I debated between this and other. One of the things I've wanted the game to do better is transgender sims. It's all well and good that we can for instance give a 'male' sim a female frame but we can't give her breasts without a mod. All we can really do is give her a more defined hourglass shape. She'll still have a male stance and the default male musculature. It does feminize her face, but until you officially switch her gender to female, things like hair and makeup in the female sort don't display properly. When that happens, you can choose the female options, but not all of them show up, and the ones that do, have a thumbnail that lacks detail and everything is displayed on a male head. Same thing with nails. You can't see what a particular lipstick shade or nail shape looks like before selecting it. Half of the female options don't show, and the thumbnail doesn't give you a good look at the nails, just a male hand with a tiny sliver of the nail. I don't feel like it's a cc creator issue since their item is available to use on that sim so the creator hasn't marked it as a female only item.
The sim in question may have been assigned male but she's transitioning and living as her true self and the game does a horrible job of depicting that journey. It does the full before and after well, but the journey in between is, diplomatically speaking, a complete mess. Also I agree gender identity should be a separate option, but all pronouns should be available to any sim. I don't feel like certain gender identities should be limited to certain pronouns.