The first time I ever used the womens' room was after my therapist gave me my letter... she had to go really bad and so did I so we both ran to the ladies' room while talking. Chatted briefly in the stalls, and she was off to the next client.
There I was, sitting in the womens' room for the first time, going... well... huh. She told me "For god's sake, don't use the mens' room anymore. It isn't safe." And that was even back before estrogen. She was right though, ever since I shaved my beard, years prior, I got a lot of bad stares in the mens' room. It still took me several months to feel comfortable doing it.
For a good 5 or so months I couldn't use the restroom at work without a LOT of grief from customers and comments of mistaken identity from coworkers, so I just didn't use it until I FINALLY got to transition, then womens' all the way.
It was awkward, back before I was out at work, when female customers would come to me and ask me to help with problems in the womens' room.