They are a chronic poster on reddit, which means he almost certainly contributed to helping push other people into this pit through the same means he was a "victim" of.

An abusive "victim" is still a criminal when they carry out that abuse on other people. A tranny is no exception.

True enough I suppose. The people who misguided him into this deserve far worse fates than what he is going through (especially since he's probably not the only one they "helped") but at some point a person has to start making their own decisions.

I think at the point of the drugs I would still feel some sympathy since doctors give them out almost like candy and most people probably don't understand chemical reactions inside the body well enough (myself included). But when a doctor proposes something like...that. Most surgeries should already be considered affairs as things can always go wrong, and these ones more so as they are, for a lack of better term, outright butchery.

Maybe I just expect too much from a person who makes sweeping life choices like these and I should regard them as the mental npcs they are so often portrayed as

That is precisely why I have no sympathy for him. He had (presumably at least) all these people who loved him tell him to think about what he was doing and he still made the choice to do it.

At some point in the whole process he should have considered the implications of what a surgery, especially this kind of surgery, would mean and at that point it stops being the strangers on the internet's fault and starts being his.

He choose this so my sympathy is better going to the ones who tried to stop him for his own good. Then again in current year wouldn't be surprised if the parents and friends are the ones that convinced him to do it.