Peterson examines how transmisogyny was part of colonial statecraft across many parts of the world, focusing in particular on the genocide of two-spirit people in the Americas, the criminalization of the hijra people in India under British rule, the murder of Jennifer Laude in the Philippines by an American soldier, and the policing and sensational press coverage of sex worker Mary Jones in New York City.

[1] Throughout the book, Peterson uses the term trans-feminizing to refer to a process in which people are marked for transmisogynistic violence by an institutional power.

In interviews, she has said she was motivated by a desire to differentiate trans-feminized populations from the contemporary category of self-identified trans women, which she describes as specific to Euro-American culture and inappropriately universalized.

[3] Scholar McKenzie Wark described it as a "game-changer of a book" and "a much-needed account of the genesis of trans misogyny and its subsequent history".

[2][9] Researcher Julianna Neuhouser criticized the book for its perceived orientalist attitude toward travesti populations and lack of engagement with Latin American transfeminism, saying it "[underestimates] the very real problems faced by transfeminine people outside the imperial core while idealizing their lifeways".