“What does the other person look like?” asks Mahogany, joking about her swollen face in “Born to Be,” after just undergoing surgery at Mount Sinai’s Center for Transgender Medicine and Surgery. In fact, there may not have been any fisticuffs involved in getting here, but it was nonetheless a fight, with the 2016 opening of the pioneering clinic in New York giving unprecedented access to transgender and non-binary people to health care when the lack of dedicated care, let alone at a reasonable cost, had caused so much anguish and unnecessary pain to previous generations. (A 2015 state law that mandated that gender-affirming surgeries be covered by health care providers was a watershed moment.)

The establishment of a clinic may mark a turning point for the transgender community in being able to live life on their own terms, but it also is a work-in-progress as director Tania Cypriano is able to show in “Born to Be,” following five patients seeking care at the facility and the Center’s lead surgeon Dr. Jess Ting, who isn’t only developing an entirely different set of surgical skills specific to benefit his specific group of patients, but must cater to a process that is as emotionally delicate as it is intricate medically. Once intending to be a viola player, Dr. Ting is revealed to be the right person for the job in any number of ways, sensitive to a fault, nimble with his hands and able to adjust quickly, though even those considerable gifts are tested by tending to those attempting to reconcile what they’re experiencing internally with who they are on the outside.

“Born to Be” cultivates a deep understanding of just how fluid and fraught the process of transitioning is, and even with a state-of-the-art facility and the availability of procedures that had been previously out of reach for those in most need of them, Cypriano’s warm and compassionate chronicle of the clinic’s early days allows you to admire the strength it takes on all sides to carry on each day, attempting to be truer to oneself than the last. With the film now available nationally virtually through Film Forum a year removed from its celebrated premiere at the New York Film Festival, the director spoke about the importance of showing a variety of experiences within the documentary, how Dr. Ting emerged as central character and how she was able to get so close to her subjects.

How did this come about?

I have a history of working on films that deal with health and communities and health campaigns [outside of] documentary work. I was introduced by a common friend to Michelle Koo Hayashi, the producer who had just learned about the center that was being formed at Mount Sinai Hospital and she thought that could be a film in there. I met her and was very fortunate on the same evening to meet the doctor, Dr. Jess Ting, who was actually being introduced to me as somebody who would help us get access to the hospital. He had just been assigned as the leader of the surgery department of the transgender center at Mount Sinai, and by the time I left our meeting, I was so excited about it because I could tell right away this was a historical moment, not only for New York, but also for our country. The opportunity of being there to tell the story of this center being formed was very, very exciting, and Michelle gave both the the cinematographer [Jeffrey Johnson] and I a lot of room to be inside of those rooms however we would want to be.

The idea was to see how the center was being formed and also follow a few of the patients, but by the second day of being there — I didn’t bring the camera — it was pretty obvious that Dr. Jess Ting would have to be part of the film, not only because of who he is and seeing the type of work that he was doing, but as a cis woman, walking inside of that environment and learning what I was learning firsthand, I felt Dr. Ting was actually close to the experience of what I was going through, learning about this community and why those surgeries were so important. It was a way to explain to a larger audience what the issues were from somebody who knows very little about this population and falls in love with this community and then becomes an advocate for them, and through him, [it] was a way also to get close to the patients.

You have to approach every film with sensitivity, but going into such emotionally charged situations, was it an even greater challenge to get what you needed to get on camera?

Once I was let into the room, the people that would let us film were all very excited about the project because they all knew the importance of what was happening. This was the first time that in New York, if you come from a background without having the financial resources to go through these surgeries, there was the opportunity not only the surgeries, but to go to hormone treatment and other types of treatment that transgender people are looking to have. And I think that everybody knew how special that moment was and wanted to be part of the conversation, but it was a very, very difficult film to make as well because a lot of the stories were incredibly painful.

We did have to follow more people than we ended up with [in the final cut] and trying to make sure that everybody was heard and that everybody knew that they were important —because I learned also outside the camera a lot from them and I pretty much moved out of my home for that period because it was quite stressful and demanding. It was actually talking about the process of the doctor when I too fell in love with so many of the people that I met in this film that I then felt like I had to become part of their everyday life. Even when our cameras were not there everyday, I was there pretty much everyday through their process of transitioning, and it’s hard for everybody involved.

