The following version of this book was used to create the guide: Duncan, Eliot. Ponyboy. W. W. Norton & Company, 2023.

The novel begins in Paris, where main character Ponyboy, a transmasculine 20-something, lives with his girlfriend, Baby. As the novel begins, Baby is out of town for work, and Ponyboy's childhood friend Toni is staying with Ponyboy. The two are carrying on a romantic affair. Ponyboy thinks about their adolescence and battles memories of being sexually assaulted by a man at a party when they were fourteen years old. In the present, he battles alcoholism.

Baby and Ponyboy met at a party in France and drugs bonded the two of them together. In the present, Ponyboy is concerned by Baby's increasing attention toward her mentor, Sophia, and thinks about how Sophia asked callous questions about his gender when they went to a cafe together. Ponyboy believes Toni sees him much more clearly as who he is than Baby does. Soon after, Baby returns, and Ponyboy keeps his affair with Toni a secret for awhile but eventually spills the details. This leads to Baby explaining she had an affair with Sophia, and then Ponyboy tells Toni definitively that he is not a woman. The two make up, but Ponyboy still thinks about Toni.

Ponyboy and Baby move to Berlin to work on their artistic pursuits. Ponyboy calls Toni to see if they will come visit but they cannot. They try to get Ponyboy to see they are battling a drug addiction, but Ponyboy will not have it. One morning, Ponyboy and Baby wake up beside a nameless male photographer. After this, he begins to supply them with speed and other drugs in exchange for sex, and he abuses Ponyboy and takes advantage of his power over him. Baby finds herself sexually interested in the photographer, and Ponyboy continues to feel hurt by how Baby does not view him as a man. They go to a party at the photographer's apartment and Baby has sex with the photographer in front of Ponyboy, which feels like a betrayal to the latter. After, they agree to revert back to monogamy.

Ponyboy tells Baby he wants to medically transition, and Baby is insistent she does not want to be in a relationship with a man despite her fling with the photographer. Shortly thereafter, Ponyboy meets someone named Gabriel at an art gallery and begins an affair with him despite the fact that they are both in relationships. Baby begins to wonder where Ponyboy is off to all the time and Ponyboy explains that Gabriel is editing his writing for him. After carrying on a passionate affair for a bit, Gabriel breaks it off to try to make things right with his girlfriend. Ponyboy enters more of a depressive spiral after this and feels a lot of guilt toward Baby for the affair he had with Gabriel. She eventually arranges an intervention with Gabriel, but it does not work and Ponyboy just goes on to drink more. He enters into a frightening relationship with the photographer in exchange for drugs until, one day, he wakes up in a hospital to find his father there. He tells him that he is to move back to Iowa to enter a rehab program.

Ponyboy moves back to his childhood home with his mother to enter rehab. Before he starts rehab, he sneaks out to go to a bar, gets drunk, and wakes up in a hospital, detoxing. He finally goes to rehab and meets someone named Lee there. His relationship with Lee and his sobriety makes him see the world in a new light. He fights withdrawal symptoms and the conflicting views the people around him have on trans people. He leaves rehab sober and ready to take on the world.

After this, he goes to Vienna to attend his father's wedding. There, he struggles to remain sober until he eventually relapses, partially as a result of having to play the role of a girl. He fights an uncle at the wedding reception who harbors bigoted views on trans people and has to apologize to his father and his new wife the next day. He goes to an AA meeting in Vienna and learns that Toni is in Paris with their boyfriend. He goes to visit them, and one night, he gives his name as Eliot to a man on the street, christening himself with a new name that acts as a rebirth.