+But the reasons not to take it literally might not be obvious to _everyone_. The detailed exposition above about what it would even mean to change sex is the result of a _lot_ of thinking influenced by everything I've read and learned—and in particular, the reductionist methodology I learned from Yudkowsky, and in even more particular, the very specific warning in "Changing Emotions" (and its predecessor in the Extropians mailing-list archives) that changing sex is a _hard problem_.
+
+We can imagine that a male who was _like_ me in having this erotic-target-location-erroneous sexuality and associated beautiful pure sacred self-identity feelings, but who [read different books in a different order](/2020/Nov/the-feeling-is-mutual/), might come to very different conclusions about himself.
+
+If you don't have the conceptual vocabulary to say, "I have a lot of these beautiful pure sacred self-identity feelings about being female, but it seems like a pretty obvious guess that there must be some sort of causal relationship between that and this erotic fantasy, which is realistically going to be a variation in _male_ sexuality, such that it would be silly to interpret the beautiful pure sacred self-identity thing literally" you might end up saying something simpler like, "I want to be a woman." Or possibly even, "I _am_ a woman, on the inside, where it counts."
+
+(As Yudkowsky [occasionally](https://www.lesswrong.com/posts/3nxs2WYDGzJbzcLMp/words-as-hidden-inferences) [remarks](https://www.lesswrong.com/posts/f4RJtHBPvDRJcCTva/when-anthropomorphism-became-stupid), our _beliefs about_ how our minds work have very little impact on how they actually work. Aristotle thought the brain was an organ for cooling the blood, but he was just wrong; the theory did not _become true of him_ because he believed it.)
+
+What theory I end up believing about myself _matters_, because [different theories that purport to explain the same facts](/2021/Feb/you-are-right-and-i-was-wrong-reply-to-tailcalled-on-causality/) can make very different predictions about facts not yet observed, or about the effects of interventions.
+
+If I have some objective inner female gender as the result of a brain-intersex condition, then getting on, and _staying_ on, feminizing hormone replacement therapy (HRT) would presumably be a good idea specifically because my brain is designed to "run on" estrogen. But if my beautiful pure sacred self-identity feelings are fundamentally a misinterpretation of misdirected _male_ sexuality, then it's not clear that I _want_ the psychological effects of HRT: if there were some unnatural way to give me a female body (or just more female-_like_) _without_ messing with my internal neurochemistry, that would actually be _desireable_.
+
+Or, you might think that if the desire is just a confusion in male sexuality, maybe real life body-modding _wouldn't_ be desirable? Maybe autogynephilic men _think_ they want female bodies, but if they actually transitioned in real life (as opposed to just having incompetently non-realistic daydreams about it all day and especially while masturbating), they would feel super-dysphoric about it, because (and which proves that) they're just perverted men, and not actual trans women, which are a different thing. You might think so!
+
+But, empirically, I did grow (small) breasts as a result of [my five-month HRT experiment](/2017/Sep/hormones-day-156-developments-doubts-and-pulling-the-plug-or-putting-the-cis-in-decision/), and I think it's actually been a (small) quality-of-life improvement for approximately the reasons I expected going in. I just—like the æsthetic?—and wanted it to be part of _my_ æsthetic, and now it is, and I don't quite remember what my chest was like before, kind of like how I don't quite remember what it was like to have boy-short hair before I grew out my signature beautiful–beautiful ponytail. (Though I'm _still_ [kicking myself for not](/2017/Nov/laser-1/) taking a bare-chested "before" photo.) I don't see any particular reason to believe this experience wouldn't replicate all the way down the [slope of interventions](/2017/Jan/the-line-in-the-sand-or-my-slippery-slope-anchoring-action-plan/).
+
+Fundamentally, I think I can make _better decisions_ for myself by virtue of having an accurate model of what's really going on with me—a model that uses all these fine mental distinctions using the everything-is-a-vector-space skill, such that I have the language to talk about my obsessive paraphilic desire to be shaped like a woman without wanting to actually be a woman, similarly to how the _verthandi_ in "Failed Utopia #4-2" aren't actually women.
