Johannes Brevis wasn't playing dress up when he began wearing men's clothing.

It wasn't just for fun, it wasn't just experimenting, and unlike the books he read suggested, there was no erotic thrill attached. It simply made sense and felt right.

At age 25, Brevis made the decision to live full time as a man. It was not an easy decision. It was a decision that had to be made because, despite his birth gender, it is who Brevis is.

Like every other minority, transgender people - people whose gender identity does not agree with their birth identity - have always existed. Although activism and visibility may be at an all-time high, few non-trans people - including the gay, lesbian and bisexual communities - appreciate and understand the struggles and challenges trans people face.

To some, the trans community is just another minority to marginalize and misunderstand.

Like gays, lesbians and bisexuals, members of the trans community must deal with a variety of real-world issues by virtue of living their lives openly and honestly. But unlike the sexual-minority community, the number and depth of the issues faced by the gender community can be daunting: health care, legal issues, civil-rights, employment, harassment, stigmatization are overwhelmingly part of coming out as transgender.

At an even more personal level, it can mean losing friends, family and a place in the community you are used to living in just to be yourself.

It's impossible to encapsulate everything in a community, but area trans activists Naomi Barbee, Mary Cochran, Tamara Hopson, Wally Moyer and Ben Singer are able to share many details. Like sexual minorities, there is a struggle for basic civil rights and a lack of trust and understanding with law enforcement. But there are other issues - health care and the ability to live and work without fear - that are unique to many transgender people. This raises the question among sexual minorities if the transgender struggle should be part of the the gay movement.

Medical care
 
Regardless of their gender expression, barriers remain for many trans people.

Not every trans-identifying person chooses to have complete sex-re-assignment surgery; some have partial surgery, others either cannot or do not want any at all, but choose to live as the opposite gender or somewhere in between female and male.

Problems with health care range from doctor visits to sex-re-assignment surgery and the care that follows it. The cost of surgery is high, higher for those who want to transition from female to male.

And beyond surgery, there are follow-up visits and hormone treatments that continue for years. Activists say there is a dearth, especially in Philadelphia, of doctors who are familiar with the treatment and care of people who either seek to or have undergone re-assignment surgery.

Responding to this void is a growing collection of support groups for trans people where health and other issues can be discussed and referrals can be made.

While a network of acquaintances and friends is often the most helpful way to find trans-sensitive health-care providers, people who facilitate and participate in them say it isn't enough.

"There's really been no overwhelming, enthusiastic response from the alternative or queer provider community regarding services for the trans community," Singer said. "For those of us who choose to ... when it comes to accessing transsexual medical technologies, some [health care providers] have very bad reputations, and the way to find the few knowledgeable ones is pretty much by word of mouth or if someone has a therapist who can recommend doctors they collaborate with or through support networks - it's fairly chaotic sometimes, in terms of getting the necessary information to make an informed decision about your medical care."

Like any other situation where service is unsatisfactory, there is no reason to stay on with an unsatisfactory doctor, Moyer noted. But for a transgender patient, this can be especially exhausting, he added. People who choose to dress by gender "standards" not of their biological sex, and people who choose surgery may face a series of tenuous situations.

"If you go [to a doctor] for a cold or any common medical condition, you still have to go into the whole thing about your body, and what it looks like and what surgeries you've had and haven't had, and I think these become issues," Moyer said. "Some professionals are really professional; others are human, and have their own prejudices. It's really a mixed bag."

Singer said some doctors remain reluctant to treat trans people because they may be scrutinized by insurance companies and colleagues because it is still considered a "controversial area of medicine."

"And sometimes, after a while, they get nervous about it, and back out of treating us," Singer said. "It is difficult to find stable, quality, sensitive care, and as a population - from the most privileged to the most underprivileged - we all are in a very precarious situation when it comes to medical care."

Like any relationship, understanding and trust must exist between patient and medical personnel.

Therapist Mary Cochran has been working with sexual and gender minorities for 20 years. She is the significant other of a trans man, and counts herself as an activist for transgender rights. Psychotherapy is important not only for mental health and wellness, but American Psychiatric Association standards require a recommendation from a therapist for trans people to receive hormone treatment and surgery, should they desire it.

"I found out very quickly there was ... no knowledge [of trans issues] in my collegial community," Cochran said. "Trans people are [the ones] who educated me about trans people, and I think that's very fortunate. It's my strong opinion that to be a good provider for trans people, you need to be a trans activist in some way or you don't have a real, basic understanding of what the issues are."

Even after an understanding and helpful physician is found, keeping up with the financial demands of treatment can be a burden, especially regarding medical insurance.

