I am a post-op transwoman. I live and present as a woman full-time. Everyone, from friends, family, coworkers, and strangers, can see that I'm a woman, although some might remember me as a man from years back and may need time to adjust to the change. My children see me as their biological father even though the rest of the world sees me as their mother or some woman taking care of them. When I'm at work, everyone respects me not just as a woman, but as a highly skilled woman. Everyone in my diverse workplace knows about my situation and my children. Unlike part-time crossdressers, there are things about my presentation that I cannot hide, such as my hair, my facial features, and my breasts. I have a full head of hair that has been cut, styled, and highlighted as a woman since 2007 so unlike crossdressers and many transsexuals there is no wig to remove at the end of the day. I've had rhinoplasty in 2011 to give my nose a more feminine appearance. I've also had Botox and silicone fillers injected by board certified physicians from 2004 onward. I grew breasts from taking hormones since 2003. I've had bilateral breast augmentation with silicone gel implants in 2011. I've also had vaginoplasty surgery in 2012, so I am now complete. I am naturally hairless on most of my body even before I started laser hair removal treatments. I have always had a slender female body. Prior to HRT and breast augmentation, all of my physical gifts were given to me by God and my parents.
In 2013, I saw a chiropractor about my neck and back pain issues. His X-rays revealed that I have a female pelvis. Note the round-shaped cavity in my sacrum and the angle formed by the two ischia bones below the pubis is greater than 90 degrees. My pelvis looks more like the "butterfly" shape of a female pelvis than a male pelvis and is further proof that I should've been born female. Please note that my pelvis was not reshaped during my vaginoplasty surgery.
What I wanted to be when I grew up
My mother always knew I wanted to be an artist, but she never saw art as anything other than a hobby. She was hysterical when she discovered that I liked drawing and coloring women's faces. I was an illustrator for as long as I can remember, but I gave up on my art after high school because my mother discouraged me from studying art in college. She said "Artists don't make money... until they're dead" and this deeply discouraged me, so I took refuge in my second talent, computer programming. I studied computer science in college, which really worked out well for me because with a computer science education, you can make enough money to support all of your endeavors. My mother always thought I was soft and sissy-like, since I was always very emotional, and never thought I'd get married. She knew about my crossdressing as a child, since I always wore her clothes, makeup, and wigs in private, but never confronted me about it. The funny thing is I did get married and had two children as a result, so being soft and sensitive is an attribute in relationships.
How long I've been on the Internet
Since 1986. We didn't have web sites, forums, or chat rooms back then. It was all one-on-one conversation using the UNIX talk command. I was 18 back then and probably the last student to learn IBM System 390 Assembly Language at Boston University, so I'm a pretty established technology veteran. I manage to learn new technical skills every year, so I'm never obsolete.
Why I have so many pictures of myself on the Internet
I've been on the Internet since 1986. For me not to have a lot of pictures of myself on the Internet would be unusual. As more people attend the same places that I do, more pictures will invariably crop up of me and I have little control over this. I'm proud of who I am and how I've evolved over the years and each year my pictures show how much I've progressed.
Supporting my work
Not everything can be learned for free on the Internet. Purchasing my books and videos gives you access to a vast encyclopedia of knowledge collected from my years of experience in transformation. For years, I was an educator at two of the finest universities in the world. I love teaching and inspiring people. I applied the research skills I learned as a doctoral student at the University of Pennsylvania to male-to-female transformation and wrote eight full-length books as a result. In the beginning, it was an art to me. In the end, it was a way of life. From 1994 to the present, over 4,000 crossdressers and transsexuals have purchased my books. Every book contains practical advice that you will use for years to come and every purchase helps this web site grow. Everyone who supported me through the purchase of my books and videos has made me what I am today, one of the leading transgender self-help authors in the world. Thank you for your support!
Supporting the transgender scene
Supporting your local scene is the best way to improve the public image of transgender women. Support can come in many ways, including donating money to transgender-friendly charities, buying products and services from reputable transgender businesses, volunteering to assist in the production of transgender-oriented events, or simply making your presence known by attending parties and other events. In a community as small as ours, EVERY PERSON COUNTS, whether you're a first-timer just starting out or a seasoned veteran who lives as a woman. Check your local papers for any events in your area and contact any interested groups that might need help setting an event up.
