i figured it out that i wasn't happy with my gender in middle school, but i also didn't really have the words for it, plus the stigma and family pressure was such that at the time that i decided to just repress and focus on studies/career. it didn't help that the environment in both the college i went to and the career i picked trended towards the conservative and misogynistic.
i survived mentally via escapism, playing female characters in stuff like wow helped a lot. after graduating, moving to a new city, and working for like a decade i finally started to realize how depressed i was and started transition.
by that time i had got more involved with my local anarchists and i was good friends with a really cool trans woman that i met through organizing and she really helped pull me out of denial.
i never really trusted the medical system and would never be particularly honest with doctors, especially male ones. eventually my comrade pointed out that i could just walk into a clinic and get a prescription with informed consent, so i did! it only took me like 20 years.