"Does this mean she'll have to have surgery?"
The counselor leaned back in his chair. "Not necessarily. That is an option to consider, in a few years. But in recent years, we've seen some patients choosing not to take that step. In essence, they live as females without having SRS - Sexual Reassignment Surgery (ed.: now called gender reassignment surgery) - just hormone therapy. But yes, it could also mean that, at some point she will choose to have such surgery. It's really her choice."
"Oh my," Aunt Margaret said with raised eyebrows. "Could she... have children, if she had that surgery?"
"No that seems still beyond medical ability for the foreseeable future. but in all other respects, given her obvious physical appearance, and hormone therapy begun soon, she would, after such surgery, be indistinguishable from any other female her age. Even her gynecologist wouldn't know."