A court ruling that ordered Massachusetts to pay for an inmate's sex-change surgery is being seen as another milestone for transgender people.
In recent years, more than a dozen states have revised anti-discrimination laws to include transgender people.
And transgender people have helped raise their community's profile by winning elective office and being appointed to jobs at the White House.
Advocates say access to health care is the biggest problem for the transgender community.
Sex-reassignment surgery can cost as much as $20,000. Opponents say a government should not be forced to pay for an operation that many insurance companies reject as elective.