@jokerxhisoka If someone's sex doesn't match their gender, they're trans. Many trans people choose not to have any kind of sex reassignment surgery because they're comfortable with their birth genitalia. While hormone (not pheromone) replacement therapy is very common, there are some trans people who choose not to undergo it or can't for medical reasons. Not feeling good about being female doesn't mean Amane becomes a transgender person because he can't become something he's always been.