Despite the growing visibility and acceptance of extreme ladyboys, the community still faces significant challenges and controversies. Some of the issues include:

Despite the growing visibility and acceptance of LGBTQ+ individuals, extreme ladyboys often face significant challenges. One of the primary issues is societal acceptance. In many parts of the world, even within the more open and accepting communities, there remains a threshold of acceptability regarding gender and sexual expression. Extreme ladyboys often find themselves on the fringes of these communities, facing judgment and exclusion from both mainstream society and parts of the LGBTQ+ community itself.