Transgender people experience their transitions in a variety of ways, with many opting to transition only socially, only hormonally, or opting for a combination of hormonal transition and surgery. In this week's "Sex Talk Realness," Cosmopolitan.com spoke with three women about their experiences with having surgery and taking hormones in an effort to become the person they always were.

First, a brief glossary of terms you'll need to know.

Hormonal transition: When someone changes the balance of sex hormones in their body via some form of supplement. For trans women, this means taking extra estrogen.

Surgery: References gender reassignment surgery, which involves altering the physical aspects of a person to match their gender identity. "Top surgery" involves breast implants, and "bottom surgery" is when the genitals are surgically altered to match the person's gender identity. An orchiectomy involves the surgical removal of one or both testicles, and vaginoplasty is a reconstructive plastic surgery and cosmetic procedure for the vaginal canal and its mucous membranes. Facial feminization surgery is a set of reconstructive surgical procedures that transform typically male facial features and make them closer to typical female facial features — sometimes including cheek implants, jawline slimming, a brow lift, and/or a nose job.

How old are you now?

Woman A: Almost 30.

Woman B: Fifty-two.

Woman C: Thirty-two.

How old were you when you came out as transgender to your friends and family?

Woman A: Mid-20s.

Woman B: Forty-five.

Woman C: About 18 to 20. That time in my life feels like a blur and it didn't all happen at once.

How old were you when you began to transition and when you completed your transition?

Woman A: I started in my mid-20s and completed it when I was 27.

Woman B: I started at 45. I was living full-time as myself before my next birthday, but I think of transition as an ongoing thing. Like any other woman, I'll be discovering what it means for me to be the woman I am for the rest of my life. I just started the process later than most.

Woman C: That's such a complicated question because what it means "to transition" is so subjective. I started transitioning when I came out to my friends. Then I started taking hormones when I was 22 and had an orchiectomy when I was 28 or 29. As far as "completing" transition, I can't say for sure if that's something I'm ever going to do. To me, seeing transitioning as something that "starts" or "ends" is really oversimplifying it. Some trans people do think of it in terms of "start here, do this, then do this, fill out this, get this procedure, etc., etc." That's OK too. For me, it's an endless process. It's not the same process today that it was 13 years ago, but it's not over.

How did you decide to transition, and whether you wanted to pursue hormones or surgery or both?

Woman A: I knew I had to transition. Deciding to transition isn't something you can look at on a spreadsheet and weigh out intellectually, it's something you just have to do. Like many, I tried to ignore that feeling for a long time but eventually, I had the right combination of financial independence and support to act on it. When I first started transitioning, I had no idea whether or not I wanted to have surgery. I definitely didn't like what I currently had between my legs, but "surgery" is such a scary word. The further I got in my hormonal transition though, the more I felt a painful disconnect between the way I wanted my body to work and feel sexually, and its then-current state. Entering a relationship with my partner only heightened that feeling. She could tell how dissatisfied I was with my body and felt firsthand how it affected our sex life. I wanted to have surgery for me, and for us.

Woman B: Once I realized what my issue with gender was, I had to transition. I was at a place where I knew that if I didn't transition, I wouldn't live to see my kids graduate from high school. Facial Feminization Surgery (FFS) was the top surgical priority for me. To function as the woman I am, I needed to have what I saw as a woman's face to present to the world. It cost me $33,000 I didn't have and my formerly good credit rating, but it was worth every penny. Breast implants allowed me to walk around in a woman's body without falsies in my bra. I also discovered that with a typical woman's secondary sex characteristics, I could also experience sexuality as a woman. I had FFS and implants within a year of coming out to myself. It took me six years to get bottom surgery. My credit was awful, and I had to wait until the state of California mandated that insurance carriers had to provide all medically necessary treatment for transgender people. Then, I had to wait two years before my insurance actually started providing the surgeries. To be clear, surgeries don't define trans people. They aren't a finish that makes us our true gender. Surgeries and hormones and all the other steps are just tools to help us live our true gender with as little pain and dysphoria as possible. Not everyone has access to or can afford the treatments they need.

Woman C: I didn't know if transition was really what I wanted because I had no idea what to expect. All I really knew was that I didn't want to live the way I was living any longer. Every step of my transition was more about being fed up with how things were than having a set goal for how I wanted them to be.

What were your biggest fears about transitioning?

Woman A: Before transitioning, I was worried that if I didn't know exactly what I wanted and when, then I should never start. But if you allow the complexity of transition-related decisions to overwhelm you at the beginning, you'll never get anything done. I remember my amazing therapist once calming me down by saying, "If you want hormones, take hormones. If you don't like what they do, stop taking them." To have it broken down that simply took so much of the pressure away. For most people, transitioning is a matter of years — in my case, three. It's not a single process, it's 1,095 days of little decisions that you have to take on individually until you're happy.

