Sam Smith is a classic example of what happens if you have a **** therapist or doctor.
As a young lad, he was horrifically bullied at school for being overweight and having man boobs.
So, now, all these years later, he's a cross dresser who doesn't feel comfortable being called a man, or woman. It's a reaction to his childhood torment.
His therapists are hacks, they probably reinforce his insanity.