is fat and dark-skinned). Informants say they face more pressure to attain beauty than do ordinary Thai women in order to obtain approval from society:

Som: If you’re to wear women’s clothing, you’ve got to be a beautiful woman and look good. We can’t go out and have others condemn us. Having been born as kathoeis, we are constantly under the gaze of others. If there’s any minor imperfection, we’ll surely be gossiped about and blamed. If we’re not to give them a chance to blame us, we’ve got to be super confident each time we go out. ‘Oh, so pretty! More beautiful than women!’ I feel so proud that in this life I’ve been able to achieve it – looking better than real women who haven’t ever given a thought to these things that they call ‘image’.

Injectable wonders: beauty crafted as desire

In times past, kathoeis could only look more feminine by choosing feminine clothing and accessories, or by applying makeup. In the current era, medical technologies can now overcome many biological limitations. Kathoeis now have easy access to feminine beauty through the use of chemicals, guided by their own and their friends’ experiences, independent of biomedical gatekeepers.

All chemicals used in the injection parties were injectables, which our informants believe are more powerful than chemicals administered in other ways. The effects can be felt immediately, for example by smelling the chemical in one’s nose, or by feeling the burning sensation some of these chemicals cause in one’s veins when injected intravenously. These sensations are considered harbingers of the beauty that will soon follow. Importantly, injectables are not at all difficult to obtain – they can be bought online for much less than they would cost at clinics. Kathoeis also feel that to maintain or increase their beauty, all they need to do is inject larger doses, inject more often, and inject more continuously. For these reasons, injectables become necessities in kathoeis’ lives:

Namdaeng: These chemicals are strange. Really, it’s unbelievable that they can make you beautiful. It’s confusing! Like, hormones or contraceptives – it’s not that they did some research and found out that, er, they’ll make a man beautiful, but kathoeis just started to use them and realized that really, they do make you beautiful. There will be changes. It is strange.

Injection parties: transforming beauty

The terms ‘drug party’ and ‘injection party’ emerged through kathoeis in the wedding studio likening their events to a ‘party’. But kathoeis in the group also used other terms such as ‘coming to make beautiful’ or ‘coming to inject beauty drugs’. The terms reflect the fun, party-like, and supportive atmosphere where kathoeis come together to make one another beautiful. One necessity is a room for injecting – which group members call ‘the secret room’ – since injecting outside medical establishments by non-medical personnel is illegal and injectables purchased online are not approved by the Thai authorities. Arranging injection parties therefore runs the risk of legal consequences. For this reason, only trusted friends and acquaintances can attend these parties and injections cannot be given openly. The secret room is on the second or third floor of the studio, which is normally not open to the public. Special equipment is not required – just a bed for lying down and a pillow to support one’s arm when receiving an injection.

The injectables, which our informants called ‘beauty drugs’, include glutathione, vitamin C, collagen, and placenta-based preparations, all of which are available in various formulas and under different brand names. The products are brought by Phi Jup. She would often bring samples of new products to present to the group, or take requests for the following week’s party. This is how Phi Jup makes her money since her injection services are free. Should anyone be too impatient to wait until the following party, they can borrow drugs from their friends or from Phi Jup and pay later. Injection equipment, such as needles and syringes, are bought collectively by group members, with each contributing 100 baht each time a new lot has to be bought. Other equipment such as saline solution for mixing the injectables, scalp vein needles, tourniquets, cotton wool, rubbing alcohol, and plasters are provided by Phi Jup, free of charge to group members. Finally, each gathering will feature energetic music from beginning to end to give the event a fun, party-like atmosphere. In sum, the key characteristics of an injection party are a secret room, beauty drugs, someone to perform the injections, equipment, and music.

