People are diagnosed with conditions late, or never diagnosed. One person with an enlarged clitoris may have gone through a process that medicalized them, another might not have even realized their genitalia were different from the female norm.
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And, that's before we acknowledge that we don't yet know what sorts of brain or chemical factors contribute to what we've decided to call gender dysphoria. (Brains are, last time I checked, part of our biology.)
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