Updated: Aug 24th 2010, the post has not been edited. Just formatted a little to make it easier to read. Just answer any topic that interests you. I've received a lot of insights since I posted this, some questions like the labels section is no longer relevant 
I have done extensive research myself and now understand somewhat more clearly what exactly transgendered and transsexual means. The process of MtF, effects of HRT, and more. Unlike before I have decided to keep an open mind about the surgical possibilities. From my own personal evaluation, I'm pretty much confident that I'm a 21 year old transsexual girl - a female brain and a male body, much like a birth defect I think. I need a little more help understanding the steps to take and the surgical options available today.
I don't have any health care coverage or insurance. I always had to pay things myself, so I was not aware any other way. Unfortunately, I'm not very rich being just a freelancer online but have been saving some to buy a new house for my mother. I'm sure she will be happy to co-operate with me since this is more important and life changing path for everyone involved. So the budget is a little over 150,000 USD. Whatever that is left will be invested and put on bank for interest as the new life-style will indeed require some steady cash flow than what a casual freelancer can get.
[Update: Sep 3rd 2010, not important at all, but regarding the money... I just got pressured into putting all that into buying the house. There goes that... >.<]1. Gender therapy/evaluation: Psychological evaluation, and gender therapist sessions? I believe that is the first step to really identify me. In those evaluations should I use my natural voice, or the fake male voice (um maybe not quite male either but somewhat, it's different every time because I'm not good at voice acting) one that I developed to cover up my natural feminine one? Because I'm introverted and always very quiet I was never caught, except by my late grandmother who often swore that I sound like a girl despite my efforts.
[Notes: the purpose of the question was to know whether the therapist will be confused if I'm a MTF or a FTM on first meeting. By common suggestion just being myself with my natural feminine voice is the best option I guess]2. Hair Problems: The family has a genetic hair problem. Somewhat high body hair growth and young baldness. Luckily I don't have much body hair and what's here I can indeed remove through waxing and electrolysis. But I did not escape from the young baldness. I do somewhat still have a head full of hair, but my hair fall started the moment I hit 11 years old. Right now it doesn't have the depth I desire. I believe hair transplant is the solution? Should I get it done before or after HRT?
3. HRT usage/withdrawal: HRT changes the body from inside out, I really like that. I'm not sure how it can change my mind any further considering my mind completely lacks male thoughts, interests, or anything. Anyway, once you start HRT do you have to take it for life or for a long while for the body to get used to it? From what I know the ovaries in those that are luckily born female produce the estrogen and progesterone hormones, whereas in the case of a transgirl there are no ovaries present because of general transplant issues. So that does mean that one has to continue HRT long term to remain purely female, doesn't it? Does withdrawal cause any reversal? Another question that's been bugging me is that the HRT introduces the hormones that are normally produced by the ovaries which are homologous to the male testicles, is there any way to suppress testosterone production without removal (pre-SRS)? Would the suppression allow me to develop more defined feminine qualities as opposed to not suppressing it?
4. Chromosome role: Chromosomal makeup for a male is XY and for female it is XX. I am realistic enough to accept that there isn't anything that can be done to update millions of cells in the body. However, does something exist by any chance? Or do hormones eventually affect them? Alternatively I suspect I may have a XXY chromosomal makeup, although there are no specific abnormalities other then rounded shoulders, lack of height etc... I'll have to get it checked out I guess. I'm not quite sure if it's good or bad should this be the case.
[Notes: the reason for inwardly hoping for XXY condition was to build tangible source as a discussion material to help with coming out.]5. Medical comparison/analysis: Some say that female and transsexual girls have a smaller region in hypothalamus compared to males. Another factor relates to somatostatin neurons where men have a greater count (P < 0.006) compared to females and transsexual girls (P = 0.83). Is there any truth to these claims? Are there any more similar supporting factors?
[Notes: this similarly acts as a tangible source of discussion material to help with coming out.]6. Gauging FFS possibilities: Facial feminization surgery generally includes hairline correction, forehead contouring, brow lift, rhinoplasty, lip lift, jaw line contouring etc... However, rather than just feminizing the face, would a complete reconstruction possible? Completely different look, but realistically based on the face build so far? Do you have a say in how the end result should look like or is it random depending on the surgeon and procedures used? Will the same surgery fix any lack of symmetry between the two eyes as well? I noticed that my right eye opens slightly more.
