I am in Pennsylvania here. I had alot of issues with expressing my feelings of discomfort within the gender role of male, and then having the physical anatomy of a male.
Getting my family to understand my need to do the transition, and that it's not some aesthetic choice.
Finding a reliable Healthcare facility was a big one. Though I found Papillon, so that was very convenient :-)
Most of my problems stemmed from communication issues with my family, and then just the general lack of understanding on their part.
I had to break away from them and start building a community that is more understanding and open to what I feel.
The school system was also like a prison sentence for someone like me.