Stan is searching for answers about how a person who he’s always known to be one thing could suddenly identify with another. In the meantime, the pressure of holding on to a giant secret is starting to get to Randy.
The episode begins at the bus stop, where the boys are waiting for the bus. Cartman is thinking about his newest plan, which he will go through with at recess, depending on what happens.
At recess, Cartman enters the boys' bathroom. Butters is using the bathroom and tells Cartman with joy that he's not suspended anymore. Cartman ignores him, however, when finding the stalls to all be taken by Craig and Kyle, he goes through with his plan. He places a bow upon his head and goes into the girls' bathroom, much to the dismay of Wendy, Bebe, and Red, and tells them off that he is "transginger", of course meaning transgender.
Principal Victoria attempts to punish him but to no avail, as Cartman knows he cannot be made to use the bathroom with cisgenders.
Principal Victoria and Mr. Mackey go to Mr. Garrison for help. Mr. Garrison explains that Cartman has got them in a "royal flush" because if they refuse to meet his demands then the media will be all over them.
At South Park Elementary, Cartman has made the girls' bathroom smell awful and because of this, Principal Victoria gives Cartman his own bathroom in the Janitor's Closet but Wendy doesn't find it fair.
In his garage, Randy contacts his record executive and attempts to quit but the record executive persuades him not to. The record executive reveals to a man named Ron that Lorde is Randy and asks him to do something to anyone who gets close to finding out.
At the Marsh Residence, Randy is trying to write new songs when Sharon almost catches him.
At the school, Cartman's bathroom is now completed and Cartman takes great joy in using it.
At the school, Wendy is now transgender and refers to herself as Wendyl to Cartman's chagrin. Cartman goes straight to Stan and starts calling him a girl and a homosexual for having a girlfriend who likes girls. This confuses Stan.
That night, at the Marsh Residence, Stan goes to Randy for help but Randy mistakes him for asking if he is Lorde and confesses. He did it because he likes to be in the girls' bathroom. He shows the process of how he makes his songs to a disbelieving Stan.
The next day, Stan uses the transgenders' bathroom making Cartman mad.
At the United States Geology Survey, Randy, as Lorde, is given his own bathroom which, in turn, depresses him.
At the school, everyone calls out Stan as a cissy.
Meanwhile, Sharon, almost as if she knew, gives Randy the speech he needs to get back to making music.
The song he releases emotionally effects everyone.
Lorde's boss decides not to give Lorde her own bathroom and the SPIN reporter decides not to the tell-all article about the truth of Lorde.
South Park Elementary decides to let anyone use any bathroom except for cissys. Stan, who was outed as a cissy must use it. While using it, he starts to sing his own version of Randy's song.
AV Club gave "The Cissy" a "B+" rating saying: "So South Park apparently has a weird continuity now? The show has experimented with loose continuity before, but it’s most been in the form of multiple episode arcs and the offhand returning character (or “200”). This seems like something different, something that might not be revolutionary, but will at least be new: At least if this week and last week are any indication, the season will continue to explore the consequences of the boys’ actions, allowing the plots to be motivated in part by their attempts to dig themselves out of a hole. (Kyle’s remark about the decreasing value of apologies plays pretty clearly off the show’s history with big speeches.) So last week, Stan, Kyle, Cartman, and Kenny threw a party to apologize for storming out of South Park for startup-land. This week, not only are Stan’s troubles with Wendy ongoing, Randy’s Lorde returns."
IGN gave "The Cissy" a "7.5" rating saying: "This week's South Park went back to basics with Cartman, who exploited yet another PC hot button -- in this case, gender identity -- to get his way at school. However, the more entertaining (and thought-provoking) storyline this week was the continuation of Randy as Lorde. While the "what" and "why" of this storyline remains somewhat unclear, it did offer several amusing moments, and it actually probably said more about gender identity than Cartman's storyline did."