Body dismorphia is clearly a related issue. The self loathing is likely caused by that.

Naturally the problem comes down to if you don't feel "at home" in your own body, that's not going to change if you alter your body. You'll still not feel comfortable with yourself. Your body has changed but it's still yours. You're just as likely to continue to suffer from disphoria with your new body. You've not dealt with the underlying cause which isn't physical.

I have at the very least some sympathy towards people that understand that and just want to dress weird or whatever. I don't understand the reasoning why but at the very least "acting like a woman" for whatever the fuck that means doesn't have permanent effects on your body like surgery does.