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Hello, I am Dr Whelihan - a gynecologist, and I manage M>F and F>M transexuals in my practice. Your questions are quite common. You are correct, not all doctors are familiar with how to manage these patients. I do lectures to physicians to assist them. There is a website www.WPATH.org which is a terrific site to inform doctors and patients about what's new in the management of transgendered patients. It has links to protocols for docs to follow. Not sure of your state, but I am in South Florida. The degree of transition is totally up to the patient and all options are generally on the table. Yes, hormones are generally prescribed and maximum breast development in M>F patients is generally seen by 2 years of treatment. If you are not satisfied with those results, you can have a breast augmentation (implants).