>What are the perceived benefits?

If you’re a man, how do you know you’re a man? Is it because of your genitals? If you looked down at your groin tomorrow morning and saw something different, would you still think of yourself as a man? Or would you suddenly believe otherwise?

>In what way is it that different from using different clothes without the (not sure if small or big) risk of health?

My body is physically uncomfortable for me to exist in for significant periods of time, because it feels wrong. Health risks from just estrogen are increased risk of clotting and breast cancer, but in line with what cis women experience, from what current evidence suggests. Anti-androgens change this a lot, and I don’t really want to get into it because of how varied it is.

>Is it not enough to know oneself is X or Y or Z identity-wise? Why is there a need to externalize it and externalize it in this particular way?

You say later that it’s an insult to be called a girl or woman where you grew up. Imagine if it felt the same way to be called a boy or a man.

>At risk of sounding condescending, one particularly hard thing for me to understand is the need for the rest of her friends to call her appropriately especially since she is just beginning. If someone called me a girl or a woman (common childhood insult where I grew up, and very bad in its own way) I simply could not care less.

To put it simply: you’re not trans. And to ask another question, wouldn’t it bother you if people called you a woman and furthermore treated you like one all the time? (it’s ok if not, but there are some cis people for whom it would. trans people are more like those cis people in those ways.)

>What are the benefits of putting oneself over such a hard (at least it seems socially and medically) ordeal to change how others perceive one?

Because it hurts that much. It just feels that wrong.

>One thing I know is that expecting others to perceive us in a certain way is a losing proposition. We can only change ourselves and it is unreasonable to expect it from everyone else I think.

Sadly, most trans people are well acquainted with this fact. And that is why we end up going through this ordeal. Unreasonable to expect it from other people? No, I wouldn’t say so. Unless you think it’s reasonable for people to expect you to shave your whole body and grow your hair long and start wearing blouses and dresses and skirts, which is the other side of this coin. Unrealistic? Perhaps, and that’s what being an activist in this area is about.

>Once again, sorry for being so extended, I just would like to understand better my friend. I have tried asking her and she seems to have a block around it, saying that I would not understand.

She probably does think you wouldn’t understand. This is something cis people do have a fairly difficult time understanding, and it’s not easy to explain. The best I can explain is if you woke up tomorrow and everyone around you started acting like you were a woman, but nothing had actually changed about you.

The interventions might seem superficial, but it’s not about what they physically do to our bodies. It’s about how those changes feel to us, and how they quiet the discomfort we often feel with our bodies. The identity is already with us, it’s our bodies that we feel the need to change.

Please don’t feel bad about the length. These are difficult things to discuss.