It could be that your friend’s brother is trying to distance himself from his past actions by becoming someone else. And, since he sees his gender as a fundamental part of himself, becoming another person is as simple (to his pathological way of thinking) as having his genitals mutilated.
I see the same thing happening with traitor Bradley Manning. He was profoundly unhappy prior to joining the Army; he did not find happiness in the Army, and rather than seeking help, he committed treason. And now he is unhappy in prison, and seeking to distance himself from who he is. I wouldn’t be surprised if sometime in the future, after he has been allowed to indulge in “reassignment”, he finds a way to suicide. (Don’t get me wrong—I have no sympathy for him—I like to understand the factors that make people behave the way they do, that’s all.)
No one who humors the mentally ill by going along with their delusions is doing them any favors. Yes, it takes time to treat the illness, and success is very tenuous in these cases. But treatment is far better than using their condition for profit.
Agreed, trying to escape who he really is. Just tragic all the way around. I couldn’t begin to imagine watching my brother go through something like that.