I've always refused to live as a woman. I've never really lived as one, even though I'm pre-everything. I'm not out to everyone though, so I'm just like whatever, it's their problem if they don't see me as male since I dress and act like one. But now came a point where the physical dysphoria is just too much. It's what holds me back. I can't see my life living with this body and name. The most appropriate time to transition is highly personal, of course, but if you get to the point where you just feel like you can't take it anymore, then that's a stong signal you should set transition as your priority. That's what I'm doing now, even though I can't transition now because it would mean having to come out to my entire family and it'd be an issue, and I'm not even financially independent, and still live with them. So, that's another thing: being independent immensely helps if you don't live in a super accepting environment. Financially independent, that's another thing to consider. And first of all, your feelings. You don't have to get to the point of being desperate and suicidal though, you should just feel like you're ready.