I agree with the "male/female" designation reflecting more so the Sim's identity/gender. I believe it affects pronouns, otherwise, physical attributes affected by it are minimal; mostly whether or not they have breasts (which you can kind of expand a breastless chest to give it similar shape anyways, so it's mostly about if their chest is covered or not, I think).
Oddly enough, my cis-male sim is set that he can pee standing up, but I have yet to see him do so. I'm starting to wonder if that feature wasn't implemented properly, or as intended.
