For Serano, her conception and use of the term is rooted in her activism, and came out of deeply practical need. “I was actively involved in challenging trans-woman exclusion within queer women's communities,” she said. “One of the things I encountered over and over and over again within those communities was people saying, ‘I can't be transphobic. We're letting in all these trans men into our events.’ And it became a way for me to point out that, oh well, you know, you're saying that you're not transphobic but you are being transmisogynistic." The concept of transmisogyny has become widely used by trans women not just to describe our experience but also to account for how cisgender people evaluate trans people. A good example is the public’s scrutiny of Caitlyn Jenner’s appearance and actions, even as it’s willing to give many cisgender people a pass on both casual and extreme transphobia.

Serano also pointed out that society continues to project negative meanings onto feminine gender expression — ideas that purport feminine people are just being feminine to fit in or to please men, rather than their inclination coming from a place that’s more intrinsic to their identity. “I think for anyone who moves through the world as a woman,” she said, “femininity is going to be a double-edged sword, in that if you are very feminine, people would dismiss you in certain ways, but then there's a certain amount of praise that you can get, but it's praise that comes from being judged in other people's terms and not necessarily your own.”

Another important concept in Whipping Girl that departs from both traditional models of gender and queer academic theories that try to dismantle them is the idea that gender isn’t simply a performance, but is the product of complex interactions between one’s subconscious sex and the social influences to which a person is exposed. Serano calls this the intrinsic inclinations model, as she asks readers not to deny that gender has a biological component, drawing from her academic background as a biologist.

“The beauty of the intrinsic inclinations model is that it simultaneously explains why most people appear to have typical genders […] and accounts for the vast diversity of gender and sexuality that exists in the world,” Serano writes. Among trans people, Serano’s theory is also powerful because it mediates among trans people who transition toward the binary end of the spectrum, and those whose identities and presentations defy binary categories altogether, allowing both identities to be fully acknowledged and respected.

Nevertheless, Serano has gotten flak for bringing biology into her discussion of gender. “I've heard people assume that I'm making a born-that-way argument or a biological determinism argument,” Serano said, while also acknowledging that the interpretation might have come about because she shied away from getting into biological details in the book as she wanted to be accessible. “The social world obviously also intersects with biology in order to create all sorts of gender and sexual variation.”