I went to renew my passport today, to a local government agency that does that.
I hand the stack of documents and my old passport to the dude at the counter. Before I can explain what I just handed him and why, he flips open the passport, looks at the picture, and then looks at the woman standing across from him. He looks at the passport again, then back at me, then suddenly really wide eyes - and realizes that, yes, the owner of the passport is right in front of him.
Then he says, "I'm going to need a different ID so I can verify this is you. And I'm thinking you probably have some medical documentation you want to send with this." He did it very politely and such - no problem there, and I had what was needed.
This was probably one of the most validating moments of my life - that passport was a bit less than a year old, and I still very much see the guy in the mirror. I also didn't bother getting dressed very fancy or anything - just a T-shirt, a hoodie, jeans, sneakers, and the bare minimum for makeup.