It's usually people suffering with body dysmorphia, often combined with other issues such as autism/aspergers etc who should really just be living their lives as gay men/lesbians but have been essentially groomed by an ideology and enabled by "healthcare professionals" into living a lie that will never come true, it's honestly really sad when you think about it. The cunts who have been pushing this shit on people, especially the youth need to be held accountable. Ideally, these people should be getting the help they need to feel comfortable in their own skin and accept who they are so they can live a healthy life.
Of course you also have hardcore autistic gooners that go that far down the rabbit hole of pornography that they eventually want to become the "woman".. those are a different story though.