+
+If the _actual_ desire implemented in one's actual brain in the real physical universe takes the form of (roughly translating from desire into English) "You know, I kind of want my own breasts (_&c._)", it may be weird and perverted to _admit_ this and act on it (!!)—but would it be any _less_ weird and perverted to act on it under the false (in my case) pretense of an invisible female gender identity? If you know what the thing is, can it be any worse to just _own it_?
+
+If we _actually had_ magical perfect transformation technology or something close to it—if you could grow a female body in a vat, and transfer my brain into it, and had a proven solution to the motor-mapping and skull-size issues—if it cost $250,000, I would take out a bank loan and _do it_, and live happily ever after.
+
+Since we _don't_ have that ... the existing approximations don't really seem like a good idea for me, all things considered?
+
+As a professional computer programmer, I have learned to fear complexity and dependencies. If you've ever wondered why it seems like [all software is buggy and terrible](https://danluu.com/everything-is-broken/), it's because _no one knows what they're doing_. Each individual programmer and engineer understands their _piece_ of the system well enough that companies can ship products that mostly do what they claim, but there's a lot of chaos and despair where the pieces don't quite fit and no one knows why.
+
+But computing is the _easy_ case, a universe entirely of human design, of worlds that can be made and unmade on a whim (when that whim is specified in sufficient detail). Contrast that to the unfathomable messiness of evolved biological systems, and I think I have [reason to be wary](https://www.nickbostrom.com/evolution.pdf) of signing up to be a _lifelong medical patient_. Not out of any particular distrust of doctors and biomedical engineers, but out of respect that their jobs—not necessarily the set of tasks they do to stay employed at actually existing hospitals and corporations, but the idealized Platonic forms of _their jobs_—are _much harder_ than almost anyone realizes.
+
+_All_ drugs have side-effects; _all_ surgeries have the potential for complications. Through centuries of trial and error (where "error" means suffering and disfigurement and death), our civilization has accumulated a suite of hacks for which the benefits seem to exceed the costs (given circumstances you would prefer not to face in the first place).
+
+In a miracle of science, someone made the observations to notice that human females have higher levels of [(8R,9S,13S,14S,17S)-13-Methyl-6,7,8,9,11,12,14,15,16,17-decahydrocyclopenta[a]phenanthrene-3,17-diol](https://en.wikipedia.org/wiki/Estradiol) than human males. In a glorious exhibition of mad science, someone did the experiments to notice that artificially synthesizing that ...-iol (or collecting it from [pregnant horses' urine](https://www.fundforanimals.org/duchess-sanctuary/about-the-duchess-sanctuary/pregnant-mare-urine.html)) and administering it to males successfully pushes some aspects of their phenotype in the female direction: [breast growth and fat redistribution and agreeableness—at the cost of increased risk of venous thromboembolism and osteoporosis](https://srconstantin.github.io/2016/10/06/cross-sex-hormone-therapy.html).
+
+For all that my body is disappointingly male and therefore ugly, it _works_. It makes the hormones that it needs to function without me needing to [dissolve a pill under my tongue](/2017/Jul/whats-my-motivation-or-hormones-day-89/) every day—without saddling me with extra dependencies on the supply chains that make the pills, or the professional apparatus to draw my blood and tell me what pills to take—without me needing to know what "hormones" _are_.
+
+For all that my penis is boring at best and annoying at worst, it _works_. The organ does the things that it's designed to do; it lets me pee while standing up, and reward myself while pretending that it isn't there.
+
+Did you know that trans women [have to dilate their neovagina after bottom surgery](https://www.mtfsurgery.net/dilation.htm)? Yeah. There are these hard tubes of various widths, and you're supposed to stick them up there multiple times a day after surgery (and weekly indefinitely) to prevent the cavity from losing depth. I'm told that there are important technical reasons why it would be objectively wrong to use the phrase _open wound_ in this situation, but the body doesn't know the important technical reasons and you still need to dilate.
