Most Americans have learned about transgender people only in the last few years, with celebrities like Caitlyn Jenner, Laverne Cox, Janet Mock, and Chaz Bono helping to raise awareness of trans lives and identities. A few may remember Christine Jorgensen, whose 1952 sex change operation made headlines, the male-to-female tennis player Renee Richards, or queer liberation icons like Sylvia Rivera.

But Joanne Keatley, now director of the Center of Excellence for Transgender Health at the University of California San Francisco, is celebrating the 50th anniversary of her transition.

That’s not a typo. Fifty years ago, as a frightened teenager in 1965 Los Angeles, Keatley left her home and began living as the young woman she always knew herself to be.

When Keatley casually mentioned fact that in a conversation—we’ve worked together on international LGBT issues—I was thunderstruck. What was it like to be transgender before the word ‘transgender’ existed? How did she survive?

Her story was even more astonishing than I expected. Drawn from The Daily Beast’s exclusive interview with her, here is her life, in her own words.

* * *

Fifty years ago, the word transgender didn’t exist. But I didn’t ever think of myself as a boy. I really struggled with the sense, like many people in that era, that I was going through this on my own—that I was unique. Looking retrospectively, it seems almost unreal that I ever thought that way, but I really thought, “Somebody fucked up here, and my wires are crossed.”

I thought of myself as a girl, and something went wrong with how I came out.

I was born in Mexico. As early as five years old, I was really freaked out that I couldn’t relate to anybody around me of the same assigned sex. My brother and I were both in a boarding school that my Mom had left us in in Mexico when she and my Dad left for the United States. It was an all-boys school, and I did not fit in.

For example, all the boys would shower together and I could not do that—I would break down and start crying. My brother would try to force me sometimes—he would take me in there with him. I remember resisting, not being able to do it.

There was a cook there that was very kind to me—sometimes I would hide behind her skirt because she would defend me. And sometimes my grandmother would arrange for me to stay at her house. But I would struggle with being forced to fit into this fellowship of boys in this environment.

When I got to the US, I was eight years old. By 9 or 10, there was a fair amount of bullying—even before I had embraced my identity as a girl completely, people were aware of it. I remember at 10, 11 years old, I already had a female nickname that I didn’t give myself—other kids my age started referring to me in this way because I was exhibiting more female attributes.

So even without my having to claim an identity, people were already imposing a more feminine identity on me because of my behavior, my speech, the way that I looked—all of it. At 12 or 13, I started stealing clothes from my sister’s closet, having a female presence more, feeling more liberty in using it, even though I would get beaten and bullied as a result.

I didn’t know any trans people, or know the concept of trans identities. It was just my own internal sense of self that I was challenged by, and that my family struggled with. It was me trying to let myself emerge from this package that my family thought I belonged in. It was a huge struggle.

My family were very typical Latinos—my Mom by then was a single parent, and my brother was the oldest in the family. He had very clear notions of masculinity and femininity. I didn’t fit those stereotypes and my family really struggled with it. To the point where there was lots of physical and emotional abuse about my not fitting into those patterns.

I left home at 14. My brother had gone off to Vietnam, and my Mom and I lived in a two-story apartment.

I came downstairs and was headed to the kitchen, and I saw this blur coming out me from the side—my mom was coming at me with a knife, and she was screaming that she would rather see me dead. It was horrific.

There had been a lot of attempts at browbeating me, but this was—she really was coming at me with this weapon. We fought; I will always remember that, how I knocked the knife out of her hand, it flew across the kitchen, and we struggled. I left home that day, and ended up out on the streets of Los Angeles.

* * *

Leaving home and then being out on the street, in one fell swoop. I worked my way down to downtown LA—14 years old, totally naïve, totally without a sense of community. I was just trying to find refuge.

The thing is, there were other people like me, and I did end up connecting with other trans people in downtown LA. There were also lots of adults more than willing to take advantage of my naivete. I got exposed to a lot of things very quickly because I was afraid go to back home.

So I got exposed to prostitution, sex work—really in the beginning it was exchanging my body for a place to stay and a place to sleep and eat. Really just surviving. But one learns.

I ended up getting exploited a lot, and also learning lessons along the way. Of course there were lots of interactions with criminal justice. I would end up getting picked up by the police, getting sent to juvenile hall, they would call my mother who would refuse to come and get me out.

