We live in a culture where we can get frozen meals we can stick in the microwave and be ready to eat in less than 3 minutes, we can get the answers to almost any question via the internet in a few seconds, and even if you can't get it in the store, you can buy it online and have it the next day.
If you want a pair of 'instant breasts" buy some really good breast forms and wear them at night for at least 3 hours a day, with a bra that's about 2 inches too tight around your chest. While your at it, wear some 4 inch heels with pants and a sweater for the same period. HRT is not access to "Instant Boobs".
When your therapist starts talking to you about HRT, he or she wants to know that you are a good candidate. Have you told family and friends? Or will you end up losing wife, kids, job, friends, and home because you haven't told anybody at all? Part of RLE is designed so that little things like the pierced ears, the clear nail polish, the bit of make-up left over from last night, and the feminine mannerisms that come from spending hours as a girl WILL spill over into your "regular life". It's a necessary part of the process. It takes a lot of courage to face people you really care about and tell them about your most treasured secret, and having to face the possibility that they may not be able to accept the REAL YOU! Do you think it's going to be any easier if you show up at your next family reunion with C-Cups and no other warning or indicator?
How much RLE do you actually need? That has changed over the last 40 years. At one time, most programs were absolutely strict that you had to live 24/7 as a female with no reversions to male ever before you could even START on hormones. Unfortunately, because it was easy to revert to male, many patients did under social or marital pressure and the results were catastrophic, including suicides or self destructive behavior.
More of the modern programs want to see evidence that you have been living evenings and week-ends as female and that you've had discussions with family, friends, and employer prior to starting hormones. This is often called "120" mode. There are 168 hours in a week, if you spend 40 at work, and 8 hours in commutes, that leaves about 120 hours/week including sleeping for you to dress and act like a girl.
Normally, the therapist will ease you into it, giving you assignments that may start with something like going for a drive at night for less than an hour and coming right back home, maybe even only 2 or 3 nights. Then longer drives, a trip to a store to buy a soda, a trip to a dark nightclub that's friendly to LGBT, and attending support groups that may include transgender support groups, or groups like AA, NA, or Weight Watchers - as a girl.
How quickly you get up to 120 hours/week depends on you. When I started, it took several weeks to be comfortable with going to a candlelight AA meeting. About 3 months before I was comfortable in a restaurant that had drag queens as patrons. it took about a year to reach the point where I was able to do 120 hours a week. There were many changes along the way, I DID have to give up my wife and let her and her new husband have primary physical custody of my kids, I DID have to leave my job. I DID have to move to a city that was more LGBT friendly. I DID have to get a new job with an employer who not only knew I was transgendered, but would support my transition. I DID fall in love with a girl who loved Debbie and supported my transition.
Your therapist also needs to know that you will be able to handle the biological changes. Will you start freaking out because you can't lift a suitcase anymore, or you don't have upper body strength? Will you freak out when you have erectile dysfunction? Will you start freaking out when you cry at a movie, or for no reason at all? She may want to discuss your sex life, does your sexual satisfaction depend on intercourse? At one time in my life, I was told I wouldn't get hormones because I wasn't gay. I had to explain in detail exactly what I did with my girlfriend before she realized that I really WAS a lesbian and almost NEVER relied on intercourse.
Often, the doctor will start with the testosterone blocker first. The effects of no testosterone can be easily reversed by eliminating the blocker. The OTHER reason is that some men who are inter-sexed will actually begin producing higher estrogen levels on their own once the T levels are blocked. Important to know so you don't overdose the patient, and may indicate acceleration of the transition process. About 1 in 300 male babies are born "gender ambiguity" which could range from a very small penis to a uterus and vagina as well as the penis. Often these facts are discretely NOT noted in the record because cisgender male patients can get really upset about it when their chart suddenly says they have "girl parts". Granted, the number of adult men with a functioning uterus is more like 1 in 5,000, but even this is uncertain because the records are not kept publicly.
