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Well, I know for sure gender identity confusion is very much real, and it is just that way and people suffer from it since they are born. Science accepts it and I'm sure they will come up with an explanation soon, which hopefully will make their lives better by making people more accepting.
It existed way before surgeries did - so it doesn't make much sense to call it some sort of consumerist urge. Now, there'll be crazy people (like the person in the link I posted) with other problems (like BDD perhaps, or simply "insane") who'll undergo surgery for whatever reason but the right one.
That's why they generally have psychological scanning and stuff, but in his/her case being a millionaire probably allowed him to skip this stage.
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