Just your friendly neighbourhood annoyance poking her nose in again.

Your post made me think. And one question especially.
Do they go through the same scathing self-analysis every minute of every day?
Probably yes. But with different variables.
Understanding is one thing, accepting is another. You can understand something but be unwilling to accept it, even though you know something is how it is. Because of who
you are.
Throughout my time here, I've seen a lot of people. A lot of changes. Mental as well as physical. And something which stands out to me is how trans people see the world during various stages of acceptance. Particularly late transitioners. It's as though the lens of their perception flips at some point.
I'll try to explain what I mean.
If you read through many accounts here of people who accept themselves later in life, they tell you that the world shaped them until that point. Maybe even you, too, Emma. They got lost in the vision of what being born male bodied, or female bodied,
should be. Got absorbed in that life. Maybe as a way to shove down how they felt inside in the hopes it went away. Did all the things people born that way were expected to do. Get married, have a family, be who you were supposed to be. do what you were supposed to do. And sometimes it was so all-encompassing that for a time... it worked. And that connection to who they really are got buried under a literal lifetime worth of baggage.
Then, at some point, it changes. Because what drives trans people is something coming from deep inside us. A need that doesn't go away. Something which supersedes all the social conditioning. Something which builds and builds, like a reservoir behind a dam. Until the wall we create for ourselves begins to crumble.
At that point, the lens of perception flips. Shifts 180 degrees. And we stop using the outside world to form our identity. We stop relying on everyone around us to tell us who we are. For different people that takes a different amount of time. But it happens.
I have found that people who aren't trans... they don't have that shift in perception. There doesn't come a point where what drives them comes from inside. Not in the same way as it drives us. Their identity is formed from the relationships they form, the connections they make, the... stuff they have... the way the world makes them feel they should be. They do not have a square peg trying to fit a round hole, so they don't even notice the hole at all.
It isn't deliberate. It's how a lot of trans people go through life until it gets so unbearable that they cannot do it anymore. And in the case of trans folks, it becomes even more important in trying to suppress what's going on inside. I suspect it's how we're evolved to behave as a species. And in dealing with people, I think you kind of need to understand that. And understand that someone isn't deliberately out to hurt you because who you are makes them question who they are.
Understanding why someone is the way they are is better for dealing with it than resenting them for being that way. Even if it means, ultimately, that you have to lose your ties to that person. I don't think any part of this is abusive, from any party. It's people trying to deal with things the only way they know how.