I am good friends with two women who have children who were not comfortable with their female gender from a very early age. I knew these women well and listened to each of their stories with interest and compassion, because frankly I just can't imagine anything worse than not being able to identify with or relate to your biological gender.

What a wretched thing.
So much of our identity, for right or for wrong, is defined by our gender, and yes, far less in this current time than ever before, but still. The stories these women told me were gut wrenching. By age 3 in the one case and 5 in the other, each of these kids were spurning the traditional gender roles, and rebelling against wearing dresses, the color pink, playing with dolls, having long hair etc....some very obvious things that were expected of girls 30-40 years ago. The Moms were sympathetic and flexible but the Dad in one case REFUSED to condone or allow ANY behavior, dress, play, that wasn't "appropriately" gender based. The dad in the other was less dogmatic, but still disturbed by the preferred choices of his daughter.
Fast forward to these kids 20 years later. Both were still adamantly opposed to behaving/dressing/acting in a way typical for being female. Both were doing everything they could to appear male, even though they were biologically female. The hardships both these kids endured from well meaning family members, school peers and officials, even strangers, was just so heartbreaking.
Thankfully, in both cases, the kids were put into intensive therapy, and both were able to deal with the disconnect they were feeling with their bodies vs who they felt they were. Ultimately both opted for gender reassignment therapy, which was a long process, not just because of the surgery, but even more so because of the evaluations, therapy, counseling, testing that they were subjected to before they were allowed to begin the transition. Doctors don't treat gender reassignment surgery as just some kind of a "whee!!! OK then let's chop off this, and add that, and drug you up so you can grow a beard and develop muscles." It's a grueling emotional process for the kid as they're tested and evaluated and dealing with all of the questions and examinations from professionals whose job it is to ensure that the person knows just what they're doing before the surgeons and doctors are allowed to take the next step, and all the while the "patient" just wants to finally feel comfortable in their own skin!
My friends kids are enjoying life now as males. They look amazing!! They have girlfriends, and friends, good jobs, and are finally, in their mid-late 30's, beginning to live the life they feel they were meant to. They are surrounded by people who have supported them, not judged them, been willing to see them as people first, not just a gender....and no, almost all of these folks are not themselves gender challenged, gay or otherwise involved in alternative life styles. They, too, are just people, enjoying their friendships and living their lives without judgment or being judged.