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While gay and lesbian people fought for the removal of homosexuality from the DSM (Diagnostic and Statistical Manual of Mental Disorders) in 1973, the trans community still requires a diagnosis—Gender Dysphoria—to access insurance coverage for hormones and surgery. This creates a culture of gatekeeping .

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These aesthetics are now bleeding into mainstream gay male and lesbian fashion. The "femboy" look popularized on social media owes much to trans women’s early online tutorials. The "butch with top surgery" look is now common among cis lesbians who are not trans but desire a flat chest. In Western LGBTQ culture, the focus is often on marriage and corporate pride flags. For the transgender community globally, the focus is on survival. While gay and lesbian people fought for the