He's lost it. Some people believe the first thing is an operation, but not so. They give puberty blockers and hormone treatments attempting to make sure they are correct before surgery, and generally do a good job of it from what I read. I lived in the Philippines for 10 years and transgenders are very accepted over there. I ran into them. And they had a Tomboy show for the male Lesbians - can't say the stylized look was flattering, but the show entertained. Vice Ganda is a huge hit there ( A male to female TG - I'm not aware of any operations).

I met one who hadn't had operations and I couldn't tell just by looking. Usually I could. The ones who had operations had Korean lovers that paid for them.

So they are normal, all over the world, and he's just another hateful preacher.