The main objective of these injection parties is to enhance attendees’ beauty. The journey to beauty begins by opening the door to the secret room. But before any injections are administered, attendees must first settle their bill with Phi Jup or their friends. Many pay for their beauty drugs in installments, like paying an entrance fee to the party. After payments have been made, all group members will gather in a circle around the bed to choose which drugs they will inject. Phi Jup will have each member place the drugs they want injected in front of them. This is when attendees share their experiences of what each previously injected, and which substances gave good results. Many will boast about their body shape or skin and compete with each other over who looks the most beautiful. Some will turn to Phi Jup with questions, for example how many ampoules or mini bottles of each chemical must be injected at a time, how long each chemical must be used to attain results, and how frequently they can be used. Attendees also talk about the advantages and drawbacks of each product, the price of products, and how to attain them; changes in dosage or modifications of usage often follow. In sum, this is a time for exchanging information both among the group members and with Phi Jup.

When everyone has placed their chosen pharmaceuticals in front of them, Phi Jup will prepare the injections, one by one. She will do this by using a 10 cc syringe and a needle for dissolving dried powder preparations in saline solution, or by simply loading each syringe with the desired mixture of preparations sold in liquid form. Vitamin C will usually be injected separately from the other substances because as an acid, it will cause pain when injected, which the group members refer to as a burning sensation in their veins. When all preparations are complete, everyone will have loaded syringes in front of them, some of them boasting a full set of three syringes.

Phi Jup does not prepare all the concoctions; some of our kathoei informants like Namdaeng and Som, will prepare their own. How they do so is based on trial and error, and attracts a great deal of interest from other group members who watch with excitement as they break the neck of an ampoule; glass shards can ruin the product and sometimes the entire ampoule breaks in their hand. Nevertheless, Namdaeng and Som insist on doing their own preparation work. Mixing beauty drugs in a syringe is akin to experimentation. For example, dissolving glutathione in vitamin C solution (instead of normal saline solution) has become popular in the group as they believe faster results can be obtained when both substances act simultaneously:

Namdaeng: They say that if you want gluta to act fast, you’ve got to add vitamin C. The gluta will cause the vitamin C to be absorbed first. You’ll take two bottles of vitamin C and inject it into the gluta bottles, then load it all together. Add the vitamin C straight in. Wow… really professional…

Mixing chemicals has its purpose. In Namdaeng’s case, mixing glutathione and vitamin C will make the skin whiter. A popular mixture for younger-looking skin is placenta (for firmer, more radiant skin) and collagen (against wrinkles). By mixing chemicals, participants believe that the effects will come faster.

The preparation stage, which has many steps, is also free time for group members to socialize. Hilarious stories are told about men, beauty, managing charisma, beauty drugs, work, celebrities and other aspects of kathoei life. Many of the stories are about sex. Teasing each other, dancing, and jumping and running around trying to grab each other’s behinds are normal occurrences, as is boasting about and exhibiting one’s beauty, including that of one’s breasts or vagina. The injection parties are thus an intimate form of socializing among kathoeis, often filled with laughter in a relaxing and private space.

When all the preparation work is done, it is time to inject each member with beauty. The order in which group members have their preparations injected is voluntary, but if anyone is in a hurry to leave, they can be injected first. Usually the order of injection follows the order of preparation. Group members can negotiate with Phi Jup about which arm will be injected. When someone is ready to be injected, they will climb on the bed and lie down, facing the ceiling; a pillow will support their elbow. For multiple-syringe injections, Phi Jup will use a scalp vein needle instead of the needle used to mix the drugs, which means she will only need to prick the vein once. She will ensure no air remains in the syringe, clean the injection spot with alcohol, find a vein, and prick it. Then she will inject the cocktail. Group members who are afraid of injections will look the other way or close their eyes, which inevitably attracts friendly teasing from other group members. Others may climb onto the bed to gently touch the skin of the person receiving the injection, who cannot move.

