This is a GENDER critical sub, perhaps bring your question to those who pursue the issues you've typed, and typed, and typed, all about on your keyboard.

Your questions have nothing to do with the issue of gender.

Sex may be determined a number of ways, depending on what we know of an individual. This is because sex refers to the two and only roles played in sexual reproduction by these body types. There is no such thing as being less female or more female, nor being less male or more male.

You are incorrect when you state that sex is a spectrum. Sex refers to the manner in which nearly every species on the planet reproduces, and that reproduction is conducted via the pairing of the two and only two complimentary sexes, male and female.

As for your last sentence, is it a question? Regardless, a woman who does all you described is mentally ill and has been misled by those around her and is mutilated. None of the options you list as 1 through 4 really matter compared to those elephants in the room: mental illness, misled by those around her, and mutilated.