At age 6, Sarah McBride used building blocks to create a make-believe version of the place she dreamed to visit one day: the White House. McBride’s early dreams came true. She interned at the White House in 2012, during her senior year at American University — where she came out publicly as transgender at the end of her term as student body president. And at the 2016 Democratic National Convention, she made history, becoming the first transgender person to speak at a national convention.

McBride’s new memoir, Tomorrow Will Be Different: Love, Loss, and the Fight for Trans Equality, describes her experience as a trans woman, helping Delaware become the 17th state to protect trans people from discrimination, and her relationship with Andy Cray — a transgender man and activist — who died of cancer at the age of 28, only days after their wedding.

McBride says addressing trans equality is a life-or-death matter. “When I think of families accepting and embracing their transgender children,” she told me, “I remember when a mom of a transgender daughter said: ‘When my child came out, I was faced with a decision — whether I wanted a happy daughter or a dead son.’”

I spoke with McBride, currently the national press secretary of the nonprofit Human Rights Campaign, about the issue of coming out as trans, the “empathy gap” of liberals, and the ban on transgender people in the military, among other topics.

Our conversation has been condensed and edited for clarity.

Hope Reese

Being a young activist for trans rights is central to your identity. And now we’re starting to see activism in this younger generation — most recently in the Parkland protests [after the shooting at Marjory Stoneman Douglas High School in Florida]. What advice do you have for young activists?

Sarah McBride

Young people have always been at the forefront of social change, whether it was Sylvia Rivera and Marsha P. Thompson at a young age helping to launch the Stonewall Uprising or John Lewis organizing a march across the bridge in Selma.

Students are turning tragedy into action and taking on an issue that for far too long hasn’t seen enough action. They will get to decide who was right and who was wrong in this moment — and I think elected officials and the public at large understand that.

Hope Reese

Recently, a trans person openly enrolled in the military, despite Trump’s ban. How do you see this issue playing out?

Sarah McBride

This president’s discriminatory and dangerous ban on transgender people serving in the military was entirely impulsive and erratic. This was not done, contrary to his assertions, in consultation with his generals. It was not done in consultation with the Pentagon. It was done based on a whim, by a commander in chief who has governed with bigotry from the start. Fortunately, several court positions have affirmed that this ban is based on nothing but animus and is, indeed, unconstitutional.

What we’ve seen from the public’s response to this ban is similar to what we saw in North Carolina [where Republicans passed, and later partially repealed, a bill preventing trans people from using the bathroom corresponding to their gender identity] — every time they attack us, they end up creating a national dialogue that only further opens hearts and changes minds, sowing the seeds of the destruction of the politics of hate.

Hope Reese

I’ve heard that part of the reason we don’t see more trans people in the media is because there are many who just want to pass and don’t necessarily want to come out as trans. How important is it to come out?

Sarah McBride

Frankly, I think one of the more dangerous narratives that exists in the LGBTQ community is that everyone has to be out. It’s a dangerous burden to put on an already marginalized community — particularly when being out, for transgender people, can end up being an asterisk on your identity. While coming out and sharing one’s story can be incredibly empowering, and I want to build a world where everyone feels comfortable and safe doing so, the reality is that’s not the world faced by far too many LGBTQ people, particularly trans folks.

I’m fighting for every person to be able to live their gender identity or sexual orientation the way they feel they need to. By requiring people to be out, you’re violating that principle.

Hope Reese

In your book, your family comes across as supportive and loving, but when you first came out to them in December 2011, your transition was a challenge for them. You write that your parents “were struggling with the same empathy gap that ... was one of the main barriers to trans equality among progressive voters.”

Sarah McBride

I was prepared for the initial shock and extreme fear that my parents expressed when I first came out to them. Frankly, that’s one of the reasons why it took me so long to come out. But I resolved to be patient with them, and to walk with them through that process of what, to them, at first felt like a loss. It eventually led to not just acceptance but pride — in the fact that they’ve raised three great kids, two of whom are LGBTQ and have the courage and confidence to share those identities and that beauty with the world.

When my mom first asked, “What are the chances that I would have a gay son and a transgender child?” she was asking it out of a place of self-pity. My hope is that she has gone from asking that question from a place of pity to a place of awe.

Hope Reese

This generation of trans youth are, perhaps, the first to come out starting at a young age. How can you talk to families about their trans children?

Sarah McBride

Embracing a child when they come out as transgender can be a matter of life and death. We know, based on all of the available research and on the overwhelming consensus of the medical establishment, that allowing a transgender child to live their authentic gender identity has significant benefits for their long-term mental and physical health.

There are a lot of misconceptions and misinformation about what it means to allow a transgender child to live authentically. But despite the misinformation and myths, transgender kids are, in many cases, thriving.

Hope Reese

When you say that there are myths about what the transgender path looks like — what exactly are they? And why are they harmful?