7. Gauging body feminization possibilities: Thyroid cartilage reduction, it is good that there is such an option. Mine isn't particularly that defined but it's worth a try for sure. Would reducing it affect my naturally feminine voice? How about other cartilages, would any surgeon work on say wrists, elbow, or even knee bone? Just asking as I have not found anything directly related to this. Does reducing cartilage increase the risk of arthritis later in life?
8. Shoulder, collar bone, and ribcage possibilities: I understand that the bones are fused once a person reaches a certain age. It may not be possible to broaden it, but can it be surgically reduced surely? Can the inclination of the collar bones be altered? Similarly can the ribcage be reduced? In my case I have a shoulder width of 16 inch from the front, around 30-32 inch lower rib cage circumference, and a rib cage height of 12-13 inch. It may not need alterations, but I'm not too sure. If no alterations are needed to my frame, then I must be incredibly lucky.
9. Pelvis modification options: Can the male pelvis be altered to resemble the female pelvis? Is there a surgical option for that? I will need to get my own x-ray to make sure if mine is already similar to the female type or not.
10. Minor body feminization possibilities: Is there a surgical option to feminize hands and feet? I understand that fat distribution changes from HRT will affect it. However, my hands (palm) are 7 inch in length (long finger) and 3.3 inch in width, I'm not quite sure what the average female hand will be like, as many search results out there returned ambiguous results.
11. Gauging SRS possibilities: In sex reassignment surgery a good surgeon reconstructs the male organ to resemble the female vagina with similar cosmetic appearance and sensation. However, some say that female vagina has several more nerves than that of males and that the sensations of the reconstructed vagina in transgirls are limited. Is that true? Additionally female prostate
[Skene's gland] and the male prostate are somewhat homologous in their function, so will it be rerouted to the new vagina for any sterile (due to HRT) release (if any)? Will the new glans (clitoris) be void of any connection to it unlike the male penis?
[Notes: the last sentence/question here is asking if anything is still connected to the new clitoris]12. Breast development options: As far as breasts go, I do have some breast tissue even if I do exercise and try to keep fit. Strangely I never developed any muscles - I think it's a good thing. I believe HRT will relatively develop my breasts, but supposedly if it doesn't increase to the bare medium proportions that I desire, then I may need to surgically improve it. I'm not too fond of implants though, so are there any natural alternatives to slightly develop it surgically? Fat filling or what else?
[Notes: by fat filling, I mean the non-implant stem cell approach. i.e. lipo, split fat, enrich one part with stem cells, then use the enriched fat for augmentation]13. Scar recovery/removal: Scars, will all the surgical scars heal and disappear eventually (a year's time)? if not what can be done to remove the scars?
14. Care and hygiene: Once you have transitioned, are the care and hygienic practice the same as that of those who were born with the correct female body? Similarly, due to HRT do skin care products meant for female be effective on the skin?
[Notes: one purpose of this question was also related to the new vagina. Does it clean itself? Will it contract/closeup indefinitely? The answer I think I've gotten now is douching and dilation]15. Body care/checkups: After transitioning, from a health perspective if I were to go to a doctor do I have to tell her that I was originally born with somewhat of a male body? Does that affect any medicine or prescriptions I am given? Or can that be kept quiet? I rather not remember or bring up the past on and on again.
[Notes: one other purpose of this question was also related to the newly developed organs. When it comes to occasional checkup visits to ob/gyn, mammograms, physicals etc...]16. Stealth possibilities: If you had went through SRS and fully transitioned, were you able to update your birth certificate with your corrected sex? Was it difficult? I understand that this varies from state to state and the country you are in. I have to investigate that about my own country's rules and regulations on it, though I'm not sure who to talk to. Also is it best to change name before or after SRS?
17. Trans labels: Correct me if I'm wrong: a Transsexual Girl is a girl born with a male body, and a TransGirl is a girl who has corrected her problem through HRT, surgeries, and SRS. The word "Transgender" on the other hand is an umbrella term that covers various gender roles and sometimes act as a 3rd gender, which doesn't really apply to this transgirl who only identifies fully as a girl after transitioning.
[Notes: no longer relevant. I understand the labels perfectly and it is somewhat subjective. I tend to fall under the illusion of gender binary for myself alone ,so that I can rest easy when I reach the end of the 'trans' journey]I know I'm indeed over analyzing this. In reality I'm not rich at all, all the money I saved are locked away in investments and banks for some two years. To get a good therapist - a gender therapist I'd have to fly aboard, and with everything locked away I rather do a research from a layman perspective first. I learned a lot from my initial research, and I'm hoping to learn a lot form this as well. This is only my primary research. I simply don't want to be clueless when i do meet up with a gender therapist.