Woman B: I didn't have to deal with a lot of the more practical fears many trans folks have to deal with. My job was secure. My ex-wife couldn't take my children away from me even if she wanted to, and she didn't. I suppose my main fear was that I might be transitioning for the wrong reasons, like maybe I was actually a gay man or had issues with my masculinity. I just wanted to be very sure of why I was doing it.

Woman C: Really, everything about it was scary. I was afraid of the possible medical complications, like blood clots and breast cancer. I was afraid of being disowned by my friends and family, I was afraid of living my life as a pariah. I was afraid I wouldn't be able to find work and that I would face discrimination in public. I was afraid that people were going to laugh at me or try to hurt me. Overall, I was most afraid that it wouldn't work, and I'd go through all that and still have to live as a man. I don't know if I could have done that.

How long after you began your hormonal transition did you start noticing a change?

Woman A: There's this period after you first start taking estrogen when you convince yourself that every little thing is a sign that the hormones are working. The first thing I felt, about a month in, was peace. It was like someone had put out a forest fire in my head. Then you start to notice emotional and physical changes. Everyone's personality is different, and everyone's experience is different, but, for me, I started to feel things more deeply. Physical changes are slower but start to be noticeable within a few months: breast development, changes in face shape, thinner body hair, etc.

Woman B: In some sense, I noticed a change the night I got my first prescription, even before I filled it. It represented a gateway to changing my body and addressing my gender dysphoria. Emotionally, that was huge. Physically, the effects of estrogen treatments are fairly subtle. I started to notice a tiny bit of breast tissue growth after about nine months. About that time, the connection between sensation in my breasts and my genitals seemed to appear. In many ways, it was like a typical adolescent girl's experience with her hormones kicking in. Over the years, my skin has gotten softer, my body hair is more fine, and when I gain weight, it congregates on my butt and breasts rather than my belly. I'm not sure that other people really noticed the changes from the hormones.

Woman C: I remember that the first changes I noticed were that my emotions and thought processes changed, but it was very subtle. I started noticing some physical changes within the first few weeks. Again, it was all little by little. I couldn't even begin to guess when other people started noticing changes. I remember that it was a few years before I was consistently being read as female by strangers.

Were there any aspects of the hormonal transition that surprised you?

Woman A: I wasn't expecting how completely it would change my life. I try to think back to a time before hormones, and it's so blurry, it's like I was barely alive. I felt more like myself (which is an uncanny sort of feeling that not everyone can understand), I was happier, friendlier, and more confident. So much of the discourse around hormones is about how it changes you physically, and that was great, but hormones are so much more than just a means to an end of bodily transformation. They also alter how you feel and think, and for me, that was more important than the physical stuff.

Woman B: The ability to feel nipple sensation that connected with my vagina really caught me off guard. One night I was walking through the hallway in my house wearing a silk nightie and the sensation was overwhelming. I literally had to sit down because my legs wouldn't support me.

Woman C: In a way, it was all unexpected. I was still pretty young when I started and most of the stuff I was able to find about transition seemed to focus on the experiences of older folks. Smelling differently was a surprise though.

Was there a gap between starting your hormonal transition and having surgery?

Woman C: There was a gap and it had everything to do with money. I didn't have insurance and finding a doctor was a big issue. When I first started taking hormones, I ordered them online and self-dosed. It was very expensive. Over the years, I've gone on and off hormones a lot because they're not cheap, especially if you're not getting them through a clinic.

Since some transgender people don't feel it necessary to get any surgery, why did you feel it was necessary for you?

Woman A: It was a gut feeling that eventually became a conviction.

Woman B: It was a means to the end of more ease in my body and more importantly, a means to be able to transition socially. Everyone sees my face and to function, I wanted a face they could look at and recognize as female.

Woman C: I wanted to get an orchiectomy because it was a cheap alternative to vaginoplasty that would nearly eliminate my body's production of testosterone, allowing me to stop taking spironolactone. I'm not sure if I'll ever have vaginoplasty, or if that's something I want enough to deal with the risk and the expense, but orchiectomy was a pretty straightforward decision for me.

How did you pay for the surgery? Did you have insurance when you began transitioning?

Woman A: Yes. My insurance covered mental health counseling, hormone replacement therapy, and a portion of the surgery. Friends and family members helped me pay for the rest.