Sarah McBride

The myths are that there’s some sort of early medical intervention [such as hormones or gender reassignment surgery]. The reality is that when a child comes out as transgender, they’re what’s called “socially transitioned” — they’re allowed to live authentically. They’re allowed to be called by their name and pronoun. It’s not until later in life, as puberty starts to hit, that there’s any degree of medical intervention — hormones, etc. Even then, it’s temporary medical intervention, done in consultation with medical professionals. It’s done in a way that gives them the maximum amount of time and space to make decisions.

There’s also a misconception about when people know they’re transgender. By all accounts, gender identity is something that is known from a very early age — frequently, it’s one of the earliest memories. This is something that these youth are insistent about, consistent about, and persistent about. The families that are affirming their children are doing so in a lifesaving way in consultation with medical professionals.

Hope Reese

The point you raise about how early transgender people know their gender identity — in 2013, author and New York Times opinion contributor Jennifer Finney Boylan told me that gender identity is formed in the sixth week of pregnancy. Is this science up to date? And how much does it matter when it comes to someone’s identity?

Sarah McBride

The science continues to explore the causes and sources of gender identity. Families, particularly if they’re having a child come forward expressing trans identity, need to educate themselves and seek out support from medical professionals.

But I also think we too often try to medicalize trans identities. We focus too much on whether it’s a medical transition or the potential scientific forces of gender identity. The reality is that, for whatever reason, transgender people exist. They’re part of the natural diversity of humanity — and a beautiful part, at that. The more pressing question before society that I seek to work on is: Do we treat transgender people with dignity and respect?

Hope Reese

What did you learn about being a woman, about how society treats women, after your transition?

Sarah McBride

Before I came out, I was so consumed with the transphobia I would face, understandably, that I didn’t think as much about the sexism and misogyny that would come my way. It was truly everywhere. Whether it’s the double standard of walking down the street and being treated as both a delicate infant and [a] sexualized idol in the exact same moment, or the double standard of being forced to work two, three, or four times harder to get half as far — while being punished, simultaneously, for exerting a degree of determination, tenacity, and ambition that is required to work that hard.

Hope Reese

Many anti-LGBTQ arguments fixate on the “bathroom issue” — which you express frustration with.

Sarah McBride

I frequently hear, “Why are we all talking about bathrooms so much?” Frankly, transgender people would rather not talk about bathrooms. We are pursuing full dignity and equality in society. It’s opponents of equality who are focusing on restrooms. One reason is that everyone feels a little bit vulnerable in a restroom, so it becomes fertile ground for scare tactics and fearmongering to take hold.

If these opponents allow for discrimination to occur in bathrooms, it is the closest thing to a silver bullet in legislating discrimination throughout daily life. If a trans person can’t use the restroom that makes sense for them safely, it becomes much more difficult to go to school, work, and nearly impossible to leave their house for more than a few hours. That’s what these efforts are: thinly veiled attempts to legislate transgender people out of public life.

Hope Reese

In North Carolina, you posted a selfie in a public bathroom protesting the legislation, which went viral. But some of the perhaps well-meaning comments, saying you should have access to the women’s restroom because you “fit in” — that you looked like a “typical” woman — troubled you.

Sarah McBride

When we start policing gender expression, when we start saying, “You don’t look woman enough to be in the women’s restroom,” or, “You don’t look man enough to be in the men’s restroom,” we’re not just kicking transgender people out of restrooms — we’re going to be kicking cisgender people out of restrooms too. Bathroom policing has often impacted cisgender women who don’t conform to gender stereotypes. Who “present” too masculine. Whose hair is cut. That’s why trans equality is so inextricably linked to the broader fight for gender equality.

Hope Reese

The Affordable Care Act included language protecting transgender people from discrimination based on sex stereotyping and gender identity in health care. Where does this stand now?

Sarah McBride

The Trump administration has announced that they are revisiting this regulation. There have been court challenges by anti-equality activists to undo or undermine that regulation. The overarching ban on sex discrimination in the ACA is still enforceable, and transgender people who face discrimination can still bring suit under that statute, no matter what happens to the regulation.

But what’s clear is that discrimination remains far too common in health care — whether in accessing medically necessary transition-related care or whether it’s transgender people accessing any care without discrimination. If you can’t access health care, if you can’t live, then all of the other rights wash away.

Hope Reese

The commonly cited statistic is that 41 percent of transgender people attempt suicide. It feels like a shockingly high statistic. Does the number tell the whole story?

Sarah McBride

It’s still cited widely, but the challenge is that there aren’t a ton of surveys about the trans community that are wide enough and collect enough data to get a clear picture of what that looks like. One of the most important things in that statistic is the fact that when transgender people are affirmed by their family members, that number drops in half. When they are affirmed by their community, it drops even further.

The statistic is so clearly a byproduct of a society that stigmatizes, discriminates, and harasses transgender people far too often. It underscores, for me, that LGBTQ equality is not a luxury issue. It’s not a social issue. It’s not an issue that should be reserved for when we’ve addressed other issues. It’s truly an issue of life and death.

Hope Reese is a journalist in Louisville, Kentucky. Her writing has appeared in the Atlantic, the Boston Globe, the Chicago Tribune, Playboy, Vox, and other publications. Find her on Twitter @hope_reese.