A week after she turned 20, Danielle stood in front of her family to tell her secret.
She braced herself, waiting for their negative response as she told them she was transgendered.
To her surprise, that response never occurred.
"I thought it would be a really big deal," says Danielle, of Santa Rosa, "but my family was just open about it, and they seemed like they were expecting it. When I came out, it seemed like everyone knew before me."
Biologically a male, Danielle, who didn't want her last name used for this story, is a transgender female, who joins a growing number of youths who are coming out earlier in their lives than ever before.
Only 15 years ago, transgender people were wary of revealing themselves, but the advent of the Internet has allowed a new generation to meet in chat rooms and message boards to discuss their most personal issues.
That has systematically fueled a better understanding and an increasing acceptance of transgender people in the mainstream, although some prejudice still exists.
"There is a start of a recognition that people who are transgendered face quite a lot of discrimination and that there isn't a lot of protection for them," says Brad Decker, executive director of the Gay, Lesbian, Bisexual and Transgender National Hotline. "A lot more people are now calling themselves transgendered." Transitioning -- or switching from one gender role to another -- is done so a transgender person's body matches the gender they identify.
But regardless of what age or generation transgender people are, most have problems with health care and insurance. Financial problems limit the medicine they need because of barriers insurance companies often raise to trans-related treatment.
While gender identity is classified as a psychological disorder, insurance companies rarely include treatment in their coverage, forcing many transgender people to pay for everything out of pocket.
"Some insurance companies may not pay for hormonal treatments or may not pay for sex reassignment surgery," says Decker. "Often there's a financial burden for that individual even if they have insurance. It's financially devastating for someone who has to try to pay for that."
Hormone replacement therapy – which is essential to the transition and consists of injecting the body with hormones of the gender the patient identifies – is especially difficult to acquire.
Sometimes, doctors refuse patients' prescription requests – prompting desperate people to turn to the streets for the hormone drugs to help with their transitions.
"It's a lot more common than anyone wants to admit," says 21-year-old Nicky, who didn't want his last name used. "It's really dangerous because you just don't know what's in there. You don't have blood work, you don't know if you have heart issues -- it's just not a safe practice."
Depending on the medium of replacement – including gels, injections, patches and pills -- the cost of HRT can range from $50 for a month's supply (gels and pills) to $50 for three months' supply (injections).
Many transgender people -- particularly the younger generation -- will not be able to afford such prices, especially if they wish to go further with their transition.
According to the Transgender at Work Project, the average cost of sex reassignment surgery can range from $11,000 to over $50,000 and does not include costs for therapy.
"Basically, transpeople just find a way to work around the system, although I know guys paying $100, $200 just for a [clinic] consultation," says Nicky of San Jose. "I'm very lucky with just going up [to San Francisco] for 20 bucks, showing my prescription, and paying another 20 bucks for my blood work." According to the standards set by the World Professional Association for Transgender Health, before beginning HRT, patients must be at least 18 years old, be able to demonstrate knowledge of hormones' medical abilities and prove that they are ready for transition through either the Real Life Experience, in which patients live as their target gender for at least three documented months, or a period of psychotherapy for at least three months.
"There's a lot of issues where transgendered [youth] want to take hormones or do surgery or any changes like that," says Cassie Blume, youth program coordinator at the Billy DeFrank Center in San Jose. "I've seen them work harder to express themselves in the same way. They're working really hard, but there's a lot more expression and a lot more understanding."
For their part, the younger generation thrives, though not without some disappointments.
Having known almost nobody like them until they stumbled on transgender communities, some transgender people can't help but feel a slight tinge of jealousy for younger generations who have always had the Internet at their fingertips.
"I feel like I missed out on childhood, the way I wanted it to be," says Nicky. "I wish I could have [transitioned earlier], had I been able to describe this when I was about 13 or 14."
But for$100, $200 just for a [clinic] consultation," says Nicky of San Jose. "I'm very lucky with just going up [to San Francisco] for 20 bucks, showing my prescription, and paying another 20 bucks for my blood work."
According to the standards set by the World Professional Association for Transgender Health, before beginning HRT, patients must be at least 18 years old, be able to demonstrate knowledge of hormones' medical abilities and prove that they are ready for transition through either the Real Life Experience, in which patients live as their target gender for at least three documented months, or a period of psychotherapy for at least three months.
"There's a lot of issues where transgendered [youth] want to take hormone