Survival sex is the act of engaging in sexual activity with another individual or the act of selling sex in order to meet one's basic survival needs. A recent multi city study found that about one in four homeless and runaway youth has engaged in survival sex. Transactions typically result in the youth receiving monetary value, but also can be utilized to gain a bed for the night, a meal, or clothing. While there is an awareness of the possible dangers associated with survival sex, it is often reported that a sense of pride in being able to support oneself accompanies the activity or the positivity of being able to eat and have somewhere to rest that night. Dangers do lurk when it comes to this transaction, primarily being the stigma that results from the transaction and the possibility of contracting an STI/STD (sexually transmitted infection/disease). In the past, transgender youth faced many hardships in obtaining medical treatment for gender dysphoria. This lack of access was often due to doctors refusing to treat youth or youth fearing negative reactions from health care providers. Psychiatrists and endocrinologists and family physicians now have clear guidelines on how to provide care to trans* youth of early puberty through its completion. These are in wide use in Europe, UK, and in North America. While in other countries, doctors may be generally reluctant to provide hormone therapy to youths under 16, and obtaining sex reassignment surgery prior to the age of 18 is almost impossible in most countries. Some of the medical professionals who are permitted to prescribe hormones include medical providers, nurse practitioners, and physician assistants. Many youth who have used hormones to develop desired secondary male or female sex characteristics have obtained these hormones illicitly. This can be potentially dangerous, and can result in a multitude of health problems for the youth, including improper pubertal growth and HIV due to contaminated needles. Sexually transmitted infections are a large health problem for transgender teens as well, as sexual partners often do not perceive these youth as health risks, especially since male-to-female youth cannot become pregnant. This trend of unprotected sex among the transgender population puts them at increased risk and has led to higher numbers of STIs among the group However, the latest revision of the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People has addressed the needs of transgender children. When an individual is transitioning from female to male (FTM) or male to female (MTF), there are several avenues that are available to them pendant upon their financial capabilities, insurance's agreement to cover costs, and personal desire to utilize these options.