A couple has a baby that's another sex from the one they wanted or needed. For whatever reason, they decide that rather than keep trying, they're going to raise the existing child as if the child were the desired gender. Very often applied to young girls being raised as boys because their families needed an heir.
Once the kid is a little older, this usually leads to conflict between the child and the parents and/or inner conflict for the child, who has to weigh the desire to be themselves against their desire to please their parents (or keep their inheritance or what have you). In a few cases, though, the child turns out to identify just fine with the gender they were raised to be. When the child's gender identity does match their sex, they may still retain some Wholesome Crossdresser tendencies.
Can result in a lot of angst if the child suppresses their desire to be themselves (until it can't be suppressed anymore, like when the child begins to show prominent secondary sexual characteristics, or when the child begins to love someone of another sex), or when the child rebels against the parent's desire and the parent simply can't accept the child for who they are.
Girls Raised as Boys
- .hack//SIGN: Throughout the series, Tsukasa acts like a boy and plays the game using a male avatar. In fact, due to her circumstances in the game, she actually doesn't remember that she's actually a girl. Only near the end does the audience learn that her abusive father apparently raised her as a boy, for unspecified reasons. One flashback scene shows her attempting to shoplift a bra, and her father screaming and beating her over it. By the end of the series she's regained her memory, but doesn't start acting noticeably more feminine.
- Binbogami Ga: When Rindou Ranmaru shows up, people specifically bring up this trope (the very title of the chapter/episode is "Is This That So-Called Girl-Raised-As-A-Boy Pattern?"). It's actually not quite the same thing — Ranmaru has never been told she is a boy, just forced to live like one.
- Ceres, Celestial Legend: According to the tie-in novel focusing on her backstory, Tsukasa Shuro didn't even realize she was a girl until she was about 8-year-old. She was raised as a boy to protect her from the curse of the Hagoromo, since she's one of the Celestial Maidens; her parents, and especially her mother, feared that she would take her Hagoromo and run away from them. As an adult, she's Bifauxnen Idol Singer.
- Dororo: Dororo is a girl, but wasn't even aware of it. His parents raised him as a boy that way and didn't tell him otherwise.
- Dororo (2019): Unlike in the manga, Dororo knew she was a girl the entire time, but was still raised as a boy and doesn't want anyone to find out the truth.
- Fruits Basket: Akito Sohma. Due to a complicated sort of reverse Oedipal power struggle, her mother Ren Sohma is to blame for it. The reason why this decision was made is probably the main reason why Akito hates her mother so much. She was always aware of her true gender, but other than that, only some of the old family servants and the oldest Zodiac members—Ayame, Hatori, Shigure and Kureno—know about it until she goes through a HeelFace Turn and then willingly reveals herself as the girl she is, via showing up in a very feminine kimono instead of the manly yukata robes she usually wears.
- Gintama: Kyuubei was raised as a boy so that they could succeed their family's clan. They eventually reveal they don't consider themselves male or female.
- Nisekoi: Seishirou Tsugumi was raised as a boy because Claude, her guardian, couldn't tell that she was a girl. She just sorta went along with it because she didn't particularly care. Somehow, despite her now being a teenager with a very obviously female figure, Claude still thinks she's a boy.
- Noble Witches: Isabelle was disguised and raised as the male "Isaac" in order to hide her identity as a witch which would have her forcibly conscripted into the military. She resented this and voluntarily joined the RAF anyways, still hiding her true gender. Eventually she was discovered and to avoid punishment she was forced to join the titular Noble Witches.
- Princess Knight: Princess Sapphire is raised not only as a girl but also as a boy due to a law that only men can rule. It's complicated by the fact that she has the hearts of both a boy and a girl due to a mistake in Heaven.
- Romeo X Juliet: Juliet Fiamatta Asto Capulet is self-identified as a girl since birth, but has been presented as a boy to everyone outside her closest confidantes since the other members of her family were murdered when she was just two-year-old; it is common knowledge that the Sole Survivor of the massacre was a girl, so under the disguise of a boy named Odin, Juliet arouses less suspicion. When she learns her true identity as a Capulet on her Dangerous 16th Birthday, she presents as a boy to those outside her closest social circle, but begins wearing dresses in private; when her true gender is publically revealed (which includes a scene in which Juliet is "presented" to the Big Bad while wearing her hair down and a simple dress), she switches her cross-dressing for a tomboyish Skirt over Slacks look, occasionally complemented by a Tomboyish Ponytail.
