Even in situations where one's identity is accepted completely, there can still be lingering doubts derived from internalized acephobia and arophobia or from a wider sense of otherness from general society or even other members of the community.
Source: wiktionary
This leads to a society that is rife wih m-spec phobia, arophobia and acephobia and erasure that can be internalized, causing people to struggle with their identity, which can greatly impact their mental health.
Source: wiktionary
Comments like those listed above, especially comments such as 'you're just depressed' or 'you're cold and heartless' are arguably a big contributor to internalized arophobia.
Source: wiktionary