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MadDogMike
Apr 9, 2008

Cute but fanged
Speaking as somebody who actually worked in a lab studying genetic engineering once, I would think the easier way to adjust sex wouldn't involve a full body rewrite of the genetic code per se. First off, that's an crazy amount of work to change every drat cell no matter what vector you use. Viruses run the terrible risk of severe immune response (this in fact infamously killed Jesse Gelsinger, the first person to die in a clinical gene therapy trial) even when you aren't trying to use the insane viral loadout required for taking care of every single cell. Granted for Technobabylon here they have nanotechnology available which could probably be tolerated better, but I'd still think trying to change every cell to XX or vice versa would be more danger than it's worth. Second, it's not technically necessary to remove the Y chromosome to generate a female phenotype. It's not XX that makes someone female so much as certain sex determination genes on Y that turn the "default" female template to male. In fact female cells are designed to randomly deactivate one of their two X chromosomes (producing something known as a Barr body) so they don't have excessive activation of X-linked genes. There are in fact many women out there with an XY genotype thanks to issues with Y function; they're not fertile normally I believe (and IIRC there can be ovarian cancer issues) but they are physically female in every other way. Third, the real big issue is it's not just having the right genes but having them turned on the right way and the right time. I would think just swapping the gene code would not actually change the phenotype of a post pubescent human enough to do a full gender swap on its own, the genitalia structures and secondary sex characteristics already grew the way they were. Knocking out the Y chromosome might make a penis non-functional but the thing wouldn't just magically fall off and get replaced with a vagina.

Based on those considerations and my understanding of the tech in Technobabylon, I would assume the easiest way to perform transsexual change would be to clone the appropriate sex organs using the patient's DNA (and a donor/artificial Y chromosome for female to male transition) and surgically implant. Some genetic alteration would probably be required to deal with things like hormonal reactions (men have very real health risks if exposed to excess estrogen; not just enlarged breasts but thing like type 2 diabetes), but in general I don't see any benefit of going full XX/XY outside of the actual testes/ovaries vs. just editing areas to remove unwanted reactions to the changes in organs. Truth be told given just the technical challenges of getting a fertile transition vs a purely structural one I'd almost think it would be easier to just create functional but infertile genitalia and deal with the infertility with in vitro fertilization, but Technobabylon has crazy enough genetic tech that I could see them going all the way there.

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