- The Rose of Versailles: Lady Oscar is raised by her father as a boy due to the lack of a son to continue the family's military tradition. By the time she meets Andre at 7, she already knows she is a girl. By the time Oscar joins the military at 14, most people can tell she is female.
- Seton Academy: Join the Pack!: Yena grew up thinking that they were male because, due to being a hyena, they have a false penis and they somehow never figured out why their family members called them female. They also somehow completely missed the fact that in this universe, female animals look Little Bit Beastly, while males are Beastmen.
- Urusei Yatsura: Ryuunosuke Fujinami's father wanted a boy to carry on his family seaside shop and decided to raise his only daughter as one. Ryuunosuke knows she's a girl and wants to be more girly, but fails due to her father's meddling — both in the sense that being brought up to exhibit "manly" traits her whole life (with her father physically beating her senseless if she refused or failed) means she really has no idea how to act like a woman, and in the sense that Mr. Fujinami will actively intervene to thwart plans by Ryuunosuke to do things like buy women's clothing. In fact, Mr. Fujinami is so obsessed with the idea that Ryuunosuke will be his "strong, manly son" that he insists that she actually is male, despite all evidence to the contrary. For added irony, Ryuunosuke is in an Arranged Marriage with a boy who sits on the opposite side of this trope; Nagisa Shiowatari.
Ryuunosuke: I AM A WOMAN!
- The Window Of Orpheus, by Riyoko Ikeda: Julius is a girl forcibly raised as a boy by her Big, Screwed-Up Family as a condition to be considered as a worthy inheritor. Julius desperately wants to live her life as she sees fit, though, and both her hate for her cruel relatives and her love for her friends and her abused mother drives her to a massively tragic life.
- Gold Digger: Brittany was raised as a boy due to a curse that can only be lifted by a kiss from the boy she loves.
- Ninja High School: Sammi was forced to pretend to be a boy by her father for the sake of not losing an office bet. It worked until she reached puberty, which is when he sent her to live with her uncle to keep anyone from finding out her true gender.
- Wonder Woman (1987): When Sangtee Empire clones turn female during gestation, they're secluded from society and raised as men, only being allowed to interact with the empire once they've come of age and can convincingly pass as male.
- Daily Odd Life with Monster Girls: Princess Kishimura of Igneous has been raised as a boy since she was born in order to prevent her Evil Uncle from inheriting the throne — women are not permitted to inherit, and remarriage is frowned upon, so her father couldn't simply get married again after her mother died. She's eventually exposed, but luckily much of the populace stands with her, and her uncle is exposed as a traitor, so the laws are reworked in order to allow women to inherit.
- Belle Époque: Violeta, the middle daughter, was raised by her mother as a boy and became lesbian.
- Dragonslayer: Valerian was raised as male from birth to protect her from the lottery. It was known to most of the villagers though.
- Four Flies on Grey Velvet: The killer is one of most tortured ones to ever appear in a Giallo and a Dario Argento film as she was beaten and mistreated by her step-father for being a girl and for not acting like a boy. Nina kept her sex identity intact, but sadly not her sanity. He only managed to make her hate him to pieces and after he died his memory so much so, that her obsession led her to marry Roberto solely because he looked exactly like him and wanted to finally enact her vengeful fantasies.
- The Hidden Fortress: The princess of Akizuki was raised as a boy because Akizuki needed an heir. This manifests as her being violent and having only one way of speaking: shouting in rage.
- Homicidal, by William Castle: Emily was raised as a boy named Warren because her father wanted an heir, but the masquerade eventually warps her mind, turning her into a murderer.
- Queen Christina: Christina is raised as a boy, dressing in men's clothes and acting in an assertive, masculine manner, because King Gustavus Adolphus has no male heir.
- Arabian Nights: One of the stories has a groom reveal to the bride on their wedding night that he was actually a woman raised as a man because her father put pressure on her mother for a son.
