The answer depends on the specific situation, because there are several medically recognized reasons a person who identifies as female, or who was identified as female at birth, may have a penis or penis-like anatomy. The two broadest categories are transgender women and people born with differences in sex development, sometimes called intersex conditions. Each has its own terminology, its own biology, and its own set of experiences worth understanding on their own terms.
Transgender Women
A transgender woman is someone who was assigned male at birth but whose gender identity is female. “Assigned male at birth” means that at delivery, a doctor recorded the baby’s sex as male based on external anatomy. That person may grow up knowing, sometimes from very early childhood, that her internal sense of self does not match that assignment. The medical and psychological literature uses the term “transgender woman” or simply “trans woman” to describe this experience.1PubMed Central. Health considerations for transgender women and remaining unknowns: a narrative review
A trans woman who has not had genital surgery, or who does not want it, retains the anatomy she was born with. This is entirely normal within the spectrum of transgender experience. Some trans women pursue hormone therapy, which changes fat distribution, breast development, and skin texture, but does not remove a penis. Some eventually undergo vaginoplasty, a surgical procedure that constructs a vagina. Others do not, for reasons that range from personal preference to cost to medical risk. None of these choices make someone more or less of a woman in clinical or social terms.
The phrase you will sometimes encounter online, “a girl with a dick,” is casual and can be either self-chosen slang or a slur depending on who is using it and in what context. Many trans women are comfortable referring to themselves this way. Others find it reductive or offensive. When in doubt, “transgender woman” is the respectful, widely accepted term. Pornographic categories have introduced a number of other labels, most of which are considered derogatory outside those spaces.
Differences in Sex Development
The other major category involves biology rather than gender identity. “Differences in sex development,” abbreviated DSD, is the current medical umbrella term for a group of conditions in which a person’s chromosomes, hormones, or reproductive anatomy do not follow the typical path for either male or female development. Some older texts use the word “intersex,” which many advocacy groups still prefer. Both terms describe real, well-documented variations in human biology.
Clinicians look for a range of signs when evaluating whether a newborn may have a DSD. These include ambiguous genitalia, an enlarged clitoris in an otherwise female-appearing baby, labial fusion, undescended testes in a male-appearing baby, or a mismatch between genital appearance and prenatal chromosomal testing.2PubMed Central. Consensus statement on management of intersex disorders The point is that sex development is a multi-step process controlled by genes, enzymes, and hormones, and a disruption at any step can produce anatomy that does not fit neatly into “male” or “female.”
A person with a DSD may be raised as a girl and live as a girl while having genitalia that look partly or fully masculinized. In some of these conditions, the anatomy in question is not exactly a typical penis but is an enlarged clitoris or ambiguous structure that developed under the influence of androgens. In rarer conditions, the person may have what appears to be a small but recognizable penis alongside other female characteristics. These variations are not cosmetic oddities; they are the predictable result of specific genetic or hormonal pathways going in an unexpected direction.
Congenital Adrenal Hyperplasia
The single most common DSD that leads to masculinized genitalia in someone with XX chromosomes (the chromosomal pattern typically associated with female development) is congenital adrenal hyperplasia, or CAH. In CAH, an enzyme involved in producing cortisol in the adrenal glands does not work properly. The body compensates by ramping up production of precursor hormones, and those precursors get converted into androgens, including testosterone.3PubMed Central. Severe Hyperandrogenism in 46,XX Congenital Adrenal Hyperplasia: Molecular Physiopathology, Late Diagnoses, and Personalized Management – Section: 2. Congenital Adrenal Hyperplasia: Genetic Features and Pathophysiology
This androgen exposure begins as early as the seventh week of pregnancy, which is precisely when fetal genitalia are forming. The result is that a baby with XX chromosomes, ovaries, and a uterus is born with external genitalia that look partly or even fully male, depending on how much androgen exposure occurred. The medical literature describes these individuals as “females with androgen excess” who present with “varying degrees of external genital virilization.”4PMC Central (PMC). Disorders of Sex Development: Classification, Review, and Impact on Fertility – Section: 5. DSDs due to Anomalies in Sex Differentiation (Hormones and Enzymes)
In milder cases, a baby girl with CAH might have a slightly enlarged clitoris and partially fused labia. In severe cases, the external anatomy can look like a penis with a urethral opening. These babies have internal female reproductive organs, but their outward appearance may lead to initial confusion about sex assignment. CAH is usually detected through newborn screening in many countries, and treatment with cortisol replacement can prevent further virilization. Some families opt for surgical correction of the genitalia in infancy; others choose to wait until the child is old enough to participate in the decision.
5-Alpha Reductase Deficiency and Similar Conditions
Another condition that produces a mismatch between appearance and expectation is 5-alpha reductase deficiency. This one works almost in reverse from CAH. People with this condition have XY chromosomes and testes, but their bodies cannot convert testosterone into dihydrotestosterone (DHT), the hormone responsible for masculinizing the external genitalia before birth. As a result, these babies are often born with genitalia that look female or ambiguous, and they are frequently raised as girls.
At puberty, rising testosterone levels cause significant physical changes: the voice deepens, muscle mass increases, and the genitalia may masculinize noticeably. In some cultures and communities, this puberty-driven shift is well known and has its own local terminology. A small study of patients with 5-alpha reductase deficiency who were raised as girls found that most continued to identify as female, though one identified as male and requested gender reassignment.5Elsevier / PubMed Central. Gender identity in patients with 5-alpha reductase deficiency raised as females – Section: RESULTS The takeaway is that gender identity in these cases is not automatically determined by chromosomes or by how a child is raised. It varies from person to person.
