I can not speak from personal expierence as I am not transgender, but I do have friends who are. I knew them all before and after the change. The thing they all have in common is that they were very clearly one gender (not an effeminate man or a masculine woman) and they sought out to make themselves more like the other sex. The order they did this in was the same. 1. The way they act changes. They suddenly become more confident and have a sense of purpose 2. New identity. They start dressing differently, change their name, etc. 3. Hormone therapy. 4. Surgery. 5. Deny "old" person ever existed. Every single one of my friends struggled with depression before the change. I think for many of them, it was more of a rebirth, and a new lease on life. I have no idea of their motives or their inner thoughts obviously, i just know what I have observed and I think it is interesting.