A thank you to @centipedekun for proof reading and editing this post!
After looking at the fully translated English scans, I think it’s safe to say that Karren did not wish to live as a man, and was rather forced into the role out of obligation and familial duty.
Her dying wish was for Shuu to call her by her real name - one that she identified with when she was able to live as a girl.
However Karren knew that wouldn’t be possible because of that duty that tied her to the continuation of the family name. In the end this resulted in her not being able to pursue the wish of Shuu loving her. It would be a betrayal to the Rosewald family to do so, as that would require her to reveal her gender. After all, she wants to be loved for who she really is, and not as Kanae. Hence her insecurities surrounding that emotion.
We know Eto took advantage of this, manipulating the built up frustration and lack of self esteem - living as the gender you’re not intended to be can damaging to a person’s psych. Karren was uncomfortable with her body, which was masculine, “bony”, and “ugly” because of her life style.
Karren also compared herself to Eve, believing that they’re situations were similar: tempted to eat the fruit out of the desire to love a man, or perhaps rather how Eto saw it, the desire to be loved at all.
There was also the little game Eto played with Karren. She would say a word and she would reply with the word that she believes relates to it the most.
When Eto says woman, Karren replies woman. The kanji in her male name appears next to the reply, as 叶 (Kanae), symbolic of the female ♀. I doubt Ishida would have put the effort to focus on this, when we already know Karren was assigned female at birth. Unless… he wanted to tell us something more, as if trying to differentiate the situation between Mutsuki and Karren.
Going back to chapter 57, once Shuu finally calls her by her name, Karren tells us of how sorrowful it is living unlike yourself, but how much joy she feels in her final moments to be able to at least die as herself. As Karren, a woman.
Oh shit I’m tearing up writing this, the scene has so many emotions. Beautifully written.
Goodnight Karren. At least you had a chance to feel the happiness you were looking for.
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