How did you ultimately decided who to include?

Each person that appears in the film has a little bit of a different story, but a couple of them were people that the doctors themselves said, “You have to meet this person.” Jordan and Al, I met outside of the surgical [department] at another building from the hospital before they went for their first meeting to see Dr. Ting. What would happen is the day before we would go with our cameras, [Dr. Ting] has two amazing assistants that helped us a lot with the film — they would send out an e-mail to all the patients letting them know a film crew was going to be there [which was] just two to three people including myself, already asking who would be interested in being a part of this. I spent some time there without the cameras there, listening a lot so once I was in there, I could already tell who and why we should follow this person or that person. Of course, there will never be one representation of this community, but I tried to really go not only with people of different ages and ethnicities, but also from different financial backgrounds – people who had family and people who didn’t and who had a partner and those that didn’t, [perhaps] hoping that the surgeries would bring somebody to love.

Every time I see the film, I wish I could include three more people that we followed also closely, but there came a time when I was asked by the producers, why do we have two black women of the same age in the film, Cashmere and Mahogany, and why don’t we pick up this other person we had also followed, but I thought it was super-important to show two women that are black and are around the same age, but their experiences were completely, completely apart because even as we talk about black trans women today, it’s important that people understand there is not one black trans woman out there. We wanted to [speak] to different experiences within the community and to them specifically.

When you present everybody as being far more complicated than what they appear to be at the start, was it difficult how to express that in one experience while tracking many different ones?

I worked with two editors at the same time on this project and a big part of our work was really looking at a wall with all sorts of possibilities in cards and trying to really figure out the puzzle, but once we really saw the doctor as a main character in the film, we tried to then bring him in and out of the stories and when I saw could put a lot of the questions together — a man who wished to be a musician and he couldn’t do what his heart and soul wanted for him to follow and the way that he has transformed his life into being a top surgeon, but then later on his life becoming a surgeon who helps people to be who they are, I thought “Okay, this is the gut of the story.” That’s the story we try to present very, very slowly throughout the process, but together with Chris White and Scott Foley, we spent a big part of the time talking and trying to figure things out, and once they went into the edit, it was magic because so much of the conversation and the figuring out had already happened outside.

Was there a moment during the filming of this where something happens that changes your ideas of what this could be?

There were quite a few, but originally the title of the film was “Transformation” and what I learned the most is the realization that even though the surgeries are there and the health care can be there, we’re living in a very tough time right now because of what Trump has done with reversing that whole law, but it’s really seeing that the transformation, if we’re calling it that, had to come only within the medical experiences that people were going through, but that real transformation has to come from our society, being able to get educated and understand. It’s about not compassion but empathy and education because so many people, even people that I’ve met who are super open-minded, have problems with the surgeries. I say you don’t know until you learn about them, otherwise we’re all just coming up with our own assumptions or judgments about it.

Then because we are very much touching the subject of surgical transitioning, these surgeries are life-saving for many, many people, but at the same time, the transgender people that go into this process have to be aware that it does not cure depression. It does not erase trauma. And if I had the time, I would’ve included more in the film the importance of the psychological help that needs to be with those surgeries because a lot of people go into them thinking it’s going to change their lives. Even as I was learning about them, I was like, “wow,” but then as you see, we have a couple of very sad stories, [including] one who sees herself and thinks she’s complete and then you find out that there’s more work to be done than going through the surgical procedure.

It looked like your subjects were really moved when they saw themselves onscreen at the film’s premiere at the New York Film Fest. What was it like for you to share this movie with them?

I’ve been to the Walter Reade Theater so many times, but to be there on the stage and witness that moment for those women that had been so oppressed, who had such a difficult life, being celebrated and loved and understood was one of the most beautiful things I ever experienced in my life. We really formed a very strong relationship with them and they felt an ownership over the project in many ways because I would often consult with them throughout the process, so there was not just the conversation on camera, but also the conversation outside the camera. So we’ve been very, very lucky to have continued support from all of them because people always want to know where are they now and how are they because a year or two years have passed, and when they were there, they were there for our film, but they felt they were there for themselves and their community, and to be in the spotlight and to be celebrated, it was really awesome.

“Born to Be” opens virtually on November 18th at Film Forum with a virtual panel on November 19th at 8 pm EST.