Sometimes I use cash just to avoid this problem, but it's not a very practical solution. I've found that people don't usually notice anything. They can look right at it and not raise an eyebrow because they're at work, just doing their job, and half of them are operating on autopilot anyway.
Also, I've had cismales use my card, and they don't seem to have any problems. You don't really need to match your card at most establishments. Like Mahsa said, there are legit ways people end up not matching.
My driver's license looks like a stoned 13 year old boy. They made me remove my glasses for it, and my hair was all shaggy, and I couldn't see so I wasn't smiling or focusing my eyes. And there's the F.
As long as I have money, I don't often run into issues buying things, though.