- Beasts in Velvet: Viscount Leos von Liebowitz is raised as a boy because his elder sister, Countess-to-be Emmanuelle von Liebowitz, declared she didn't want a sister taking the attention from her. He was repeatedly beaten if he showed any signs of femininity, including an awareness that he had girl parts. As a result, he became a serial killer, targeting whores, while wearing his sister's green velvet cloak and dress. The truth of his gender was only discovered after his death. He actually does take a male lover and threaten them into keeping quiet during the story (and has done so before), but thanks to very precise wording the scene comes off as him covering up his homosexuality on a first read.
- Celeste: Celeste is raised as a girl for the first few years, but after her twin brother dies, her mother makes her over as a Replacement Goldfish.
- The Marvelous Land of Oz: The twist at the end is that the male Kid Hero, Tip, is actually the heir of the Ozian throne that everyone has been looking for. Princess Ozma was magically disguised as a boy for most of her childhood, so even she didn't know the truth. She originally dislikes the idea of being turned into a girl, but upon transformation she seemed to adjust to being a girl very easily, however.
- The Metamorphoses: Iphis's mother raises her daughter as a boy on divine orders to avoid exposing her at birth. Iphis falls in love with another girl named Ianthe, so the goddess Isis turns Iphis into a man and the two get married.
- Safe Keepers: Kellen, from The Dream-Maker's Magic, was raised as a boy by her mother, who was convinced she had actually given birth to a boy and couldn't handle having a daughter instead. Kellen started occasionally dressing as a woman around the time she hit puberty. When she left to go to Wodenderry, she switched back to pretending to be a man for her own safety, but was eventually forced to admit the truth to her friends. It turned out her mother really had given birth to a boy, and the babies were Switched at Birth.
- Split Heirs, by Lawrence Watt-Evans and Esther Friesner: A queen gives birth to triplets, two boys and a girl. However, her husband's people have the belief that multiple births stem from infidelity, so she asks her loyal retainer to take away the daughter and youngest son to be raised elsewhere, so the king would never find out about the triplets' birth. Unfortunately, the retainer messes up and take the two boys instead. By the time the queen discovers the mistake, it is too late and she is forced to raise her daughter as an heir to the throne.
- Starless, by Jacqueline Carey: Khai was born female but as per the regulations of being a Shadow, had to be raised by male warriors. Khai doesn't find out that he was born a girl until there's a change in management. This turns out to be convenient once Khai joins Zariya so they can stay in the same location in a way they would not have been if Khai had a penis. Khai does go back and forth with regards to gender presentation as they please as time goes on.
- Tamir Triad: Tamir (a.k.a. Prince Tobin) was magically transformed into a boy at birth (long story short, the people currently in power required a male heir, but certain groups wanted a return to the country's old matriarchal ways). She didn't know she was a girl until puberty hit and weakened the spell, and had some awkwardness adjusting to being female later.
- Arrow: Shado mentions she learned to fight from her father because "he wanted a boy." Slade comments, "Well, he got one."
- The Beverly Hillbillies: Elly May was raised as a boy by Jed after her mother died, leaving her no maternal influence. As Jed himself says, by the time Granny moved in with them she had already become too boyish to be made ladylike, causing them a fair amount of headache whenever they attempt to get her to settle down.
- The Big Bang Theory: Penny has many tomboyish traits. Her father wanted a son. Lampshaded by Leonard's mother multiple times:
Beverly Hofstadter:: If you want to have intercourse with that girl, find out what kind of cologne her father wore.
- How I Met Your Mother: Robin Scherbatsky was raised as a boy by her father, until he caught her kissing a boy. Currently, she still has some boyish tendencies and a lingering desire to please her father whenever he appears in her life, and his constant dismissal of her is a Running Gag.
- Scholar Who Walks the Night: Yang Seon was raised, dressed and acted like a boy after an accident when she was little caused a monk to advise the family to do so to prevent further misfortune, however, she still thinks of herself as a woman, as do her relatives.
- Fate/stay night: Saber, real name King Arthur, was raised as a boy to provide an heir who could lead the military in battle and didn't show any weakness. According to her, she he never thought of herself as a woman even once.
- Queen of Girls of the Wild's was raised this way for much of her life, as her parents were major figures in the financial world. She didn't even know she was female until age 5. When she was 9 her brother was born and thus she was allowed to live as a girl.
- Afghan girls raised as boys are referred to as "Bacha Posh", which means "dressed like a boy". In Afghanistan, where a mother of a newborn girl was considered as a disgrace for not being able to bring an heir into the world, this practice was to give the girls a higher survival rate. When the Bacha Posh hits puberty, they are required to revert back to a Proper Lady.
