Before I get started, let me be very clear about something: In this blog, I’m not talking about what it’s like to be trans. I’m talking about what it’s like to be trans for me. Each trans person is an individual, with her or his own experiences; some may be able to relate to some of what I say here; some will not. I am speaking for myself only.

If you were to ask me what it feels like to be trans, the closest I could come to putting it into words would be to say, “You know that throbbing ache you get in your heart when you really miss someone you’re very close to? It’s sorta like feeling that way all the time, only the person I miss is myself.”

I’ve previously shied away from writing anything this honest about my experience of being trans, because I know that no matter what words I use, they will seem to me utterly incapable of expressing what I feel, and because I don’t want to be seen as complaining about my situation. In many ways I’m very fortunate, and I’m thankful every day for the multitude of blessings in my life.

But it hurts. My heart aches every day. I don’t talk about it much even with good friends, because it never really changes, so there’s nothing to say on each new day that I haven’t already said. And that’s one of the greatest difficulties in my experience of being trans: the way it overshadows so much else in life, and leads to a sameness of feeling, day in and day out.

I think of it as a birth defect. This doesn’t ring true for all trans people, but it rings true for me. I believe I have a brain wired for life as one gender, and the body of the other, and the constant clash between the two gives off sparks—like two electrical components that aren’t designed to work together—that reverberate disruptively through every aspect of my life. It interferes somewhat with my ability to connect with others and to be empathetic; it’s hard sometimes to focus on other people when there’s a knife twisting in your own chest. And I hate that. Nothing is more important than our connections with others.

In middle school, girls occasionally told me things like, “You’d be a pretty girl.” I pretended to be slightly insulted or embarrassed, but the reality was that these comments gave me hope. Though I felt completely alone in the world and certainly didn’t dare to talk to anyone about my feelings, I knew, thanks to Phil Donahue, that other people like me existed, and that some of them went on to live as the women they actually were.

It was a hope that one day I could do the same that kept me going through the painful and interminable years of adolescence and beyond. It was also the arts—when I was watching a book or reading a movie or listening to music (or, yes, playing a video game), I could escape temporarily from the anguish of my gender dysphoria and experience something as a whole person. Perhaps, as a result, I became unhealthily attached to these things, spending too much time escaping into them from the real world, but I don’t know; sometimes I think that this constant escape may have saved my life.

Now that I’m 35, it still is the hope that I can one day live as myself that keeps me going. I never really imagined when I was young that I might reach this age and still be at this awkward stage of my transition, but then again, back then I had no understanding of the financial costs associated with transition.

Those costs vary from person to person depending on what each person feels they need for their transition. I personally consider a procedure called facial feminization surgery essential for my own transition.

The face is far and away the most important factor our brains use when the subconscious act of sorting people by gender takes place. Hormones and genetics have given me a particularly masculine face; a strong jawline, a prominent brow, and so on. It’s the pain that seeing this face—which doesn’t mesh with my strong internal sense of who I am—causes me that leads me to flinch from photos of myself. It’s this face that leads close friends who know full well that I identify as a woman to still have a hard time seeing me as one. It’s this face (at least, in part) that leads lots of bozos to post nasty things in comments on videos in which I appear (which doesn’t bother me) and which led security at E3, which I just returned from, to occasionally look at the name on my badge, then look at my face, then look back at the badge, then back at my face, then ask skeptically, “Is this you?” before scrutinizing my identity in more detail than they did any of my colleagues (which does bother me).

Sometimes people ask me why, if I identify as a woman, I dress in the way I do. I do this for two reasons: one is that I’m the sort of woman who is perfectly happy wearing a t-shirt and jeans much of the time; the other is that, while ignorant comments directed my way on the Internet only make me laugh, I’m terrified of real-world confrontation. Violence against transgender individuals is a reality even in the Bay Area, and my sense is that, as long as my face is the way it is now, dressing in more feminine clothes would only make me stick out as a transgender individual on the streets that much more.

Facial feminization surgery isn’t about being beautiful. It’s about looking in the mirror and seeing the person I am looking back at me, and knowing that other people see that person, too. Unfortunately, it’s prohibitively expensive for me and for many other transgender women who feel it is essential for their transitions. I’m fortunate enough to be able to save up several thousand dollars a year, and might finally be approaching the point within the next year or two where I can afford a trip to see a respected surgeon in Thailand for FFS. But of course, after that, I’ll need to begin saving up for still more transition-related expenses, when people my age are ideally saving up money for things like houses, raising a family, travel, and so on.

I apologize if this sounds like I’m whining. As I said earlier, I’m tremendously fortunate in so many ways, and I’m grateful for that every day. And in some ways, things are better for transgender people in the U.S. now than they’ve ever been. More companies are helping their transgender employees cover the costs of transition. Sports Illustrated printed a respectful article about the challenges of the transgender athlete. And it means something to me to see the word transgender on this credo hanging in the White House.

If this post seems selfish, well, I admit, I am concerned about myself. I’m painfully aware that every day that passes is a day I don’t get back. But there are thousands of transgender individuals out there who aren’t living their best lives because they can’t afford the costs of transition-related care and procedures. This fact isn’t getting enough attention. A recent article in New York Magazine examined the experiences of parents who are supportive of their transgender children, and that’s fantastic. But the reality is (as People Magazine editor and trans advocate Janet Mock pointed out on Twitter) that many parents who would be similarly supportive of their transgender children can’t be for the simple reason that they can’t afford to be. President Obama can talk now about supporting gay marriage, but what if he came out in support of tremendous reform for the way our health care system handles transgender care?

Some may think that these are low priority issues. They’re not. Transition may not be a matter of life and death, but it is, in the deepest and most profound possible sense, a matter of life.