A transsexual prostitute orders a man to suck on her breasts, which he does.

A man has sex with a transsexual prostitute, with the buttocks of both being visible.

We briefly see a man reach his hand down his pants to presumably masturbate (no nudity is visible).

We briefly see a man from the waist up, showering through clouded glass; his arm moves back and forth implying masturbation (no nudity is visible).

A man pulls his pants down to engage in sex with a woman, but they stop because of his roughness handling her (we see the man's bare buttocks).

A transsexual prostitute gives a man a back massage in preparation for sex before another man barges into the room and begins beating the prostitute.

A man severely beats a transsexual prostitute, drives her to a church, strangles her to death, kisses her corpse, and leaves it by the church. It is later revealed that he has killed many other transsexual prostitutes.

A man slits his own throat and dies.

The gruesome acts of a serial killer are graphically described along with the abuse that the serial killer suffered.

While having sex with a transsexual prostitute, flashbacks to a man being raped as a child by other boys are seen.

The word "fuck" is used numerous times, along with many other profanities.

One scene depicts brief marijuana smoking. We see a lot of cigarette smoking

The overall tone of the film is exceptionally dark and menacing.