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@freemo I'd even argue the extent that the "assigned/birth sex" differs may not be as dramatic a change as you may think. Consider cases where they just KNOW they are boys or girls contrary to all appearances from a very early age. In a very real sense, they may already be closer than you may think. In cases where there is extreme dysphoria, I think it may well be a case where the brain is one way and the body another. The brain has a built in neural "map" of the body. It's how our physical sense of our body's presence in space works. So if there is a discrepancy between what it sees and what it expects to find...