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The relationship is not without its fractures. Some cisgender (non-trans) LGB people have historically embraced a "LGB drop the T" movement, arguing that trans issues—which center on gender identity—are distinct from sexuality. Others have criticized trans inclusion in women’s spaces (such as lesbian bars or women’s colleges) as threatening.

: If an HIV-positive partner is on effective antiretroviral therapy (ART) and has an undetectable viral load , the risk of transmission through any sexual act is effectively zero .

Originating in Harlem in the 1960s, ballroom was pioneered by Black and Latino trans women and gay men. Structured around "houses" (chosen families), balls offered a stage where trans women could walk in "realness" categories, competing for acceptance and glamour denied to them in the outside world. This culture gifted the world voguing (popularized by Madonna), unique slang (shade, reading, werk), and a framework of community resilience that continues to influence fashion and music today.