Transitioning stages for transsexual women are described on the current page.
Transitioning stages for trans men are completely different and can be found HERE.
The transitioning stages for crossdressers share similarities with trans women's stages, and can be found in Chapter 7 of the book The New Gender Paradigm. (Transitioning for Androgynous People can be found in the same chapter.)
Stage 4 offers a stable life as a "transgender person". That means...
1. The deep fulfillment of right-gender living
2. Social needs are fulfilled within the gender community itself.
That's the good part. Unfortunately, there are also bad parts, such as dead-end jobs (such as sex work & drugs), poor health, discrimination, violence and HIV. In fact, alienation can become a value that defines the community: Group members perceive themselves as “gender variants”, “gender outlaws”, “queer”, “non-conforming” and other terms of exclusion. Exclusion can unite outcasts (It's us against the world!) Getting past WPATH's obstacles is a victory over the establishment. As a result, “coming out” becomes a celebration of stigma. (I'm abnormal but proud!)
DISAPPOINTMENT: Transitioning occurred in Stage 3. By Stage 4, full-time right-gender living has brought relief from wrong-gender distress (Type 1), but at a cost of increased distress due to social coercion (Type 2 Distress). Withdrawing from mainstream society is a common strategy for minimizing the harassment and the distress.
For many, Stage 4 is a letdown after Stage 3 because of...
-- UNFULFILLED EXPECTATIONS: Transitioning doesn't bring the "happy ever after" bliss of fairy tales. Emotional distress remains, albeit at a lower level & from a different source. Past relationships have been severed. Exile is wearing, the longer it persists. It sucks to be unemployed. Hormones & surgery don't provide the knock-out beauty queen body that one might have hoped for (especially with ineffective treatment under the WPATH Guidelines). ...And there may have been medical complications from the procedures.
-- LESS EXCITEMENT: Stage 3 was energized by the excitement of discovery. The hours were filled with learning how to walk, sit and speak properly. Each day brought a new addition to the wardrobe. In Stage 4, there’s nothing more to discover or learn. No more new clothes because the bank account is empty.
-- LESS RAGE: What a relief to vent! It’s fun to protest and picket! …Until one realizes that the status quo will never change. In fact, a large part of the transsexual community NEEDS to be a victim. It's their source of identity. They're terrified of a world without it. It turns out, all that anger has been wasted energy.
Post-transition disappointment may lead to depression or even Regret -- especially as the memory of wrong-gender distress fades. Resilience in Stage 4 depends on how well the trans individual deals with these disappointment factors.
FINDING EQUILIBRIUM:The Runaway Train of Stage III has left devastation in its wake: Loss of family & friends, unemployment (or a hostile work environment), poverty & debt, lack of healthcare access, loss of legal documentation, religious exclusion, etc. Success in Stage IV requires rebuilding what was lost:
-- Teaching family members the truth about transsexuality & repairing family ties on that basis
-- Forming new right-gender relationships (usually with other transsexuals)
-- Finding new employment (with possible re-training)
-- Finding an affirming school
-- Negotiating with coworkers for a healthy work environment
-- Restoring legal documentation
-- Finding affirming healthcare sources
-- Finding affirming religious groups
COEXISTENCE: The form and structure of Stage IV living is determined by the interactions between the transsexual community, the lesbian & gay communities, and mainstream society.
-- VIOLENCE: In all locations, violence and harassment are constant threats. Streetwise habits are essential. However, some locations allow the gender community to be visible in most public areas; while in other locations, the police and extremist groups attack on sight. In the later case, every movement & activity must be carefully hidden.
-- POVERTY: Most transsexuals live a life of abject poverty, discrimination, unemployment, healthcare denial, and violence. That means, sex work, HIV, street hormones, silicone injections, homelessness, drugs, suicide and early death.
However, there are enlightened locations with moral & empathetic employers, civil rights protections, inclusive social programs, and so on. As a result, a transgender person can survive in mainstream society.
Successful coexistence may require a relocation from extremist areas to, say, the Pacific Northwest, middle New England, or San Francisco.
SEXUAL ORIENTATION: Particularly after genital surgery, a transsexual must deal with issues regarding their future sexual activity. It's a complicated task because...
-- EXPLORATION: Adolescence is the natural time to discover & experiment with sexuality. …Including sexual attraction & orientation. Few transsexuals are allowed to go through sexual development at the appropriate stage of life (see HERE).
