It's that and a recognition that the "ideal self" must be grounded in reality. In my case part of the "ideal me" involves being a healthy weight, because humans do in fact have an optimal weight that I was well in excess of. In this guy's case it has to involve being a guy, because he is in fact a guy.

This guy to his credit correctly observed that "ideal him" didn't include whatever severe mental health issues he had. But since his "ideal self" wasn't grounded in reality (thinking he was a woman instead of a man) it didn't actually fix his mental health problem.

Then to top it all off, when he looked like a sideshow freak he doubtless had people telling him "you should be happy with who you are", which was doing him no favors. If he at least tried to make himself look like an attractive woman one could attempt the argument that his sense of "ideal self" had a rudimentary grounding in reality (in that he understands what an attractive woman looks like and that he was not attractive). But that's not the case.

If that "ideal self" isn't grounded in reality then you get what this dude was doing to himself. Perhaps he is no closer to his sense of "ideal self" than he was when he pretended to be a woman, but that sense of self is now grounded in reality which is a net positive for him.

If you make your sense of "ideal self" equal to "actual self" at all times then you never have incentive to improve yourself. One is free to have that sense of "ideal self", but having it is not and should not be considered a virtue. Unfortunately we have a bunch of people running around saying it is, and it will be our end.