GRAND FORKS, N.D. -- Theresa Marshall’s journey from a young boy in suburban Chicago to transgender woman in Grand Forks started one of its earliest chapters in the dark.

Marshall grew up in Orland Park, 30 minutes from the Windy City, in a sprawling extended family. Bags of hand-me-down clothes were passed from home to home, and Marshall recalls snatching a bag of girls’ clothes as a 12-year-old before heading back to privacy while the rest of the house slept.

“I would sneak the bag of clothes up to my bedroom, lock the door of my bedroom and start trying clothes on,” she recalled. “I knew it was wrong, but I knew it made me feel good. I would hide the clothes -- the ones that made me feel good -- and I would try it on again.”

For Marshall, now 50, a lifetime of distance from that moment has transformed her into a completely different person. As she sits on the couch in her Grand Forks apartment, her long, reddish hair falls across shoulders covered by a pink and purple shirt; her jeans end just above her heeled shoes; her fingernails are painted. It all belies her past as a truck driver and a U.S. Army veteran, as well as the long years of grappling with her identity.

It’s not an easy appearance to maintain. Marshall still has to shave -- carefully --- to keep her once-thick beard from growing back. She has a small bottle of hormones that’s helping her grow breasts, and she’s balanced it all with coming out to her wife and children, who have stayed by her side through the physical transition she started in December 2014.

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For transgender people like Marshall, and others, there is frustration that most don’t understand the definition of what it means to identify as transgender. According to many LGBT advocacy groups, it’s a term that describes people whose gender identity is different than the sex that shows up on their birth certificate.

Marshall is the founder of Gender Friendly Grand Forks, a transgender advocacy group she says has grown to 50 local members, including 20 who are transgender. She said the group counts about 200 members, counting contacts around the country.

It’s an important resource in North Dakota, a state that’s only just learning how to incorporate the transgender community into everyday society, Marshall said. When she first started transitioning, it was hard for her to find information on the transition, and it was hard to find medical professionals who could help her through the process. Compared with some states, she said, North Dakota is unprepared to help transgender people.

“We’re probably in the mid-range,” Marshall said. “There’s a lot worse. (But) this is something that’s caught a lot of people off-guard.”

The debate on how LGBT persons fit into the national fabric has passed through several watershed moments in recent years, the most significant of which was the U.S. Supreme Court’s ruling last year legalizing gay marriage. On the national level, recent momentum has backed left-leaning advocates of more rights for sexual minorities.

But in North Dakota, change hasn’t come as quickly. Kyle Thorson, an organizer behind Grand Forks Pride -- a festival celebrating the LGBT community -- said that, while large cities are friendly to LGBT people, there are large swaths of the state that aren’t.

“In the rest of North Dakota, it’s a big challenge to talk about it. Compared to other places, we’re a very red state,” he said.

Perhaps most notably, the North Dakota House of Representatives voted down multiple measures in April 2015 that, taken together, would have outlawed discrimination based on sexual orientation and gender identity -- from housing to employment to public services. Though Thorson noted the failure, he said the fact that the measure reached Bismarck at all owed to the anti-discrimination protections that have sprung up in cities around the state, like housing protections in Grand Forks or a Fargo ordinance protecting city employees from discrimination based on sexual orientation -- which, in the language of the bill, included gender identity as well. The legislation is expected to be reintroduced.

Thorson also worked to explain a nuanced point: that while transgender persons are certainly a part of the LGBT community, they face challenges that lesbian or gay individuals might not.

“Gender is one of those touchy issues, and you can see gender and how people are portraying their gender, as opposed to sexual orientation,” Thorson said. “I would say that, frankly, marriage is all fine and well and important, but that’s not the critical issue. Transgender people across the United States face many more immediate dangers.”

Marshall took the divide even further, though, noting that she doesn’t like being lumped into the same group as lesbian, gay and bisexual persons, because she said there’s a mismatch between the rights those groups have and the issues trans people struggle with. She pointed to the struggle transgender persons have recently had over bathroom policy -- whether than can use the restroom matching their gender identity -- as an example. The issue is particularly tough for male-to-female transgender persons.

“A lot of them are fearful,” Marshall said. “They just refuse to use the restroom in public. Those are the things we’re working on as a group.”

Marshall describes regular meetings of Gender Friendly Grand Forks as small and intimate. There are about 15 people at any given meeting, she said, and about six or seven attendees are actually trans. The rest are often wives, or significant others helping their partner navigate their change.

Marshall said it’s hard to be transgender in North Dakota, but the state was likely in the middle of the pack when it comes to transgender acceptance. Many of the attendees at meetings of the group have similar experiences -- perhaps they can’t get their employers or coworkers to use their new gendered pronouns or new name, despite legal changes.

“There’s a lot of misunderstanding of what transgender is in the first place. You’re confused with being a prostitute or a transvestite,” Marshall said, stressing most people have likely met a transgender person without realizing it. “If you’re at Wal-Mart on a Saturday, you’re probably shopping with two or three transgender people and you don’t even know it.”

