Think about it like this: everyone around you is born with the inherent knowledge of their gender and s*x lining up. They don’t have the mismatch, they don’t have the question of “why is this wrong, why do I feel wrong?”
When you finally understand what’s going on with your body, that it doesn’t line up with your gender that your brain is saying it should, you can work to change it. For some people, it’s enough to JUST be called their preferred pronouns and name, and that relieves the mismatched feeling. For others, it’s not.
Not having the mismatched feeling of your body lining up with your gender does, actually, help with being misconstrued as the opposite of what you are, because it doesn’t trigger that mismatched feeling, the feeling of things not quite adding up.
Gender is different for everyone, and some people (like myself) only feel a bit off put by being misgendered. (Which is why I can handle being called she/her in game and on forums, I bring it upon myself by using fem characters for the aEsTheTiC) For others (like my boyfriend) it’s a daily struggle knowing you’re going to get ma’am’d at the store and having to smile through it, knowing you worked SO HARD to get to where you are.
It’s like if you spent hundreds of dollars and five months, dying your hair blonde, and everyone looks at it and goes “I like your blue hair!”. You wonder if you messed up, if it really is blue, is it worth trying to go further blonde, is everyone around you deliberately calling it blue to rile you up or are you just dumb for thinking you could ever pass for a blonde? But even worse because you have an inherent NEED to be blonde, it feels like the only way to align your body and mind.
A lot of peoples dysphoria is based on perception, too. It’s enough for me if my close circle perceive me as masculine in real life, and just because I play a female character in game doesn’t mean the people in my life will perceive me any less masculine. It’s not enough for my boyfriend. I hate comparing it to mental illness (because while it can CONTRIBUTE to mental illness, it isn’t. That’s like saying needing braces is a mental illness. The bullying that you’ll receive, sure, the feeling like things are wrong, those things can contribute to mental illnesses like depression and anxiety, but there are different treatments for depression and anxiety, and gender transitioning is one thing that can treat it for people with dysphoria.), but just like how depression is different for everyone, so to is dysphoria.