One principle among group members is making the most of the drugs, which means Phi Jup needs to ensure that the preparations are injected to the last drop. After all, these are expensive chemicals. Even when group members ask Phi Jup to stop out of pain, she will simply remove the syringe and add more saline solution to dilute the preparation, then continue injecting, reasoning with them that it would be a shame to waste it. When the injection is complete, the same ball of cotton wool first used to clean the spot is used to close the wound. The person who received the injection will bend her arm around it, climb off the bed to make way for the next one, and revert to being a spectator and rejoining the fun of the party.

In these parties, it seems as if beauty is already contained in the injectable itself, with each attendee simply choosing the kind of beauty she desires. Should she wish to have whiter skin, she can find that in the glutathione ampoules. Should she want firm, well-hydrated and youthful skin, it would be in the placenta products. Or should she desire elastic, wrinkle-free skin, it would be in the collagen ampoules. Party attendees can simply mix and match their injectables to gain their preferred kind of beauty, while Phi Jup has the role of transferring the beauty contained in the injectables into the party attendees’ bodies through her access to medical technology that ordinary people do not have. When the drugs have fully entered the recipient’s body, that body will no longer appear to be the same, but become a body supercharged with beauty. Each time Phi Jup removes the needle from someone’s arm, group members instantly express their admiration: ‘oh…so beautiful’, ‘yes, beautiful’, ‘beautiful, immediately!’, ‘oh… awesome!’, ‘beautiful already’, ‘oh, beautiful straight away, to think of it, the medicine hardly had time to go in, and yet elder sister already looks pretty!’ As for those who have already received their injections, their facial expressions convey their satisfaction: ‘I’m already beautiful!’ Some rush to compare their arms with those of other members in the group to see if they have really become whiter, even if only a few seconds have passed since their glutathione injection.

The duration of these injection parties is roughly 2–3 hours, depending on the number of attendees. They begin at dusk and finish late at night. Large parties are usually arranged once a week, mostly depending on Phi Jup’s availability. Group members are informed of upcoming parties by telephone. Smaller events are also arranged with the core members of the group who are in a particular hurry to see rapid effects every 3–4 days. If group members do not have the time to attend, they may visit Phi Jup at her home. But this does not happen often; in addition to beautification, the parties are opportunities for kathoeis to socialize with their peers, exchange experiences, bond and enjoy the festive atmosphere.

DISCUSSION

Beauty as capital

If beauty is a basic necessity for kathoeis, it must clearly play an important role in their lives. Considering this through Pierre Bourdieu’s expanded understanding of capital, we see that human bodies are a form of social and symbolic capital that can be exchanged with other kinds of capital; altering the body is thus a form of capital accumulation (Kaewthep and Hinviman 2008). In this sense, the construction of beauty kathoeis engage in does not differ from other kinds of capital accumulation. Firstly, beauty is used as capital to claim social space. It gives kathoeis increased confidence to interact with others and transform the perspectives of outsiders – from viewing kathoeis as an oddity to viewing them with admiration for their beauty, thus reducing the social stigma felt by kathoeis. Beauty helps kathoeis build their sense of self, both within kathoei circles and in society at large.

Secondly, beauty is used as capital to choose a partner or to be chosen as a partner. Among kathoeis, beauty tends to realize its value when successfully used to attract a desirable partner. Managing to do so increases her status among other kathoeis. This is clear from A’s experience. Given her ample bodily capital, she was able to manage her charms to choose a man she wanted. Besides being able to choose, being chosen can also be a confirmation of one’s beauty. A, for example, used the national kathoei beauty contest to measure her beauty; for those involved in sex work like Nam Daeng and Som, being chosen by a customer is taken as a mark of beauty. Some kathoeis sell sex not just for the money, but because being chosen by a customer gives them status among other kathoeis.

Finally, beauty can also be rendered into economic capital as it gives kathoeis more work options beyond stereotypical kathoei occupations such as makeup artist, stylist, cabaret performer, or sex worker. But beauty is important even in sex work because the more beautiful one is, the more income one can earn. Whether in beauty contests, with potential partners, or with sex work clients, those who are more beautiful are more likely to be chosen, to be admired. The construction of beauty among kathoeis has no finite endpoint, but goes always further, from pretty to prettier still. Or as one kathoei puts it: ‘If you’re a kathoei, don’t stop being beautiful.’

