My wife tells me constantly about her patients and this reads like a backstory for some of them no problem. So many people with so many fucked up lives...
Being only an underachiever feels like a blessing in comparison.

It sounds real to me. I've known similar folks. Traumatized people can get really unpleasant and desperate.

They are female to male so top surgery is breast removal, technically cosmetic but vital for mental health. Whether they were able to get a mobility surgery and chose not to I don't know.