Puberty may result in breast development but menstruation does not occur. Although they have XY chromosomes, these people mainly identify as female. If one thing is clear, it is the idea that whatever the root of an individual's gender identity, it should be a personal decision. It is important, therefore, to remember that gender identity could have biological roots, but it does not necessarily have to. Many people maintain a gender identity which opposes the gender role they are assigned without having a biologically identifiable root to their gender identity.
Gender is a fluid category involving a spectrum of attributes which contribute to gender identity.
In the biological respect, there are examples of chromosomal and hormonal combinations in which an individual cannot strictly be deemed a man or woman. In this respect, there are as many sexes as there are humans. Gender and sex do not necessarily coincide, nor do gender assignment and gender identity. Often times the concepts of gender identity, gender role, and sexual orientation become mixed. But, each is separate and not necessarily a determinant of the next.