Need help in resolving your transgender issues? Contact Renaissance Transgender Association for a local chapter near you.
The meaning of passable
Passability does not equate to physical beauty, although the physical aspect is very important. Beauty certainly helps, but when the following traits are all aligned properly, you don't need much physical beauty to be thoroughly passable:
Calmness is a mental state of well-being. When a transwoman is an offensive, belligerent prick to others, she shows no calmness. Some transwomen blame their medication for their mental state, but they were most likely pricks to begin with. Conviction is how much you believe in who and what you are. Some transwomen lack conviction and that creates a negative aura around them. If you do not believe in who and what you are, how can you expect others to, too? Mental stability is a state of mind where everything just feels right. When you can stop, think, and smile about your situation and feel happy about it, you are mentally stable. Sincerity of intentions is how sincere you are in your efforts to be who you are. I believe this is the single biggest hurdle most transwomen face in their transitions. I see so many transwomen who still look, think, and act like men it's unfortunate. In other words, they lack sincerity of intentions. This is why strangers are scared when they see these transwomen. They do not see a woman, but a man who thinks he's a woman. Many of these transwomen want vaginoplasty, but don't have the necessary social skills to integrate into society. Societal integration is how well you integrate into society as a woman. If you were in a restroom with 100 other women, do you honestly believe you would blend right in or would you stick out like a sore thumb? If you don't blend in, what can you do to enable you to blend in better? Believability is how much others believe in who and what you are. Some transwomen don't understand the importance of this trait. How believable you are equates to how well you are perceived and accepted as a woman, and a human being, in society.
The best way to learn passability
Start by sitting in a public park or garden and observing everyone in your immediate vicinity. Take notes of what people are doing, both men and women. Study how women interact with men and other women (what to do) and how men interact with women and other men (what not to do). Incorporate these what-to-do behaviors into how you interact with men and women. If you want a jump start to developing a more passable female image, purchase my books, How to Look Like a Woman, The Art of Gender Illusion, and Passable.
A lot of unpassable girls look the way they do because they don't try hard enough to be passable or they learn bad advice from people who just don't understand the needs of transgender women. Some girls settle on a look because they think that that's all they are capable of, but the truth is everyone can look better than they already do. A commitment to one's physical attractiveness is a very important part of what being a woman is all about. Many of you have mastered the mental aspects of being a woman, but in order to be socially accepted as a woman, you have to look like a real woman and that requires mastery of beauty techniques that might require a lifetime of training and practice. You can schedule private lessons from me through my makeover service.
Once you study what it takes to achieve a passable female image, the next step is to apply your knowledge in real life. Don't just limit yourself to webcams or photographs of yourself. Go out into the real world and evaluate people's reactions towards you. You may not receive very many positive reactions in the beginning, but that will change over time as you improve your look. Take any harsh criticisms as motivators to work harder the next time you go out. If you decide that gender transition is in your future, it will be doubly important to achieve a passable female image. Your success as a part-time or full-time transwoman is heavily based on this very simple flowchart:
"Fixing the problem" will require confidence, better makeup techniques, and possibly cosmetic procedures and plastic surgery. Some of you have misunderstood my previous mantra of "Flesh and bone, no silicone." I was very proud to be all-natural back then. In my own bold and confident way, I just wanted to amaze people with the way I looked and lots of people admired me for what I could achieve with the features I was born with. When I got to a point where I wanted to look better, I took the additional steps necessary to do so. It's in line with my "icing on the cake" philosophy. I'm the kind of woman who never stops improving herself physically, intellectually, and socially.
Achieving my passability
When you want something so badly that mental anguish turns into something physical and torments you so badly that you cannot eat, sleep, or think straight, that's when you will understand how I felt when I was conquering two major obstacles in my life: my music success and my passability.
I've been heavily into music my entire life listening to everything from my parent's records from the 50s to current dance music. With very little formal training, I started producing my own music, mostly instrumental dance tracks with self-recorded vocal samples, my own rhythm tracks, and my own melodies. I spent thousands of dollars recording and manufacturing vinyl records, cassettes, and CDs, sold my records through various record stores, and sent demos out to radio stations. The fruits of my labor resulted in little to no airplay. Lots of clubs played my songs, probably because most DJs want to be the first to discover the next big thing, especially in their hometown.
