For a 25-year-old self-identified katoey like Tetay, there's nothing more important than having the perfect female appearance when dressing as a woman. In daily life, Tetay dresses as a stylish man, while attending parties or special functions means he dresses as a glamorous woman.
Heavy make-up, colourful hair and sexy dresses are his first choice. To overcome any obvious sign of having male genitals, Tetay completes the look with a crucial procedure -- the secret weapon -- for katoeys who wear tight-fitting dresses, the tab (tuck).
Tabbing is the method used to conceal a man's genitals by wearing multiple layers of underwear and using duct tape to push the genitals back in between the legs.
"To be honest, the only thing I am concerned about is beauty," Tetay said. "I don't really care much about any health issue as long as I can wear tight clothes with nothing showing in the area where it should not be -- like a woman."
But transgender leaders and some medical experts believe strapping one's sexual organs for too long can lead to serious health issues.
ART OF CONCEALMENT
Earlier this month, transgender internet idol Pancake became a hot topic on social media when it was revealed she was undergoing penile cancer treatment. Discussion centred around the cause -- with some suggesting tabbing as the likely trigger.
GREAT CAPE: Transgender woman Tetay in full performance mode.
Pancake shot to fame three years ago with humorous depictions of life as a transgender woman in rural Isan, and has 466,000 followers on Facebook.
She would tape up her genitals for photo shoots every day, and often leave them that way overnight.
While the cause of Pancake's cancer is unclear, she remains in hospital. Part of her penis was removed in an attempt to stop the spread of cancerous cells. In a Facebook update >> >> late last week, she said she was very ill and there was a possibility the cancer would soon spread to her lymph nodes.
To the casual observer of her social media posts, Pancake appears like a post-op transgender woman -- even while wearing a bikini or tight dress. The art of concealment, or tabbing, ensures no lump is visible.
Tetay tabs whenever the need arises. As the cheer squad leader for the Thammasat University football team, Tetay dresses in female clothing and entertains the crowd at matches.
In preparation, he told Spectrum, he urinates one final time before beginning the process of tabbing. He places duct tape on one side of clean-shaven skin and wraps the tape across the genital area. He then spreads his legs, in order to push the testes back into the inguinal canal, before sticking another piece of duct tape back towards the buttocks to keep the penis in place and out of frontal view.
"I won't be able to urinate for many hours but it's worth it. I feel more confident in women's clothes and I look beautiful in them," Tetay said. "I have no idea if it can lead to health problems. It's a concern but I will try to keep myself as clean as possible in order to avoid complications."
Mimi Tao, a 22-year-old professional model and another pre-op transgender woman, is often required to wear a small bikini for fashion shoots. She also uses duct tape to conceal her genitals while working. Sometimes the hours are so long she has to undo the tape to release the pressure.
Mimi is not alarmed over potential health issues of tabbing.
"Every pre-op transgender is doing this," she said. "We tab when it is necessary and undo it when we don't have to. I have been doing this for so long and I am sure I will be safe."
DEBATE RAGES ON SOCIAL MEDIA
Social media debate on whether tabbing can lead to penile cancer ran hot following news of Pancake's diagnosis.
One medical technician, Pakphoom Dejhassadin, who hosts a Facebook page titled Mor Lab Panda, has discussed the issue at length for his 300,000 followers. Pancake's penile cancer diagnosis was due to her habit of tabbing for too long -- often all day and sometimes overnight, his Facebook page states. This meant she was holding urine in too long which can cause urinary tract infections, which might lead to cancer, he believes.
He said that when the genital area is tight for a long time, the skin in that area can become infected. This can lead to the development of smegma, which contains mycobacterium smegmatis, a bacteria. This bacteria is more common in uncircumcised men.
HIGH FASHION: Transgender woman Mimi Tao, right, works as a model, but isn't concerned about the risks of tabbing.
An adolescent medicine specialist who founded the Gender Variation Clinic at Ramathibodi Hospital, Jiraporn Arunakul told Spectrum penile cancer is more likely caused by a lack of hygiene.
"Tightening any area on the body too much is not a good thing to do," Dr Jiraporn said. "Anything against the natural way is not good. I suggest cleaning the genital area well before tabbing to avoid health issues."
Dr Jiraporn said human papillomavirus (HPV) is of greater concern. "HPV can cause penile cancer, anal cancer and the more commonly caught oral cancer," she said.
"Vaccination, which can be done at any hospital from the age of nine, is the best prevention method.
"Normally I recommend this to women but men, especially those at high risk such as transgender or gay men, should be vaccinated as well. There are not many viruses that can be prevented with vaccines but HPV is one of them."
Awareness is one key step in prevention. A stigma and care support worker at Pattaya's Red Cross, Somkoun Kongdee, has educated transgender sex workers on the importance of hygiene.
"None of the katoey I talked to said they will stop concealing their private parts," she said.
"They have been doing it for so long and they are still perfectly healthy. As a healthcare person, my advice is to keep the private area clean and practise safe sex."
Thai Red Cross Aids Research Centre chief of prevention Nittaya Phanuphak
The Thai Transgender Alliance (TTA) has also reacted to the issue by posting an info-graphic on Facebook on how to tab safely. If done correctly, it won't cause cancer, their Facebook post states, and lists symptoms -- such as the presence of blood and bad odours -- that should be considered warning signs. TTA coordinatior Jetsada Taesombat told Spectrum pre-op transgenders were generally unconcerned with health issues related to tabbing.
"We have no idea whether tabbing causes health issues," she said. "I tell people in the community to be hygienic in order to avoid unwanted health problems.
"I know many transgenders wrap their breasts or genital area to build up confidence. Many do it to pass as the opposite sex for their work or to fit in with an expectation from society."
The TTA works to empower transgender people to love and respect their identity. "I want all transgenders to be able to express themselves in their own way without having to follow the social norm," Jetsada said.
LACK OF HYGIENE
Thai Red Cross Aids Research Centre chief of prevention Nittaya Phanuphak has been aware of issues relating to tabbing since running Thailand's first transgender clinic, Bangkok-based Tangerine, of which she is the director.
She told Spectrum that although she doesn't know the details of Pancake's case, penile cancer generally occurs for three main reasons: HPV, smoking and a lack of hygiene, especially among uncircumcised men. "Circumcision is an effective way to maintain hygiene in the genital area," she said. "In addition to good hygiene, circumcision can also help prevent HPV, STIs and can reduce the chance of HIV infection by 50 to 60%."
HPV is easy to catch and pass on, especially through oral sex and penetration, she said. But it's rare for HPV to lead to penile cancer, whereas a cervical cancer diagnosis is higher for women. Almost 100% of cervical cancers are caused by HPV compared to 33% of penile cancers.
Dr Nittaya said vaccination is the best weapon against HPV, and the best prevention against penile cancer is hygiene and a healthy lifestyle. "Men should clean the genital area well in order to wash off smegma. Also not smoking is a good way to maintain health. Always wear a condom and don't have multiple sexual partners."
Suffering for her art : Internet idol Pancake goes to great lengths to look like a woman.
DRESSED TO IMPRESS: Below, transgender woman Tetay, left, seeks to emulate the female appearance.
STRAPPED IN: Below right, 'tabbing' is used by transgender models or pageant contestants to appear feminine in a bikini.