[5] She first co-chaired the Pennsylvania Gender Rights Coalition, during which time she recognized the need for a professional activist presence in Washington for transgender people.

In 2007, Keisling and NCTE co-led "United ENDA," a coalition of over 400 LGBTQ rights organizations lobbying for a version of the Employment Non-Discrimination Act that had explicit protections for transgender individuals.

[3] Under the Obama administration, NCTE also successfully lobbied for the modification of State Department regulations, allowing transgender people to change the gender marker on their passport without necessarily having undergone genital reconstruction surgery.

[20] In her capacity as executive director of NCTE, Keisling has been an oft-cited source of political commentary in mainstream American media.

[6] In 2016, North Carolina Governor Pat McCrory signed the Public Facilities Privacy & Security Act into law, thereby eliminating anti-discrimination protections for LGBTQ people and legislating that, in government buildings, individuals may only use restrooms and changing facilities that correspond to the sex listed on their birth certificates.

[34] As she recounted to BuzzFeed News, other women in the restroom did not respond negatively to her presence and a state police officer in the area took no action to prevent or reprimand her.

"[41] During this time, transgender activist and journalist Monica Roberts published an article on her GLAAD Media Award winning blog, TransGriot, which accused Keisling of calling her and Dawn Wilson, a fellow Black Southern transgender activist, an "uppity n-word" at the 2002 Southern Comfort Conference.