It almost certainly does affect my self-image compared to reality.
Some friends say I pass. But, they are friends.
I rarely get The Look in public, unless I am holding still for an extended inspectiion, such as sitting at a restaurant table, where I've infrequently had people look at me directly for minutes. ("Oh, did I confuse your wittle bwain? Awww..."). I have caught older men checking me out, which was frankly pretty creepy feeling, even if a sign of passing (or something...).
When I see myself in a mirror, all I see is that big nose and sometimes that chin. When the dysphoria bites hard, it's a dude in the mirror, the sad old man returned. I hate that. Fortunately its becoming a rare event these days.
We're our own worst critics. Dysphoria warps that into self-loathing.