Between 14-18, there were lots of times when I was apprehended and then my Mom would not come and get me for months, and then she would break down and get me, and I’d come home for a day or two and then leave. That’s what it was like for the first few years.

You have to remember that in the ‘60s, it was against the law to cross-dress in public. You could get arrested, and we often did get arrested, just for being out in public. So what many of us would do is, we’d get all decked out—and back in the ‘60s people would wear what we’d call “wiglets” and we’d have beautiful things that we wore on our heads—and you know, at that age, you do lots of things over the top.

So everybody would get all decked out and somebody would drive us to the parking lot of the Waldorf—not the Waldorf-Astoria but a place called the Waldorf on the main street in downtown L.A., which at the time was skid row. That’s where what I think of now as trans people hung out. Back then, of course, everybody just thought of drag queens and queens, and there was language in Spanish around who these people were—primarily, trans people of color.

Lots of seedy characters would go into this place, lots of people using drugs, non-trans hookers. Obviously, this is before HIV and AIDS, so lots of stuff was going on there. We would get driven to the parking lot and we’d run from the parking lot—you’d have jeans on and a dress tucked into the jeans, and you’d run into the bar because, if you were caught on the sidewalk wearing a dress, you’d go to jail. Sometimes we’d be inside the Waldorf and a paddywagon would come up and take us all out.

Like many trans people of the era, we didn’t have a defined consciousness at the time. There was a consciousness emerging around queer identities, but I had a lot of trouble seeing myself as part of the queer community. I didn’t think of myself as gay, I thought of myself as female.

And I had a lot of internal shame, even about behavior which now would be thought of as same-sex behavior. I didn’t see it that way. I thought, “He sees me as female, so it’s okay.”

You have to remember, I went out on the street when I was 14. I was not educated, and I didn’t have the level of understanding that I have now. It wasn’t like I was looking for a community for validation—I was looking internally for validation and having trouble finding it. I had trans women friends whom I felt close to. The ones that I could identify with were other trans women who saw themselves in the same light as me, who saw themselves in their female identities and not as part of the queer community.

At the time, there was lots of friction and division between people who saw themselves as more female, and less part of the drag community. I had a friend, Cynthia, who had her surgery in 1970 or ‘71.

When we went out together to a bar, and the other trans girls at the bar reacted angrily to her being there, because she had had surgery, and they felt she didn’t belong there anymore. There was lots of that kind of friction.

The community didn’t understand itself yet. There was a lot of struggle.

* * *

In 1975, I met my husband (now my ex-husband). I met him in Chicago—when you’re involved in sex work, you move around to different cities because you earn money that way, and I went from LA to SF to Denver to New York to Chicago. There we met and fell in love, and in Chicago is where I decided to have surgery.

I wanted to have surgery, but I couldn’t get it together financially or emotionally. I didn’t have the stability to have the resources. When I met my ex-husband, he saw in me something I hadn’t seen in myself: my intellect, and an appreciation for me as a human as opposed to a sexual object. The fact that he saw that in me allowed me to see it in myself, that changed my perspective on what I could do with my life.

I really thought, prior to that, that I was doing all that I could do with my life, which was sell my body to survive. Being seen by someone else with a different lens allowed me to see it for myself.

So in 1975, I decided to stop being a sex worker and stop using drugs. It didn’t happen overnight. There were struggles, and relapses into sex work and drugs. But over a couple of years, I made changes.

I got my first official employment in Chicago, working at a telemarketing company—my first job where I actually got a paycheck. It was the middle of winter in Chicago, and getting that paycheck—it was probably $100, if that, but I remember going outside, leaving where I was working and walking to the bus stop, and waiting out there in the frigid cold, and I couldn’t believe that I had a check in my pocket that I had earned that wasn’t related to sex work.

From the mid-70s, we decided to focus on my having surgery. In 1977, there was a gender dysphoria program, a surgical program, at Stanford University. I saved every check I got. In 1978, we moved from Chicago to San Jose so that I’d be closer to Stanford, and in 1979, I ended up having surgery. Donald Laub was my surgeon. He was a pioneer in trans surgeries.