-- COERCION: Society forces trans children to adopt a wrong-gender facade. That pretense may extend to an imposed sexual orientation. Or the trans person may adopt "heterosexuality" just to reduce the harassment. ...Or adopt "homosexuality" in order to buy gay allies.
On the other hand, some "gender experts" demand that trans people adopt a particular sexual orientation before transitioning (or instead of transitioning -- see HERE).
-- NO NAME: If a post-op transsexual is in a romantic relationship with another female, is the relationship homosexual or heterosexual? If two post-op transsexuals are in a romantic relationship, are they homosexual or heterosexual? Does genital surgery turn a homosexual into a heterosexual? (Or vice-versa?)
-- PARTNER AVAILABILITY: In today's hostile society, it's rare to find someone willing to enter a close relationship with a trans person. ...And there's a high risk of violence if a sexual partner is outed as trans. Most relationships that do form are with other transgender people.
-- After exiting the operating room, it’s natural to want to try out the new plumbing.
-- Innate arousal patterns remain unchanged through the transitioning process.
-- After exiting the operating room, it’s natural to want to try out the new plumbing.
Studies have indicated that as many as 27-46% of post-op transsexuals are asexual.
PROGRESSION: Stage IV is a stable social state; most transsexuals remain here. Remaining in Stage IV or moving to Stages V & VI depends on the individual -- their needs, interests and available resources. It's the individual's encounter with femininity that may lead to further progression.
Stage 1 involves searching for an answer. Stage 2 is learning to live with that answer -- that is, living with a disgusting sexual perversion that everyone abhors. Driven by a need that can't be suppressed. And by now, life's experiences have shown that the "defect" is permanent.
During Stage 2, a trans person begins to arrange times for right-gender expression -- instead of fighting desperately against the need.
ALONE: For many reasons, trans children flee from the world. Exclusion is imposed by an intolerant society, but it's also self-imposed due to the fear of discovery & the torment that would follow. The inner peace of right-gender expression is only possible while hiding alone. Parents, teachers & doctors are known enemies.
THE CYCLE OF PURGE & STASH: Right-gender expression requires a hidden stockpile of gender-appropriate clothing. During Stage 1, dressing is done on an ad hoc basis: When the need is overwhelming, clothes are fashioned out of whatever’s at hand (towels, bits of cloth, etc.) — or there’s a raid on a sister’s closet.
But with time and acceptance of the reality of the “defect”, a hidden stash of right-gender clothes will be gathered in a hidden corner of the attic -- ready for use at the next available opportunity. But if that stash is found, it’s damning evidence for the inquisition that will inevitably follow.
Episodes of right-gender expression reflect a balance between wrong-gender distress and guilt. A high level of wrong-gender distress triggers an episode of hidden right-gender living. The right-gender expression calms the distress but guilt increases with every passing hour: It's disobedient! It's a mental defect! It's a sin! ...What if someone finds me? The episode stops when the guilt reaches overwhelming levels. At this point, the wrong-gender distress has mostly dissipated. In a fit of self-hatred, the trans person vows NEVER to succumb again. The secret stash of clothing is burned.
But even as the smoke rises from the ashes, wrong-gender distress begins to build again in a never-ending cycle of collecting a stash of clothes, then destroying it. The cycle of stash & purge is the outward expression of the inner turmoil of irrevocable need vs guilt & self-loathing.
ROLE MODELS: The search for understanding that began in Stage 1 leads to encounters with actual living members of the transgender community -- at the local Pride Center, at a support group meeting, at a GSA Club at school, or whatever. The outcome of these encounters defines the pace and direction of future evolution. On one hand, the group may be actively welcoming & affirming, with assurances that being trans can be fun. On the other hand, some groups are made of competing cliques that offer fashion critiques with a sneer, while warning of surgical nightmares. ...That is, if they notice the newcomer at all.
PROGRESSION: Each stage in trans evolution offers a choice. For Stage 2, an individual can continue the pretense of wrong-gender expression with planned intermittent secret right-gender expression (long-term Stage 2 -- more likely when role models are rejecting). ...Or they can cut all emotional ties with mainstream society and plunge into the transgender community (progression to Stage 3).
...Neither choice will be viewed as a good outcome, because perverts can have no hope for the future. Stage 2 isn’t a glorious procession into enlightenment, it’s hesitant and trembling steps into the dark unknown. …With bystanders warning of the terrible abyss that lies ahead.
