"This isn't like a tattoo. It requires a lot of planning and thought," transgender surgeon Dr. Marci Bowers tells PEOPLE

By Patrick Gomez
Updated February 06, 2015 08:30 PM
Credit: Getty

With Bruce Jenner planning to speak out about his transition from male to female, transgender stars such as Orange Is the New Black‘s Laverne Cox finding success and hit shows like Transparent and Glee featuring characters publicly transitioning, the transgender community is becoming increasingly visible in American culture.

PEOPLE asked experts to talk about what it means to be transgender – and the nuanced journey transgender people (an estimated 700,000 in the U.S.) undergo as they begin living life as their preferred gender.

What does it mean to be transgender?
GLAAD defines transgender as “an umbrella term for people whose gender identity differs from what is typically associated with the sex they were assigned at birth.”

“We’ve found that [most transgender people] have felt wrongly gendered for years – since very early childhood,” says Dr. Marci Bowers, a surgeon who is transgender herself. “This is why we can so confidently say when a person seeks to go down this path, they are very unlikely to regret their decision.”

A transgender person may or may not get sex-reassignment surgery.

“It’s a tremendously positive development that the conversation has moved away from the usual clichés about surgery and secrecy to something more subtle and more humane,” says author and Barnard professor Jennifer Finney Boylan, a GLAAD board member who underwent hormone therapy and sex-reassignment surgery in 2002.

By what name and pronoun should a transgender person be called?
Generally, a transgender person will choose a new name more commonly associated with their preferred gender and ask to be referred to by the corresponding pronouns – but that might not happen right away.

“It’s important not to get too ahead of the person transitioning,” says Mary Andres, an associate professor of clinical education at the University of Southern California and clinical psychologist. “Let the person transitioning take the lead and tell you when they’re ready to be called by a different name or pronoun.”

What are the steps of transitioning?
The World Professional Association for Transgender Health, which sets guidelines that govern treatment, first suggests counseling.

Though there’s no psychological illness associated with being transgender, “that psychological process is a helpful thing to a person overcoming obstacles and going through the process of self-discovery,” says Bowers.

Next, a doctor is likely to recommend hormone therapy and that the person live life in the desired gender role for at least a year before any surgery, Bowers says.

“[The WPATH] allows for flexibility. There are people who come in who, frankly, have lived that way for years. So they don’t need years of psychotherapy,” she continues. “[The WPATH] accommodates people who come at transition from all walks of life.”

What does it cost?
Hormone treatments can run up to $20,000, according to Bowers.

And if the transgender person ultimately decides to undergo sex-reassignment surgery and other related surgical procedures, it can cost more than $70,000.

“This isn’t a process like getting a tattoo, where you can wake up one day and go and get one,” says Bowers. “This requires a lot of thought and planning. ”

Why do some transgender people wait until they’re older to transition?
“Everything else before their transition was an incongruence and unhappiness,” says Andres. “I think that there is an internal struggle: ‘I can do this for one more day, or one more year.’ That is part of being closeted, but at a certain point the costs outweigh the benefits.”

“With older people, they are finally coming into that age and developmental cycle where it is okay to take care of themselves again,” she continues. “They get to the place where they are thinking, ‘Okay, I’m done taking care of others. I’ve been the sacrificial caretaker and now the kids are doing okay for themselves. I’m not going to shatter them.’ ”

How does someone tell his or her family?
“[I’d tell someone transitioning], ‘Figure out who your allies are, and tell them first,’ ” says Andres. “The people you are coming out to may be overwhelmed, so try to provide resources like books or blogs.”

Adds Bowers: “It’s almost always harder on the people around the one transitioning. They have to say goodbye to the former person. Yes, they’re the same person, but they do change.”

But Andres says it’s a change for the better: “They’ve let go of the internal struggle.”

For more on Bruce Jenner’s decision to transition from male to female – and how his famous family reacted – pick up the new issue of PEOPLE, on newsstand now.

And for more information about transgender issues, visit the Human Rights Campaign, GLAAD, and PFLAG.

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