It's true that everyone pretty much refers to Gabriel as "he", with one exception I'll mention below. That's part of the sleight of hand of the screenplay to fool the audience. In-universe, clearly Gabriel identifies as a boy. Not sure why, but "he" has no sex organs so the designation of "he" is more of a placeholder, a non-physical gender identity, as opposed to something biologically derived. We could surmise that the doctors simply defaulted to "him" in the absence of Gabriel having "his" own genitalia.
Although, when they're watching the video the scientist explaining Gabriel says, verbatim, "So what exactly is Gabriel? Gabriel is an extreme version of a teratoma. A tumor consisting of tissues, hair, muscles, bones. But more specifically in this case, it's a parasitic twin. When two embryos develop in the womb don't separate like they should, one twin is dominant, while the other is underdeveloped. It's not considered conjoined because the underdeveloped twin is dependent on the body of the other."
She says this right after we see Gabriel, and "he" clearly has no sex organs, or lower body at all. "He" is merely ribs, spine, arms and head, but no organs of "his" own (they even share the same brain). One could argue that the movie takes advantage of the current climate of identity politics run amok to fool the audience, but regardless, we're quite literally shown that Gabriel has no physical sex organs, i.e. Gabriel itself may technically be an "it", despite the fact they refer to him as "he". I'm not sure "he" is even androgynous since there are no sex organs to speak of. He/she/it, i.e. Gabriel, is the embodiment of a purely psychological gender identity.
Still, though, Gabriel shares Madison's sex organs, so by proxy “he” is biologically female, even if psychologically male.
As an interesting side note, take a look at the below article, where it cites an example of a fused "twin" that wasn't identical, but genetically different, resulting in a mother giving birth to two children that didn't share her DNA (a major shock to her, I'm sure) but that of the non-identical fused twin instead. So although medical science might describe parasitic twins as "identical", there is at least this one case where a "fused" twin wasn't. And I think anyone would be hard pressed not to label that as "parasitic".
https://www.theguardian.com/commentisfree/2015/apr/27/teratoma-tumour-evil-twin-cancer
In a case from Boston, US, a woman had gone to the hospital for blood tests ahead of a kidney transplant. Her three biological sons were potential donors. But the tests said that two of them were not actually hers, though her husband was their father. That, she knew, was impossible, so further checks were done. They discovered that her body was composed of two genetically distinct groups of cells. It seems she had actually been one of a pair of non-identical twin girls whose embryos had fused, very early on. Presumably her blood was carrying DNA from one twin, while other tissues carried DNA from the other. In which case, genetically speaking, her unborn twin was the parent of two of her boys. Like Karanam’s benign tumour – not evil, but you might say, she sort of found her twin.
This article uses the term "parasitic twin" for both twin fusion (two distinct embryos merging) and fission (a single embryo not successfully splitting into two distinct embryos). So it does seem possible for there to be non-identical parasitic twins.
https://ncjs.us/seeing-double-a-look-into-twin-types-and-twin-studies/
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Never believe. Always question. Rebuke belief, a.k.a. bias, a.k.a. groupthink, a.k.a. ideology, the bane of skeptical, logical reason
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