Confused. Enabling confusion or confirming others in their confusion is simply misguided. Of course, like everything else embraced by the left, this is simply another flag of convenience to advance the "class struggle". The left cares no more about the welfare of "transgendered" than any other co-opted group. They're simply another flavor of "useful idiots" to be used as needed and discarded when no longer needed.

Sex is determined by one's chromosomes. XX = Female, XY = Male. There are rare cases of genetic diseases where individuals have some other chromosomal makeup and there are rare cases of hermaphrodism where the expression of sex characteristics goes awry. We used to call things like these "birth defects" and they were always handled as rare medical conditions.