It’s been 50 years since the LGBT equality movement started in Philadelphia. So Billy Penn decided to look at the transgender experience in the city today, from data to personal stories to health challenges and anti-discrimination policies. This is Trans Philly.

Ever since Daye Pope can remember, she felt different about herself. Growing up in small-town Iowa, Pope had always identified with girls and women, and went through young life not realizing that acting like a girl was taboo — always wondering why she didn’t fit in.

Pope was assigned male at birth, but had always identified with feminine traits. At the time, she didn’t know what transgender was, and wasn’t acutely aware that her feelings meant she would one day be a transgender woman. But by age 17, Pope joined student groups for LGBT teens, learned the vocabulary and immersed herself in the community. It was her safe space.

“It’s hard to deal with, to be having these feelings like, ‘I think that I’m not living authentically’ and ‘how can I find a way to do that?’” Pope, who is now 23, said. “There’s a coming out, or a reconciling of what we know ourselves to be and who we know ourselves to be based against who people think that we are.”

Pope, who says she was lucky to have the support of her parents, later moved to Philadelphia. She now advocates for transgender people across the state as the transgender rights organizer at Equality PA, a statewide organization that works toward the advancement of LGBT rights. She’s one of thousands of transgender men and women living in Philadelphia, facing daily challenges ranging from discrimination to health care to social stigma and violence in a city widely seen as on the forefront of acceptance.

For activists, the welcoming of transgender men and women was given visibility with the coming out this year of Caitlyn Jenner, thrusting transgender-related issues into the national spotlight. Transgender celebrities like Laverne Cox star in popular, mainstream shows. But advocates also say there’s a long way to go before transgender men and women across the country can no longer fear discrimination and acts of violence.

Transgender in Philly

At the beginning of June, Philadelphia flew a special flag right next to its United States one. In the shadow of the massive City Hall was a blue, pink and white flag — it symbolized transgender pride. It was the first time the flag flew there; officials did so to mark the beginning of the 14th annual Transgender Health Conference that took place at the Mazzoni Center, the city’s space for LGBT health and wellness.

“The flag-raising is a powerful symbol of just how far we have come, thanks to the work of so many dedicated leaders and activists committed to advancing our rights as equal citizens,” Conference Coordinator Samantha Dato said afterwards.

This city has a reputation as being friendly for the LGBT community; the question was even once raised if Philadelphia “was the new transgender capital of the world.” So how many transgender men and women are living and working here?

It’s hard to say. Research is still uncommon, and most government-funded population surveys ask for a gender: male or female, without specification whether or not a respondent is transgender. One 2014 study conducted by an LGBT demographer at the University of California Los Angeles School of Law’s Williams Institute suggests that 700,000 people — or about 0.3 percent of the American population — are transgender.

This would indicate that about 4,500 transgender men and women are living in Philadelphia today. That estimate is probably at least in the ballpark. Medical personnel at the Mazzoni Center, Philly’s most popular health center for LGBT patients, currently treat about 2,200 gender non-conforming patients who live or work in the city or the region.

Researchers don’t know if that population is growing or not based on studies conducted. But activists and those immersed in the transgender community say that as trans-related issues hit the mainstream, transgender men and women are coming out and transitioning at younger ages. The Mazzoni Center has treated adolescents and children as young as 6, and teens are welcome to come there as a safe space without having to bring their parents or provide insurance.

“I think all in all around the country, Philadelphia is known as a place that’s easy to transition,” Dane Menkin, a certified registered nurse practitioner specializing in transgender medicine at the Mazzoni Center, said. “Services are available. It’s a relatively open-minded city. But it really depends on what population we’re talking about. If I’m talking about a white, 35-year-old trans man, than his journey is a lot different than a 22-year-old trans woman of color. ”

Health care

Disparities in equity exist everywhere, and they’re ever-present in the transgender community. When Jenner came out earlier this year, some transgender allies were quick to point out that the public reconciliation was good for visibility, but her journey isn’t indicative of what many transgender men and women go through.

