People outside the trans experience have a truly hard time understanding the magnitude of the task of changing gender expression. No one would ever do this unless they were forced to by their own psychology. I did choose to follow a number of specific steps to change my gender expression; it's just that I was so compelled by inner need that I would say it's not really a choice.
This is so hard that no one would do this if they had any other option. My only other option was to die. And yes, I was prepared to die. I had carefully detailed plans and all the necessary supplies. All I needed were 10 minutes before I went to bed and I wouldn't wake up the next day. I saw it less as suicide and more like euthanasia: I had a medical condition that bordered on unbearable at times.
I don't feel that I need that option anymore; for the most part, my life as a trans woman seems to be working. But I truly cannot go back to living as a man. This is a choice like breathing is a choice. I can choose to not breathe, but not for long. I have to do this to stay alive. Truly I do.
Gender is largely a societal construct. All this "feminine" stuff I'm practicing how to do is learned, a product of our culture. If I want to look feminine, I have to adopt these culturally derived standards of dress, behavior, and speech. I've come to realize that the real differences between men and women probably aren't that great. After all, I had a female mind my whole life, and yet somehow I was able to successfully deny that for 53 years. Unfortunately, the cultural differences between genders are enormous.
Women have suffered greatly at the hands of men; there are many places where it's still evident. The whole time I lived as a male, I really believed that women were the superior sex (their contribution to making children, for example, is vastly greater). I actually had to learn to accept that I really am good enough to be a woman. At first I didn't believe it.
I've just recently had something explained to me, and it bothers me to think about it. Apparently, some people feel that trans women aren't real women because we had a life of male privilege and then became women. This is wrong on so many levels. My medical school class was half women. Getting in and staying in medical school is mostly about grades, and that's largely indifferent to gender. Actually, at times it may have been harder, because I was living as a man. On my OB/GYN rotation, the residents I worked under were mostly women. They didn't like the males. No one even knew my name; they just called me "stupid."
As explained somewhat above, gender dysphoria is unspeakably painful, and changing gender expression is extremely hard. It really would have been a lot easier to have just been a born woman the whole time than to switch. No matter what I do, I'll always be a trans woman, second-rate. There will always be people who won't accept me, because they think I'm a fraud. I wouldn't have that problem if I were a born woman.
I have said before that I like being a trans woman, and I wouldn't be a born woman even if I could. That's wrong. Clearly I'd be a born woman if I could: Life would be vastly easier. I wouldn't be a man even if I could, but I probably feel that way because I don't understand men and can't imagine what it would be like to be one.
I tell the following story in my book Untying the Knot: A Husband and Wife's Story of Coming Out Together, and it applies well here. My father told me about a movie he saw many years ago where two male police officers, one white, one black, are riding together in a car. The black guy turns to the white guy and says, "Do you ever think about being white?"
"Of course not," says the other guy. "Why would I?"
"Well," the black man said, "I think about being black every day."
I doubt that born women and men ever spend much time thinking about it. I'd do anything to be able to be that way. I'd do anything to have a uterus, ovaries, and periods. My many born-woman friends all think I'm totally nuts for wanting periods, but they don't understand. When you're outside this, it's hard to comprehend what it really feels like.
I'm stuck spending my whole life looking over the fence, wishing I were on the inside. Sometimes it's hard to believe all this struggle is worthwhile. But, again, I have little choice.