I knew I was good. My production skills were top-notch because I learned everything I could by watching famous engineers mix my songs. Because I was a no-name, I couldn't get the airplay I deserved. I got depressed thinking about my failure to make a dent in the music world, so depressed that my mind would cloud up and I'd get dizzy every time I heard an inferior song on the radio. I'd get nauseous when I ate. I couldn't sleep for more than four hours a night. I'd listen to parts of songs on the radio or in clubs and criticize them. Sometimes I even believed that parts of my songs were stolen and used in hit songs. I became hateful and overly critical of everyone else's music without looking at the one possible problem that was preventing me from becoming successful: maybe my music wasn't as good as I had thought, maybe my production values weren't quite there yet.
I got so fed up with the music scene that I took a break from it. In 1997, I started rebuilding my music studio by getting a new computer and sequencing software and building around it. I made the decision to dedicate all of my energy into music production. I read and re-read everything available to me and built my studio piece by piece to the tune of over $50,000 worth of gear. No expense was spared because I didn't want the lack of instrument sounds to be an obstacle in any of my productions. I slowly learned the art of dance music production and then it all came together one day and I was churning out song after song, some in as little as an hour.
Getting my first royalty check for songs that were used on MTV shows, such as The Osbournes and MADE, was proof that I had "made it." The demons that haunted me, telling me I was no good, were no longer on my shoulders. When you feel so rotten that you hit rock bottom and you just want to give it all up, including precious life itself, then you will know how I felt at the time. Then you will know it's time to make your situation better.
And so it was with my passability. There is no doubt that I was a beautiful crossdresser for many years. I spared no expense on top shelf clothes, jewelry, perfume, and makeup. I wore the best wigs, ones that cost well over $400. Many beautiful non-Asian transsexuals thought that I was a full-time transsexual just like them; however, the one group that I always admired that always made me feel like I was not "in" with them was the beautiful Asian transsexuals, the ones who could walk into any environment and never be read.
I tried very hard for many years, but could never be like the beautiful Asian transsexuals. I became bitter and ill thinking about it. The thoughts of not being like them consumed me for so long that I began taking the steps necessary to be like them. I went out to clubs and restaurants several nights a week to get more comfortable with being around real people in public. I had several friends I routinely hung out with, including Cesar, a self-identified "friend to the trans community." At the time, Cesar was dating Dee, one of the most beautiful Asian transsexuals in Philadelphia. In a large way, Cesar helped guide me on my path.
"You will never pass by wearing a wig. No transsexual wears wigs. Wigs look unnatural," Cesar told me.
At the time, I thought he was an asshole for saying that, but he was right. One night in 2004, after being so fed up with my situation, I cried to him. I cried intensely. I wanted to pass so badly that it was gnawing at the very core of my being.
He wiped the tears from my cheeks, held my face in his hands, and looked into my eyes.
"You already have what it takes. You have such beautiful features... your eyes, your high cheekbones, your lips... why must you hide them behind a wig?" he said.
At that moment, I realized something. Without him saying it, I realized what I needed to do in order to be like them. I first needed to be me. I was trying so hard to be like them that I lost sight of the fact that being me was what I should've strived for all along.
So one night I stopped wearing tons of makeup and wore only the bare essentials and people noticed something different about me. Somehow, I looked better than ever before. The dark red lips were replaced with pink. The heavy multicolored eyeshadow became a single shade. I still wore wigs because I was afraid to let them go. A wig was like a security blanket to me. For others, it was a necessity, but for me, it was like a magic hat that I could hide in and cover parts of my face.
"You have a beautiful face, so why hide it?" Cesar commented.
And then one day something magical happened. Maybe hormones helped me. Maybe it was the way I was carrying myself. I started being called "miss" without any makeup on. I shrugged it off. And then it happened again. And again. In everyday places, such as the post office, in fast food restaurants, while walking down the street. It wasn't consistent, but it happened quite often. If I wasn't called "miss," I was called "ma'am" and I was fine with that. It was a new experience for me and it has puzzled and pleasured me for many years to be referred to by feminine pronouns even though I didn't try very hard to look female.
What would possess people to call me a feminine pronoun even though I believed I clearly looked like a boy?
"Because you don't look like a boy anymore," my friend Philip told me.