- Famous French spy, diplomat, and soldier Chevalier d'Éon claimed later in life to have been raised as a boy because her father could only inherit from his in-laws if he had a son. The French government accepted this claim, but she was more likely a transgender woman.
- Famous female pirate Mary Read was raised as a boy under her late brother's name "Mark", in order to cover up her illegitimate status and for her mother to continue receiving financial support from her mother-in-law.
- One Ripley's Believe It or Not! book had a story about a middle-aged person in China who thought they were biologically male finding out they were biologically female after going to a hospital for a swelling in their abdomen. The confusion was caused by an extremely rare combination of a condition causing them to look male and Turner Syndrome, a genetic disorder causing female bodies to lack traits normally associated with them, such as a menstural period and the ability to become pregnant.
Boys Raised as Girls
- Angel Diary: Ee-Jung is raised as a girl because he is the Red Phoenix.
- Assassination Classroom: Nagisa Shiota's abusive mother, Hiromi, never wanted a son so she raised him as a girl.
- Demon Slayer: Kimetsu no Yaiba: An author's note in the manga states that men in the Ubuyashiki family are very fragile and sickly, and thus are raised as girls until they're older. After Kagaya's death, it is quickly revealed that Kiriya is a boy as he is thrust into the position of head of household.
- Hetalia: Axis Powers:
- North Italy was raised as a girl by Austria and Hungary. Though it's implied that everyone but Austria (and the Holy Roman Empire, but that's another bag of cats) knew that he was a boy, simply going along with his crossdressing until Italy reached physical puberty and started openly presenting himself as a male.
- South Italy/Romano dressed up as a girl when living with Spain, but everyone treated him as a boy from the beginning likely because he was much more brash and kinda bratty.
- Jo Jos Bizarre Adventure Jo Jolion: Firstborn sons of the Higashikata family are raised in girls' clothing until a certain age due to a superstition to ward off evil spirits. The tradition is actually caused by an unknown hereditary disease that slowly turns them to stone unless someone else is willing to take on the disease for them. Currently this is done with Tsurugi Higashikata, as only family members and close family friends refer to him as a boy.
- Kunisaki Izumo no Jijou: Izumo Kunisaki was raised to perform female roles at kabuki.
- Mei no Naisho: Haruna Mei's mother raised him as a girl. Mai only learned the truth when "her" classmates saw his penis. Mei believed it'd eventually fall.
- Princess Prince, by Tomoko Taniguchi: Prince Lawrence raised as a girl named Lori, due to a prophecy that if one of the twin sons born to the king was raised as a 'child of the moon' (read: a girl), there would be prosperity in the kingdom. (It doesn't help that of the two, he resembles his dead mother more.) Hilarity Ensues as Lawrence has a crush on a girl, is constantly hit on by men, and wonders what will happen when he hits puberty. His brother, Matthew, while sympathetic to his situation, gets in some brotherly teasing about Lawrence's crush and then finds himself in a Dude Looks Like a Lady situation in which a thief thinks the twins are both female and Matthew is the one disguising their gender.
- Tokyo Ghoul: Juuzou Suzuya was raised as a Human Pet by the sadistic ghoul Big Madam, who regularly dressed him up as a girl and molested him. When she began worrying that puberty would ruin his angelic looks, she castrated him with a hammer so that he would "remain a girl" forever. It was only after CCG rescued him that he started living as a man, though his looks and unconventional gender expression continue to confuse others when they first meet him.
- Urusei Yatsura: Nagisa Shiowatari's father raised him as a girl just because he wanted to fulfil his promise to have a daughter to marry Fujinami's son (and apparently never thought about how to keep the son from protesting that his "bride" was actually another guy). Nagisa knows he's a boy and identifies as such but he just prefers to act like a girl, coming off as a Creepy Crossdresser (especially given he's a "living ghost" and so can do stuff like walk through walls).
- Finder: Lynne was raised as a girl because her mother was from the Llaverac clan, where everyone, regardless of functional gender, has breasts and dresses and acts female. Lynne grew up to be an odd mixture.
- The Invisibles: Lord Fanny is born as a boy into a family of powerful female witches and raised as a girl so that she can continue the family tradition forbidden to men. Her grandmother even chastises her father for producing a son instead of the preferred daughter. Fanny quite easily accepts the gender she is given and grows up to be a transgender woman with magical powers.
