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You bring up some interesting issues. I think it's worth clarifying that my use of the word "intrinsic" doesn't preclude social influence on desire. So, if someone sees a trans person, and they never had a desire to be trans before that and never would have without having seen it and known it was possible, but they do still want to change their gender now that they know that they can, just as a want-in-itself, then that would still count as an "intrinsic" desire, in the sense in which I am using the word. The cause of the intrinsic want is not relevant, provided that the desire for a particular gender is a desire for that gender rather than wanting the gender as a tool on the way to something else.
So, for example, if some of those Iranian trans women would never have wanted to be trans if they could have simply been homosexual, but, over time, they've adopted their female identity and now it feels like their own and they've come to like that identity in and of itself, then that would count as a socially-mediated intrinsic desire, by my definition. Whereas, an Iranian who is living as a trans woman but who would transition back to male in a heartbeat if they could just be homosexual does not have that intrinsic desire, and indeed I think many people who generally support self-ID as a measure would still concede that such a person is not "really trans" -- because they don't really want to be, not for itself.
If you want to be trans solely in order to make your friends accept you, then that's not an intrinsic desire for a gender. But are there really people who would transition solely for that reason? It seems far-fetched. On the other hand, people can sometimes manufacture genuine desires, in order to fit in. Kind of like the difference between wearing jeans because that is the socially acceptable costume and you don't want to be questioned, on the one hand, and wearing jeans because you have absorbed that you feel socially comfortable in them and now they just feel "comfortable" in themselves, even when no-one is watching. The former is not an intrinsic desire; the latter could be.
Yeah, this is an interesting one. If you think that transitioning will improve your mental health, but you don't actually want to be the other gender as a thing in itself ... yeah, could happen, some mental illnesses make people latch onto solutions indiscriminately.
I think some people would want to say that a person like this is still close enough to "really trans" if the transitioning does actually help. I'm not sure that I would, though. Honestly, the more I explore these edges, the more I find myself feeling like "intrinsic desire" actually does describe something important about what it means to be trans. Mind you, I am not, myself, transgender in any way, and I hesitate to present myself as an authority on a subject that hinges so closely on the personal experiences of others.
In and of itself, none of this addresses the question of whether we should attempt to reduce the prevalence of an intrinsic desire to be another gender, of course. Whether or when to police the existence of such intrinsic desire is also a separate question; proponents of self-ID would say "don't ever," but some might be willing to move to a different standard if they still believed that intrinsic desire itself would be respected under that standard.
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