I've been reflecting lately on the different paths those who begin to cross gender express prior to puberty take. Some are clearly transsexual and never waiver in their insistence of who they are. Others perhaps have milder forms of dysphoria and deny or suppress their trans nature while others seem to be able to somewhat comfortably live a prolonged dual existence. Note that I am leaving out post-pubescent starts because quite often (but not always) there are sexual overtones and motives as primary driver.
My temptation is to say that all prepubescent starts are by people who are trans in nature but have different gradations of dysphoria. Of course societal, family, religious and other situational constraints will drive what each of them does but it is not uncommon to read about some of these older people identify as "crossdressers" and thus partly downplay their situation when there is clearly more there than meets the eye.It should be noted here that appearance of sexual overtones once puberty is reached does nothing to denigrate who these people are because for many (if not most) it is a way to cope with their gender dysphoria.
For those gender variant people starting at or after puberty who are driven primarily by seeking arousal, it need not be problematic provided it is not accompanied by distress.
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