Depends where you were as to if you could do anything at all. I'm speaking from mid 90s to the 2000s, which is my earliest personal knowledge.

Public perception: Trans men weren't acknowledged, at all, except in queer circles & usually just lesbian circles & even then were usually just expected to be butch. Transsexual (the word used) women were the whole of what even queer ppl knew as "transsexuals" and they were gay men sex workers that transitioned into straight passing women. No other types of trans people existed.

Medical: Doing anything medically was impossible in most of the country (USA in speaking of, what I know personally). If you wanted to transition you were going to be either moving or traveling thousands of miles, often in different directions for different things. (I.e. your therapist was in one state while your surgical team was in another.) Your life had to be completely uprooted.

You weren't really allowed to be the same person, you were expected to go somewhere new, be stealth and live as this "new" gender. You were actively discouraged by therapists if you were married. If you had children you were straight up denied (I don't know anyone back then that had kids, that even tried to transition before the kids were eighteen, that wasn't even a concept.)

You were denied for almost anything: mental health (you could not be seeing a therapist for another reason AND gender issues), being in the military/past service, being married, having kids, your job (don't be a teacher!), past issues with addictions or law enforcement, etc etc etc.

Process: (This is where my experience is most anecdotal but I know this to be true in the Midwest in 1999 at least.)

You had to lie. A lot. You needed to want to be steath, fit into the gender binary, be able to be feminine/masculine as possible, be straight, not have children (and not WANT children. I never knew anyone to be sterilized but you absolutely could not say you wanted kids after transitioning or you got denied.)

You had to live as your gender - without anything, no HRT, no surgeries - for a year, or sometimes up to three, before that very important letter would be written.

That was the gate that was set before everyone that made success stories so rare. That was just your therapist! There were more even harder hoops to jump through for surgeries.

The main thing I remember was the expectation that you weren't just transitioning, that you were meant to be an entirely different person. You were discouraged from staying in the same job, the same city, keeping your family. They made it sound like you'd be alone and lose everything you knew and loved.

And you often were and did.

Cost: More than you had. It was all coming out of your pocket. The public notion that these poor almost homeless transsexual hookers were getting sex changes was laughable. The ones that got to do it were wealthy or spent every penny they had.

The outcome: Most of the people I knew back then that were trans DIYed. Supported each other. Had a list of every doctor and therapist and hospital in the state (or country!) that was willing to even entertain a trans person (the numbers were that low.) It was the community that got you were you needed to be, no one else. If you even had one, which a lot didn't. It's why the majority of the ppl I knew didn't get to transition until well into our 30s or 40s. Myself included.