Faye explores how issues of social class, employment and housing insecurity, police violence and prisons, and sex work affect transgender people.

She drew from Revolting Prostitutes and Why I'm No Longer Talking to White People About Race in her writing, while reviews frequently contrasted it with Helen Joyce's Trans: When Ideology Meets Reality, which was published in the same year.

The book covers a range of issues through the lens of how they affect transgender and non-binary people, including: bodily autonomy and sexual liberation; class discrimination; healthcare; sex work; job and housing insecurity; and police violence, prisons and treatment of asylum seekers.

[9] Several reviews contrasted the book with Helen Joyce's Trans: When Ideology Meets Reality and Kathleen Stock's Material Girls, both published the same year.

[3][10][11] Sophie McBain of the New Statesman gave a comparative review of The Transgender Issue and Trans, concluding that "if you find yourself nodding in agreement with Helen Joyce, I can only recommend that the next writer you read is Shon Faye".

McBain praised The Transgender Issue as "a bracing and vital corrective to mainstream writing on trans rights", but criticised "self-defeating" political positions such as opposition of increased police diversity.

Patterson praised her as a "highly intelligent" author who "writes with compassion and clarity about marginalised groups", but criticised that she "doesn't fully acknowledge" that some of her proposed ideas "clash with the rights of" cisgender women.

[3] The Guardian's Felix Moore was "profoundly grateful" for the book, lauding that Faye's analogies "deftly answer complicated questions" and "shatter the divide whereby trans people are seen as incomprehensible and separate from all other groups".

Sturges stated that the book was "measured in tone" and contained "a cool dismantling of the myths and falsehoods that continue to blight [trans people's] lives".

However, O'Malley criticised incomplete exploration of transgender mental health, some "leaps of logic" and "shallow" argumentation, and said that the book intersperses "dependable peer-reviewed evidence with much more dubious sources such as online surveys".