Changing the appearance of your body to that of the opposite sex is a long process. This is because being viewed as female, or male, has a lot more to do with performance and role, than it has to do with what is between your legs.
Gender reassignment as a process, follows the same path for FTMs (female to males) as well as MTFs (male to females) at the beginning.
Beyond surgery there are formal changes that need to be made to personal documentation such as passports, identity documents and the like. When you undergo gender reassignment, your whole world has to shift at every level.
This is the first step for transsexuals. You usuall feel very uncomfortable with your body and role, but unsure what this all means. There are so many ways to express gender, and surgery and hormones are not for everyone.
It is helpful to locate a therapist, Trans group or find some information in books or on the internet, in order to realise how your experience fits into the context of gender reassignment, what your options are, and how to begin the journey. It is important to find some sort of support that will give you strength and love when you are coming out to those closest to you, like your parents, friends, or other family. It is important that you have a soft place to land, as the coming out process is often the hardest step in claiming and realising your identity.
There are two different approaches to transsexuality. The first school of thought deals with transsexuality as a mental disorder, and labels the patient as being gender dysphoric. The medical practitioners who adhere to this thinking require that the person wishing to obtain hormonal treatment and surgery, live as the preferred gender role, for a minimum period of two years. This is known as the “real life test”, and is in accordance to the Harry Benjamin standards of care.
It is thought by these practitioners that this test will ensure the validity of the patients' claims of feeling like a transsexual. The person is labelled as having Gender Dysphoria. The treatment is said to align the body with the mind, as the mind cannot be surgically treated.
There are practitioners, usually operating in the private sphere, who perform surgeries on receipt of a therapist's letter that the person wishing to undergo treatment is of sound mind, and will live more comfortably if surgery and hormonal treatment is received.
No real life test is necessary, as it is seen to do more harm than good to the patient's identity and emotional stability. Not all FTMs will want the same treatments, and it is up to each person to decide the order and necessity of each treatment. - (Health24)