Made it 50 yrs without, but hit a wall that basically said, "you're done." The options then became very limited, basically, die, commit yourself to a psych hospital, or transition. I chose the path of least harm. At least this way, even if everyone eventually can't tolerate me; I'll still be able to support the woman I married and promised to support. The other two possibilities drag everyone down with me into a financial and emotional disaster.
That said, I am pursuing a "least disruption" path on transition. HRT, but no social requirements; dressing is minimal, but none of the other females in my family dress femme either, so whatever. Women's jeans fit me best, and loose tshirts seems to be the perpetual uniform, bra optional. I'll have to pass on name and pronoun stuff for quite a while as well. But I won't be dead. And that's a pretty spiffy thing.