Daniel G. Cobos, BSN, MPH, RN, ACRN, is Ryan White Part C Program nurse/outreach coordinator, University of Nebraska Medical Center, Omaha, Nebraska. Jonathan Winston Jones, MA, is development associate, Nebraska Appleseed Center for the Law in the Public Interest, Lincoln, Nebraska. Transgender persons are on the front lines of negotiations on expectations of gender identity and expression. For the purpose of this report, transgender includes ‘‘any person who has a gender identity that is different from their natal sex and/or who expresses their gender in ways that contravene societal expectations of men and women’’ (Bockting, Robinson, Forberg, and Scheltema, 2005, p. 2). Gender variations have strong roots in the histories of many cultures. Depictions of transgender persons have been found in artifacts from ancient Rome. Some North American indigenous cultures include two-spirit people, meaning that individuals who embody both genders have been part of native cultures. Various Hindu cultures embrace the concept of hidras, which is neither man nor woman (Lombardi, 2001). Samoans accept fa’afafine (also spelled faafafine, fafafige, or fafafine), biological males who choose or are chosen to be raised female and fulfill important domestic roles in Samoan culture. The Thai are tolerant of kathoeys (also spelled katoey), male-to-female (MTF) transgender persons who often work in traditionally feminine occupations (Croall & Elder, 1999; Matzner, 1999; Winter & Udomsak, 2002). Today, transgender may include ‘‘crossdressers, drag kings/queens, transsexuals, people who are androgynous, Two-Spirit people, and people who are bi-gendered or multi-gendered, as well as people who do not identify with any labels’’ (Bockting et al., 2005, p. 2). Lack of acceptance of transgender persons in the United States is an important measurement of how far this country must go to realize its promise of equal