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My take on it is that Kwame is male but identifying as trans (read:not female) so he is in the process of transitioning. Whether that is through hormone therapy, surgery, or anything else, he's at least making steps. One of my best friends is trans, and he said the surgery to remove his breasts cost an absurd amount of money. Things like that may be preventing Kwame from transitioning from M to F.
Also, there are different levels that people are okay with transitioning. Some want the hormone therapy, some want everything but the surgery to change their undercarriage, and some want the works.
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ΔX - Founding Father, Massachusetts Chapter
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