Johannes Brevis discovered this when his medical insurance backed out while he was in treatment.

After paying for nearly three years of hormone treatments necessary in conjunction with previous surgeries, Brevis' HMO notified him they would no longer pay for the hormones. He says they have given reasons ranging from lack of proper doctor's recommendations, to their policy of not covering costs associated with sex re-assignment even though when he signed on with the company he was, in the eyes of the law, a man.

Brevis said he can't understand why the company would cover the hormones for such a long period of time if it hadn't had the proper doctor's notes. To stop treatment now, he added, would cause him physical and psychological harm, a violation of Medicaid policies.

Since last August, Brevis has filed a grievance against the company which now involves participation from the Department of Public Welfare. He also filed a complaint with the Pennsylvania Human Relations Commission. He has been doing the legwork for himself while working and going to school because it has been difficult for him to find a lawyer who will take his case. He talked to about 14 before finding one who would assist him, he said.

"If I don't try, it's not going to change," Brevis said. "And it might not [change] after all the work I've done, but I'd rather do this than wonder what would've happened."

Sometimes Naomi Barbee would like to simply live her day-to-day life. But every day, Barbee finds herself enmeshed in the work of being a vocal transgender activist.

For Barbee and many transgender people, activism almost comes with the territory of being out about their gender identities.

As a member of a community which is often overlooked by other minorities, mostly ignored by society at large, and in which many of its members are not out, it's almost impossible not to become aggressively involved in the struggle.

Like every other civil-rights movement, there are differences of opinion and agendas in the transgender movement. Along with the issues that come with living openly each day, there is an almost inherent need to work in some way for the movement.

Almost every trans person has to be an advocate - or an activist - for his or her own health care, legal issues and civil rights. Others choose to take that additional step, and be one of many voices speaking out for the community.

And although there are many voices, there are a number of activists - both in and out of the "spotlight" - who are working hard to find solutions that will better the lives of transgender people.

Like lesbians, gays and bisexuals, members of the trans community must deal with a number of real-world issues by virtue of living their lives openly and honestly. But unlike the sexual-minority community, the number and depth of the issues faced by the gender community can be daunting.

And like every other minority, transgender people - people whose gender identity does not agree with their birth identity - have always existed. Although activism and visibility may be at an all-time high, few non-trans people - including the gay, lesbian and bisexual communities - appreciate and understand the struggles and challenges trans people face.

Where compassion and understanding might be expected from other minority communities, often there is exclusion. To some, even gay, lesbian and bisexual people, the trans community is just another minority to marginalize and misunderstand.

Despite a variety of viewpoints, there is one thing all trans people want: to live their lives with legal and social equality.

>From this simple desire, trans people face many obstacles to get to a place of civil and social equality.

Across the country and in Philadelphia, steps are being taken that have potential to improve the lives of transgender people. That day could come even sooner if sexual and gender minority communities recognized their differences as well as their similarities and worked together.

Local trans activists Tamara Hopson, Wally Moyer and Ben Singer say things are slowly changing for the better. There are no quick fixes or easy solutions, but progress is being made.

Just as change has not come easily, nor has it been fully realized in lesbian and gay communities, it has not and will not come easily to transgender communities.

In addition to the typical fatigue that comes with activist work, some trans activists withdraw from public life once they have transitioned.

Changes have to be made in health care and civil rights, they say. Doctors and legal professionals need to be trained to serve, or at the very least, be aware of the needs of all patients and clients. Tiring work that should be shared with allies. The needs of youth have to be examined and met.

Youth
 
As the lesbian and gay communities came to realize, identities - sexual and gender - don't always emerge in adulthood.

Today, many youth are recognizing their gender identities at a younger age. Like their gay, lesbian and bisexual counterparts, healthy, educated and safe youth have a better opportunity to become healthy, educated and safe adults. The needs of transgender youth, like sexual minority youth, are many and varied.

Activists say as difficult as issues are for adult transgender people, they can be more harrowing for youth who may want to transition, but not have sufficient knowledge or funds. Many drop out of school, which, combined with their gender presentation, can make it especially difficult to find employment. Without a job to make money to afford the treatment they need to transition, or just to live, many turn to prostitution.

Addressing youths' needs when they're young could vastly improve the adult lives of the next generation of trans people.

But while services for gay and lesbian youth have become a hot topic and seen an increase in awareness and support in the latter part of the '90s, many seem to be only realizing the needs of trans youth.