That was one of the catalysts that enabled me to have the confidence to say yes, I can do this. I can remove the magic hat. You can bet that the first few times my friends saw me without my magic hat, they had negative things to say because they didn't understand what I was doing at the time, which was reinventing my look. Over time, my hair grew out and I experimented with a myriad of hair styles. I had my hair colored and highlighted as any woman would and now it is the magnificent mane of hair it is today.
I'm on speaking terms with Cesar again after four years of discovering myself. I realized that the harsh, blunt advice he gave me was really for my own good and I became a better person as a result of it.
The importance of passability
Passability is not very important if you live a mostly hermetic life and don't wish to socialize with people face-to-face. We have social media services to thank for this antisocial behavior. However, the moment you feel compelled to share your life with someone on a more intimate level or interact with people face-to-face, you will see the importance of passing. It is already pretty difficult for cisgender women to find friends and soulmates, so non-passability only adds to this difficulty. Not being able to pass doesn't make you any less of a woman, but it will make it much harder to be accepted as a woman by most people. New legislation seeks to fix this issue, but it is a very real issue that affects most transgender women who look masculine.
Talk to everyone you meet whom you consider a reliable source: gender therapists, clinical psychologists, psychiatrists, endocrinologists, full-time well-adjusted transsexuals, etc. Study information in books and on the Internet, but don't trust any single source entirely. Find common knowledge among all your sources before you proceed with hormone therapy and plastic surgery. Transition is not for everyone. In fact, most who transition probably shouldn't or aren't ready for it. Read or listen to as many different personal experience stories as you can and keep an open mind when you read or listen because everyone has something to offer, some wise little tidbit of advice that may help you on your own gender journey.
When to start female hormones
Many transsexuals mistakenly believe that a pill can transform them into a woman. Not true. Based on my strict philosophy, hormones should only be taken once you reach a point of impasse after you've done everything humanly possible to improve your appearance. Too many transsexuals start their hormone therapy too early in their transition and when they find out that they are still treated badly or seen as men, they get very distraught and jaded. Nobody gives a crap about how distraught you are and there would be no reason to be jaded if you learned everything that you needed to know about improving your appearance and self-image before taking hormones. Don't start hormones until you are truly ready. Learn makeup application first. Learn how to style your hair. Learn how to improve your skin. Learn proper female behavior. In other words, learn what beautiful women already know. Hormones are icing on the cake after you've mastered the basics. You can't turn an ugly duckling into a beautiful swan.
Telling everyone at work about your transition
If you've been working in the same place for many years and were hired as a man, it would be a good idea to contact your human resources department and get your manager to inform everyone in your department about your name and gender change. That way you will have management on your side in case any discrimination issues arise. Tolerance is an easy thing; acceptance is much more difficult. If the people you tell don't accept you as a woman, then the problem might stem from the fact that they always knew you one way and now you're trying to present in a totally opposite way. Some of them may have looked up to you as a mentor and now feel betrayed. By becoming a woman, you have failed them as the friend they once knew. If they always saw you as a genderless, harmless, and effeminate person, they will have a much easier time accepting your gender identity. It would make sense to them. Unfortunately, 99% of you were once masculine men and that's why you will lose almost all of your friends and family by telling them that you want to live as a woman.
What "full-time" really means
I believe you're not living your life as a woman if you're not accepted as a woman. You're basically living your ideal of what you believe a woman is, which may convince some people to accept you as a woman, but unless you have unanimous acceptance, you're not a full-time woman. Some haughty transsexuals condemn crossdressers as people just living a fantasy, but if you are a transsexual and you're just living your ideal of what you believe a woman is and not everyone accepts you as a woman, then you're living a fantasy, too, a full-time fantasy... or nightmare depending on how you look at it. I feel that some transwomen detransition because they realize that the grass wasn't greener on the other side. Not everyone can transition well.
Name and gender marker changes on id cards
Getting your name and gender marker changed on your id cards is for your own peace of mind. If someone calls security on you in a public restroom and they demand to see some id, you can show them proof that you're in the right place. However, something like this is not going to happen if you're not seen as a physical threat to the genetic women who use public restrooms. The more you look like you fit right in with the scenery, the less confrontation you'll experience. If you're as tall as the average male and built like one, then that id card is probably a necessity because to all the world, you don't look like a woman, but a man dressed as a woman. If you're small like most genetic women, you don't have to worry about it. It's a non-issue.