Stage 0 represents the ground state of the self-discovery process: A 2-3 year old girl makes an unequivocal declaration of her gender identity. ...And she has personality traits (gender) consistent with that gender identity. However, the parent responds by overruling the child’s declaration and demands that the child adopt wrong-gender expression. At that point, transsexuality is born.
The essential characteristics of Stage 0 are:
DEFECTIVE: Parents, teachers and psychiatrists tell the trans child that her inner voice is defective and must be ignored; that her innate needs are irrelevant — even dangerous and evil. She's drafted into a war against her own psyche. She must “overcome her defect” and reprogram herself through pure force of will.
Over time, many trans children go to extremes to purge the supposed “defect” — leading to hyper-masculinization: They lift weights, compete in martial arts, drive 18-wheelers and join the army. It all proves that the trans female is Really a Man, like her parents told her to be. Maybe all that manliness will cure her defect....
POWER: Stage 0 is about power: Adults have it, the child doesn’t. Parents, teachers & psychiatrists use their power to establish and enforce wrong-gender stereotypes. Social leaders take control of the child’s entire mental and developmental growth. Spontaneous play and gender role exploration are forbidden. …Even to the point of puberty denial during adolescence. Strict blind obedience is required.
FAILURE: Every wrong-gender coercion attempt is doomed to ultimate failure. It’s simply not possible to turn a girl into a boy. Adults’ promises of happiness & success through wrong-gender living turn out to be false. The right-gender inner voice can’t be squelched. Failure erodes the trust and blind obedience of early childhood, to be replaced by confusion, despair, distress and alienation.
PROGRESSION: With age and growing independence, the balance of power gradually shifts in favor of the individual. Stage 0 is inherently unstable.
The New Gender Paradigm
Stage 3: Gender-Role Adoption
Stage 0: Wrong-gender Conflict
Stage 5: Gender-Role Re-Direction
Stage 2: Gender-Role Comparison
Stage 4: Gender-Role Stability
Stage 6: Personality Synthesis
Stage 1: Gender-Role Confusion
Many transsexuals are quite content to remain in Stage 4 for their entire lives: I'm transgender -- neither male nor female. I don't fit in mainstream society, so I seek personal fulfillment through the LGBT community. …Or they may move into Stages 5 & 6: I'm a woman, just like any other woman. Of course I live in mainstream society -- where else would I be?
Stage 5 begins the path toward womanhood. To a great extent, it's learning what other women learn during childhood and adolescence:
-- What kind of woman are you? Values, interests, hobbies, obsessions
...Including fashion sense and the communication of self through appearance
...Hair length, color, style
...Nail length, color, style
...Shoe height, fabric, style; pants, hose or stockings?
...Signature fashion styles. Ie, contemporary, sexy, professional, casual, sporty, Victorian, vintage, etc.
...Favorite or iconic shopping locations?
...Signature perfume, favorite color
...Personal icons & role models
...Athletic skills, interests and schedule
...Acquisition of feminine skills, such as housework, cooking, gardening, handcrafts, sewing, child rearing
-- What kind of a feminist are you? Where do you stand on women’s issues?
…Abortion, contraception, dating—marriage—cohabitation, intercourse & virginity, prostitution & sexual exploitation, children, schools, violence, employment, social equality, diet & weight control—to mention a few.
...Which women’s magazines do you follow?
Remember, going through Stage 5 doesn't require Stages 3 or 4. Many transsexuals know they're a woman from early childhood. Understanding parents can smooth the way to Stage 6. (Many well-meaning parents, however, tell their children they're "transgender", and expect them to remain exiled to Stage 4.) ...And then there are transsexuals who live a while in Stage 4, gathering the self-confidence to re-enter mainstream society.
PRESSURE:The choice between Stage 4 (transsexual) or Stage 6 (woman) isn’t made in a vacuum. Powerful coercive forces seek to influence the decision:
Society feels compelled to punish transsexuals for transitioning. That means exile to Stage 4, hopefully never to be heard from again. To that end, courts have ruled that transsexuals aren’t human, can’t inherit property or marry (Corbett v Corbett , Ulane v Eastern Airlines , Littleton v Prange , In re: Gardiner , etc). Likewise, Congress has repeatedly refused to protect them from discrimination (eg, the Employment Non-Discrimination Act—ENDA). Transsexuals have been specifically excluded from the healthcare system. The current trend is for states to enacting laws to prohibit trans people from using restrooms. …All these actions are designed to make it impossible for a transsexual to function successfully in mainstream society.
