We will never know. Since he did not have a penis since birth, he might have adapted the way Oscar Pistorius adapted to having no legs. If they could give a lesbian a penis, they could give this boy a penis.
My husband's daughter intended to work with children after she graduated from college. The child development classes she took emphasized that the differences between boys and girls are all "nurture" and there is no such thing as "nature". ALL creatures are born being neither male nor female, it is all socially imposed. Naturally she could not get a job because no sane person working with children would hire her. She did get a very good job though and has spent the last three years trying to prove the theories she was taught using a puppy. She has spent three years trying to teach her female bulldog that it's okay to lift her leg when she pees. The dog still squats. The young woman still can't figure it out. There is something wrong with the dog, not the education she received.
Didn't you find it unusual that these parents say that their preschool child wants a vagina? Preschool children don't use those terms. How did this child KNOW he doesn't have a vagina? There is something unhealthy going on in this household. The boy might not want to be a girl. He might want to be MOMMY instead, and look like the way he sees mommy when she's naked.
The term gender fluid is newly coined. It describes those who think they are male then change their minds and think they are female. Most very young children exhibit some form of gender fluidity because they don't see a difference until they are older. The abusive parents in this household send their child to school one day as a girl, and expect that he will be accepted as a girl, then send him as a boy and expect he will be treated as a boy. He will instead be tormented and accepted by neither boys nor girls.
Norman Bates was a gender fluid. One day a normal male, attracted to women, then a woman, jealous and hostile to women. If we fail to identify gender fluidity as the mental defect that it is and instead shoehorn them into some normal niche, it is entirely possible that a man who believes himself to be a women will be in that restroom or dressing room when he changes his mind and becomes a man. When a man, caught outside dressed as a woman, he will not take kindly to being treated as a woman.
We are inculcating and nurturing forms of insanity.