Ivana Black was assigned male at birth. Now 45 years old and living as a woman in New York City, she works part-time as an entertainer and an actress. She lives in West Harlem with her small dog, Angel. Ivana started transitioning in her late-teens while living in the Midwest. She began with birth control pills because, she says, they were the most accessible form of hormones at the time. Ivana said she wanted to transition to a woman as quickly as possible. Faced with too many financial hurdles and finding difficulty in navigating the health care system, she turned to alternative means.

Although health care laws have evolved since her transition started, many transgender people remain without health insurance coverage for transition-related care. Eight states and the District of Columbia now offer transgender health care under Medicaid, and 15 states and the District of Columbia require private insurance companies to cover transgender health care, according to the Transgender Legal Defense and Education Fund.