Woman B: I had insurance, but it didn't cover much of anything until I had my bottom surgery. My school district's plan had an explicit exemption saying that they didn't have to fund anything having to do with a "sexual transformation." Those exclusions were legal in California until 2013, and insurance companies stalled for another year or two after that before it was changed. I paid for hormones (between $6,000 and $9,000 over six years), facial feminization surgery ($33,000), and implants ($7,000). Insurance covered my vaginoplasty, which cost them about $25,000. I paid for FFS and implants on my formerly good credit and out of my salary as a community college professor.

Woman C: I didn't have insurance. I've always paid out of pocket for hormones and I crowdfunded the money for my orchiectomy. The cost of surgery was fully funded, though other expenses wound up being higher than expected. Overall, the crowdfunding almost completely absorbed the impact, but left me with very little in the bank anyway.

Describe the day of your surgery.

Woman A: I really should start this story the day before my surgery because the worst part of the experience isn't the surgery itself, it's the dreaded bowel prep. They want you to be completely empty before they operate on your pelvic region, so the day before I went in, I had to gulp down sips of this awful, noxious milk jug full of medicine, which basically makes you shit every five seconds until you're, um, running clear. The only relief is that you're allowed to drink Gatorade and, if I remember correctly, eat Jell-O, but only certain colors. Because I had an empty stomach and was unable to sleep much the night before due to a mixture of anxiety and excitement, I was exhausted when my friend drove my partner and me to the hospital the next morning. Once there, I got all gowned up, spoke with a few nurses and my anesthesiologists, and then I held hands with my partner and we cried a lot. I got wheeled into the OR, some happy juice got pumped through my IV, and poof. Next thing I knew, I had a vagina — or, at least, next thing I knew, I was half-conscious and could feel a lot of bandages between my legs.

Woman B: I've had three gender-confirming surgeries and every time, on the morning before the surgery, I felt excited, anxious, but also resigned because I'd done all I'd needed to do and it was up to them to the rest. I think I felt the most fear before my FFS. In part, because it was my first gender surgery, but also because my face is such a huge part of how I see myself and I didn't know what I would look like when it was all over. After I woke up from my bottom surgery, I was in intense pain and the pain medication was not enough. An ex-girlfriend was with me the whole time and she made them call the surgeon at home so she could authorize more pain meds, but I was so out of it I don't remember any of that. I woke up the next day happy as a clam and relatively pain free.

Woman C: I'd found a surgeon online and he was a weird guy. When he visited with me beforehand to explain the process, he played with my feet in a way I think he thought was paternal, but I just found it creepy. The nurses also made me kind of uncomfortable. It was like they were making too much of an effort to affirm my gender. One of them told my cis female friend that she'd need to take me shoe shopping once I'd healed to replace the "dude shoes" I was wearing. As far as the procedure itself, everything went fine. I was nervous going into it, but they put me under and I woke up later in the recovery room. I didn't have any problem with disorientation or grogginess. I was very, very sore after, but otherwise I was fine.

Did you have any complications post-surgery?

Woman A: Nothing serious. I had some very slight tearing of the skin below my vagina (one of the more common, minor complications) but it healed on its own with some Neosporin.

Woman B: I had some tearing around my perineum after my bottom surgery. I was devastated that my shiny new vagina was tarnished. The doc stitched me up again, but that tore too. After a couple of months, it healed closed on its own.

Woman C: I was told that my recovery would take about four weeks. However, I was still experiencing a considerable amount of discomfort for over a year after surgery. My crotch was constantly sore and was especially tender when touched. There are still some days where it's uncomfortable, although they are much fewer and farther between than they were previously.

What surprised you most about the changes in your body post-surgery?

Woman A: The anus is pretty close to the vagina and I knew that before surgery, but now I really know it. Other than that, I think I knew everything I was getting in for. More seriously, the way I had orgasms was already different after years of hormones, but it changed even more after surgery. Sexual pleasure feels so much more like floating on your back and letting waves slowly wash you to shore, as opposed to, say, getting shot out of the end of a water slide.

Woman B: It's hard for me to explain the feeling I had when I looked down at my crotch and saw what has always belonged there. There is a line in The Vagina Monologues where a trans woman uses the phrase, "A wrong had been righted." I did three productions of the monologues, but I didn't fully understand that line until that morning when I looked down and saw the right anatomy. Even swollen and bruised, the line kept running through my mind.

Woman C: I was surprised by how much of a shock to the system it was. My hormone levels went all over the place. Honestly, the most outwardly noticeable thing was that I started sweating profusely from my armpits. I was also very surprised by my feelings of regret. I hadn't expected to regret the surgery at all, but there was about a week or so where I felt like I'd made a terrible mistake. It was powerful and it really threw me for a loop. I kept thinking, You're in a cult. Being trans is a cult and you're in it and you just committed to it forever. I don't feel that way now and don't know if that's something other people experience. I hesitate to share this, because I can imagine how some people will latch onto as "proof" that trans people are frauds or something, but I don't read that much into it. I also regretted destroying my ability to have kids. Being a parent isn't something I'd ever, ever wanted before, but I thought about that afterward.

