While drag is distinct from being transgender (drag is a performance, being trans is an identity), the two are culturally intertwined. The Ballroom scene, immortalized in shows like Pose , was created by Black and Latino trans women and drag queens. It provided "chosen family"—a vital concept in LGBTQ culture that is perhaps most critical for trans youth who face familial rejection. The slang, the "shade," the "reading," and the celebration of "realness" that permeate mainstream gay culture originated largely in trans and gender-nonconforming spaces.

The relationship has not always been harmonious. Historically, some mainstream gay rights organizations attempted to distance themselves from trans issues to make their own goals more palatable to the straight majority. There was a time when the strategy was: "We just want to get married and be normal; don't scare the horses with gender fluidity."