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Notes -
Any number of real medical conditions don't prove that Munchausen Syndrome isn't also real.
There's always been a small number of LGB and what we nowadays call T. The social sanctions on these people used to be very strong. Despite those sanctions gay men, for example, would still go cruising public toilets looking for strangers to have sex with. They might get arrested, or they might get their teeth punched out, but that didn't stop them. I think we can credit them with sincerity. Likewise there were men who went into the theatre scene where many eccentricities were tolerated and entertained and given a route for expression, eccentricities like pretending you're a woman on stage and then not fully relinquishing the role off stage. Outside of the theatre scene such a man might push and test the boundaries by exhibiting feminine behaviours, but the explicit claim of wanting to be a (or indeed already "being" an as-yet-unrealised) woman would have been met with disapprobation.
Skip forward and we have seen practically every major avenue of cultural publishing pumping out the message that being trans is something to be proud of, that being anti-trans is something to be ashamed of, and that the diagnosis of trans amounts to whether you've ever felt like you're not totally 100% sure that you fulfill all the expectations of your normal gender role.
It's late here so in short: sometimes you get things despite the disincentives (I'm here posting an ant-trans message right now!), you can reasonably expect to get much more of something if you remove disincentives and increase the incentives, and if people perceive the incentives are strong enough they will adopt an insincere position to acquire an advantage.
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