Often, the doctor will provide the T-blocker with a placebo instead of estrogen. This helps the doctor and therapist determine whether the patient will respond well to the feminization. Most transsexuals will be more calm, relaxed, Their partners (who the therapist usually wants to be seeing regularly by then) will notice they are more affectionate and "cuddly". They also want to see how the patient responds to male impotence. if the transgender isn't a good candidate (at this time), they are likely to slip into depression, isolate, and even avoid sex, romance, and intimacy entirely. They may become more irritable at work, they may even change their mind. They may be transsexual, but they aren't emotionally ready to transition - yet.. Others are cross-dressers and will decide that the RLE is fun, but the side effects of the hormones (actually the feminizing effects) are to unpleasant to deal with.
Once the estrogen is started, the doctor will start with a low dose for a few months to see how the patient handles it. There will be emotional swings, jags, and even physical symptoms, but there will also be more calmness and lightness. The doctor will also be alert for any indications of clotting, pain or swelling in legs or veins. One of the great dangers of self-medicated estrogen is some nasty side effects like blood clots, heart attacks, stroke, even kidney or liver failure. For patients like this, an alternate form of delivery may be needed, and lower doses. Slow growth is good growth, but it can be very frustrating.
By this time, the breasts will begin growing. They will be small and lumpy at first, and very sensitive. If there are situations where male presentation is required, a sports bra is needed because it's too uncomfortable to wear a shirt directly over the sensitive breasts. The therapist will want to see how the patient is responding to the new sensations. If breast play is becoming part of arousal, this is usually a good sign.the neurology is changing and the client is responding positively to the changes. If on the other hand, stimulation is avoided, resisted, and rejected, this could be a sign that the client is not handling the neurological changes well. Wearing a bra for a few hours might be exciting to a cross-dresser, but wearing one for 8-10 hours a day, 7 days a week will either become just "Normal", or a bit irritating. if the client is upset that it's no longer exciting, this could be an indicator to stop.
By this time, with breasts beginning to form, 24/7 is almost unavoidable. Working and living 24/7 is no longer an option, it's necessary. It's not practical to try and hide anything, and usually by then, so much of the feminine has bled over to every area that "coming out" doesn't even surprise anybody. By this point, the ground work has been done, the foundation is solid, and it's just normal to be living 24/7 as female. Passing is not an issue, because the client has learned to blend so effectively that someone will look at her for 5-10 seconds, then move on to the next person. People with whom she has long and regular interactions may even have a hard time believing they were once men even though they may know it. The bathroom isn't an issue anymore because no one sees "a guy in a dress", they see another woman, doing her business and leaving. Nothing is unusual.
At his point, the main question is whether to finish "the bottom work". More often than not, the main barrier is financial. if there isn't a romantic need or a partner who is pushing for the final touches, some girls will continue for months or even years without the "bottom work". One of the big issues was that most insurance companies didn't cover vaginoplasty. Many barely cover HRT, even though the AMA and APA have now declared that for transsexuals, treatment is necessary and refusing treatment is unethical. In some countries, national health plans have realized that HRT and SRS are as essential to a transsexual as insulin is to a diabetic. Recent studies of transsexual mortality and morbidity of both non-transitioned and transitioned transsexuals has made the need even more apparently acute. If you had a disease with a 30% mortality rate and 85% morbidity rate with a 95% recovery rate when relatively inexpensive treatment is given, no insurance company would be ALLOWED to prevent such treatments. But because the treatment involves removing male anatomy, the insurance companies seem to thing this is "elective surgery" rather than necessary treatment for a deadly disease. (Off the soapbox now)
Most transsexuals, including myself, by the time they have completed a year or two on hormones, will want SRS, and will want to find the means to make that possible. Some have even turned to prostitution, many older men have used part of their 401K funds, others have taken out home equity loans to pay for the procedures. Some people with highly prized technical or professional skills will only consider companies who provide SRS coverage.
Hard to imagine at this moment, just struggling with the prospect of having to get even 40 hours a week of Real Life Experience, that you will reach a point where you are completely happy living as a woman inside and out, on a 24/7 basis without even the possibility of presenting as a man. If that prospect excites you and makes you feel like life is worth living but only on those terms, then you will breeze through RLE and the time spent between the start of RLE and HRT will just seem like time well spent.
There are hundreds of other reasons why you want to do RLE, many too subtle to describe here, but even this posting only touches the surface - even as long as it is.
Sorry about the length.
