To the moral theologian the most interesting feature of this conception [of gender transition surgery] is that there is apparently no point at which the human decision supervenes upon the natural process. To speak of decision and action implies that we stand back from the world and respond to it, whether sympathetically or unsympathetically, by the self-determination of our wills. On this account, however, it appears that the surgeon never “acts” in this sense, since the process of nature also embraces what he does; his technical intervention is simply the most mature and developed work of the natural process. Thus it might seem that we have to say exactly the opposite about this procedure conceived in this way to what we said about the general tendencies of technological society. Instead of treating nature is a special case of artifice, we treat artifice now is a special case of natural process.
Oliver O’Donovan, Begotten or Made?