Natural estogens do not act the same way DES does, DES is a chemical.
Stage 4 Ts is Benjamine Stage 4. It means my dysphoria allows me to live somewhat in both worlds, both roles. It is not as straightforward as being a "true transexual". There are large portions of me that remain male, mostly psychologically, and there is an overwhelming need for my female body. So I operate "stealth" - living in a way that looks normal to most on the outside, but get me into a safe, private place and you'll find a fully transitioned trans-woman. Like right now.
They have trouble classifying me. My hormone letter says I have "many autogynephic tendencies" and am "not a true transexual" and if I cherry pick that diagnosis I fit some of it rather well. But since the auto theory is flawed and biased, it falls apart. My therapist said it was a way to get me the hormones I so desperately needed. Whatever. I know who I am and why now.
So its not a transition stage its a standards of care stage.
I believe DES transitioned me in the womb first trimester, causing me to have estrogen receptors where most males do not, including and especially in the brain, that it reprogrammed my entire central nervous system to female and that it made me physically and structurally female until the darned testosterone finally became active at a very late puberty. If only they knew what we know now, I would have been gorgeous.
Social conditioning abusively forced me to male, and there are many other things like I race cars and stuff. But reality is that I am surely not male, and I'm not female either. I am pre op transwoman.
Stage 4 unfortunately means no legal SRS by Benjamin Standards. I am ok with that I am beautiful regardless.
Benjamin is what is used to determine hormone and SRS eligibility by the gatekeepers. My gatekeeper fortunately recognized that it was clearly necessary for me to be on hormones - maybe because I have been starving for them ever since DES transitioned me in the womb.
Its all controversial here but I'll bet anyone its true.