And because they do not accept themselves, they try to justify their life-changing decision from their social contacts.
That is how the build their "self-worth".

So they are demanding that everyone agrees with the mutilation of their bodies.
That we accept them not accepting their biological form.
But there is no self-basis for this choice, as they did not accept them-selves.
So as soon other people change, and the social contacts change, the self-acceptance depends on themselves again.
Which was absent in the first place. So we often see them wanting to end their lives.

In psychological sense it is all very logical and sad.

And spiritually I would see it as a challenge for your own life.
The challenge is to accept yourself and your body.
Some people are born with a physical handicap, and they usually smile when I meet them.
To become a unique and happy person does not need extreme changes.