Case studies are no more than anecdotal illustrations where rigorous scientific enquiry is limited by ethical constraints (reasonable so). As such, the must be interpreted carefully with regard to the case in question and not extrapolated to a broader, nomothetic populus to whom the idiopathic does not apply.
What do I mean by that? Well, the sad case in question, and it is a tragic case for all concerned, was of an ordinary male birth whose penis was damaged beyond repair by medical negligence (unipolar diathermy in a pedicled structure like the penis is just a recipe for disaster). Anyway, his mother and doctors felt they would give the child a better chance at normality by raising said child as a girl with appropriate gender reassigning treatment including surgery.
Now, this is the first point: THIS IS NOT A TRANSSEXUAL PATIENT - i.e. gender reassignment in this case was performed on someone without evidence of psychiatric or physical intersex features - biologically there had been NO ambiguity at birth. In so doing, the medical profession were, naively, assuming that gender identity could be programmed by social conditioning.
It is the ideological dream of the fifties and sixties that we are not deterministic beings but free spirits, malleable and open to shaping our personalities under purely environmental pressures. It implies everyone is born with equal opportunity and parenting and education shape that tabula rasa that is the child into the adult they eventually become.
However, it is a model which remain unproven at the time of this case; as it still does today. Clearly, not everyone is born with the same genotype and hence, whilst environment no doubt influences how a brain develops, it does so on the inherent biological blueprint given to that child by their genome (e.g. Down's syndrome, such children are often learning impaired and have special educational requirements as they grow; no matter how standardised childhood might supposed to be, such individuals will never thrive without the added support they need to develop).
So, the case study was published when David reached his teens by a zealous idealist who had an agenda of his own to prove. It implied gender identity was truely shaped by environment and not genetics. What a blow for support of the libertarians like the feminists eh? It's not that we;re "different", we just haven't been given the same opportunities in life.
It was however, not only reported to early but, by David's own report, incorrectly so as well. By the time of the report, David was already showing incongruity with his assigned female gender role and who knows, maybe the authors didn't want to risk their ideological investment turning out to contradict their agenda.
In fact, David himself unblinded the case report by coming out and going to the press about who he was and what had happened because he was so appalled at how the official literature had misreported his case and abused it to their own political ends.
He eventually re-transitioned back to male (not surprising given he was to all intents otherwise a biological male). Yes, he did end up so depressed that he ended his own life prematurely, hence the appalling tragedy of his case. But when you look at adult men in society, none of them would take too kindly to being gender reassigned against their will and losing their little fellow.
So, it illustrated that "sex change" cannot be forced on someone, nor is gender soley a function of environment. Rather it is hardwired, to what extent we cannot extrapolate, but apparently from birth. If you force a non-transsexual to go through SRS they will undoubtedly end up ****** up as you say, more than likely commiting suicide.
However, the transsexual is equally born with a predisposition towards their gender identity also, in fact they live in this gender incongruent limbo for most of their lives and also tend towards suicide if denied their true gender expression. The evidence that does exist supports the notion that gender transition in TRANSSEXUAL patients actually improves quality of life and reduces suicide rate.
So do not cite this case study as supporting a bigotted subtext implying that transsexuals are ****** up people; we have a hard enough time as it is getting acceptance for who we are in society. True, Gender reassignment procedures can only approximate the absolute biological congruity we desire, but the approximation is good enough to produce a convincing phenotypic realignment. We are a unable to refute our transsexuality as David was his own masculinity.
Live and let live, tolerate and be tolerated. One thing we are all born equal in is our RIGHT freedom, regardless of race, religion, colour or creed, sexuality or gender identity.