Is Male-To-Female gender identity mostly about appearance (if the person already identifies as female)?
This is an interesting question and there is no way to answer it as stated. As you must be aware, there is more to being female than appearance and identifying as one. There is also gender expression. Gender expression includes important areas such as how one feels inside (Is it a feminine feeling or a masculine one?). Gender expression dictates how one dresses, moves and talks. And probably most importantly, gender expression has a big influence on how we are perceived in the world and how we relate to others in turn.
