The shared acronym has not always meant seamless unity. Historically, some gay and lesbian organizations excluded trans people, viewing them as liabilities or separate causes. The push for "respectability politics"—trying to win rights by appearing "normal" to cisgender, heterosexual society—sometimes led to the abandonment of trans and gender-nonconforming siblings. The infamous "LGB without the T" movement, while a fringe minority, highlights an ongoing tension: a misguided belief that trans rights are not "gay" rights.

About 0.95% of the U.S. adult population (roughly 2.3 million people) identifies as transgender, while another 1.7% identify as non-binary or gender non-conforming.

In recent years, much of the political friction surrounding LGBTQ+ rights has shifted specifically toward trans-inclusive healthcare and sports.