Lewis cites a recent study by National Center for Transgender Equality (NCTE) that shows 80 percent of women and 95 percent of men do not undergo sex reassignment surgery because of the cost, which can be tens of thousands of dollars.
The report, released in February, paints a bleak picture of life as a transgender person in the United States. The survey, "Injustice at Every Turn," says discrimination is pervasive.
Most respondents said they lived in extreme poverty, and many reported attempting suicide. They revealed harassment in education, employment, housing and health care, as well as in the government and prison systems.
"We have an unemployment rate twice the national average and four times the national average of people who live on less than $10,000 a year," said Mara Keisling, NCTE's executive director. "Part of the problem is people are less employable because they don't have IDs that match who they are?It's tied together in a cycle."
One of the litigants, Sam Berkley, who is a student, has had a double mastectomy, but not genital surgery, partly because of cost. "I don't have $20,000 to $100,000 at the moment," he said.
Berkley also said he didn't want to subject himself to an invasive procedure to create a phallus. "It doesn't make me a man."
"I think that transgendered people should have access to updated and accurate documents," Berkley, 30. "To have a document that says I am female and I am not completely legitimized by the city where I pay taxes, doesn't make any sense. It sets me up to be a second class citizen and for discrimination."
Another litigant, Patricia Harrison, 58, has been fully transitioned since 2000 with all appropriate legal documents.
She faced a challenge when she moved from New York to New Jersey and had to transfer her driver's license. One of the requirements was to show a birth certificate or a passport. She didn't have the latter.
When she presented her male birth certificate to the New Jersey DMV, they turned her away. "I had to go back to the doctor again and get another letter even though I had gone through that process for New York State," said Harrison.
"All I did was cross the Hudson and I had to prove who I am all over again," she said. "It was like going to a foreign country. It wasn't right."
She, too has not had surgery. "My doctor and therapist agree that it has reached the point where I present myself as a female and am comfortable with the way I am," said Harrison. "It's not like I am 22 and sexually active. It's major surgery with a lot of potential complications."
As for Prinzivalli, for years she "hid" as a woman trapped in a man's body until she was inspired by reading the story of Christine Jorgensen, an American soldier who had sex reassignment surgery in Denmark in 1952.
Prinzivalli had give up plans to transition to a woman when her psychiatrist was not supportive. She married for 20 years and had four children, but eventually came out fully in 2000 with devastating consequences.
"I lost my spouse, my family and my home and the last straw was my job," she said. "That was the last day I did anything male."
Prinzivalli changed her name and all her documents. She sought counseling and underwent 400 hours of electrolysis and hormone replacement therapy. After three years she knew, "I wasn't going back."