WARNING: The following does contain graphic descriptions.
NOTE: When quotes are cited with a single name, it is because they were taken from interviews I conducted in real life. I will post these interviews after the final blog, which will be the next one. These people are referred to by the name they said they wished to go by, for privacy.
Transsexualism was originally labeled as Gender Identity Disorder, a pathological condition (Moelker). However, transsexuals are present in many cultures. Some Native American groups recognize a separate gender for men living as women. Likewise, the amazon tribe of Brazil recognize a separate gender for women living as men. In Thai culture, the term kathoey is similar to trans gender but broader, including effeminate gay males (Moelker).
Looking back, many people realize they expressed their gender identity when very young. “I noticed the way I used to act when I was little, all the toys I used to play with,” says Dulcinea, who started to identify as transgendered at twelve. Regina, who realized it at eight, said she first realized her gender identity when “I asked my mom for a doll house for Christmas, and I realized all my friends were girls, and I was really close to them.” Xander also realized it when it came to playing, “ I've always acted more masculine, and when I turned 8 or so, my mom told me I can't walk around the block without a shirt on anymore. I always took the fatherly role when playing house. If I didn't get the father role, I'd complain till I was able to get some other male role.” Eleanor realized it in middle school because “ things change in middle, school, with how boys are supposed to act... like, puberty hits, and you're like oh my god, my body is so weird.” Most realized their gender identity sometime between 8 and 16, during puberty. 
Coming to terms with gender identity can be difficult. “ I knew as soon as I turned 12. I believe I was trying to fight it for some reason...because I didn't really understand all of the different views.. because I was so new to it all” (Dulcinea). This lack of information is a common problem. Julia said “always thought I was gay, because I didn't know what transgendered was. Then, when I turned 16, I was in a placement, and I found out that transgendered is a real thing, and I was like 'Oh, that's what I am.'”As well as a lack of information, societal pressures can also keep people from
expressing their gender identity. Across the board, transgendered people interviewed stated that they had been harassed by strangers at some point due to the way they dressed. Eleanor says she “dropped out of high school, and a huge reason for that was harassment and fear of violence. I've never been really physically assaulted in a serious way, but it's always a fear that exists, that's very real.” Family also presented as issue, mostly in that many parents have trouble believing their child did not identify with their physical sex. Xander's mother “still doesn't respect it”, Julia's said “I hope it's a phase, but if it's not, we'll see what happens after...”, and Waffle's mother “doesn't want to accept it”, However many of them also continued to present as the gender they identify as.
Transitioning
Despite prevalence, the causes behind transsexuality remain unclear. Despite this, many transsexuals are already transitioning to sex they feel they should have been born as. The processes differ drastically for both sexes, and some surgeries are more effective then others. Commonly referred to by the blanket term “Sexual reassignment surgery,” the change involves a variety of steps, such as counseling, hormones, and operations.
Male to Female
Male to female surgery starts with a year of therapy with a psychiatrist, to ensure surgery is the best option. It can cost between $7,000 and $24,000, depending on how many procedures are undergone (Reed). Then, the patient starts taking doses of estrogen, and lives as a women, to make sure they can adapt. This redistributes body fat to the chest and hips, and reduces body hair. Then, breast augmentation is performed, a similar process to breast implants in females. Some opt to have their vocal cords surgically tightened, in order to the raise the voice, and for a tracheal shave, to get rid of the cartridge that causes the Adam's apple (Reed). The final step is a vaginoplasty, in which the testicles are removed, and the penis is essentially turns inside out to create a functional, sensitive vagina, capable of achieving orgasm. Many of the procedures are dangerous and irreversible, and can result in infections, loss of the voice, or even death.
Female to Male
Once again, the process stars with therapy, hormones, and immersion. Female to Male surgery is more expensive, and can cost over $50,000. Chest reconstruction, similar to a breast reduction, removes breasts completely, tightens the skin, and reduces the nipple size. Next, most choose to undergo a hysterectomy, in which the uterus and ovaries are entirely removed. A Metoidioplasty involves cutting the ligaments that hold the clitoris in place, making it longer. Then, in the final step, a phalloplasty, skin from the forearm or side is used to enclose the extended clitoris, forming a penis, and the vagina is sewed closed. Implants can be put in the new penis to achieve an erection, and implanted in the labia to create a non-functioning scrotum. In most cases, the patient is still capable or achieving orgasm (Reed).
Reed, Dr. Harold. "Gender Reassignment Surgury." The Reed Center. 2009. The Reed Centre for Genital Surgery / Sex Change, Web. 17 Feb 2010.
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