The actual term is "Sane".
Really, it's no different than the delusions that one is Napoleon.
Fierce denial of reality, construction their own delusions, self mutilation... these people need serious mental treatment, not coddling
Manning and other transgender people know what reality is, therefore they are not insane.
They have a mismatch between what their brain thinks their body should look like and what there bodies are like.
It is similar to that story of the woman who wanted to cut her legs off because of a brain defect where the brain's sense of "normal" didn't include legs.
She was perfectly sane, as are most transgender people, they were just born with a defective "checksum" in their brains.
Now, hatred or loathing to people who have done nothing to you, that might just be a diagnosable neurosis, as well as one that might respond to treatment :)