I had suffered from terrible gender dysphoria for many years, wanting to die because I couldn't be a girl and even sometimes considering plans to. It was not until 22, however, that I actually felt confident that I really was trans, and not just a boy who wanted to be a girl. At that time, my failure to transition was not about a lack of confidence in who I was, but rather a lack of confidence that I could actually do it. I lacked any social and financial resources and was too socially awkward presenting as 'male' to either work or find someone to help me transition. Additionally, I assumed that any therapist would say "go home, boy," or that my parents would stop any attempted transition by making me use my $2000 life savings on food, or by giving me synthetic steroids, so that there was no way it could possibly work.
For me, too, it was desperation, not confidence, that drove me to transition. By the time I was 27, I had bad MPB and only one year left to total baldness. I knew that transitioning was the only way to save the one thing I actually liked about my body. I had also recently acquired some money, enough to transition, I thought. I overcame my fears due to desperation to save my hair.
Once I discovered the joys of estrogen, I knew there was no going back. The hormonal changes gave me the confidence to present as female openly, something that always seemed out of reach before. The wild emotions and changes to my skin and chest further reaffirmed my sense of femininity, and there was no going back. And while my hair count is lower than ever, the hair I have left is thick and shiny, quite a contrast from just over 2 years ago. If I had not suffered from hair loss, I would probably still be presenting as an unhappy male.