I feel like the sex change line was about the fact that transgender individuals have a very high rate of suicide so it's a very risky solution to their problem. He then says that they pled sane and really imitating Ed Gein. I believe he's drawing comparison to how they "alter" their bodies. Ed Gein well... I'll let you look that up. That's how I took it. I'm open to being wrong, tho.
