I think he started out as a she, and had surgery to remove the breasts (do I see some scars in this pic?), but KEPT the vag and the internal organs even while taking testosterone for growing the beard and such.
I don't know. I can't imagine being in this person's head. It must be an existence that is often confusing and frustrating, I'd think. I feel lucky in comparison...
Knowing how these things work, someone will probably try to beat him to death or drag him behind a truck or something.... sigh...