CSAM does not have a universal definition. In Sweden for instance, CSAM is any image of an underage subject (real or realistic digital) designed to evoke a sexual response. If you take a picture of a 14 year old girl (age of consent is 15) and use Grok to give her bikini, or make her topless, then you are most definately producing and possessing CSAM.

No abuse of a real minor is needed.