I think 'I'm trans' is the tip of a huge iceberg that has so much churning away below the surface.
Of those I know who identify as trans ...
One fifteen year old autistic butch lesbian
One straight 30-something woman who was the victim of childhood sexual abuse and never had any form of therapeutic help
One 40-something woman with a husband, who always knew something was dreadfully wrong but was never able to articulate what it was
Several clearly (from their behaviour and conversation) AGP middle aged men.
I can only speak of those I know, but it does seem the big difference in mtf and ftm is that women and girls are trying to get away from their experiences and society's expectations directly related to their sex (the female reality), while men are attracted to the sexual element of crossdressing, drag, being in women's space, and 'girl talk' 🤮. The female fantasy. Funny how menopause so seldom seems to feature in the fantasy.
And from what I've read, what lies beneath can include unsupported homophobia from family and school, bullying, autism, child abuse, mental health issues...
So much that, to me, needs robust psychological support, not pandering to a fantasy that cannot become real (changing sex), not mutilating, scarring, sterilising and a lifelong potentially harmful (see Scott Nugent's writing) drug addiction.