USA TODAY

ASHEVILLE, N.C. — Marcie Bernardo spent most of her life as Mark. The name didn’t fit. It pointed to a gender she didn’t own. It made her feel uncomfortable, out of out-of-place and alone.

Today, Bernardo hands out business cards with the name Marcie.

Soon, she hopes that name will replace the one on her driver’s license, her Social Security card, her passport and her birth certificate. Eventually, she’d like to correct the record so that it now says Marcie Bernardo, born Oct. 24, 1955, in Boston, sex: female.

"I’m working on being the woman I've always wanted to be," she said.

Like Bernardo, transgender people are changing their names with a sense of urgency as they fear tighter restrictions against the LGBT community will follow a divisive election, activists say.

Worries are especially high in North Carolina, where the General Assembly planned a special session Wednesday to debate the merits of House Bill 2, which limits protections for LGBT people.

Commonly known as "the bathroom bill," the measure passed in March requires that transgender people use bathrooms in public schools and government buildings that match the gender recorded on their birth certificates. It further prohibits local governments from banning discrimination against LGBT people, setting a local minimum wage or adopting other local rules on employment.

GOP lawmakers hurried through the legislation in March but are considering its repeal amid national backlash. Transgender people and their advocates worry similar restrictions could surface as long as Republicans maintain control of the state legislature.

Two nonprofit groups - the Campaign for Southern Equality and Tranzmission - held separate name change seminars in Asheville earlier this month with nearly 50 people in total attending.

The Campaign for Southern Equality emerged as a national leader on LGBT issues in 2015 after it played a pivotal role advocating for the legalization of same-sex marriage.

Its Dec. 10 event marked the first in a series of free legal clinics the group has scheduled throughout the South as people grapple to understand what’s next for LGBT gay rights.

The process for changing a name on a birth certificate in North Carolina is complex. It can take months and cost hundreds of dollars. Though many people do it by themselves, some hire a lawyer.

One hundred and four people petitioned Buncombe County Superior Court to change their name on their birth certificate from July 2015 through June of 2016, an increase up from 84 people during that same span the year before and up from 74 the year before that.

While the court doesn’t track whether requests were made by transgender people, petitioners must state reasonable cause for wanting a name change.

“Transgender name changes are a big part in most of what I have been doing lately," said Johanna Finkelstein, an assistant clerk of court who processes the requests.

The clerical notation has more meaning than any form could possibly convey, said Zeke Christopoulos, a transgender man who is the co-director of Tranzmission, an Asheville nonprofit support and advocacy agency for transgender people and their allies.

The organization’s Dec. 7 Emergency Name Change clinic was part of an ongoing series on the topic.

An official name change increases personal protection, provides legal relief and offers closure to a process that for people like Bernardo has been decades in the making.

"We lived in such a state of fear and reprisal when we were young. I mean we were three closets deep," she said. "We weren’t just out of the norm or gay, we were trans, which was so, so socially unacceptable. I mean you could be beaten to death for being gay, forget cross dressing.

"Historically it has been very, very ugly, so a lot of us waited a long time," Bernardo said. "This is kind of the end of the line."

An 'uncertain' future

After the November election, the National Center for Transgender Equality reported an uptick in attention and efforts by transgender people to update identity documents, said Arli Christian, state policy counsel for the advocacy organization.

The current political climate has caused fear that federal gender marker policies might change. This is paired with an increase in hate speech and discrimination, Christian said.

The center is advising people to update their identification documents now if they are ready.

"We want our trans communities to feel as safe and respected as possible in the world, and we recognize that we are headed into an uncertain political climate," Christian said.

"We don’t want our communities to panic and ultimately we want to ensure people we are fighting to protect trans people no matter what their ID says, no matter who they are."

The center this month completed the largest-ever survey of transgender Americans. Its findings are grim.

The agency studied the responses of 27,715 transgender people from all 50 states, the District of Columbia and three U.S. territories.

