She was born in Philadelphia into a Jewish family. Her parents are David Nef, an advertising executive, and his wife Robin. They divorced when she was two and she was raised by her mother in Newton, Massachusetts.
She began attending Columbia University in 2011 and graduated with a degree from the theater program in May 2015.
Her writing has appeared in Dazed, Vice, Original Plumbing, and BlackBook. She has also written a regular sex advice/experience column at Adult magazine.
In 2014, she was on the cover of Frische Magazine. That same year, she was placed at number 68 on Dazed's 100 list. She also moved to the top of the Dazed Readers 100, ranking #1 overall, and appeared in the i-D Pre-Fall Issue twice.
In 2015, she again walked shows during New York Fashion Week, including Adam Selman, VFiles, Vejas, Degen, and Eckhaus Latta once more.
In May 2015, she was signed to IMG Models, making her the first openly transgender model signed to that agency.
In the summer of 2015, she was cast in the second season of Amazon Prime's Transparent, which debuted in December 2015. She also starred in The Drums' music video "There is Nothing Left" in August.
In 2015, The Forward newspaper included her in the Forward 50, a list of the year's fifty most influential Jewish-Americans.
Elle printed special collectors’ covers for their September 2016 issue, and one of them featured her, which was the first time an openly transgender woman had been on the cover of a major commercial British magazine.
In January 2017, she starred in a television commercial for the L'Oréal Paris True Match line alongside Blake Lively, Lara Stone and Xiao Wen Ju. The campaign was premiered at the 2017 Golden Globe Awards telecast.
She is one of the stars of the 2018 film Assassination Nation. In the same year, she starred as Blythe on the Lifetime thriller You.