Chris does have genuine gender issues. He's uncomfortable with aspects of his body that remind him he's male. He's self harmed over this. There's some sort of body dysphoria going on there. That's not really in dispute.
I think people online think Chris isn't genuinely transsexual because they're distracted by the circus surrounding Chris' internet fame.
If your main exposure to Chris is through the circus, just assume you don't know much about Chris' mental state. (This applies to all of us.)
Chris doesn't know how to work the system. In fact, I don't know how he managed to ply a drug prescription out of a doctor's hand.
I know the institutional deficiencies that enabled it, but I don't know where Chris learned how to doctor shop.
But yeah, unless some tard holds his hand, flying to Thailand or somewhere for the chop sounds out of his range of knowledge.