Advice for young transsexuals
Stay in school and go to college, the best college you can afford and get into. Find a good job and save up a lot of money because you're going to need it if you want to live full-time. Find some transgender friends who are like you and who have similar goals. Stay away from aimless people. Some girls who start their transitions young and already look pretty passable are often the ones who think they know it all. It isn't until they get older and realize that the laser or electrolysis treatments didn't quite work as intended or their hairlines receded due to genetics or their bodies fought the effects of the hormones that were supposed to feminize them that they then become wiser to my message that we're all in the same boat, young or old, and that we are all transsexuals who have passing and social integration issues. The young need the old for their experience. The old need the young for their energy. Successful relationships can exist between the two groups and to shut any group out divides an already small, niche group even further.
Advice for older transsexuals
If you are in your thirties or older with a spouse and children, you need to be prepared for many changes in your life. Your spouse, who may have been your biggest supporter, may or may not agree with your transition and you may find yourself faced with divorce, child support, and loss of half of your assets. Even if your spouse supports you, her friends and family may not and that may be enough to change her views on you. The life some of you want to live, that of a lesbian with children, is nothing but a fantasy. Don't expect your marriage to work out. Some of you may be in for a rude surprise in your senior years because she is just holding onto you because you are her meal ticket. More than one of my friends had spouses who stayed with them until they retired because they wanted to go along for the free ride. Be cautious of entering a relationship with anyone who isn't your equal. Be prepared for a new chapter in your life after you transition.
Hyperfemininity is when you act a lot more "feminine" than what is called for in a situation. I see a lot of transgender women overexaggerate their feminine characteristics, including their voice and mannerisms, thinking that what they're doing makes them look and sound more like women. It doesn't. In most cases, it will make them look like a caricature of a woman. Restraining or reserving the use of those little nuances that make you appear or sound more feminine is the key to your success.
What you can learn from me
Some of you would rather spend eight thousand dollars for a nose job than eighty dollars for arguably the best makeup and style advice for transgendered women in the world. This really doesn't make sense to me. Crossdressers and transsexuals who know my reputation for making people look beautiful come to me for answers. One of the most beautiful Caucasian transsexuals in the world bought my book, Lower Torso Enhancement, long ago so she could learn about hip padding. Since then, she has progressed beyond hip padding to the lovely natural beauty she is today. She used my book to help improve her image at the time and wasn't afraid to spend a little money to learn how to improve her body shape. Many of the most beautful crossdressers and transsexuals on the planet have all learned from my books and videos, so you have an opportunity to be a part of my very special family by learning from me.
Most of you have probably been called "sir" at least once during your transition. A stranger usually calls a male-to-female transsexual "sir" with the sole purpose of denigration or disrespect. Why would you get called "sir" when you know for sure that you do not look like one? To answer this question properly, we need to look at all of the types of people who might want to call you "sir":
Obviously, if you are on a transition path, you do not want to be referred to by any male gender pronouns. Unfortunately, your full-time status does not guarantee that any stranger you meet is going to refrain from calling you "sir" if he or she doesn't accept you as a woman. People are afraid of what they do not understand. Some need a good laugh at the expense of others, so the more we look like large, unattractive Mrs. Doubtfire types, the more they can just write us off as nonthreatening, eccentric people. We are only threatening when we can successfully enter the realm of looking like petite, attractive women and even if we successfully do look like petite, attractive women, only the most tolerant people will accept us as women.
In cases of peer pressure, if a transsexual is seen as beautiful by the majority of people in the world, some people will not care what their peers think, but if there is any doubt about a transsexual's beauty, people may succumb to how they think their peers would react to the transsexual. Respect is always earned, not forced upon. You have to realize that some people will never understand or respect you because you are transgender in the same way that some people will never understand or respect people because of their race, ethnicity, national origin, disabilities, etc. It would be a wonderful utopia if we all accepted, or even tolerated, everyone else's differences, but unfortunately we do not yet live in such an open-minded world.
Seeing that there are so many close-minded people in the world, you can take it upon yourself to try to educate some of the people you meet or you can volunteer in groups that have more outspoken representatives that can speak about transgender people on your behalf. I believe that education is the key to convincing others that we are people, too, just like everyone else.
