Imagine living a life as lie. Always feeling as if there was something wrong with you, feelings of not belonging. Then you find out that as a child your parents were forced to make the decision of raising you as either a boy or a girl. Cases like these are not too rare and occurs only in 1 in 2000 people in the United States. It's called intersex, when sexual development is intermediate enough that it is uncertain whether the sex of the person is male or female. In the case of Debbie, formally Andrew, she felt uncomfortable with who she thought she was. Even though Andrew had a family and kids, it did not feel right.
Gender identity is more than just physiological and rearing factors, there has to be something else that makes us feel comfortable with the role we've been placed in.