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When you've always known you like girls, it's easy to grow up believing you were really meant to be a boy. After all, that's the way the world works, isn't it? Boys like girls. Girls like boys. If you like girls, you must be a boy, especially if you were born with the bits boys have.
Everyone reminded Draco he was a boy as he grew. The first born son. The much awaited and desired son. The son and heir. His masculinity was celebrated.
Which is why it took so long for Draco to realize he wasn’t a man at all.