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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.
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.)
