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Furthermore, the medical gatekeeping for transition care remains brutal. While PrEP (HIV prevention) and same-sex marriage were the major fights for LGB communities in the 2010s, the 2020s have been defined by the fight for gender-affirming healthcare for trans youth and adults, and the battle against "don't say gay" laws that also erase trans existence in schools.

While LGB people face homophobia, trans people face transphobia layered with cissexism (the belief that cisgender identities are superior or more natural). Key distinct struggles include: shemale perfect ass top