Public perception of us and understanding of our condition.
People still believe we do this for sexual thrills, that we all get surgery, that trans women are all entertainers, streetwalkers, or totally off-the-wall and that trans men don't exist, that gender is purely a social construct, etc.
It results in discrimination, people fired and denied housing because they transition, trouble finding romantic connection, crazy laws that require us to have surgery to change our documents, etc.