The problem is that he is having a great deal of difficulty with the profoundly disquieting (for him) experience of being a male. He’s experiencing it, and no matter what he does it feels foreign.
Yes, I think that going from the experience “The feeling of being a male seems foreign to me and has never seemed any other way” to the conclusion “I must actually be female, in spite of my body” is a rash conclusion. Having said that, it is an experience that relatively few people have to go through. Of course it raises the question in the person going through it–what does it even mean to be a man or a woman, anyway? It is a question both of self and a question of one’s place in humankind. Anyone who feels a conflict between their psyche and their body is in a very unenviable position.
We don’t have a really good answer for how to cope with this kind of interior conflict. Putting on a female persona, to the point of changing one’s name, using hormones and plastic surgery to suppress one’s physical appearance, and asking others to change pronouns used to refer to us, however, is akin to renouncing a part of the self that isn’t wanted. It is pronouncing an integral part of the self to be inherently wrong and utterly renouncing it. Is it surprising that other people don’t feel comfortable with that, when those other people feel that is a very important part of yourself that you are renouncing?
It is not realistic, I think, to put on a persona and to ask everyone else to accept the persona as real and the renounced part of the self, the part of ourselves that we ourselves have difficulty accepting, as false. That this part of the self is profoundly upsetting is undeniable, yet it is a real part of the self and convincing others that it is not…well, I don’t think this is any more tenable than convincing people to honesly pretend you’re 39 when you’re 65 or forbidding anyone from acknowledging that no, you’re not a blond, you’re a brunette with barely a hair left that still grows in brown instead of gray. You can change your looks all you like, but people are not going to accept being told they are nasty people for not going along with the pretenses you have put on, even if those greatly help you to feel more at home with yourself.
These situations–a woman accepting she is now really an older woman on one hand and a man accepting that he is a man and not a woman–are on a different plane in terms of difficulty. I only mean there is a commonality in the difference between making cosmetic changes that help you accept yourself on one hand and expecting people to prop up a made-up persona as if it were your true self on the other. People will rebel at being told that they have to pretend that in changing your appearance you have actually changed the truth about yourself.