For James Huff, 19, stocking produce at the grocery store where he works isn't a bad gig because he rarely has to deal with customers. But when he mans a cash register, awkward interactions aren't uncommon.

 “Sometimes people aren’t really sure what I am,” James said.

His buzzed haircut and lack of feminine curves create an androgynous appearance, but his feminine voice sometimes prompts customers to call his gender in to question. Children sometimes ask their parents if he is a boy or a girl as he scans and bags their groceries. That makes for a tense transaction, he said, because there is no simple answer.

James is a man birthed into a woman's body. He and his trans-brother Levi Vincent, 19, are a part of small but growing group of teens who have realized early in their lives that they are transgendered.

Soon, they plan to begin the process of transitioning from female to male and have already begun hiding their breasts with a tight spandex 'binder.'

James hopes to soon begin testosterone therapy so his voice will drop and hurdles in the check-out line will come less often, he said.

But, licensed psychologist Julia McAninch said many trans Tennesseans find that a new set of complications await them after completing the transition.

The transitioning process is lengthy and expensive, McAninch said. It can require at least a year of therapy, several surgeries and drug prescriptions that insurance won’t cover.

Beyond that, the social ramifications of the surgery are not nearly as predictable as the physical outcome, she said.

“Transition can be a wonderful thing for an individual but it is also a big change and carries with it a lot of stressors,” McAninch said. “It is important to have a lot of support.”

McAninch specializes in gender identity issues and provides therapy to people throughout the transition process, a requirement before a person is eligible for a sex change. She said she evaluates where a client is in his or her identity development, how they understand themselves and their body, and what they expect the transition to be like.

 “It’s important to find out what feels congruent about having breast or not having breast and how that matches with how they understand themselves,” McAninch said.

Understanding themselves is only half the battle. McAninch encourages her clients to become intimately familiar with Tennessee State Laws regarding gender, she said.

“Tennessee is not very trans-affirming when it comes to laws,” McAninch said. “There are a lot of legal hurdles that often have to be challenged.”

Even at 19 and before beginning transition, Levi worries about his job security at his part time job.

“I go by female name about half the time because of my job in fast food,” Levi said. “They’re fine with me being a quote-unquote lesbian, but you never know how people are going to act toward a transgender.”

He said he is waiting to be further along in the transition before telling his boss or coworkers. Tennessee Transgender Political Coalition President Marisa Richmond said Levi’s fears are not unfounded.

“A lot of employers don’t want to hire trans people,” Richmond said. “There’s no protection for us in Tennessee on a federal level.”

Tennessee is one of 38 states in which a person can be fired because of their gender identity.

That problem is amplified by the Social Security Administration, Richmond said.  When a trans person fills out a W-9, the SSA will send a no-match letter to the employer if the gender on their form doesn’t match what the department has on file.

Since the department won’t change the gender they have on file until a person has undergone gender reassignment, people who are early in the process or have recently undergone the surgery could be flagged and a no-match letter would be sent to their employer, Richmond said. That could result in a loss of employment or prevent a person from getting a job, and according to state law, there's nothing they could do about it.For trans people, such as James who appears to be male but has not had a gender change, that could make life difficult. Richmond said the unfair employment issues lead some trans people to take to the streets to earn money as a last resort.

“That’s why so many trans people end up on the streets and that’s what leaves people vulnerable to hate crimes and STDs,” Richmond said.

But, Richmond says despite how well a person adapts to their new gender, a new set of problems can arise post-transition. One of them is the Vital Records Act of 1977.

Because of the Act, it is illegal for persons born in Tennessee to change the sex on their birth certificate even after having a full sex change.

"I can change my name, take all the 'test' I want and have as many surgeries as I please, but I still can't change my gender," Levi said. "It's the law."

And a frustrating one at that, considering that no other state has such a law and in some states, such as Indiana, it isn’t required to list either sex on a birth certificate, Levi said. Idaho and Ohio have similar policies which could be changed by the governor’s signature, but the Vital Records Act was put into place by the Tennessee General Assembly and only they can repeal it, Richmond said.

The Passport Administration, on the other hand, has a policy which starkly contrasts Tennessee’s law and mandates that all new passports must clearly identify changes of gender. According to Richmond, that can make for troubled travel.

 “It’s like putting a scarlet letter on their forehead,” Richmond said. “In some places that could get them killed.”

Richmond said the American Civil Liberties Union and many other GLBT advocacy groups plan to fight unfair legislation in the upcoming year including the Vital Records Act but she doesn’t expect it to go up for a vote this year. Instead, the battles will be used to educate people about the issues, she said.

Despite the challenges ahead, Levi and James remain hopefully determined that life will be better after transition.

“When I found that out (that I couldn’t change my birth certificate), it made me feel like ‘What’s the point of doing this if technically I’ll never be able to be a male, legally,” Levi said. “But I realized that I don’t care what law says. I still feel this way and I won’t let them change who and what I am. I know how I feel and that’s what I’m going with.”