...Regardless of the question of whether he has had his genitals amputated, Cox is not a woman, but an effigy of a woman. Sex is a biological reality, and it is not subordinate to subjective impressions, no matter how intense those impressions are, how sincerely they are held, or how painful they make facing the biological facts of life. No hormone injection or surgical mutilation is sufficient to change that. Genital amputation and mutilation is the extreme expression of the phenomenon, but it is hardly outside the mainstream of contemporary medical practice. The trans self-conception, if the autobiographical literature is...