They wouldn't necessarily need a sex change. There's a congenital disease called 5 alpha reductase deficiency where an XY person lacks the gene to make 5 alpha reductase (the enzyme that catalyzes the conversion from testosterone DHT (that molecule that grows your dick when you're still in the womb)). As such, they are born phenotypically female and usually raised female until they hit puberty and testosterone kicks in, which gives them the male secondary sex characteristics.
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