- Insidious: One of the featured ghosts in the first film, the Old Lady, turns out to be a man named Parker Crane in the second film, who was horribly abused as a child by his mother into behaving like a girl and suffered because of her issues.
- Sleepaway Camp: Angela is revealed to be a boy raised as a girl by an obsessive aunt who already has a son and "another one simply would not do".
- The Counterfeit Marquise: A woman whose husband died in battle raises her son as a girl so he won't have to join the army. She doesn't tell "Marianne" that he is actually a boy until he is engaged to be married. Even then, he doesn't tell his husband until after the wedding. Everything turns out better than expected when Marianne's husband reveals he is a cross-dressing woman.
- Flavor of the Month, by Olivia Goldsmith: Lila was already born with a testicle issue and a gay father who wasn't going to be able to handle having a son, so her crazy mother, Theresa, got her remaining testicle removed and gave Lila hormones and breast surgery. It's unclear as to whether or not Lila was a transgender personality, but she pretty much hates both genders equally, and gay men especially. When she has sex with her fiance, well...she manages successfully to hide something.
- Middlesex: Calliope/Cal, although being genetically male, is born with a condition that makes him look externally female. As neither the parents nor family doctor realized it until the child hit puberty, Callie was raised as a girl. Eventually, upon discovering his true nature, he comes to terms with his male identity. Although his parents specifically intended to have a baby girl — their first child was a boy — they obviously didn't intend to force him to fake his gender identity.
- Perfect Peace, by Daniel Black: The mother of a black Southern family raises her youngest son as a girl. She manages to get away with this for seven years because she makes sure to be the only one who changes her clothes, helps her in the bathroom etc.
- 30 Rock: It's mentioned as a Noodle Incident that Josh was raised as a girl for 10 years.
- Law & Order: Special Victims Unit: An episode features a pair of fraternal twins. However, it's later revealed that they were born identical, and the sister was actually a boy who was given a sex change after a botched circumcision. This was Ripped from the Headlines, oddly enough.
- Series/Mental: In "House of Mirrors", the key to a patient-of-the-week's self-immolation attempt lay in his disgust for his female body.
- Pepper Chocolate: There was a woman who suffered from a serious illness and promised to St. Bernardette she'd adopt a girl if she was cured. A maid working for the woman had a son and desired for him a better life so she passed the boy as a girl with no family and claimed the "girl's" name to be Bernardette. Not caring about her foster child more than required to keep good on her promise, she spent years unknowingly raising a boy until the truth came out and Bernardette renamed himself "Bernardo". The woman then started to think everything bad that happened to her was divine punishment for not keeping her promise.
- True Life: "I'm Living As Someone I'm Not" has a woman who is biologically a man. She was raised by her mother as a girl after her mother saw that she was transgender around the age of 13. She did not really see herself as transgender, just as a woman and in fact had lived as a woman so long that she had even perfected techniques so that it looked like she had breasts, and it was impossible to tell that she was biologically a man — she just looked like a skinny tall woman. The story follows her trying to come out of the closet, so to speak.
- The Who's "I'm a Boy":
I'm a boy, I'm a boy, but my ma won't admit it; I'm a boy, I'm a boy, but if I say I am, I get it.
- Prince Kaguya: Maru and Akahoshi raise Kaguya as a girl for his safety at his mother's request.
- Dark Souls: Gwyndolin was born with an affinity for the moon even though he's the child of the Lord of the Sun. As such, he was raised as a female.
- Ensemble Stars!: Until an unspecified point in his youth, Natsume was made to wear dresses and portray himself as a girl. He's highly embarrassed by his past and prefers to pretend it didn't happen. So, of course, the one other person at school that knew about it had to spread the rumor, so now everyone knows.
- Guilty Gear: Bridget was raised as a girl because of a superstition in his village about having same gender twins. His story mode actually has him setting off to become a bounty hunter to actually prove that he wouldn't be a curse on those he loved.
- Matryonas Last Night: The titular character was raised as a girl by his parents mainly because the mother wanted a daughter. She gave him a girl's name, made him wear girls' clothing, forced him to grow his hair out, and taught him generic feminine hobbies. This led to Matryona being bullied and rejected by his classmates. When his cousin was adopted by his family, his parents were content to finally have a girl. The stress of being replaced by Sasha and being told by his parents to "go back to normal" caused him to snap and to kill his family. The True Ending subverts this by having Matryona, called Matvey, be raised as a boy in another life.
