Consider the case of Patrice.
Born to a teenaged mom, living ragged as do those masses who are found clinging to the fringes of society. Assigned male at birth, her previous name... unimportant. She was raised with no father. Neither she nor her mother nor anyone else knew who he might be. Patrice lived some time with her mother, who finished neither school nor her job as a parent. Her later years as a youth were spent with her grandparents, who tragically died, leaving her to finish her minority in a foster home. It was here she was introduced to sex-- at first piecemeal and joyfully self-discovering with her foster sisters, and later as a cloying, demanding, pressured imposition by others.
Turned 18 and set loose into the world, Patrice had no credentials, no money, and very few contacts. She turned (who wouldn't?) to the vices; crime, drugs, prostitution. In short order she found herself one of a harem, rented to all takers. Here, the only 'male' amongst a cohort of those she would soon see as her fellows, she realized the truth about herself. She was given the chance to transition by her pimp, who saw her metamorphosis as a lucrative business opportunity ("Have sex with the same girl every month as she becomes more and more Woman! Feel her ass and boobs swell, watch her face and lips soften, hear her moans pitch higher and higher!").
Within three years, she had transitioned to her satisfaction. Her face was re-sculpted to remove the hard, masculine edges she had despised. Her lips and ass were artificially inflated, her hair was longer, her voice a trained, soothing, pleading alto. Her best features, though, were natural. Her 7.5" dick, much to the rest of the harem's delight, was still very much in service-- more so now, with hormones and gender euphoria setting her libido off more frequently. And those same hormones grew her breasts naturally to an E cup, placing her easily among the bustiest of her colleagues.