Physical Changes and Self-Perception

The simultaneous loss of scalp hair, eyebrows, and eyelashes led to body shame, reluctance to undress, and avoidance of being seen. Profound fatigue represented not merely tiredness but a loss of bodily agency, control, and the capacity to engage with everyday life. Weight changes — both gain and loss — disrupted self-image and created a sense of alienation from one's former identity. Surgical alteration destabilized not only body image but core gender identity and the sense of self-continuity.