+
+I am glad that these interventions _exist_ for the people who are brave and desperate enough to need them. But given that I'm not that desperate and not that brave, would it not be wiser to trust the paraphrased proverb and not look a gift man in the mouth?
+
+My beautiful–beautiful ponytail was a _smart move_ (and hair length isn't sexually dimorphic anyway; it's only our culture's [arbitrary gender conventions](/2020/Jan/book-review-the-origins-of-unfairness/) that makes it seem relevant in this context).
+
+My [five-month HRT experiment](/tag/hrt-diary/) was a _smart move_, both for the beautiful–beautiful breast tissue, and [For Science](https://tvtropes.org/pmwiki/pmwiki.php/Main/ForScience).
+
+My [laser hair removal sessions](/tag/lasers/) were ... arguably a waste of money, since I still have to shave even after 13 treatments?—but it at least got the density of my ugly–gross facial hair down a bit. Trying it was definitely a _smart move_ given what I knew at the time, and I _just might_ be rich enough and disgusted-by-facial-hair enough to go back for more density-reduction. (Electrolysis gets better results than laser, but it's more expensive and a lot more painful.)
+
+People get cosmetic surgery sometimes for non-sex-change-related reasons. I guess if I grew a little braver and a little more desperate, I could imagine wanting to research if and how "mild" facial feminization surgery is a thing—just, selfishly, to be happier with my reflection. (Probably a _smarter move_ to check out [movie-grade latex masks](https://www.creafx.com/en/special-make-up-effects/taylor-silicone-mask/) first, to see if it's at all possible to attain the bliss of passing in the mirror _without_ taking a knife to my one and only real-life face.)
+
+And I should probably look into [figuring out if there's anything to be done](https://en.wikipedia.org/wiki/Pattern_hair_loss#Treatment) for my hairline before it gets any worse?
+
+But _staying_ on transition-grade HRT indefinitely—doesn't seem like a smart move? Even though I would be happy with the fat-redistribution effects, I don't expect the health effects to be net-positive, and I don't expect the psychological effects to be net-desirable (even if I [wasn't](/2017/Jan/hormones-day-33/) [self-aware](/2017/Jul/whats-my-motivation-or-hormones-day-89/) enough to notice much besides libido change during my five-month experiment).
+
+And _social_ transition—really doesn't seem like a smart move? If we _actually had_ magical perfect transformation technology, that would happen automatically (people are pretty good at noticing each other's sex), and I would expect to be very happy. (After some socio-psychological adjustment period; remember, in the real world, I didn't even manage to change _nicknames_.) But given that we _don't_ have magical perfect transformation technology, the main objection here is that I _don't expect to pull off_ that kind of ... perma-[LARP](https://en.wikipedia.org/wiki/Live_action_role-playing_game). I mean _really_ pull it off—everyone in Berkeley and Portland will be very careful to respect your pronouns the minute you come out, but [_they will be lying_](/2019/Dec/reply-to-ozymandias-on-fully-consensual-gender/). I know, because I lie. Of course I _say_ "she" when [the intelligent social web](https://www.lesswrong.com/posts/AqbWna2S85pFTsHH4/the-intelligent-social-web) requires it—I'm not a _monster_—but it's only on a case-by-case basis whether I _believe_ it.
+
+It's definitely [_possible_ to pass alright](/2018/Oct/the-information-theory-of-passing/) with a lot of work ([voice training for trans women](https://en.wikipedia.org/wiki/Voice_therapy_(transgender)#Voice_feminization) is a thing!), but it's not clear why I would want to put in all that work, when overall, my life is fundamentally _okay_ as ... a man? An adult human male? As a matter of objective fact, which doesn't care about my beautiful pure sacred self-identity feelings.
+
+How dumb would I have to think you are, to expect you not to notice?
+
+And how dumb would you have think I am, to expect me to expect you to _pretend_ not to notice?