I ask myself, what if I identified as a woman? (I don't.) I would want to use whatever means available to me to become more like a woman, and I would want others to respect me as a person even if they didn't understand my life choices.
However, the desire to be something is not the same as being something. No matter what extreme measures I might take, I will never be able to bear children. We could argue about what constitutes womanhood. Women who are barren are no less female, but natural biology created me a certain way. If I were to mutilate myself so badly that I resembled a dog, that would not make me a dog.
I understand the difference between desire and reality. I desire to be a chess master, but I am not likely to become one. I desire to lift weights, but my damaged shoulder makes this a questionable idea. I desire better vision, but my bad left eye is unfixable.
Although I would hope for respect, I would not demand that people pretend that I am something that I am not, nor would I demand that people lie about it just to protect my feelings.
If my unachievable desire was so compelling that it interfered with my happiness and my ability to function in life, then I would not rule out the possibility that I might have a form of mental illness. The logical thing to do under these circumstances is to seek help.