The title comes from the film Boys Don’t Cry about the life of a 21-year-old transgender man who attempts to hide the fact that he has female genitalia to avoid persecution starring Hilary Swank.
Jake Tucker playing the William Tell Overture upside down is a reference to Victor Borge, who often did that in his act.
The scene where Meg lies on the couch deflated is a reference to the Partnership for a Drug-Free America ads where a teenage girl is shown flattened on the couch and her friend tells the viewer that her marijuana abuse caused her to become dull and listless.
The scene where Stewie wonders how fascinating it would be to meet Jesus is a reference to a parody of a scene in the 1985 film Witness in which Harrison Ford sees the Amish widow played by Kelly McGillis bathing and she turns around and lets him stare at her breasts.
On the news broadcast about Stewie being possessed the caption reads, “Brat out of Hell.” This is a wordplay on the saying “like a bat out of hell,” and on the Meat Loaf album of the same name. The picture of the Super Devil on the newscast depicts him on motorcycle in the same position as the demon on the Bat Out of Hell album cover.
The scene of Peter having an on-the-road flirtatious encounter with a beautiful young woman in a red Ferrari is a spoof of the scenes involving Clark Griswold (Chevy Chase) and a sexy blonde (Christie Brinkley) in National Lampoon's Vacation.
When Stewie protests his entry into the Little Miss Texas Pageant, he makes the series’ fourth reference to JonBenét Ramsey about the talent show being a one way ticket to a semen-stained death in the basement.
At George W. Bush’s Crawford ranch, Dick Cheney is guarding the house with a shotgun, talking in his sleep about his and Bush’s “18% approval rating,” and how he would like people to meet his daughter’s husband, Michael. In actuality, Cheney's daughter is a lesbian. Inside, Bush has pictures of him with Ronald Reagan, Saddam Hussein, Osama bin Laden and the Super Devil. Additionally, Chris points out that Bush has several lines of “sugar” i.e., cocaine, cut and ready for snorting, a reference to Bush’s alleged cocaine use. Bush is also shown drinking alcohol, a reference to him being a recovering alcoholic. Bush also gets into his car while drinking, a reference to his DUI.
Chris showing the people at the Texas high school George W. Bush’s underwear spoofs the scene in Sixteen Candles where Anthony Michael Hall’s character shows off Molly Ringwald’s underwear to his fellow students.