A bildungsroman set over three acts, Ponyboy is a quest for self-identity set among the art world of Paris and Berlin. In the first act, Ponyboy's eponymous narrator-a pill-popping, speed-snorting trans-masculine lightning bolt-unravels in his Paris apartment. Ponyboy is caught in a messy love triangle with Baby, a lesbian painter who can't see herself being with someone trans, and Toni, a childhood friend who can actually see Ponyboy for who he is. Strung out, Ponyboy follows Baby to Berlin in act two, where he sinks deeper into drugs and falls for a fellow writer, all the while pursued by a megalomaniacal photographer hungry for the next hot thing.

As Ponyboy's relationships crumble, he overdoses and finds himself alone in his childhood home in Nebraska. The novel's final act follows Ponyboy to rehab, exploring the ways in which trans identity, addiction and recovery can reforge the bond between mother and child.