It's telling that there isn't a single mention of surgery in the study or the interview.

Facial feminization surgery (FFS) exists but is extremely rare in Finland. After puberty, hormones alone can't change bone and cartilage structure, nor can they make vocalization congruent. Only surgery can do that.

Comparing what life was like before I had FFS+VFS, and I remember the way people treated me. After puberty locked in my bones, expecting life to be easy with hormone therapy alone simply wasn't realistic socially. Most people were incredibly judgemental. Life is a lot easier when people can't instantly spot you as something they see as abnormal.