As bad as the situation is now, it was much worse during my youth. The poverty and homelessness, and the lack of insurance, probably were even bigger problems for trans people thirty or twenty years ago than they are now. However, there was yet another factor that made it difficult, or even impossible, to get the necessary therapies and treatments, and helped to create a lost generation of transgender people.
That factor is a trait of a particular group of people--the ones who were, in essence, "gatekeepers." I'm talking about medical as well as psychiatric professionals. They, like nearly everyone else, were inculcated with their culture's notions of gender and sexual norms. That is to say, nearly all of them believed in the "male-female" gender binary and the normalcy of being a heterosexual.
What that meant, of course, is that nearly all such professionals were deeply homophobic to one degree or another, whether consciously or not. (I will admit that I shared much of that homophobia.) So, for example, a female-to-male transgender who wanted hormones and surgery could not give even any indication of sexual attraction to women. She also had to exhibit what were considered "feminine" traits and desires. Worst of all, she had to commit herself to living a life of denying her past. In other words, she had to re-invent her life as that of a woman growing up to become a girl, in the name of "passing."
Victoria Brownworth has written, "Passing never works; the lie distances you from those who aren't a party to it. Society may reward the lie, may even demand it, but the passing person is punished for passing--either by being caught in the lie or believing it. Every closet is a prison, whether it is a construct of sex or class. Passing kills; it annihilates who we are and keeps us from who we could be."
About the only beneficiaries of this emphasis on "passing"--which is to say, living in an enforced closet--were the Four Horsemen of our community: AIDS, drugs, suicide and violence. They all reached staggering proportions during the 1980's. Although good, let alone exact, statistics on trans people from that period are nearly impossible to find, I would guess that an even larger percentage of trans people died from those causes than are claimed by them now. In a literal sense, they are the reasons why we have a lost generation of transgender people. But even the survivors of that generation--who include me--had to endure decades of depression, isolation and, in many cases, substance abuse, as a result of not seeking the care we needed until much later in our lives. That left us as isolated from each other as all of those transssexuals who "passed", or tried to, were from each other. The result was that, really, we didn't have a community for at least a decade, and could therefore not offer each other the advice, mentorship and other help we so desperately needed.
In other words, even those of us who wouldn't begin our transitions for another two or three decades had to live with the same lie as those who told doctors, psychiatrists, endocrinologists and surgeons what they wanted to hear. They, of course, told those lies because the health professionals themselves believed, if not the lies themselves, then in the homophobia that made them necessary. Those of us who survived are still dealing with the aftermath, and will probably do so for the rest of our lives.