The plot explicitly revolves around Sin-Dee's rage at her pimp boyfriend cheating with a cis woman, with subplots highlighting trans experiences of marginalization, sex work, and camaraderie among characters of varying races and transition stages. Casting prioritizes authentic trans performers in lead roles drawn directly from the actresses' real-life anecdotes shared with director Sean Baker during collaborative script development at locations like the LGBT Center and Jack in the Box.

Baker has described starting with minimal plot and incorporating their personal stories of cops, clients, and daily realities to shape the journey, making trans identity the foundational lens rather than incidental. Reception praised the film for spotlighting these lives and shattering casting norms, with critics noting its focus on black and Afro-Latinx trans sex workers, though some trans voices critiqued it as voyeuristic consumption by outsiders. No overt lectures appear, but the identity-driven premise and representation form the core appeal and emotional structure.