Context is king. If you are writing a blog post (like this one), using the term to explain a cultural phenomenon is descriptive. If you walk up to a vendor and scream "HEY LADYBOY!" that is a slur. The "Top" part of the keyword (the topping) saves the term from being purely offensive; it specifies the product , not the person .
In the mid-2010s, the Thai internet was captivated by a unique figure known as Sexy Pancake ladyboy pancake top
In this context, "Top" refers to the "toppings" or the "presentation tier." It is the visible layer of the pancake that is dressed to impress. In the world of kathoey vendors, the top is everything. It is the aesthetic crown of the dish. Context is king