If transgenders are really people trapped inside the wrong sex's body, why is it not considered a birth defect?

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It's not identifiable at birth. Infact, you can't identify it until the kindergarten teacher declares it.

I have a hormone-imbalance/spirit-possession theory.

Gender is a bedrock human characteristic. It takes a serious personal change to rearrange your entire life.

Or, you absolutely have to get out of your high security prison to find some strange.