makeup, the voice, plastic surgery (theres a sweet spot before too much was done where he would be quite passable), and the drugs to cope with a life of suppressing true self bc of the fear of the extra harsh ridicule you have to face when you're already famous as a male and you transition. probably thought there was no point in coming out with it in full force to the public bc of the seemingly impossibility of them accepting him as a woman/living stealth. thats the theory anyway
ru paul is a drag queen. he isnt trans bc he obviously understands gender and sexuality, is already super flamboyant, so there's nothing holding him back from coming out and transitioning if he felt he was a woman.