Psychological changes come first and are the most important change, at least for me. It has a calming effect on my brain, on them I actually feel better about myself, I can look in the mirror and not hate me, I can express myself better emotionally, and all thoughts of suicide are gone, never have I ever contemplated even hurting myself while on the hormones. Its quite amazing how drastically they affect me this way, the effect is almost instantaneous too, one moment I'll be kind of down such as during times when dose in the body is running low, then next with fresh estrogen running through me again, doing a little jig and singing, all full of life, so happy. I've been off of them several times too, once on them I tell you this, you think you got it bad now, don't ever go off of them for long because you'll feel much worst than before ever taking them. But then maybe its just me, that the male side of me is an unstable train wreck and that feeling like a girl just makes me so right with myself that anything taking that away my mind becomes crippled and starts falling apart.