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If you had to balance the actual game play of it, maybe reduce elemental resistances based on the affliction. Like radiation for Trollblood (the fast regen becomes extra susceptible to dna damage, it can repair once you're away from rads and maybe took some meds). Or simply being on fire stops regen, like fantasy trolls.
If you plan on using mods that add survival mechanics, I'd definitely make them get hungrier faster. Just like Rimworld. :)
Bonus idea: Have a drug that prevents pressure damage at the shallower depths.