Most people follow the procedure recommended in the Standards of Care which comprises a series of steps. The length of time a person stays on any particular step depends on the individual. The first step is to test the appropriateness of transitioning. Typically an adult would undergo psychotherapy for a period of at least 3 months during which the gender dysphoria and the implications of transitioning are explored. Alternatively a person may choose to live full time in the new gender role for a period of at least 3 months. The person must show a realistic expectation and understanding of the transitioning process before proceeding. The second step is hormonal therapy which modifies secondary sex traits. For transwoman (i.e. people who transition to become women) estrogen induces the growth of breasts, a thicker layer subcutaneous fat, the softening of skin and the migration of fat to the hip area. An antiandrogen is also used to block the effects of testosterone and help thin body hair. For transmen (i.e. people who transition to become men) testosterone induces the growth of facial hair and a deepening voice. The third step is called the real life experience where the person lives full time in their chosen gender role. This is the ultimate test of transitioning. The person experiences what it is like to work and socialize in the new role. It also is a period of change for family, friends and work colleagues as they accommodate the new role and adapt to a new name, appearance and mannerisms of the transitioning person.

The final step is sex reassignment surgery which alters the person's body so that the primary sex characteristics are in accord, as far as possible, with the person's gender identity and life style. The person must have been living successfully in their chosen gender for a minimum of 1 year before the surgery can be undertaken. By this time the person is already integrated into society and the physical alterations of the surgery go largely unseen. This final step is therefore a personal and private matter. Some transsexuals may defer the procedure for a number of years or even indefinitely.