30 years ago psychiatrists, psychologists and other professional people who had dealings with what would now be called trans-identifying people knew that this was primarily a male issue. A tiny number of little boys had gender confusion which generally became apparent before puberty. The number of girls who were experiencing extreme distress because they were female and didn't want to be was minuscule - no more than half the number of boys.
In both groups clinicians found that the vast majority of both boys and girls outgrew their distress once they were through puberty. Therapy before then was largely aimed at getting the parents and siblings to accept the child's gender nonconforming behaviour as perfectly normal and acceptable and working with identifying and helping with any other issues causing the child's distress, e.g. sexual abuse, depression and anxiety following a traumatic family split or bereavement or bullying at school, an early realisation that they might be same-sex attracted.
The vanishingly small number of girls and barely larger number of boys who still felt they 'should' have been the opposite sex were moved on to adult gender services and some of them ended up with hormone and/or surgical treatment to make them look more the way they thought they always should have looked. As I understand it, however, an absolutely crucial part of their therapy was extensive discussions about the limitations of this treatment. They had to be very clear that they understood they would still be female or male and always would be, no matter what was being done to their bodies.
Something changed about a quarter of a century ago. Medical arrogance seems to have had a lot to do with it, unfortunately, just as it did with lobotomies. Children started being given puberty blockers and moving onto hormone therapy instead of going through normal puberty. Males, mostly middle-aged or older, were finding it easier to get surgical and hormone treatment, even though there wasn't solid research evidence that it would improve their quality of life.
Also, the numbers of girls identifying as trans, mostly around the age when puberty was getting under way, started to rocket. Even though it is well known that teenage girls are very susceptible to social contagion (see Dancing Mania in the Middle Ages for an early example) nobody seems to have wondered why this was happening and just started dishing out testosterone and double mastectomies. Obvious possible explanations, such as the influence of social media and the effect of easy access to internet porn on the behaviour of boys and men towards women and girls, were ignored.
And here we are now. Middle-aged males who built their careers as men, with the support of wives, who fathered children, suddenly identify as female and expect to be able to win places on female sports teams, prizes for female business leaders, female-only MP selection committees, and so on. Some of them have the effrontery to try to get their children to refer to them as 'mother'.
But where are the middle-aged women coming out as transmen? Why are their numbers so tiny even now that there would be no stigma? There's a puzzle. Surely the answer can't be that the transwomen coming out in later years are actually acting out a fetish, a thing which is vanishingly rare in females?