The Attic Youth Center, 419 S. 15th St., provides a safe space for lesbian, gay, bisexual, transgender and questioning youth. Programs, support groups and counseling abound for the sexual minority youth but there is not as much for gender minority youth. They are welcome, said executive director Carrie Jacobs, who believes trans youth feel very at home at The Attic, and participate in its trans support group.

Jacobs wishes the organization could do more.

"It's pretty obvious we need more programming, there needs to be late-night programming," she said. "These kids need a lot more attention than they are getting in this city. Then there are the issues of the kids not trusting the community and not trusting the gay and lesbian community, they're not saying 'please give us services' either, but if we gave them better services, they might take advantage of them."

Jacobs wants to be able to serve trans youth more fully at The Attic, but said that would require more staff. She said she'd help, even if the youth met somewhere other than The Attic, as long as they were being adequately assisted.

"We almost need a trans youth center," she said. "They have tremendous needs, one of the biggest seems to be housing. They live on their own, they need to get jobs ... they need GED training, they feel uncomfortable in medical care, and need to be more educated on issues like hormone use, and there aren't that many places even in this city for them to go. I really feel that they need trans role models who can [be] positive and show them that they can create a life ... we are providing a space for them, keeping them off the street, but I wish there was more for them, places that were open later where they could get what they need, which is sometimes food and clothes and showers."

Role model
 
One person who wants to be a role model is trans activist Nia Henderson. Henderson co-coordinates The Attic's Youth in Transition group, and works as ActionAIDS transgender outreach coordinator.

As difficult as life can be for trans youth, she points out, their futures aren't pre-determined. Henderson, 20, is committed to showing that despite the hardships trans youth face, they should not believe they will never live a "normal" life. Unfortunately, she said, they often get this impression from older members of the community.

"The youth are just coming out, and don't know where to go - where to get hormones from, where to get support," she said. "Your family turns you out, you need a place to stay. Mainly, the adults we know are well-established: They have jobs, they have their name changed. I think the youth needs are just as important as the adults, but [the youth] are more sensitive because a lot of trans youth, they fall under the wrong impression, a lot of older people are a bad example. They say, 'You're trans, you can't work, you can't live a normal life.' It's unfortunate to say this, but they do not have the right guidance at all. They are out there prostituting, on drugs, and most of them they don't get the support they need."

Henderson has no qualms about putting herself forward as a role model. She understands the needs and the potential pitfalls associated with being young and transgender, and wants to share that understanding.

"One reason I say I want to be a trans role model is I want to let the youth know that just because you are trans you can live a normal life like everyone else," Henderson said. "And there are laws that can protect you if you feel discriminated against for any reason, there are ways of working with that."

Henderson agrees with young people who say that it isn't easy to get along in society when who you are doesn't correspond with who you "legally" are. But it is a process worth working through, slowly if necessary, despite potential feelings of embarrassment.

"Until I can afford to change my name, if there should be a problem, if they say 'you don't look like your ID,' you let them know what's going on, and then there's not a problem, they can say what they want, but they can also say this transsexual is living, she is working, she is not out there prostituting," Henderson said. "I'm not knocking people that do [prostitute], you do what you gotta do to survive, and I can see that as a last resort, but most youth come out feeling like it is their only resort. But what happens when you get old? You don't get a W2 for prostituting. If you don't have to go down that road it's better that you don't."

As is often said of young people, some trans youth can be impatient, but impatience where transitioning is concerned can be dangerous, Henderson said. Without getting all the medical facts first, many youth begin taking hormones. When hormones are slow to change their bodies, as is their nature, some may choose to get surgical implants, others take harmful doses of hormones which can damage the liver and kidneys. There are some services youth can be referred to for medical attention, but often, Henderson said they don't want to go.

"In my experience, most of the trans youth go by their female name, legal documents have their birth name, and they tend not to go and get necessary health treatment," Henderson said. "They feel everyone will find out they are trans, and they don't want anyone to know, and they tend not to get the necessary treatment. If anything, I would try to talk them into it, they have to realize it's sort of what you have to go through if you are trans, in the beginning, it's all about accepting yourself as being trans and the baggage that comes with it and it's not always going to be easy."

Health care
 
There are a number of transgender organizations suited to a variety of support needs in Philadelphia, but for hands-on health care, referrals must be made.

In many cases, a series of therapists and physicians are visited before one is chosen. This doesn't have to be the case, Henderson and Singer said. There are models for better solutions for the type of care needed by trans people. In San Francisco and New York City, specialized clinics welcome trans people, and medical personnel are available to meet their specific needs.

"Trans people know they can go there and get help," Singer said. "We don't have anything like that. They have an extensive array of services for trans people and intersexed people, based on the ability to pay, which is one of the most important things - even the most well-off find their economic resources just dwindling with the connected health-care costs, and those lucky enough to have insurance, often those claims associated with a transgender-related diagnosis send up a red flag."

