“On the surface level, the album may be transgender-themed, but underneath it, there are those universal themes—alienation, depression, not being happy—that I think that everybody can really identify with,” Grace told Grantland this month.

She's right: Transgender Dysphoria Blues includes descriptions of isolation that may feel familiar to anyone who's ever struggled to fit in, like on "Drinking With the Jocks," a track about infiltrating punk's boys' club that features Grace at her screamiest (and least comprehensible). But while the themes may be universal, the album's most heartbreaking moments are the ones that feel specific to Grace's experience. (And given the frequently dehumanizing treatment of transgender people by pop culture and the media, the more voices like Grace's sharing their experiences, the better.) On the opening title track, she dreams of passing for a woman, but instead of getting noticed for the "ragged ends of your summer dress," people on the street "just see a faggot."

That stalemate—body versus self, the person she was versus the person she wants to be—kicks off the album's central struggle with death. On the second song, "True Trans Soul Rebel," Grace, or at least her concept-album character, has already eyed an escape from the alienation she describes: "You sleep with a gun beside you in bed / you follow it through to the obvious end / slit your veins wide open, you bleed it out." On the next song, "Unconditional Love," Grace asks, "What makes you think you're going to die any different?" before declaring, "Even if your love was unconditional, it wouldn't be enough to save me." The question is clear: If we’re all going to die anyway, why bother now? By the penultimate track, "Paralytic States," it seems Grace (or, again, her character) has almost given up on finding an answer: "By the time the ball dropped, it was already over / no resolutions for the New Year beginning tomorrow."

It goes on. References to graves, dying young and natural ends populate the album, which offers few moments of relief and even fewer coping mechanisms. One option is to give the world the finger and carry on: The album's closer, "Black Me Out," spews vitriol so angry it's almost funny, and it seems to take solace in the fury. The other option, it appears, is to find something worth living for. On "Dead Friend," Grace mourns a lost loved one while noticing the effect the death has on those who still alive. And on the jarring ode to her daughter, "Two Coffins," Grace reminds that all life is headed for annihilation while positing her daughter's smiling face as the best reason not rush toward oblivion.

As the album's only acoustic number, "Two Coffins" is the rare song of the set that sounds as haunting as its subject matter. Last summer, shortly before Grace embarked on a solo tour in support of the new material, she released an acoustic EP of two album cuts, including the standout "FUCKMYLIFE666." In its raw, unplugged form, the song teased a more harrowing body of work as Grace sang what has become the central philosophy of the album: "All things made to be destroyed / all moments meant to pass."