Enough Musk Spam
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I suspect it's a complex situation with multiple paths to get there. As it states in that paper "Further research is required". Based on the paper, I'm not even sure they really had a comprehensive sampling, since it's a meta-analysis and the source material is generally pretty limited. For example: "It is however noted that the small sample size (n=17) provides only weak evidence to support the finding and as such the results should be taken with caution."
Just like there are multiple paths to having different vision (genetics, developmental anomalies, illness, environmental, trauma), I suspect there's enough nuance in gender identity for there to be multiple paths there as well.