Mtf refers to individuals assigned male at birth but identify themselves female. They could undergo HRT and GCS to align physical appearance with their gender identity. Mtf are often connected to the Josou community and enjoyment expressing their femininity through clothing and cosmetics. Some people may identify as mtf on a part-time or full-time basis, based on their comfort level. In recent years, otoko no ko are becoming more visible and accepted in society, resulting in greater awareness and understanding.