Hoping to outperform his rejecting mother and become the greatest lot lizard of them all, he goes off on his own into the wilds of West Virginia and is eventually taken up by a very powerful and very dangerous pimp known as Le Loup.

Unaware that this new girl is a boy, Le Loup uses him not to turn tricks but as an object of veneration – and donations – with luck-conscious and magic-fearing truckers.

These qualities temper the harsh themes this novel shares with the other JT LeRoy books: abuse, exploitation, abandonment, betrayal, loss.

Like them, it also explores the dynamics of identity and gender and employs the plot situation of having one's hidden life exposed and the shaming, hostility, and violence that ensue.

[2] Poet and critic Stephanie Burt called Sarah "a work of art" and "a book about the risks and thrills of false identity," which derives its power "from the glee with which it refuses realism: multiple subjects (sexual trauma, coming out, rural poverty) that American fiction usually depicts with flat-footed seriousness instead come together for a Technicolor romp.