Injectable drugs as vehicles of ideology

The social organization of Thai society has a feature known as the entourage – a closely-knit group of friends. Especially in rural society, kinship-based groupings are common. Seniority is respected, members have empathy for one another, and group members tend to have shared values in matters such as religion (Potter 1976). As group phenomena, injection parties reflect such patterns within Thai kathoei society. Kathoeis use injection parties as a social space to express symbolic value. The ideology of beauty is produced and reproduced in these parties by both group members and Phi Jup. Expressions and greetings like ‘you do look better’, ‘your skin is better’, or ‘your wrinkles are gone’ reinforce this ideology. All the injectables Phi Jup recommends to the group tend to be presented only in terms of their effectiveness and rapid results, reinforced by personal anecdotes such as ‘this is a good one, I also use it’.

But in practice, there is a great deal of variation between individual kathoei in the effects they experience. There are also negative side-effects which kathoeis acknowledge, including feeling queasy, feeling moody, vomiting, headaches, dizziness, gaining weight, and knowing that these chemicals can damage one’s liver and kidneys. Regardless, they use a method of trial and error to find the right formula for each person, or ‘the right fit’. In Thai, this is called thuk gun, similar to hiyang in the Philippines and cocok in Indonesia. In order to find chemicals that are thuk gun with their specific bodies (those that deliver the intended results while minimizing side-effects), kathoies constantly experiment on their bodies with different chemicals, dosages, mixtures and frequency of injections.

Meanwhile, the constantly reproduced beauty ideology reinforces the notion that if a kathoei is to maintain her beauty, she must use drugs more frequently, in higher doses, and more continuously. In this sense, the ideology of beauty is similar to consumerist market ideology, which fits Baudrillard’s notion that the ‘needs’ of consumers are the real objective of the capitalist system (Baudrillard 1995). The subtle production and reproduction of the need for beauty among kathoeis can thus be considered a process that turns kathoeis into passive victims with limited chances to refuse, oppose or negotiate the process – ‘when beauty has no finite endpoint, then neither have injections’. Being on the margins of the heteronormative majority also increases kathoeis’ vulnerability to harassment and abuse, violence, drug and alcohol use and unsafe sexual practices (Winter 2009, 2012; World Health Organization and Asia Pacific Transgender Network 2013).

CONCLUSION AND IMPLICATIONS

Because our kathoei informants do not have the bodily capital that can constitute womanly beauty from birth, they have to resort to the careful, continuous modification of their bodies. Injections in this context are instant infusions of beauty. Their new bodies, in turn, provide opportunities to acquire more capital, social space, and both economic and romantic opportunities. Within the injection party, the construction of beauty becomes an easy and fun thing to do, while truths about beauty and chemicals are constantly reinterpreted, based on kathoeis’ individual learning experiences or thuk gun. Although medical knowledge is invoked at these parties, it is done to increase credibility rather than to confirm its principles.

The findings of this study on the complex phenomenon of injectable chemical use among Thai kathoeis present serious challenges to our general understanding of medicine use. Individual chemical use that does not fit with professional medical understandings is often branded by the latter as irrational (Lupton 1999). Yet, the injection parties arranged among Thai kathoeis feature drug use that is entirely reasonable in terms of their own lay knowledge, acquired on the basis of experience.

Empowering kathoeis by making available transgender-specific services that provide accessible information about chemicals and health in a way that both reflects the complexity and diversity of their health practices would be one important way to reduce health risks. It could also help to reduce the exploitation they are subjected to by entrepreneurs willing to profit from their greater understanding of and access to chemicals and medicines. More importantly still, society must give more long-term options to kathoeis to build their sense of self, based on things besides being beautiful. Only then could each kathoei individual build her sense of self based on what she truly wants, and be freed of her dependence on drugs.