I think it's an on-going, trans-separate issue for some of us. I know it is for me.
I have always struggled with accepting my appearance: lots of self-loathing, intense feelings of shame, inability to leave the house, torturous schemes to improve myself (starvation, primarily), dedication of all of my free money to improve my appearance, etc.
To me, the validity of my gender status is irrelevant. I'm likely always going to obsess over being attractive or not and will let it get me down until I'm satisfied. I have at many, many times throughout my life placed my entire value on the strength of my appearance, and let it limit me accordingly.
Er, not to encourage this sort of behavior or sound like I've just accepted this flaw of mine. I actively try to work with it and improve my mental state, but I recognize the problem for what it is -- and part of that is knowing that the issue is separate from my gender.
Final note: I know that the people in this thread don't inherently think that, if you transition and are unhappy that you're unattractive, it must mean that you don't value womanhood (or manhood) for what it is (a status that comes before beauty). However, it does bother me a bit that some people make that assumption. It's unfair and oversimplified. Even if you become unattractive as a result of transition, and you feel really uncomfortable with this, it doesn't necessarily mean that you feel uncomfortable with being a woman/man or having transitioned. It inherently only means that you feel uncomfortable with being unattractive.