"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."
The final effort was to amend her birth certificate and she had a letter from her endocrinologist saying she had medically transitioned.
But the Bureau of Vital Records didn't recognize her common-law name change and required a judicial name change, but Prinzivalli needed to provide a copy of her New York birth certificate. "It was circular reasoning," she said.
The 50 states have a collection of different laws on how transgender Americans can change their birth certificates.
Three states -- Idaho, Ohio and Tennessee -- ban any change to the birth certificate at all. Some require a court order, some, like New York, require proof of a surgical procedure.
In Washington state, which advocates say is a model, birth certificate changes require a doctor, under penalty of perjury, to validate the gender transition.
"Why would anyone who has not transitioned even think of doing this?" asked NCTE's Keisling. "You have a right to do this. It doesn't make sense. What possible fraud is there?"