difference is intensity.
if a person believes truly that jesus ACTUALLY walked on water, noah ACTUALLY LIVED 900 years or whatever, and things like multiplication of fish or whatever the fuck is in the bible, if they TRULY believe that, they are of no difference than the ones believing they are a woman while being genetically a man.
Again, this is completely dishonest and disingenuous.
If a trans woman truly believed that she was a cisgender woman who could get pregnant and give birth, then yes, that would be delusional.
But the vast majority of trans people do not believe that. They know who they are, they are acutely aware of their genetics and physiology, in fact much more than most people.
It's not a matter of pretending to be something that they are not. It is exactly the opposite.
Trans people who have decided to transition to their preferred gender have made the decision to live their lives as the person they are, not the person you think they should be.
Many trans people do suffer from various mental illnesses too. Gender dysphoria is not the same thing as being transgender, but most trans people suffer from it. Depression, anxiety and autism are all very common.
But they aren't delusional. They are suffering and at risk, and gender affirming care is literally the only form of treatment that has been proven to be effective.
Gender affirming care doesn't mean a sex change operation. The vast majority of trans people never have bottom surgery. Most trans people don't get any surgery at all.
For many people with gender dysphoria, clothing, pronouns, and hormones are enough to keep them alive. And that is ultimately the goal of medical treatment, is it not?