Though pockets of resistance remain, the battle for gay marriage was won. But, the war isn’t over, especially for individuals who identify as Transgender. Their struggle is just beginning to coalesce into a meaningful discussion, thanks in part to Caitlyn Jenner’s coming out. Though Jenner is the current ‘poster child’ for transgenderism, she is by no means the first. Sex reassignment surgery for those who desired a full transition dates back to the 1920s by doctors in Germany. Christine Jorgensen, a self-proclaimed transgender woman, was first known to Americans with the headline: “Ex-GI Becomes Blonde Bombshell” in the early 1950s. Chaz Bono came out in 2009. At the very least, Jenner’s step onto the stage identifies the shadow group of people who live and suffer in the day-to-day world. The ultimate benefit of this comes with the crystallization of the understanding for just how complex humans are. Any attempt to gauge the diversity between simple male and female classification is like trying to comprehend the infinite dimensions beyond the 3-D world we live in.

However, transgenderism isn’t all about gender-confirming surgery; it’s about identification, and more specifically about self-identification. It begins with the recognition that who you are on the inside doesn’t necessarily have anything to do with what you look like on the outside. In a world were almost everyone tries to label or categorize into a known – and comfortable – set of classifications, being transgender invites a multitude of problems, not the least of which is outright danger.

Of course I knew the story of Christine Jorgensen, and I saw the reports on Chaz Bono, but my knowledge of this sketchy existence was limited until about two years ago. I first met a woman as a member of my class in a Master’s Degree program for writing. We struck a friendship from our first day, and gradually a sense of trust in each other. A year later, in a conversation with her and a small group of my other classmates, she made it known that the memoir she was writing as her Master’s thesis was based on her life as a transgender woman. The courage of the revelation was astounding. I now have the privilege of doing some editing work on that very same book, and her words are electrifying.

Transgenderism is fast becoming mainstream news. There are even reality shows and television dramas featuring people who identify as such, though one complaint is that the scripted series tend to have cisgender actors in the roles rather than actual transgenders. Transparent, starring Jeffrey Tambor as a trans-dad, looks at humanity despite issues of gender and has won dozens of awards. I Am Jazz, another TV series explores the difficulties of being a transgender in school. The soap opera The Bold and the Beautiful has a plot line that featured the marriage of a transgender woman. In September, the movie About Ray will premiere starring Elle Fanning as a girl trying to make the transition as a boy and the family issues that it provokes.

Despite this new-found awareness, problems facing transgenders are overwhelming. Even basic healthcare becomes a headache.

I had a lengthy conversation with Amelia Gapin, a transgender woman and the co-founder of My Trans Health. Their mission is to connect transgender people to physicians who will provide knowledgeable and quality healthcare. Amelia stresses about “just finding a doctor, of having to go through having to have that conversation with them, and then not knowing how they’re going to react.” She had one doctor go so far as to ask if she needed a pap smear during a physical. Her friends and fellow transgender women have had doctors wonder how it was possible they had breasts. It’s clear that the medical community, despite years of study and training, isn’t automatically adept at dealing with them. One patient saw the contents of her medical file in which the doctor wrote that he was masculine looking and dressed like a woman. The doctor was “ignorant of the fact that she was a transgender woman” and used male pronouns. Other complications might arise, especially in the case of a transgender man who probably still has a cervix, a uterus, and ovaries. Doctors need to be aware that they’re treating a man with the possibility for the development of certain cancers.

So far, the hardest challenge facing My Trans Health has been reaching out to the medical community and finding those willing take the time to educate themselves to the complications or those who have had some experience already. Initially they are focusing on New York, Miami, and San Francisco. Amelia’s guess is that there are perhaps 750,000 transgender people in the United States alone, but that number could be on the very low side. Ultimately, My Trans Health would love to be proactive in the development of special medical education that will cover transgender issues.

Medical insurance can be a nightmare. Most policies do not have transgender-inclusive riders and therefore generally fail to cover the costs of gender-affirming surgery which can run anywhere from $20,000 to over $100,000 and be performed by only a small handful of surgeons. The best that most transgenders can generally hope for is the coverage of hormone therapy.

The most horrifying aspect of the transgender world is the violence they face. There has been no lack of recent news on how many murders have been committed. The recent reporting of a Marine in the Philippines, a man who should have been serving with honor, strangled a transgender woman to death when he found out. In this country alone, there have been 19 murders so far this year as of four days ago. Most have been transgender women of color. These reports are only the ones we hear about; I can’t begin to imagine how many of the total number of murders in this country might have had some aspect of transgenderism associated with it. So many find they must relocate often and disassociate with their loved ones in order to live in relative safety. The opportunity to find happiness and live a normal life is elusive and mostly unattainable.

Governor Christie, of New Jersey, recently underscored issues of documentation by vetoing a statute that would have allowed transgenders to change the sex on their driving licenses. His excuse was that “Birth certificates unlock access to many of our nation and state’s critical and protected benefits such as passports, driver’s licenses, and social services, as well as other important security-dependent allowances.” It seems to me that if a married woman can effectively change her name to reflect her husband’s (that’s another subject entirely) and have new documents issued, it shouldn’t be that difficult to figure a way to make it easier for transgenders to do the same.

These few issues are just the opening salvo of the new battle for LGBT rights and acceptance. There are many more, from legal protection and discrimination to the minutiae of how school districts administer who is entitled to use the bathrooms and locker rooms.

It took forty-six years from the time Leo Laurence called for the Homosexual Revolution in San Francisco to achieve legislated same-sex marriage. One can only hope that the wisdom gained from the emergence of these rights will carry over to the battle for transgender support, recognition, and acceptance.