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 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.
This seems to me a very different sort of phenomenon from simple homosexuality… The mass delusion that we are inculcating on the question of transgendered people is a different sort of matter, to the extent that it would impose on society at large an obligation — possibly a legal obligation under civil-rights law, one that already is emerging — to treat delusion as fact, or at the very least to agree to make subjective impressions superordinate to biological fact in matters both public and private.