Mtf refers to people assigned male at birth but identify as female. They may undergo HRT and GCS to align their physical appearance with their gender identity. Otoko no ko are frequently connected to the crossdressing community and enjoyment expressing their femininity through clothing and cosmetics. Certain individuals might identify as otoko no ko on a part-time or full-time basis, depending on their comfort level. In recent years, mtf have become more visible and accepted in society, leading to greater awareness and understanding.