This study examines the process by which people assigned unambiguously female at birth come to understand and identify a need for medical technological modification of sex characteristics as part of their identity. Theorizing about the concepts of sex, sex category, and gender utilizes the experiences of transpeople to critique reified notions of binary systems of sex, sex category, and gender. The theoretical deconstruction of these concepts, however, neglects the very real experiences of a self that is bodied---that bodies may be interpreted/experienced as more than simply a sexed/gendered body. Using semi-structured interviews, this study finds that individuals emphasize internal motivations and external validation for medical modifications. Results also show frequent non-binary identification of gender after modifications with attention to social context including the sex of the body of reference, geographical location, and age. This study questions the utility of an over-arching concept of gender identity that conflates (sex) body preferences with (gender) behavioral preferences as well as the categories woman and man that help to support this conflation.