Tiq Milan, a keynote speaker and spokesperson for GLAAD, told a crowd at this year’s Transgender Health Conference in Philly that celebrities shouldn’t represent the whole community.

“We gotta ‘Kanye’ this moment,” Milan said. “Like, ‘Caitlyn, Im’ma let you finish, but trans people are still four times more likely to live in poverty.’ Or ‘Caitlyn, Im’ma let you finish, but our children are still homeless.’”

A large difference for Jenner? Money, status and better access to health care.

Menkin said base hormone therapy for transgender men and women, whether it’s estrogen or testosterone, will run patients somewhere between $40 -$60 a month, and insurance coverage varies. Anything pill-formed is covered, but testosterone comes only in an injectable form. He said most middle-income patients can afford the hormones.

Surgeries, on the other hand, can run thousands of dollars based on what work needs to be done, whether it’s facial feminization or masculinization, chest surgeries for breast augmentations and reductions or genital reassignment surgery. Sherman Leis, a gender reassignment surgeon based in Bala Cynwyd, said some transgender men and women who elect to go the surgery route only choose one of these changes. Some choose all. It’s often dependent on the person’s preferences and what he or she can afford.

But advocates are trying for change. At the last Transgender Health Conference, Menkin convened a task force that brought together surgeons, insurance companies and advocates to talk about the issues at hand. Just getting insurance companies there is a feat in itself. Those who attended were Aetna, Cigna, CMS and Kaiser. Menkin said hometown insurance company Independence Blue Cross didn’t show.

The group met for a four-hour meeting to discuss goals for how providers and insurance companies can better serve transgender patients. That includes insurance coverage, and emphasizes increasing the number of providers. Some transgender men and women who don’t live in urban areas drive hours for health care. Nationwide, only a handful of surgeons provide these services.

Violence and discrimination

Londyn Chanel

Earlier this year, transgender woman Londyn Kiki Chanel, 21, was killed in an abandoned building in North Philadelphia. Her 31-year-old roommate was arrested in connection with the killing. In 2013, transgender woman Diamond Williams was brutally murdered in Strawberry Mansion, and a 43-year-old man was charged in connection with it. 

According to GLAAD, more than 85 percent of LGBT people who are murdered are people of color. More than 45 percent of these hate murders are of transgender women. Half of the nation’s transgender men and women have experienced some form of sexual violence. More than 40 percent of transgender people surveyed by the National Center for Transgender Equality said they had attempted suicide, compared with 1.6 percent of the general population.

What’s more, is that discrimination is still pervasive. While Philadelphia has a nondiscrimination ordinance, the state of Pennsylvania does not. Even if one passes in Harrisburg and stipulates that employers, housing officials and others can’t discriminate based on sexual orientation or gender identity, some say the everyday discrimination will continue for years to come. There are still few truly inclusive places of employment and housing, Pope said.

But activists also say nondiscrimination legislation is a good first step.

Rachel Levine this year became the state’s first openly transgender official in the statewide administration. Nominated by Gov. Tom Wolf, Levine, a transgender woman, was confirmed by the Senate earlier this year to become the physician general. And while it’s not in her job description, she’s helping the Wolf administration draft nondiscrimination legislation and is advocating for its passage.

“I think it’s really important for young people, with the progress we’ve made, and last week’s [marriage equality] decision, not to despair, not to get hopeless, not to harm themselves,” she said. “Things will get better, and things are getting better in our culture every day.”

Pope agrees. Things are getting better. With her position in Equality PA, she’ll be traveling all across the state this year to talk to transgender men and women about the challenges they face, and how groups can better lobby for meaningful legislation that’ll ultimately help decrease discrimination against members of their community.

“I just want transgender kids and teens to know that they are strong enough to make it,” she said. “And that there’s a whole, large group of us out here trying to make the world better for them. And hopefully succeeding so that each generation has it even better than the one before.”

Anna Orso was a reporter/curator at Billy Penn from 2014 to 2017.