On a more personal level, open-minded people & families may tolerate a transsexual presence, but only at an arm's length: close or intimate relationships are out of the question. There's a lingering suspicion that transsexual women are Really Men, and may even be sexual perverts.
Secrecy is a transsexual's usual response. In fact, it can be argued that secrecy is the only option for freedom in mainstream society. A transsexual must carefully hide every vestige or reminder of former wrong-gender life. Her life as a woman is overshadowed by the fact that she could be outed at any time and lose everything. Once outed, the individual returns to Stage 4; life as a woman is no longer possible. (For an example, see HERE.)
The secrecy option carries certain requirements: First, a person must pass well. Second, they must have a reliable income that doesn't require ID checks (a background check will usually uncover info from pre-transitioning life.)
Note that transitioning in early childhood results in someone who passes well, was socialized as a female, and whose records are entirely female.
Privilege: Wealth and an elite social status offers another avenue to mainstream living. Privileged people don't depend on health insurance. They can afford whatever cosmetic surgery might be necessary for passing. They're not dependent on finding an open-minded employer. And they're surrounded by adoring crowds -- eager to share the wealth. Relationships may not be genuine, but who cares?
The Gender Community: After a lifetime of harassment & rejection, it's common for a transsexual to fear & hate mainstream society. If someone leaves the LGBT community to join the enemy, they must be a traitor. Secrecy is further evidence -- interpreted as a denial & betrayal of the person's "true nature".
Forcing trans people to remain in Stage 4 is often phrased in terms of “Coming Out”. In the lesbian, gay & bisexual communities, coming out is an act of healthy liberation. What’s good for the LGB’s should be good for the T’s as well. Supposedly, that means making an unabashed announcement, “I’m a transsexual! I'm proud to be an abnormal outcast!” Many LGB's consider Stage 6 to be “return to the closet.”
The result is an ongoing conflict between Stage 4 & Stage 6, each claiming to be the True Transsexuals. Some Stage 4 people will go so far as outing women in Stage 6, to block any prospect of success.
PROGRESSION: Stage 5 is a time of learning and gaining experience. A complete & authentic woman emerges from the process.
During Stage 2, a trans individual struggles in secret & alone with her "defect". Stage 3 marks acceptance of the reality that she's transgender. She's destined to be an outcast. She'll live in poverty and be subjected to harassment & violence. But there's comfort that she's expressing her real inner self, and that she's part of a small embattled community.
Formal adoption of a right-gender role begins during Stage 3: That means legal name change & document correction. Negotiations with school or employer. ...And maybe even hormones & minor surgery. However, some ties to the old pretense remain: The wrong-gender persona may still be needed for school, continued employment and to preserve family relationships. However, it's understood that those ties will be severed as soon as possible.
PUBLIC TRANSITIONING: Short right-gender sessions during Stages 0 & I took place in a dark closet behind heavily locked doors. During Stage 2 there may have been tentative forays out of the closet, but Stage III entails a full-scale project to publicly portray a comprehensive and complex right-gender personality—which means:
-- Self-discovery to find and enhance innate gifts, perspectives and interests.
-- Define individualized fashion statements & hair styling
-- Purge old habits learned during the wrong-gender façade.
-- Plot a future right-gender life: employment, education, housing, etc.
-- Create a right-gender support network
-- Negotiate a level of participation in the gender community & gender advocacy
-- Negotiate a right-gender relationship with God
On one hand, transitioning uncovers wondrous treasures and gifts that had been repressed during wrong-gender living. On the other hand, public appearance gives birth to the dread specter of passing. People lucky enough to pass well skip happily through transitioning without repercussion or a second thought. People who don’t pass every well risk their lives every time the walk out the door.
Few people pass early in the stage. With time & experience, most can pass most of the time. ...After voice training and learning the skills other women learn from their mothers during adolescence. During Stage III, a transsexual determines how much transformation her transitioning will entail. Clinging to former relationships, methods of social interaction, exercise of power, and sexual roles results in a transition in appearance only.
…Which is fine, as long as it’s in accordance with the patient’s goals. Superficial transitioning removes any prospect for moving into Stage VI, and may influence the extent of appropriate medical transitioning.
