Pills only count toward Adult and Stompy, they do not count toward progress for any other transformation.Trinkets do not count toward progress for any transformation, with the sole exception of Kid's Drawing that counts for Guppy transformation.Familiars gained from Cambion Conception or Immaculate Conception do not count towards transformation progress.Items acquired by rerolling into them do not count towards any transformations.
The transformation will be lost if the items required are rerolled or otherwise lost, eg. Rerolling items with a dice room, the D4, or the D100 will not remove progress towards the transformation. Guppy's Head) can be picked up once and then swapped away with another without any loss to transformation progress. Only the first instance of an item Isaac owns will count. Duplicate items (like those acquired from Diplopia) do not count toward transformations when picked up. Items only need to have been acquired once in order to count. This bum collects any of the other beggars' pickups, and offers twice the rewards. Replaces Bum Friend, Dark Bum, and Key Bum for Super Bum. Taking damage has a chance to spawn rock waves. Spawns a spider familiar that applies random status effects to enemies it comes in contact with. Roughly 25% of the time, Isaac shoots an extra tear, like 20/20. Whenever a pile of poop is destroyed, health is replenished by half a heart. Also reduces Damage by 0.3 and slightly decreases Tears. When attacking, the tumor faces shoot tears diagonally outwards, similar to the effect of The Wiz. Isaac gains a stationary knife that trails directly behind him. 
Gives +2 damage and +0.15 speed, and spawns a random pill upon transformation. Isaac leaves a trail of green poisonous creep as he walks that deals 6 damage per second. Grants flight and converts small enemy flies into Blue Flies. Grants flight and spawns a Blue Fly each time ( 50% of the time) a tear hits an enemy.
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