Forty percent of respondents said they had attempted suicide at some point. The overall attempted suicide rate in the U.S. is less than 5 percent, researchers note.

The survey found significant economic disparities, with 29 percent of respondents saying they lived in poverty — roughly double the percent of the overall U.S. population.

The unemployment rate among the respondents was 15 percent, three times higher than the national rate at the time.

Further, only 16 percent of the respondents said they owned their own home, compared with to 63 percent of adults nationally, and 30 percent said they had experienced homelessness.

“Discrimination and violence threaten transgender people’s ability to have even the basics: food, a place to sleep or a job,” said Mara Keisling, executive director of the national center. “This survey demonstrates that there is a lot of work ahead to achieve simple parity and full equality for transgender people.”

The center has a grading system for the state identification gender marker change process. It gives North Carolina an "F."

Along with twelve other states, North Carolina, requires proof or surgery, a court order, or an amended birth certificate, the organization noted in September.

Twenty-two states make “A” grades for providing easy to understand forms or for allowing gender marker change certification from a range of licensed professionals, not just a physician.

Republican lawmakers in North Carolina have defended HB2 as a law that keeps the public safe and protects privacy. Transgender people have often said it puts them at risk.

The transgender equality center’s survey found 59 percent of survey respondents said they avoided using a public restroom in the past year because they were afraid of confrontations or other problems.

About one-third said they limited the amount they ate and drank to avoid using a restroom.

“These are very valid fears,” said Christopoulos, Tranzmission co-director. “There is a greater number of people who are really suffering a lot of undue stress because of the worry they might not get their names legally changed, or the process might become more difficult, more cumbersome and more costly.”

The process

Changing a name on a birth certificate in North Carolina requires state and federal criminal background checks, a visit to law enforcement to have your fingerprints made, a title search, a public posting of a petitioner’s intent, character recommendations, notarized forms and often an in-person interview with a court official such as Finkelstein under oath.

The steps for transgender people are no different than those who are cisgender, a person whose self-identity aligns with the gender they were assigned at birth.

“When I first started practicing law, it was a lot easier to get a name change," Finkelstein said. "You didn’t have to do the criminal checks. You didn’t have to do the judgement judgment checks."

The statute changed to include background checks in 2011, she added. It likely came about because someone abused the law. Prior to that, the last update was in 1971.

The idea is to prevent fraud, and keep people from changing their name to mask their identity because they are trying to evade arrest, or because they have outstanding debts, said Finkelstein, who acknowledges that some parts of the statute are dated.

For example, petitioners have to post a public notice at the courthouse for 10 days announcing their intention and revealing both their current name and the proposed new one.

“In reality people don’t hang out at the courthouse for entertainment anymore like they did 150 years ago, but it’s still a requirement in the statute statue to post,” Finkelstein said.

"The name change we do through the court is designed to change your name permanently," she said. "There will now be no record of the former name."

"This is a process you can only do once in North Carolina," Finkelstein said. "I want to make sure with everybody who does this that they are certain that this is what they want because it's not easy to undo.”

And, it’s not over once you have the birth certificate with a new name, said Allison Scott, co-director at Tranzmission.

Scott, a transgender female, estimates she has helped at least 100 people through the name-change process.

Changing the gender marker on documents is an entirely separate ordeal that can be done at the same time a name is being updated, she said.

Federal and state agencies require a note from a physician indicating a transition is in process. Yet, different departments have different requirements.

Some need the words "treatment" or "clinical." Others require a doctor to note a "surgical" change.

This is a step not all transgender people can afford or want to take, Scott said.

“It's ridiculous to force a group of people to release confidential medical information that should only be shared between themselves and their medical provider to update their name," she said. "It's an extremely dehumanizing process.”

Whether someone makes it through in North Carolina is often dependent on who is at the counter in front of them, Scott said.

Sometimes people end up with mismatched federal and state documents, she said.

