I've wondered that quite a lot myself. I see some serious parallels with those of my female peers who used self-harm as a similar plea for attention, usually because underlying suffering wasn't being dealt with. The literature on self-harm showed similar patterns of social contagion.

The bigger question for me is how could we sort between the two, and should we want to even if we could. Gender transition, and genderqueer presentation are relatively harmless ways to alleviate pain.