That's a fact of life for people who identify as "transgendered" and getting their minds and bodies in sync is a journey that's often long, lonely and violent. So people at the Transgender Center in Houston are hoping to change that.
From early childhood, Christopher Williams felt something was wrong.
"I was very convinced I would never be able to make it in life as a female," said Christopher, who is now Cristan as a female. "And certainly couldn't go on any longer as a male."
But the night he planned to take his life, the phone rang. It was someone from a transgender support group, a group Christopher had written to for help. Instead of suicide, Christopher began the transition to Cristan that night, a painful and sometimes dangerous process.
"When I began my transition, of course, I immediately lost my job, lost my home," she said. "Lots of bad things could have happened to me and they do happen to lots of people who try to transition."
In the summer of 2003, Houstonian Kendrick Perry was shot and killed. Perry went by "Cinnamon" on the streets and it's believed was turned away from homeless shelters because Perry was transgendered. No arrest was ever made.
As for Cristan, by 2004, she had legally changed her name and had sex reassignment surgery. A little more than a year ago, she joined friends in opening the Transgender Center in the heart of the Montrose district. It is thought to be the first of its kind anywhere.
The center is not a place where surgery is performed. It offers social services, therapy and referrals for medical care, a real focus, since the transgendered are more at risk of becoming victims of violence, or contracting HIV.
Lou Weaver and Tate Alexander were born female, but live male. Tate is recovering from a recent double mastectomy as a part of his transition. This is a radical change from his life on the streets as a teenager after his parents kicked him out for telling them he was not a girl.
"Literally I almost died on the street," said Tate.
"I was in the middle of a grocery store or something the other night and they were looking, 'Is this girl or boy? Is this girl or boy?" said Lou. "What difference does it make what my gender matters? Obviously it's my ID, I'm just trying to buy my groceries, let me go."
What Cristan, Lou and Tate felt before transitioning is recognized by the American Psychiatric Association as "Gender Identity Disorder.'
"It feels as if the body is betraying them for many people, especially when they hit puberty," said clinical psychologist Dr. Lynne Shepherd. "It's one of the few disorders in my field, mental health, that has a treatment that can be taken care of. You know, when people are able to transition and to have everything match, it resolves itself."
It means hormones and therapy, sometimes even sex reassignment surgery. And despite the physical and social toll transitioning takes, the rewards make it, and the center, valuable to the transgendered.
Learn more about the Transgender Foundation of America
Slideshow archive | ABC13 wireless | Help solve crimes