It's "complete chaos," a "murky mess." "We’re the group of people that are having their bodies legislated against."

The name

When identity documents have a name or gender that differs from the way someone presents, the consequences can be severe, said Christopoulos, who has a stocky figure and facial hair.

He recalled the time when he was pulled over before he had his name and gender marker changed on his driver's license and the officer didn’t believe he was providing law-enforcement with his real identification. It took hours to sort out the situation.

The finance professional said he has gone on job interviews that went off without a hitch, but then he had to hand over documents with a female name and a female gender marker and no one called him back.

It changes the way you are treated in situations from housing to seeking public services or support, Christopoulos said.

“It is so pervasive," he said. "You don’t think about how many places your name is used.”

Tranzmission recently provided support to someone who was ridiculed and harassed by another hospital patient when a nurse called out their legal name, which didn’t match the way they looked, Christopoulos said.

A given name can essentially out a person as transgender, he said, putting them at increased risk, he said.

Bernardo said she has been in transition for over five years. Even though she started taking hormones four and a half years ago, she still leads a dual duel life.

She works as a freelance audio engineer for a national broadcast network. She wears men's clothes to work and only a few trusted friends there know that she identifies as a woman.

It's a "schizophrenic" life, she says, but for now it is her only option.

A recent dispute over a medical bill made Bernardo decide to come out publicly as transgender and officially change her name.

Her insurance provider wouldn't cover a $200 procedure because the hospital noted her gender as female even though her birth certificate still says male. She fought them for months and eventually settled the debt.

"It's not the money," she said. "It's the time and the fact that this is not who I am anymore. That person had a good life. There were some great moments, but that's not it."

Marcie

Marcie Bernardo was born in a family proud of its Italian roots. She was the oldest of three boys.

Her family worked in the construction. They drove trucks and rigs carrying oversize loads throughout Massachusetts.

It was a different era, Bernardo said. "There were a lot of expectations: to be a man, to be Italian, to lead your life in a certain way."

Bernardo said she spent much of that time, especially her pre-teen years, confused and unhappy.

Her parents were strict, and she wasn't the man they wanted her to be.

Bernardo tried to do everything she was supposed to do. She got married. She had two kids. She recently became a grandparent for the first time.

"We were so indoctrinated into the get a job, get married, have kids, the house, the picket fence, you know," Bernardo said. "I mean, we thought that was what would make us happy when all the time we were so unhappy doing that because we knew something was not right.”

Bernardo didn't come out to her mother until she was in her 50s. Her dad had already passed away and her mom was in her 70s. The two went to a therapist together.

Bernardo had divorced and in the counselor's office she recalled first cross-dressing when she was 10. Her mother corrected her. She said the behavior started when Bernardo was 8.

The two rarely talked about Bernardo's gender again. "She's known my whole life," Bernardo said with a sigh.

Bernardo joined the Campaign for Southern Equality and Tranzmission at their events this month. She listened as a lawyer explained the process to a packed room in a church on a Saturday morning.

Days before, she and others met in the basement of Pack Memorial Library downtown after work. There, activists with Tranzmission explained that they would stand by them.

Yes, the stack of paperwork in front of them was overwhelming, and yes, the thought of going to the courthouse was terrifying, but they were not alone. They had each other.

First, the facilitator offered to walk with people as they went through process. He said he would take them to the DMV or the courthouse, wherever they needed. Then, later in the night, a participant offered the same. Then another and another and another.

“If I had the opportunity the young people have now to transition in your teens, in your 20s and be as accepted as they are now, I would have leaped with both feet, no blindfold, right over the cliff edge," Bernardo said.

"I think it is a blessing that society has come to this point. I am so happy for them and I am so jealous. I’m so jealous. I didn’t have that kind of opportunity and a lot of the older, transgender people say the same thing. Had we been in a society that was more accepting our lives would have been so, so different.”

The Associated Press contributed to this report.