How would shapeshifters be affected by their abilities?

So I have a race of shapeshifters in my world, and in order to change shape or make adjustments to their body (grow wings, arms, tails etc.) They rearrange the atoms in their body, probably through magical means. Greater changes require more energy to move the atoms around, and can also be rather painful, meaning that a shapeshifter could potentially die if they exert themselves too much.

Would this method of shapeshifting have any serious effects on the health or inner workings of the species, especially considering that they nearly constantly change around the particles in their body?

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How would shapeshifters be affected by their abilities?

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