Don't boast, brag, or babble
Boasting, bragging, or babbling about yourself will not endear you to others, especially those who are struggling in their transitions. It is particularly disturbing when some transsexuals try to outdo their peers. By doing so, they show the same competitive spirits they had as men. They will walk up to you, make assumptions about you, and insult you to your face even though you look and act more like a woman than they do. The trans community is full of jealous, competitive bullies and I have met many of them in the two decades I have made my presence known.
Many men like to brag about their penis sizes. Many transsexual women like to brag about their breast development. Some claim to have "B cup breasts" when it is easy to see that their "breasts" started at a B cup because of obesity. What these people gain beyond the B cup is the actual breast development. I am never impressed by any breast development of more than two cup sizes if the person is fat. If you wish to boast about your breast development, be sure it is accompanied by an equally boastworthy female body. If you are truly boastworthy, others will see it and praise you without any initiation on your part.
Some transsexuals love to tell their life stories to others, but I will tell you, with all truth and honesty, that another transsexual who has been through the entire transition process will probably not care about your transition process because her journey has been a long, arduous, and oftentimes painful one. While some of you may find it invigorating to open your soul to another transsexual, bear in mind that she may not feel the same way. If she opens up and reveals her story, then great, otherwise it is better to tell your story to others who are at the same point as you in your development. That way the two of you have a common ground on which you can relate your experiences. Don't waste a more experienced person's time with your story, especially your struggles, unless she offers to help you. Instead, tell a professional, preferably a therapist or close friend. Doing so will help you more than telling some random stranger.
What you think of haters
Everyone is entitled to their own opinions. I always tell it like it is, but many people don't want to hear the truth. They want to hear things sugar-coated or through rose-colored glasses. The truth hurts and is very painful for some people and to them I say go speak to your therapist about your issues. Don't take it out on someone who tells the truth. Look upon the people who've successfully integrated themselves into society as inspirations for you to follow. Do not despise them. Embrace them! They told you the truth because they know you can be better. If they didn't care about your well-being, they'd lie to your face about how great you are already.
It doesn't get better for some
Unfortunately, not every transperson will successfully integrate into society as their desired gender. A combination of physical issues, social anxieties, and financial problems will likely hinder most transpeople. Some transpeople will never be able to overcome these obstacles and hopefully their therapists will help them see the reality of their transition before they go through with their final surgery. There is no quick and easy path. Every transition is challenging even if you were someone who was born with a slender female body and female facial features. The trick is to be smart enough to plan out your life well ahead of time and save up enough money for whatever work you need done to raise yourself to an acceptable level where you feel comfortable with yourself and others feel comfortable with you.
People are hard to accept what they don't understand. It took years for gays and lesbians to be accepted by society. It will take longer for trans people to be accepted. The gender dysphoria that the clinical guides say we, as trans people, wrestle with may also apply to folks who do not understand us. Why would anyone want to be the opposite sex? It doesn't make sense to them. If you try to say that you were born a certain way and were meant to be a certain sex that is not what you physically are, that confuses people who don't understand or wish to understand. Being gay or lesbian is understandable. Having a physical or mental disease is understandable. Gender dysphoria is not understandable to most of the current population. To make matters worse, the physical appearance of some of us is quite alarming to people who don't understand us.
Telling medical providers
Your primary care physician should be your friend and confidante. Don't withhold medical information from him or her! He or she can help you change the gender marker on your medical records if you provide him or her with all of the necessary documentation. The rest of the staff, including nurses, screening technologists (X-ray, CT, mammogram, ultrasound, etc.), assistants, and porters should only be told about your history on a need-to-know basis. Usually, they do not need to know anything but the medical details relating to your medical problem. One of the frequent questions you'll be asked as a woman is when you had your last period. "I never had a period" is a perfectly acceptable response to give a screening technologist or a nurse. They should never ask "Why not?" but I've had one nurse look puzzled and say "Really?" Given that I was going for rhinoplasty surgery, I didn't need to tell this nurse that I was trans.
Why I prefer a real hospital over a health clinic
Free health clinics are an easy source for hormone prescriptions and gender identity letters, however, if you're afraid to go to a real hospital to see your primary care physician for hormones, what does that tell you about the reality of your situation? Real hospitals often have more complete facilities and a larger, more competent staff that can treat any problem you might have. If you work a good job and command a decent salary, why would you want to go to a medical provider intended for low-income or no-income people?