REVENGE: During Stages 0 through 2, responsible adults used their power, privilege and position to ruin a trans individual's life. Anger is the usual response to discrimination & harassment. Since trans individuals believe the myth that they're defective, most often that anger is turned inward -- resulting in depression & self-loathing. ...And a high risk for self-destructive behavior, even suicide. (Self-destructive acts include substance abuse, cutting, street medicine & silicone, self-mutilation & risk-taking.)
Other trans people fight back against the oppressive society. Since bigoted people are offended by the mere presence of trans people on the streets, payback is easy: A rebel only needs to go to any mall or other crowded space and throw kisses (they call themselves "gender outlaws"). It works even better with fashion extremes ("big hair", bouncing chest, garish make-up, ultra-miniskirts & "hooker clothes".)
Anger can also be vented through advocacy activities, from running the library at the local Pride Center, by doing presentations at schools & businesses, by doing volunteer work, or by picketing the capitol building.
But there's a risk: In addition to the danger of being an open target for anti-trans violence, anger is reactive instead of proactive. Instead of freeing the inner self to live as a Real Person, an angry person's actions are dictated by the enemy. For example, an angry person doesn't wear the clothes they want to wear, they choose clothes that will offend. They replace an I'm-pretending-to-be-a-man facade with a Have-a-bad-day facade. Both are forms of wrong-gender expression.
RELATIONSHIPS: Relationships are based on personalities. That is, common interests, values & experiences; charisma & cute quirks. Before transitioning, a transsexual’s public appearance and behavior were wrong-gender pretenses to satisfy the demands of parents, teachers & social leaders. As a result, any relationship formed during that period was with an artificial person. Transitioning introduces a new right-gender person with different gifts, values, interests, and insights. The new traits accurately reflect the real person within. But a new personality means a new relationship. …With everyone.
In addition, gender governs social interactions: Any relationship between a woman & a man will be very different from a relationship between two men or two women. Like it or not, interactions depend on social custom, relative power, positions within the social hierarchy, and sexual tensions. Men hold the door open for women, women wait for the door to be opened. Men are experts about everything; women listen & admire. Men talk about things; women talk about relationships. Male bonding rituals are quite different from female bonding rituals. Whenever a man and a woman are together, they size each other up for a possible date. ...And so on.
Unfortunately, It’s common for a transsexual to expect pre-existing relationships to continue after transitioning: They assure others, I’m the same person in a different package. It's an unrealistic expectation that can lead to an unfair sense of betrayal.
RUNAWAY TRAIN: Life as a transsexual involves surmounting one obstacle after another. Stage 1 banned self-expression. Stage 2 censored self-discovery and restricted access to information. During Stage 3, a transsexual confronts a healthcare system designed to deny treatment, coerce wrong-gender behavior and to prevent transitioning.
Stage 3 may offer a tantalizing hope for ultimate fulfillment, but the grim reality is obstruction at every turn. It’s common for transsexuals to respond by bludgeoning their way through all those obstacles like a runaway train.
I want treatment, and I want it NOW!
The obstructions are arbitrary & artificial. They're obviously motivated by bigotry. The gatekeepers don't care about self-discovery, distress or meeting needs. Introspection and wise planning aren't part of society's "game". Lying & cheating are a trans person's tools for getting past the gatekeepers. The determined trans individual soon considers decisions to be distractions; questions become impediments; advising caution is interpreted as rejection.
As a result, the runaway train ruins relationships and destroys family finances. Transitioning MUST take place, at any price. Any treatment will do, even ineffective street hormones in the wrong doses. Unfortunately, cheap surgery and silicone injections may be quick solutions, but they lead to a lifetime of complications. Every runaway train must ultimately deal with the consequences of rash decisions and taking the simple way out.
PROGRESSION: Once right-gender expression has been achieved (by whatever means), the next step is to live life on a day-to-day basis. That's Stage 4.
Stage 1: Gender-role Confusion
The agony of wrong-gender conflict (Stage 0) continues until:
-- The child realizes that her defect is permanent
-- She gains some level of autonomy
-- Adult fallibility has become glaringly obvious
-- The child encounters the concept of transsexuality
What's wrong with me?
It soon becomes obvious that the wrong-gender distress isn't going away, in spite of prayer, determination, punishment, harassment, shaming, and hyper-masculinization. Stage 0 conflict inevitably pushes a trans youth toward the library, searching for answers & explanations. For children in a non-supportive environment, answers start to arrive around 10 to 12 years of age. (Other children are free to explore gender roles between ages 5 to 10 years.)
