-- First step ... A psychiatrist evaluates the patient. If appropriate, the doctor prescribes male hormones.
-- The hormones change the body makeup, which includes hair growth. The clitoris also grows larger.
-- Removal of breasts. Dr. Alter said most states will recognize the person as a male once this occurs. A hysterectomy can also be performed during this process.
-- Dr. Alter said the decision about changing the genitalia can take several years, while the patient is taking hormones. Dr. Alter says most people stop at this point.
-- Dr. Alter says if the patient goes forward, the surgeon often makes a small penis out of the clitoris and a scrotum by joining both labia majors. Testicle implants can then be inserted. The most sophisticated option is microsurgery in which skin, arteries and nerves are taken from the forearm and made into a phallus.
As for cost, Dr. Alter said it's all over the place, depending on how far the person wants to go. We've spoken to people who have had it done, and they say the full deal costs more than $100,000.