Popular history often credits the Stonewall Uprising of 1969 as the birth of the modern gay rights movement. But the two most prominent figures who threw the first punches were not "gay men" in the modern stereotype; they were trans women and gender non-conforming drag queens: and Sylvia Rivera .

The most distinct challenge facing the transgender community, which sets it apart from LGB issues, is the fight for medical autonomy. Access to gender-affirming care—puberty blockers, hormone replacement therapy (HRT), and gender-affirming surgeries—is a matter of life and death. Studies consistently show that trans individuals with access to affirming care have drastically lower rates of suicide and depression.

The modern rights movement gained momentum through events like the Stonewall Riots (1969) and the Compton’s Cafeteria Riot (1966) , which were led largely by transgender women and drag queens fighting back against police harassment.