Listen, listen, listen. If you are born a man and get a sex change, then society mostly considers you a man. But every time someone sees your manly gait, or your overly muscular shoulders when you go off of your Estrogen shots, they know and are reminded that you were born a man (clearly this doesn't apply to all transgender folks). That said, after playing the demo of ME3: She looks like a woman and sounds like a woman, but when she runs and moves she screams all man. So, FemShep is a huge lie. There is nothing feminine about her. And whatever illusion you may have, when she takes a single step you know she was born a man.