Complete androgen insensitivity syndrome (CAIS) is yet another variation. In CAIS, a person has XY chromosomes and internal testes, but the body’s cells cannot respond to androgens at all. The result is a person who develops female external genitalia, female secondary sex characteristics at puberty (from estrogen produced by the testes and converted from testosterone), and who typically identifies as a woman. A person with CAIS would never develop a penis because her body was never able to respond to the hormones that drive penile development. CAIS is mentioned here mainly to illustrate how many different outcomes the same basic biological machinery can produce.
Why the Terminology Matters
Language in this area carries real weight. Research on gender-affirming care has found that using correct names and pronouns, employing gender-neutral language when appropriate, and validating a person’s stated identity all lead to measurably better health outcomes and quality of life.6PubMed Central. Gender-affirming Care for Transgender Patients That is not just a courtesy claim; it reflects data on mental health, treatment adherence, and willingness to seek medical care.
For transgender women, respectful language means using “she/her” pronouns unless told otherwise, saying “transgender woman” rather than slang terms, and not treating someone’s genital status as the defining fact of her identity. For people with DSDs, respectful language means following the lead of the individual and their family. Some people with intersex conditions embrace the word “intersex” as a point of identity and pride. Others prefer clinical language like “DSD” or simply describe their specific diagnosis. Asking what terms a person prefers is not awkward; it signals that you see them as a person, not a medical curiosity.
The words to avoid are easier to list. “Hermaphrodite,” once used in medicine, is now considered outdated and offensive when applied to humans. Slang terms from pornography reduce a person to a body part and are unwelcome in conversation unless the person uses them about herself. “Tranny” is widely regarded as a slur. “Shemale” is a pornographic category, not a description of a human being. If you are unsure, “transgender woman” or “person with a difference in sex development” will serve you well in virtually any context.
Common Misconceptions
One of the most persistent misunderstandings is that there are only two possible configurations of human sex anatomy and that any deviation is vanishingly rare. In reality, DSDs collectively affect a meaningful number of people. Estimates vary depending on how broadly you define the category, but even using narrow clinical definitions, these conditions are far more common than most people assume. CAH alone occurs in roughly 1 in 15,000 births in most populations, and milder forms that do not cause obvious genital ambiguity are more frequent still.
Another misconception is that a person’s genitalia determine their gender. This conflation of sex and gender is the root of much of the confusion behind the question in this article’s title. Sex refers to a cluster of biological traits: chromosomes, hormones, gonads, and anatomy. Gender refers to a person’s internal sense of identity and the social roles associated with it. These two things usually align, but they are not the same thing, and one does not dictate the other. A trans woman with a penis is a woman with a penis. A person with CAH who has masculinized genitalia and was raised as a girl is, in most cases, a girl with an unusual medical history.
A third misconception, especially common on the internet, is that anyone who does not fit neatly into a binary must be confused or going through a phase. The evidence does not support this. Gender identity tends to be stable from early childhood, and attempts to force someone into an identity that does not match their own consistently produce harm rather than resolution. For people with DSDs, the clinical consensus is that sex assignment should be made carefully, with input from specialists in endocrinology, surgery, psychology, and increasingly from the patients themselves as they grow old enough to express a preference.2PubMed Central. Consensus statement on management of intersex disorders
What Surgery and Hormone Treatment Can and Cannot Do
For trans women who choose medical transition, the process typically begins with estrogen-based hormone therapy. Estrogen promotes breast growth, softens skin, redistributes body fat toward a more typically female pattern, and reduces (but does not eliminate) body hair over time. It does not remove the penis. It can cause the testes to shrink and may reduce erectile function, but the external anatomy remains unless surgery is performed.
Vaginoplasty, the most common genital surgery for trans women, uses existing penile and scrotal tissue to construct a vaginal canal, labia, and clitoris. The surgery has been refined over decades and generally produces good functional and cosmetic results, but it is a major operation with a lengthy recovery. Not every trans woman wants it, and insurance coverage varies widely by country and by plan. In some places, obtaining approval for the procedure requires documentation of persistent gender dysphoria and a period of living in the identified gender role.
For people with CAH, surgical decisions are more contentious. Historically, doctors performed “corrective” surgery on infants with ambiguous genitalia, sometimes without fully informing parents about the range of outcomes. Advocacy groups have pushed back hard against this practice, arguing that irreversible genital surgery should wait until the person can participate in the decision. The debate continues, but the trend in clinical guidelines is toward more conservative early intervention and greater patient autonomy later on.
How Cultural Context Shapes the Conversation
The way people talk about these topics varies enormously across cultures. In parts of the Dominican Republic and Papua New Guinea, 5-alpha reductase deficiency is common enough that local communities have developed specific terms for children who appear female at birth and masculinize at puberty. In the Dominican Republic, the colloquial term translates roughly to “penis at twelve.” In these communities, the phenomenon is treated as an expected variation rather than a disorder, and affected individuals often transition socially to a male role without significant stigma.
In Thailand, the term “kathoey” describes trans women and some gender-nonconforming people, and the category carries a social recognition that has no exact Western equivalent. In South Asian cultures, “hijra” is a long-established identity for people who may be trans women, intersex, or eunuchs. These cultural categories predate modern Western medicine by centuries and remind us that the questions behind this article are not new. What is new is the medical vocabulary and the clinical ability to understand and, when desired, modify the underlying biology. The experiences themselves are as old as human populations.
Western medicine has been slower to catch up culturally than it has technologically. Until 2019, the World Health Organization classified being transgender as a mental disorder. It has since been reclassified as a condition related to sexual health, removing the implication that having a gender identity that differs from one’s assigned sex is inherently pathological. This shift matters because medical classification shapes insurance coverage, legal rights, and how healthcare providers treat their patients. A person seeking hormone therapy or surgery for gender dysphoria navigates a very different system depending on whether her condition is framed as a psychiatric disorder or a recognized aspect of human variation.