If an effigy can be made sufficiently like the reality it is intended to represent, then it becomes, for the mystical purposes at hand, a reality in its own right.
The infinite malleability of the postmodern idea of “gender,” as opposed to the stubborn concreteness of sex, is precisely the reason the concept was invented.
The trans self-conception, if the autobiographical literature is any guide, is partly a feeling that one should be living one’s life as a member of the opposite sex and partly a delusion that one is in fact a member of the opposite sex at some level of reality that transcends the biological facts in question.
There are many possible therapeutic responses to that condition, but the offer to amputate healthy organs in the service of a delusional tendency is the moral equivalent of meeting a man who believes he is Jesus and inquiring as to whether his insurance plan covers crucifixion.
Cox’s situation gave him an intensely unhappy childhood and led to an eventual suicide attempt, and his story demands our sympathy; times being what they are, we might even offer our indulgence.
This seems to me a very different sort of phenomenon from simple homosexuality (though, for the record, I believe that our neat little categories of sexual orientation are yet another substitution of the conceptual for the actual, human sexual behavior being more complex and varied than the rhetoric of sexual orientation can accommodate).