Back then, surgical candidates were encouraged to not associate with other people in the trans community because the whole goal of surgery was to be able to assimilate into the gendered world. So those of us who had been able to get surgery were supposed to be able to live and function in non-trans circles and worlds and not have people know.

In fact, that was a very clear criterion for surgical selection. In fact, in these surgical programs, when you were given an appointment, you were never scheduled with other trans people. When you went to the appointments, you were there by yourself with other plastic surgery clients. There were no support groups or anything like that.

I was a creature of my era, so my goal was to disappear from trans circles. So we lived in San Jose, we had our circle of friends, and my work—all not related to anything trans. I didn’t share my surgical path or gender history with anyone. I was alienated from the community, and was led down that path by my doctors, who encouraged me to live and function outside the trans community.

In the first year after surgery, I came to the realization: Now what? I didn’t have an education, and I hadn’t thought it through that surgery doesn’t fix everything in your life. The relationship with my family was fucked up. My husband was the only person I had a relationship with that was open and honest. The relationships I had with other people were based on a female identity I had to create.

I didn’t have the language or awareness of self. None of it. For a few years, I struggled. What do I really want to be, and do? It took me about five years to get to going to school. Even before the entry exam for community college, I needed remedial classes. I had to learn how to put sentences together, to do basic math. I had been out on the street surviving. It took me a while.

Around 1982, HIV started impacting people—or as we called it then, GRID [Gay-Related Immune Disorder]. I was working for a visiting nurse association as a care coordinator. And while I was there, we started people coming in with GRID and being sent home to die. I started seeing their cases being referred to us and started questioning what was happening to these people, who were being ostracized out of fear.

Lots of people I worked with made really outrageous comments about the people living with this disease. We would see these gay men and people made very homophobic comments about these patients that they were being assigned to see in their homes. It was a very different era. In healthcare, it was openly homophobic and transphobic. That was my impetus for really thinking that I come from a world where I met a lot of these people. I could have been one of those people. That was what started pushing me to think that I need to do something.

So I had the insight, but not the education. HIV caused me to think twice about my trans community and think back that maybe I could use myself to make a difference in my community, as opposed to just accomplishing my own goals. It didn’t happen overnight, but I got my B.A., and I got my M.S.W., and I’ve been working at the University of California San Francisco since 1999.

* * *

I think it is incredible and fantastic to have the level of raised awareness we have today. And there are people in the movement who I have tremendous respect for, like Laverne Cox, who has taken amazing responsibility of raising issues that impact the trans community: issues of poverty, of violence. She has taken the platform and used it for what we have a responsibility to do. I feel like she’s an incredible spokesperson.

There are other people in the trans community who I haven’t seen that from. There are people who are very good at creating notoriety about themselves. I have no objections about who they are as people but I don’t see them in the same light, as pioneers. I cringe when I see the word “pioneer” applied to them.

The pioneers are people like Sylvia Rivera. Like Miss Major, an African American trans woman who was at Stonewall. Christine Jorgensen, who in the 1950s had the courage to come out as a trans person who’d had surgery. the many people of that era who struggled to maintain a sense of dignity. My friends who lived and died in the Sixties and Seventies as a result of all the bias that they experienced.

To me, those are the people I think of as pioneers. It’s not the people who are doing it now. It’s the ones who came before them.

The people who are transitioning now are able to do so because of the people who gave their lives for them to be able to do so. This transgender moment has been a long time coming and it didn’t happen overnight, and we need to be mindful of that.

So I guess I’m torn about this moment. It’s fantastic, and we need to grab the moment and make the most of it—grab it and really use it to raise awareness of the issues that still affect us and still deny us the opportunity to fully function and live in this world with the human rights and dignity that we all deserve.

It’s not about the glamour or having access to the cover of Vanity Fair. As much as I appreciate what Caitlyn Jenner is doing, the real struggle is still about making sure we all have access to adequate healthcare, not just facial feminization surgery.

I want people to be able to go and see their doctors and not be ridiculed, or not have them use the wrong pronoun.

If they’re struggling with poverty, I want them to be able to access a shelter bed, and not be forced into a shelter that’s not of their gender.

I want them to be able to stay in school and participate in school functions.

I want all of the things that could have made a difference, not just in my life but in those of other people I knew and lost. There is so much work still to be done and we can’t lose sight of that.

This moment in time is precious and I think we have to make the most of it.