I think this link is worth reading.
In my limited studies of the native american two spirit tradition, it seems that the two spirit people were generally accepted in the Great Lakes region, the early French explorer had a word for them, berdache. (I may have spelled that wrong.) In order for the French explorers to have used the term, the two spirit people must have been visible, and, in order to be visible, they must have been accepted in the local culture.