Italian citizen Fluvia Pellegrino’s journey to find herself was perhaps more harrowing and costly than most.

As reported by Barcroft TV in the above video earlier this January, Pellegrino was born Fluvio Pellegrino and lived as such for 40 years, despite having identified herself as transgender since she was 16. In 2000, however, she finally set out to transition, though not before talking with her wife, Marisa, who shortly gave her blessing.

In the sixteen years since, Pellegrino has spent around $87,000 (USD) on plastic surgery to help with her transition; a tally that includes more than 150 lip and cheekbone fillers, four breast implants, and two liposuctions. Pellegrino also went on hormone therapy, eventually losing the functionality of her remaining “male attributes.”

In addition to her physical changes, the relationship she had with Marisa morphed as well — from that of romantic partners to near-siblings.

Despite having the support of Marisa and her siblings, however, Pellegrino has still had to deal with ostracization. “When I told my parents what I was, my mother pushed me away and my father asked Marisa, my wife, to sign a paper to send me to a psychiatric institution to change my mind,” said Pellegrino.

All in all, the video is a revealing and brave look into the difficulties that come with transitioning.