"All for appearance" is a common way trans health is dismissed as not being valid... But it is a cis gender bias that does not recognize how a difference of how one is perceived can so negatively effect one's experience.

Let's put the trans experience to the side for a moment.

The idea of vanity is seductive isn't it? The idea that a desire beautiful is shallow. That we should place no value on our appearance because it's fleeting and empty. The idea that wanting to appear anyway other than whatever is natural is morally defunct.

Yet if you are ugly by a society's measure people literally treat you as lesser. Some will bend over backwards for a beautiful person and deny their time and consideration to people who are not pretty. It's harder to find work, harder to be promoted, if you are past the point into what is considered "disfigured" there are people who react to your very presence as being inappropriate for children or treat you as something sub human. There can be advantages to being reasonably ugly as a lot of people essentially ignoring you can be preferred to being showed by attention as beauty comes with it's own layers of issues and lack of privilege.

What we look like holds an incredible amount of power as to how our daily experience is shaped. It influences how comfortable we are in public, how confident we are dealing with strangers what doors open and which are slammed in our faces. We are regularly are told appearances shouldn't matter and treat then as trifling issues to be dismissed and then are thrown into the world where experience shows that is absolutely not the case.

Half the issue on the trans side of things is we are told that appearances shouldn't matter but when we don't pass as cis people on casual inspection we face harassment, lack of privilege and people denying who we are and calling us things people know will hurt us. We are told by the hordes of strangers we have to face we are not "real" and thus are just pretending if we haven't medically transitioned as our social transitions are "not enough". When that becomes unbearable we are told we are shallow for wanting not to face crippling social anxiety and told it is a moral failing to want beauty... But most of us aren't aiming for beautiful. We just want to be a kind of invisible that cis people take absolutely for granted. If we are left with no place of comfort, starved for human connection on our terms a lot of us die. And yet it's a moral failure to want to look like anything but whatever random roll of the dice we got so our deaths aren't counted as being because of how we appear. It's chalked up as being more nebulously about how "being trans is hard" and why is it hard? Because of shallow thoughtless people who refuse to judge us on anything but what our bodies look like. Sometimes at the level of DNA because that's suddenly all they choose to care about.