The stresses that come with living as a transgender person can be serious. According to a 2014 study jointly released by the American Foundation for Suicide Prevention and the UCLA School of Law, suicide rates are high among transgender and gender non-conforming adults. About 41 percent of respondents in the study said they had attempted suicide; those rates shot up to 57 percent for those who were ostracized from their families, 60 percent for those who were refused medical treatment, and up to about 65 percent for those who “suffered physical or sexual violence” at work. The study cites prior reports placing the suicide rate for lesbian, gay and bisexual adults between 10 and 20 percent.

The average rate of suicide attempts among the general U.S. Population, according to the study, is 4.6 percent.

For Ray, a 22-year-old in Bismarck who asked his last name be withheld due to fear of retaliation, one of the most important days as a young person came during middle school.

He’d taken up dressing like a “tomboy,” he said, even though he still was physically -- and, as far as his peers were concerned -- a girl.

That day, Ray said, he walked out of school and fellow students blocked his path to his bike. They hurled transphobic insults at him until he called his mom to come pick him up; when he got home, he got on the phone with his aunt, an LGBT activist in California, who told him what it meant to be transgender.

For Ray -- now a student at Bismarck State College -- the road to transgender adulthood has been rocky. After speaking publicly in the past, he’s been threatened on social media and feared speaking out again too publicly too soon.

Ray still remembers his early days in the same way Marshall does -- a growing pattern of not quite fitting into the gender role he was born with. As a young child, Ray would play with the neighbor boys and pretend to be on television -- almost always as a man.

“I think all of my life I kind of knew that I was born in the wrong body, but the day that I heard that this is what it actually means to be transgender, that’s when it all kind of clicked into place,” he said.

Lisette Wright, a Minnesota psychologist who works with transgender individuals, described years of experiences with stories like Ray’s.

“I’ve even had a client who was in his early 60s transition,” she said. “It’s something that they’ve been dealing with their entire lives. By the time they come to me, most of them are pretty clear on who they are and what needs to happen.”

Theresa Marshall’s journey to realizing who she was took a long time. She graduated from OrlandPark’s Carl Sandburg High School in 1984, having lived out a high school experience of compensating: making sure, for appearances’ sake, that she had plenty of girlfriends. She spent a few years in the army, thenworked a series of jobs across the country, dated both women and men -- the latter with shame, she said -- had three children with her first wife and is now married to her second. Both of them knew about the thoughts and feelings she’s had throughout her life.

Her decision to transition, Marshall said, came in 2014 as various health issues, including heart problems, began to clear, but while medications left her with low hormone levels.

Marshall explained that, contrary to what many people thinks about transgender people, not everyone feels they were born in the wrong body, per se -- it can be more nuanced than that.

“For some people, it’s certainly true. I don’t know if it’s true about me,” she said, explaining that she had always realized there were two sides to her. “I dated lots of girls during high school, but I related to the girls. I think that’s why I hung out with them more. But I also had feelings for guys that weren’t supposed to be there. I don’t know if it was necessarily sexual.”

Wright described stories like Marshall’s as existing in a kind of grey area between the two ways most people are used to talking about gender -- male and female. It’s a binary thought process, she said, that can make transgender issues politically difficult.

“I think why this is so challenging for people is that there isn’t a concrete answer for this, and people in America cannot live with ambiguity,” Wright said. ”They want it black-and-white, they want it clear cut.”

Ray’s assessment of North Dakota’s treatment of the trans community is grim.

“I’m trying to think of a very nice way to put it,” he said, pausing for a moment. “Honestly, it’s a joke, and that’s the nicest way to put it. If North Dakota wants to be an inclusive state, they need to get their poop in a group and realize there’s more than Christians and Catholics here.”

Ray’s frustrations include anger at the North Dakota Attorney General’s office, which anticipated filing a lawsuit against the Obama administration’s school bathroom directive earlier this month, that students ought to be allowed to use the bathroom that matches their gender identity. Ray remembers that he almost never used the bathroom at his high school -- such was the discomfort and social pressure that came with entering the women’s room.

“I got some very, very dirty looks. It was just super uncomfortable, because I wasn’t friends with everyone there. They would say things, they would laugh, they would point,” he said. “I look male, I act male, I am male. I’m going to use the male restroom.”

Marshall said that she knows there need to be a lot of changes. For starters, she’d like to see the state take up the anti-discrimination bill again, which would help solve the bathroom issue; she said she’d also like more insurance companies, in North Dakota and around the country, become more accustomed to working with transgender individuals and their medical needs.

Marshall added that she also wants to see her group grow. Plans are in the works to finalize nonprofit status for the group and change the name to Gender Friendly America, with local chapters around the nation. Marshall said she wants her chapter to be the start of a movement helping transgender persons find their way in some of their darkest times.

Those who want to contact her, she said, are welcome to call her cell phone -- a number emblazoned on the group’s promotional items, like the pens she’s happy to hand out a fistful at a time.

“My vision is that this can be the biggest (transgender) group in America,” she said.