The biggest factor holding me back, family. Not my parents or siblings, but my wife and kids. I don't
Plan on doing much of anything till the kids are out of school. Which means 17 years.

Second factor, money. Probably on everyone's list

Third factor, I'm really still on the fence. I really enjoy sex with my wife.
However... If money wasn't a factor I wouldn't hesitate to get a nose job, have my trachea/ Adam's apple "fixed", go through laser and electrolysis on my beard* and maybe some other facial work done. If money wasn't a factor what would I care what people think if I looked more femme?
Or, if I ended up on some government witness protection/relocation program, I would really change my identity.
*the beard might get treated sooner when my cash flow is better