There's also the fact that one thing is to have a game avatar of the opposite sex another is to be that avatar. Not everyone would be fine with that.
I remember it was also mentioned that in the long term that affects people psychologically and their personality slowly become more attuned to their new body.
BTW I wonder, if Akatsuki was able to make that choice now, with her current feelings for Shiroe and knowing better his tastes, would she still choose the same avatar or something more... endowed?
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