This isn't the first time I've heard of situations like this. I have actually seen older individuals in E. D. who had sexual reassignment surgery from a male to a female then completely dressed, haircut, stopped taking hormones etc. using male name , having male appearance . In this day of political correctness , I'm wondering how much psychiatric work up and counseling these patients really get prior to surgery ? Do they gloss over other red flags for underlying issues also present - thinking sexual reassignment will fix this? There was a book I read by a plastic surgeon called Psycho- Cybernetics about patients becoming extremely depressed and suicidal after having plastic surgery for " flaws" because they had very deep , underlying emotional problems and psychiatric issues and falsely assumed that plastic surgery would fix all of it - they were disillusioned after surgery because only the outside had changed and everything else was still the same.