How did you learn how to use your new body?

Woman A: A little-known fact outside the trans community is that, after surgery, you have to dilate your new vagina. So there's no way not to learn about how it works because at first, three times a day, you're down there with a giant plastic dildo seeing how deep you can go (the frequency lowers the further away from surgery you get). In terms of clitoral stimulation, well, I washed my hands, got in bed, started reading some erotica, and awkwardly began to figure some things out. An unexpected challenge is that you have to set aside a lot of time for yourself. I'm a busy lady and an hour for candle-lit, self-exploration in the bathtub is a big ask.

Woman B: With my first lover after beginning the transition, I discovered what it meant to be a lesbian with a penis. Now, I am discovering what it means to be a lesbian with a vagina. I didn't foresee the learning curve, but it's definitely there.

Woman C: My body feels like the same body in pretty much every way.

How has your sex life changed, if at all?

Woman A: The funny answer is that it doesn't suck anymore. The honest answer is that it's incredible to be able to have sex with my partner in a body that finally feels like my own. It's amazing. Before my surgery, I dreaded having sex because my desire felt like it was at odds with my anatomy. Now, everything is aligned. Having sex feels great, which isn't something I could say until I was 27.

Woman B: My surgeon told me that I had to wait three months after surgery to have sex and, um, we'll pretend that I waited three months! I also discovered tantra and polyamory. I discovered kinks I'd never even heard of before. When I began my transition, I assumed my sex life was over because when I came out to my father, he told me, "What lesbian is going to want you when she can have a real woman?" and that really stung. But now, each new notch in my lipstick case is a bit of validation, like, "Look at me now, Dad. They do want me. Lesbian and bi, they do want me."

Woman C: It hasn't really changed. I wasn't a particularly sexual person before surgery and I'm still not.

Can you describe the way your transition helped you feel closer to your gender identity?

Woman A: This is a bit like asking a fish what it would feel like to start breathing water, but I don't blame you for asking. There's something untranslatable about the experience and no metaphor will ever be able to account for it, but the one I've always used is that it feels like a storm cloud clearing away. Except you grew up under the storm cloud, you know nothing but the storm cloud, and you've only ever heard rumors that the sun exists. So, I guess it would be like being born in Seattle, never leaving town for two decades, and then moving to the Bahamas.

Any individual thing I mention may seem small but when you add them together, they mean everything. After surgery, I could have terrific sex, wear a swimsuit and go in the ocean for the first time in four years, put on a pair skinny jeans without feeling uncomfortable, fit into my own underwear, and go shopping for vibrators and dildos with my partner. For cisgender women to understand what it's like to have surgery after a long waiting period, the only way to explain would be to imagine how you'd react if you suddenly woke up with a penis and had to live with it for years before having it removed. Imagine the relief and the happiness you'd feel. I didn't like having a penis any more than a cisgender woman would, so that's exactly what I felt. It was like coming home.

Woman B: There is a softness that estrogen brings. My skin is smoother and my body hair is finer. Women have a thicker subcutaneous layer of fat underneath our skin and that also subtly softens my features.

My FFS was essential to me feeling my gender identity. Before, I would look in the mirror and see an echo of my father's face. Now, I see my mom's face and it feels so much better. I may not be a beauty, but people almost never read me as trans, and they never read me as a man.

Woman C: I feel more at home in my skin and people treat me in a way I'm more comfortable with. I've changed and developed in ways that I can't explain.

I experienced a lot of dysphoria around my genitals and found them embarrassing and uncomfortable. It was like having a piece of gum stuck to your shoe, except it's your crotch instead of your shoe and it lasts forever. Having an orchiectomy hasn't completely resolved my dysphoria, but it's helped a lot.

If you could do change anything about your transitioning experience, what would it be?

Woman A: Doing it sooner.

Woman B: It would've been great to have insurance start covering my transition before I spent money I didn't have.

Woman C: I would have started sooner. I would have come out younger and tried to transition before I went through puberty.

What advice would you give other people considering a hormonal or surgical transition?

Woman A: The same advice my therapist gave me: Don't be afraid, take it one step at a time, and see what happens.

Woman B: Do as much as you can as soon as you can. Dysphoria doesn't get better with age.

Woman C: Don't let anyone else make this decision for you. It's not that big a deal, but you're the only one who should decide if it's something you want to do.

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Lane Moore Sex & Relationships Editor I'm Lane Moore, sex & relationships editor at Cosmopolitan.com.

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