This work is a vivid description of a life-in-hiding very few people ever will experience. Society errs either on the side of lax and harmful permissiveness or of harsh and destructive suppression regarding gender identity conflict. To address the problem effectively, we first need to understand it; and a pendulum approach to resolution only exacerbates the pervasive fog that persists regarding it. Long after an elegant solution finally ends the conflict before or shortly after birth, professionals and others still will be studying the fact of the condition's ages-old history. What it is and how best to deal with it are questions which must be addressed. These questions are central to Forty Years to Life.