+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.