Activists say there are ways to improve existing services. If service providers could come together to network and share information, Barbee said, it would benefit the entire community. This would include, she noted, an understanding that the lesbian, gay, bisexual and transgender communities have many difficulties in common.

"The true issues begin with those socio-economic issues, those are the most salient issues," she said.

"There needs to be a lot more communication between service providers to work with others in a non-competitive manner, address the shortcomings where they may be and through that solutions maycome to light," Barbee continued. "They need to come together. The problems down there [on 13th Street] seem to be dealing a hard blow, we need global solutions because they are global problems, we need to integrate a system that cuts across these problems in order to have solutions.'

Civil rights
 
Recently, the Philadelphia Transgender Task Force announced its presence in response to situations in the 13th Street Corridor. In an effort to follow an inclusive process the group is slowly putting together a structure and by laws.

Although in its formative stages, the group responded to recent problems in the 13th Street Corridor with an open letter to the lesbian, gay, bisexual and transgender communities that posed challenges to the Philadelphia Police Department, City Council, mayor's office, mayoral candidates, Center City developers and local businesses.

Other groups in the community took notice.

The following week, another group of trans activists responded with a letter of support.

There have also been responses by other groups in the community showing unity that activists believe is necessary to create real change.

On Sept. 8, 2000 Queers, an ad hoc group of activists who address a variety of local and national issues, made trans issues the focus of its meeting, and is planning a Sept. 29 town meeting for additional discussion.

Also on Sept. 8, the Colours Organization sent representatives to a meeting with the Police Advisory Commission to speak about issues affecting people of color in the Center City area, including transgender people.

"The gay and lesbian communities have made a lot of progress, I've been in the community for 18 years and I've seen a lot of progress happen," Moyer said. "A lot of times, the oppressed become oppressors. In Philadelphia, I feel really optimistic and hopeful. I've seen a lot of dialogue and things happening ... Philadelphia is right on the brink of this, which stirs up a lot of feelings. I think there is hope. We are moving in the right direction. Some of the gay and lesbian political organizations, at least, are becoming aware [that] they need to be inclusive, so I think there is progress ... there is a long way to go, but there is progress."

Barbee noted that the lesbian, gay, bisexual communities need to understand that many of the instances of discrimination and harassment they face are shared with the transgender communities. In particular, for lesbians, gays and bisexuals who are of a poorer socioeconomic status, the problems are as much about homophobia and transphobia as they are about class difference.

"If people would come to the realization that these problems are held in common, that there is a lot of common ground to be held, I think solutions would begin to come out," Barbee said. "These problems are not particular to any part of the community, and they need to be addressed as a whole by the community, not by tiny factionalized elements."

Inclusion
 
Activists agree that movement toward unity between the lesbian, gay, bisexual and transgender communities is beginning in Philadelphia. Unity has been there in name - the frequently used "l/g/b/t" term is one example - but now it is being realized in action.

Moyer points out that transgender groups also have to be willing to be inclusive and to recognize those who are trying to be.

"It's so easy to focus on who's not including you," he said. "There are groups out there who are inclusive, there are religious organizations that are inclusive, and I think we can learn from people who are inclusive how to be inclusive. One of the things the task force is doing, we are including other people on our task force who are not transgender, although our focus is on transgender issues, so you can either go through life looking at a glass half empty or half full, but the big thing, though, is education; a lot of times, even in the gay and lesbian community, a lot of people coming out don't even know a transgender person personally."

There is also a need for transgender people themselves to come forward and speak out. But, as it was in the early days of the gay movement, and in many cases still is, it is a difficult thing to come out as transgender. It can be harder still to stay out.

"We're at the very beginning of the process, a lot has to do with trans folks being scattered, not being visible, being punished if they are visible," Hopson said. "The fear of violence and oppression keeps people divided, but I think it's starting to form ... I see this as a growth period or spurt for the trans community, and that's a real wonderful thing, even though we are at ground zero, so it's a glass half-full or half-empty situation."

Moyer places the trans movement in a historical - and personal - context.

"I think historically we are not any different than any other community who has tried to organize," Moyer said. "It's [a] very hard thing to be out if you are passing in your gender. Actually, it's very hard to be out if you are passing or not passing, but once someone transitions, that in itself is a difficult feat, and then to go out and be public about it ... but it's like any other minority community, it's politics and personality. We come in all types, from radicals to conservatives."

Source: Trans activist Deni Scott of TransFAIR Pennsylvania