- Dies Irae: Wolfgang Schreiber was born to a prostitute mother who wanted a daughter in order to continue the businesses. As Wolfgang was a boy, however, she ended up castrating him and then raising him under the name of Anna while forcing him into prostitution regardless. This, atop of how abusive both his mother and clients were, didn't exactly do his sanity any favors.
- The Confines of the Crown: Cassidy was born male but raised female for complicated political reasons.
- Your Turn to Die: The Convict/Alice Yabusame has a Gender-Blender Name and speaks in a way where he seems to be deliberately affecting a "masculine" tone despite being more used to speaking in a "feminine" one, slipping into it while panicked (and having apparently had it more consistently while younger in a flashback), yet still seems to identify as a man (even quite angrily and defensively) when asked about it. As he explains in the side game Your Time to Shine, his mother raised him as a girl until he confronted her about it. Whether this qualifies as him being transgender or having an Ambiguous Gender Identity is still vague, and the translator has said that it can be interpreted in different ways.
- David Reimer had his penis destroyed as a baby during a botched circumcision. John Money, a psychologist, then encouraged and oversaw David being sexually reassigned to female and raised as such. John Money reported the case as a success and used it as evidence that gender identity is environmental. However, it was later revealed that David had never identified as female and began living as a male at age 15. He suffered from suicidal depression starting at 13, and eventually killed himself at 38.
- Rainer Maria Rilke's mother, in mourning after losing a baby daughter after a week of life, dressed him in dresses throughout his early childhood.
- Sporus was a slave boy who had the misfortune of resembling Nero's dead wife, Poppaea. Nero had Sporus castrated, forced him to dress and act like a woman, forcibly married him, and called him Poppaea. After Nero was killed, Sporus was also forced to marry Nymphidius Sabinus (the Captain of the Praetorian Guard) and then Emperor Otho. Afterward, Emperor Vitellius planned on having a gladiator rape Sporus for the entertainment of the public, so Sporus committed suicide to avoid this fate and likely to put an end to the abuse he kept suffering. Sporus was less than twenty when he died, so he would likely have still been a child when Nero first castrated him.
- There is a rare genetic disorder found in some African villages as well as the Dominican Republic (where it is called guevedoce or "penis at twelve") that causes male children to be born with genitals that look female until puberty, whereupon they start to grow a penis. The discovery that they were male all along often comes as a relief to these children, who in many cases felt that they fit in better with boys.
- Black Lagoon: Hansel and Gretel were raised to role-play whatever sick scenarios their owner created for them and as the result learned to "switch" gender at will, becoming a dual Creepy Crossdresser. It gets to the point that no one in-universe or out knows the actual genders of the duo. Rock might know, but he might also have been too squicked out by what was happening to really think about it.
- Hetalia: Axis Powers: Hungary grows up living as a boy, then identifying as a female as she grew up — the trick is that, as a child, she thought she really was a boy and thought that "we all get one when we get older anyway".
- The Changelings: A brother and sister are raised as the opposite gender. They go on to careers at court in those roles, but eventually switch to match their birth genders.
- CSI: The Freudian Excuse of a Serial Killer is revealed to be a gender identity issue: His father raised him as a boy, his mother as a girl.
- Saving Hope: The team is working on gender-reassignment surgery for a transman but have to stop due to a new medical issue that they can't quite figure out. It turns out the patient was born intersex and, while the doctors advised waiting to see which gender the child identified with before performing surgery, the mother decided to make the child female. This is a huge source of guilt later when it turns out that mom made the "wrong" choice when her daughter decides that she'd rather be male.
- I'm Sorry I Haven't a Clue: Parodied in Jeremy Hardy's biography on the website, which claims that what Jeremy's mother really wanted was a holiday, so he was dressed as a caravan until he was six.
- Umineko: When They Cry: Sayo Yasuda appears to have been raised as a girl, but their original gender is unknown and the narration and dialogues do nothing to help. A large reason that no one can tell due to secondary attributes is that Sayo's body didn't develop correctly due to a severe injury received as a baby. However, the manga heavily implies that Sayo was designated male at birth.