President Obama's memo that bans hospitals from discriminating against gay men and lesbians also protects transgender folks, but activists say obstacles remain.

The order signed by the president late Thursday prohibits hospitals that accept federal funding from Medicare and Medicaid, the government's elderly and poor health care programs, from discriminating on the basis of a variety of characteristics, including sexual orientation and gender identity. It also prevents hospitals from denying visitation rights to the partners of gay men and lesbians, and requires officials to honor patients' wishes of who can make medical decisions on their behalf.

Gay rights groups called the memo a small but significant contribution towards equality in the absence of the legal right to marry in most jurisdictions.

While applauding the action, transgender activists said complicated issues remain for people who have altered their gender.

“Many transgender people also identify as gay or lesbian,” Denise Leclair, executive director of the International Foundation for Gender Education, told On Top Magazine in an email. “So this bill affects them the exact same way as other gay and lesbian couples.”

Leclair, however, went on to say that lawmakers have yet to address the needs of transgender people who identify as straight. Those couples often have their legal marriages questioned. Leclair pointed to the case of Christie Littleton, a transgender woman whose marriage was successfully invalidated by an insurance company to prevent her from having standing in a malpractice lawsuit. Lawyers argued that Littleton remained a man despite having undergone gender reassignment, and as such could not legally marry Jonathan Mark Littleton.

The suit has an ironic twist: transgender people are allowed to marry members of the same sex under Texas law.

Kelli Busey, a member of the Dallas Transgender Advocates and Allies, said that the president's order cleared few obstacles for transgender people. She pointed out that only a handful of states recognize the altered documents of a transgender person.

“Suppose a transgender person has changed their documents to indicate their proper gender in one state and their loved one is hospitalized in another state that specifically does not recognize those changes and their new name?” she asked.

Altering documents remains a major obstacle to equality, Busey said.

“There are many states that have no specific laws denying or allowing this process and allow transgender people to 'fly under the radar',” she explained.

Obama's order does not specifically address either of these issues, but both women agreed it was a positive step forward for the LGBT community.

The Department of Health and Human Services is expected to implement Obama's directive over the next six months.