The requirements for a gender dysphoria diagnosis, and therefore access to medical interventions such as surgeries or hormones, reinforce a male/female binary and do not allow room for variability in how a transgender person identifies. Transgender individuals who wish to access medical interventions must reflect these regulatory requirements in order to receive a diagnosis of gender dysphoria. So what is the experience of transgender individuals who do not reflect this narrative? How do they develop identity, form community, and make decisions regarding their transition? Using feminist methodology and grounded theory methods, I conducted a research study with ten transgender-identified individuals from Phoenix, Arizona in order to address these questions. In interviews with these participants, I found that perceptions of others, normativity, and horizontal transphobia all affected how participants identity and decision-making. Further, I also found that these themes contributed to creating transgender authenticity, or the false sense that there is only one way to be truly transgender.