Richard - Great thread title! It sounds like the opening line to a country song's chorus !
You may get inner peace, but at the cost of living a lie or being alone.
If the transgendered person seeks the physical change because he/she honestly does not feel that his/her outward aspect [the body] accurately reflects the inner reality (psychologically, emotionally), then it would accurate to say that he/she has chosen to begin 'living the truth' of himself/herself.
One is most 'alone' or isolated when one feels that the true self is unknown in the midst of intimate associates.
-V