Born to a working-class Irish migrant family in Tranmere, Cheshire, O'Grady moved to London in the late 1970s, initially working as a peripatetic care officer for Camden Council. Here he developed his drag act in 1978, basing the character of Lily Savage upon traits found amongst female relatives. Touring England as part of drag mime duo, the Playgirls, O'Grady later went solo as a stand-up comedian. Performing as Savage for eight years at a South London gay pub, the Royal Vauxhall Tavern (RVT), he gained a popular following among the city's gay community and used his character to speak out for gay rights. After being nominated for a 1992 Perrier Award, O'Grady attracted mainstream attention and made various television, radio, and theatrical appearances. As Savage, he presented the shows "The Big Breakfast" (1995–1996), "Blankety Blank" (1997–2002), and "Lily Live!" (2000–2001), earning various awards and becoming a well known public figure.