I just wanted to add to Confusedinomicon that transgender =/= transsexual. You are referring to people who have gender dysphoria, which not all trans people do. There are reasons why some trans people do not persue a transition- for example, changing their physical appearance (cutting/growing hair, padding or binding, gender appropriate clothing etc) is enough to satisfy any dysphoria, or they feel comfortable enough with a change of pronouns and acceptance, or they can't afford more physical treatments, they are scared of undergoing surgery and see it as disproportional to the level of dysphoria that they have, or feel that surgery or hormones will not have the desired effect (phalloplasty, for example, is a complicated and lengthy procedure that leaves extensive scarring on the body and the person may fear that the end result will not look or work properly) so they might as well stay in the body they were born with. Not going insane to grab and change does not mean a person is a liar or that their internal feelings are any less valid.