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Background Spirit mediums, or maa khii serve as intermediaries between the spirit world and human concerns like health and prosperity. Traditionally female, this role has increasingly been assumed by gender-diverse males in Northern Thailand over the past 50 years. Aim To investigate the sociocultural conditions that may enable gender- and sexually-diverse male spirit mediums to thrive despite broader social marginalization. Methods Ethnographic research was conducted in 2006, 2013, 2015, and 2025, including in-depth interviews with self-identified male maa khii. Topics included gender identity, sexual orientation, social acceptance, sexual relationships, and health, including HIV/STI risk. Results While gender-diverse males in Thailand face stigma and discrimination, those serving as spirit mediums often gain cultural legitimacy and social respect within spirit-worship communities. This role can enhance familial and communal bonds and support well-being. Discussion Spirit mediumship enables a “gender duet,” where participants fluidly embody both masculine and feminine roles. This ritualized duality fosters resilience and partial social inclusion. While male maa khii benefit from spiritual authority and familial acceptance, structural barriers persist, especially regarding romantic relationships, intimacy, and health equity. Conclusions The role of male maa khii represents a culturally embedded, strength-based model of resilience and conditional inclusion for gender-diverse individuals. This position may act as a protective factor for health and psychosocial outcomes. Further comparative research is needed to assess whether similar roles exist for LGBTQ+ populations elsewhere in Southeast Asia.
Coleman et al. (Thu,) studied this question.