In 2013, at one of the lowest points in her life, 44-year-old software engineer Greta Martela placed a call to the National Suicide Prevention Hotline. She had been hospitalized five times for being suicidal, starting at age 28, when she realized she was transgender. But she was still struggling with coming out to the wider world. When she disclosed to the counselor that she was transgender, he was confused about what that meant. Once she explained, “he got off the phone as quick as he could,” she said.