Undeterred, Cassis, now a towering blond with swimming-pool-blue eyes and a C-cup chest, entered an underground economy of fake doctors and self-appointed medical gurus who were willing to help her make the transformation she desired. She didn't know at the time that she was putting herself at risk for AIDS.

At transgender clubs in Hell's Kitchen, she asked the convincing-looking girls where to start. One gave her a business card for a hormone home delivery service. Another, she recalls, told her about a doctor who administered treatments in the bathroom of Sally's, a popular Hell's Kitchen bar catering primarily to transgender patrons.

According to Cassis and outreach workers who are familiar with the transgender scene in New York, this so-called doctor would set up shop in a bathroom stall for hours, injecting possibly hundreds with a single needle, without sterilizing it between shots.

"You could just walk in there, pay him $30 and he injected you in your butt," says Cassis, with an anguished expression on her face, because she now knows the risks associated with such activity. "They had the needles packaged, so it looked like they were new, but the tops of the packets were always open. I don't have any doubt that they were being reused."

Hormone needle sharing has not been identified as a major risk factor for HIV transmission among transsexuals, but a growing number of physicians and AIDS outreach workers believe it may be the cause of hundreds of cases in the United States and abroad. Very little is known about healthcare issues facing transgender people -- an umbrella term for anyone who does not identify with the sex they had at birth -- because research focused on transgenders is scarce. Recently, however, public health officials across the United States have begun to explore transgender health needs, and they are particularly concerned about high rates of HIV infection in this population.

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