[11] Cox appeared as a contestant on the first season of VH1's reality show I Want to Work for Diddy, and co-produced and co-hosted the VH1 makeover television series TRANSform Me.

In April 2014, Cox was honored by GLAAD with its Stephen F. Kolzak Award for her work as an advocate for the transgender community.

[25] She then studied for two years at Indiana University Bloomington[26] before transferring to Marymount Manhattan College in New York City, where she switched from dancing (specifically classical ballet)[27] to acting.

[29] During her first season on Orange Is the New Black, she was still appearing at a restaurant on the Lower East Side as a drag queen (where she had applied initially to work as a waitress).

[31] From that came the makeover television series TRANSform Me, which made Cox the first African-American transgender person to produce and star in her own TV show.

"[34][35][36] She has also acted in a number of TV shows and films, including Law & Order: Special Victims Unit, Bored to Death, and Musical Chairs.

In 2013, Cox began her recurring role in the Netflix series Orange is the New Black as Sophia Burset, a trans woman sent to prison for credit-card fraud.

[13][41][42] Later in 2014, Cox became the first transgender person to be nominated for a Primetime Emmy Award in an acting category: Outstanding Guest Actress in a Comedy Series for her role as Sophia Burset in Orange Is the New Black.

[47] But when Cox learned that Blast was found guilty of the 1993 rape and murder of a 13-year-old child, she wrote on her Tumblr, "I was not aware of the charges for which she was convicted.

[48] Cox was also on the cover of the October 2014 issue of Essence magazine, along with actresses Alfre Woodard, Nicole Beharie, and Danai Gurira.

[50] That same year, Cox was featured on the fifth anniversary cover of C☆NDY magazine along with 13 other transgender women—Janet Mock, Carmen Carrera, Geena Rocero, Isis King, Gisele Alicea, Leyna Ramous, Dina Marie, Nina Poon, Juliana Huxtable, Niki M'nray, Pêche Di, Carmen Xtravaganza (House of Xtravaganza), and Yasmine Petty.

[57] Cox was nominated in 2017 for a Primetime Emmy Award for Outstanding Guest Actress in a Drama Series for her role in Orange Is the New Black.

[63][64][65] In September 2019, Cox brought ACLU attorney Chase Strangio as her date to the 2019 Emmy Awards, and carried a custom rainbow clutch featuring the phrases "Oct 8", "Title VII", and "Supreme Court".

[71] In December 2021, she was cast in Netflix's dystopian fantasy film The Uglies directed by McG, based on a book of the same name by Scott Westerfeld.

[73] Cox has been noted by her LGBT peers, and many others, for being a trailblazer for the transgender community,[74] and has won numerous awards for her activist approach in spreading awareness.

[77] In May 2016, Cox was awarded an Honorary Doctorate from The New School in New York City for her progressive work in the fight for gender equality.