Wouldn't he ultimately only need one of those things? I mean a Lobotomy basically makes it so you won't care about anything including but not limited to the parts you have down below, therefore the sex change probably wouldn't be needed after it, they likely wouldn't care anymore. That's not to say they should do it, a lobotomy is a nasty and barbaric procedure which damages the brain and cognitive abilities unnecessarily, it's literally the opposite of helping.