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“It always is,” she said. She sat down, leaving a polite gap of one chair between them. “My name is Joan. I started transitioning when Reagan was in office. Lost my job, my wife, my house. Kept the cat, though. Cats don’t care.”

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: Programs must be gender-affirming and recognize the specific identities of transgender women without using derogatory language. Integrated Care “It always is,” she said