Martine Rothblatt raked in a cool $38 million last year, according to The New York Times. Rothblatt tops the list as the highest-paid female CEO in 2013. Twenty years ago, Rothblatt would not have been able to claim this title—Martine was born Martin.

The 59-year-old founder and CEO of publicly traded pharmaceutical company United Therapeutics transitioned from male to female in 1994. Rothblatt made her first fortune as a founder of Sirius radio in the 1990s when she was still living as a man, New York magazine reports. She launched her current endeavor in 1995, shortly after her transition.

Only 11 women made it onto the list of the 200 highest-paid CEOs. Rothblatt clocked in at No. 10. Yahoo President and CEO Marissa A. Mayer is the next woman on the list, about 24 slots lower and earning roughly $13 million less than Rothblatt.

“I can’t claim that what I have achieved is equivalent to what a woman has achieved. For the first half of my life, I was male,” Rothblatt told New York.

Rothblatt’s hurdles might be different from those born female, but life as a transgender woman is far from trouble-free. Transgender and gender-nonconforming people face a barrage of employment-based discrimination, and it’s hard to imagine how much worse the situation must have been for Rothblatt when she transitioned two decades ago. Transgender workers have an unemployment rate of 14 percent—that’s twice the rate of the rest of the population, according to a 2013 study.

For Rothblatt, gender is more fluid than identifying as male or female. Even after deciding to undergo a sex-change operation, she prefers to use “Pn.,” for “person,” rather than “Mr.” or “Ms.”

Rothblatt remains married to her devoted wife of 33 years, Bina Aspen. They have four children, who call her “Dad,” and grandkids who have nicknamed her “Grand Martine.”