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I would assume that at 18, even if he's self-identified as female, there may not have been a lot he could do from a physiological standpoint to prepare for life as a woman.
I would think that unless his parents were on board years earlier, and they found a doctor who agreed, that he would probably be just now be at the age where he could start making medical steps to realizing his goal.
But everything I know about Transgender I learned on 20/20. So, there's that.
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