Digital composite.
A sixteen year old "ladyboy" in Pakchong, Thailand ponders her gender identity.
The male and female signs indicated that the restrooms did not discern males from females, but was used in this case to illustrate the identity struggle that many young people face.
Ladyboys are very common throughout Thailand and rarely treated differently from anyone else. The term "ladyboy" can be affectionate or derogative depending on the tone and intention of the speaker.
I have observed that Thai people are very good at interpreting the intention of the speaker based on body language and facial expression and will rarely be offended by the use of an "incorrect" pronoun.