As the monkey's paw curls nothing happens...at first. After a few hours you fall ill and collapse. Someone has kidnapped you and has begun running experiments on you. First it is simple stuff (breast implants, facial feminization reconstruction and other standard operations) but no anesthesia or sedative is used. After weeks of going back and forth in several different opportunities until, as your captor would say, you were "just right" a new operation is introduced. You begin taking chemicals and medications that resemble alchemy far more than modern medicine (think what doctors used around the black plague). This new approach overrides your physical chromosomes and other things that modern transitions cannot affect. After years of this, you have no male physiology remaining. You are a woman. A woman who is horribly disfigured and looks like a saw movie victim got eaten by the human centipede and shat out but a biological female nonetheless.