In the 21st century, gender information usually comes via the internet. Unfortunately, any information about human sexuality & gender tends to be heavily censored -- especially for children, more so in certain locales. Censorship extends to internet content ("parental controls"), reading and library materials, but also extends to biology, health and sex education classes at school.
MISINFORMATION: Stage I exists because of misinformation. Even when a youth finally gets past the censorship, the information she finds is all wrong. Her biology class teaches that genitals control a person's destiny. Anyone who doesn't obey their genitals is a “gender variant”, “non-conforming” or “queer”. They have an "identity disorder”, “gender dysphoria”, a "mental illness", or a "paraphilia" (sexual deviant & pervert). Trans youth also learn that "transgender" is a lifelong sentence to harassment, violence, exclusion, and unemployment.
Why would anyone want to be trans?
Stage I continues the self-conflict established during Stage 0, but offers the prospect of relief from the distress — albeit by a highly stigmatized path. There’s also some comfort in knowing that other people possess the same so-called “defect”.
SECRECY: Gender identity cannot be denied. Punishment and harassment only drives right-gender experiences underground. Every trans child finds a hidden spot where she can be her real self. But secrecy spawns guilt and paranoia.
PROGRESSION: Society wants trans people to stay in Stage 0 -- superficially conforming, but suffering. Any hint of movement away from conformity unleashes a storm of harassment, exclusion & violence. (For example, when her hiding place is discovered.) Fear holds a trans youth back, but Type 1 Distress drives her inexorably forward -- regardless of the cost.
Unfortunately, suicide is the only other option.
Transsexuality refers to a baby girl who has been forced by her parents to live as a boy. (Known as wrong-gender expression.) As she grows older, she quickly realizes that something is very wrong. The rest of her life is devoted to going back to the way she was when she was born -- a girl, not a boy. The process is known as transitioning -- it takes decades and involves a series of identifiable phases or stages of development:
SELF-DISCOVERY: Everyone says she's a boy, but something's not right. Through introspection & exploration, she discovers the Truth about herself.
EXPERIENCE: She must carve a place in the world for herself.
For most people, transitioning occurs in spite of society's best efforts to prevent it from happening. Exploration is forbidden; the internet and the media are flooded with misinformation; and many bystanders enjoy punishing and harassing "non-conformers" -- supposedly for the good of society.
For trans women, transitioning can be divided into 6 identifiable phases. During each phase, an individual has a certain level of understanding and experience that result in a characteristic perspective -- most feel a certain set of emotions; they face a certain set of challenges; they're driven by an identifiable set of needs. Overcoming those challenges and fulfilling those needs leads to the next phase.
Since each stage reflects a specific level of insight, difficulties and needs, all outside support must be attuned to which stage an individual is going through at the time. For example, advice & support regarding surgery (a Stage 3 concern) would freak out someone in Stage 0 or 1. Individuals in those early stages need support in finding their true inner self. They need to be open to gender exploration "outside the box", but without pressure to go in any predetermined direction. They DON'T need to wonder about preserving their fertility.
Although the Stages are numbered 1 through 6, every individual is unique. One person might linger for years in one stage, while others might breeze through that stage in days or weeks. Some people live out their lives in Stage 4, while others go to Stage 6. ...And circumstances may draw a Stage 6 person back to Stage 4. Stages are descriptive, not compulsive. They're not hurdles in a race, they're not mileage markers in a great Quest for Truth, and they aren't part of a race to the top.
NOTE: This information is far too complex to fully describe here. What follows is merely an outline and a quick overview. More detailed explanations can be found in Volume 2 of the New Gender Paradigm.
Note that the process described above has emerged as a response to the WPATH mythology:
-- The false belief that genitals are destiny
-- Promotion of values that condemn transsexuality & transitioning; something to be avoided at all possible cost
-- A social system based on coercion toward conformity
-- Medical professionals that are supposed to be gender enforcers
A different social climate would lead to a different transitioning process. ...As can be seen in the case of transitioning transmen.
Stage 6 is living a fulfilling life as a woman in mainstream society. Wrong-gender distress is a dim memory. Coercion distress (Type 2) has been eliminated through secrecy. Employment as a woman is attainable -- albeit with its inherent limitations. Health & violence risks are similar to other women. Close relationships can form -- as long as the best friend never hears the trans word.
REGRESSION: Outing can destroy it all. It's a one-way ticket to Stage 4.