This is what it feels like to be transgender in America: Some days it feels like we’re creating possibilities and finally making the world safer for one another. Other days all we can feel are the devastating threats to our community as reactionaries try to shame and legislate us out of public life.

Earlier this year, the Trump administration withdrew Obama-era guidelines protecting transgender students, and just last month, Trump tweeted that transgender people cannot “serve in any capacity” in the military (though the Department of Defense still hasn’t received any guidance from the White House about implementing the ban). The same day Trump tweeted about banning trans troops, the Justice Department argued in a major federal case that the Civil Rights Act’s Title VII does not protect gay workers.

At the same time, legal avenues for the advancement of trans people’s rights are opening up in new (and controversial) ways. On May 18, A US district court in Pennsylvania ruled that Kate Lynn Blatt, a trans woman, could sue her former employer for discrimination under the Americans with Disabilities Act. Her former employer, Cabela’s Retail Outfitter, tried to argue that gender dysphoria was not covered under the act, but it was denied the motion to dismiss.

The court ruling has reignited a long-running debate about how we understand gender diversity. Is gender dysphoria protected under the Americans With Disabilities Act (and therefore a psychiatric illness requiring care)? This debate has been a centerpiece of trans discourse for years, with arguments today reflecting those in 2013 when the newly released DSM-V categorized gender dysphoria as a psychiatric condition. The development was an improvement from the manual’s previous edition's categorization of gender identity disorder — which described the act of identifying as a different gender as an illness in itself — but the 2013 decision still caused a split between trans organizations. Some spoke out against the continued pathologization of trans experience, and others focused on the way that this designation would make it easier for trans people to receive care.

Now the future of health care for the country at large remains an open question. While Senate Republicans failed to pass their last-ditch Obamacare repeal plan late last month, they haven’t yet completely given up the fight — and some health professionals assert that repealing the Affordable Care Act would devastate transgender Americans. In a society where transgender and gender-nonconforming people are far more likely than the general population to be unemployed, live in poverty, and live with disabilities, trans people’s access to safe and affordable health care is crucial to our survival.

I have been a transgender community organizer for over a decade. Despite all of the victories that have dotted recent history, I’ve found this current political moment to be one of the most stressful and frightening to be transgender in America.

As a disabled transgender woman in America, that stress is compounded. On any given day, I don’t know which part of my identity will be under attack. Transphobia and ableism are harsh realities of my day-to-day life, and of the lives of countless other Americans who share my experience.

Trans people with disabilities are among those most affected by these recent legislative and legal battles surrounding trans rights and the future of health care — but their voices have been strikingly absent from the national conversation.

So I’ve spent several weeks reaching out to them to hear what they think about the current state of health care, gender, disability, and identity. Responses have been edited for length and clarity.