How do people really have a sex change?

Of course, they could use their skin or use an artificial ones. It doesn't matter what you do, you will never feel as good as the original ones. Keep what God gave you, it's the best because it's natural and it's REAL.

This process can take years to complete and its usually done to people that suffer from gender dysphoria after some test are performed by professionals. The change is gradual and steady and it can be done both on males and females. The individual usually starts with a hormone treatment that includes steroids from the desired sex, followed by face arrangements to masculinize or feminize the face. In face feminization, more work is required as facial hairs are removed via electrolysis, followed by Adams apple removal and voice feminization. Because the intracranial structure of men and women are different, some extra surgical work is required sometimes to achieve optimal results. In the case of face masculinization, hormones incite hair to grow and form male facial characteristics. In females the breast are removed in a process called mastectomy. Many changes are done, but the last of them is the actual sex change. In female to male transsexuals is called phaloplasty which is the reconstruction of the penis using skin graft from the forearm and in male to female transsexuals is called vaginoplasty and the term is pretty much explanatory. These organs are surgically created from scratch and aesthetically modify to resemble and function like the real ones, they are NEVER transplanted. The changes yield satisfactory results and you can find pictures of these procedures on yahoo or Google.

Most of the time the new genitalia is created by reconstructing it from the exsisting genitalia. This allows the biological material present to be used rather that simply being thrown away. It also allows the person to retain full sexual feeling. Since the body is usually unwilling to accept skin from any other source except itself, if anything "extra" is needed it is usually taken from another source on the body.

for me a sex change means I start having sex again

Yes.

I would prefer not to know. Don't let me stop you, but I gots no interest in going down that road.