Ray Blanchard pushed the idea of autogynephilia, which is defined as 'a man's paraphilic tendency to be sexually aroused by the thought or image of himself as a woman'. He separates male-to-female transgender people into two categories: Homosexual and non-homosexual men. According to him, gay men go transgender to have sex with other men, while straight men do so because they're turned on by the thought of themselves being feminine. In other words, there are gay transgender MtF who want to knock up guys and straight MtF who have a fetish. Needless to say, Blanchard ideas are... heavily contested.
On top of the lifelong problems with acceptance throughout life, the sex lives of a MtF would be affected as well. The amount of people willing to date a transgender person is still relatively small, and the lack of testosterone can hamper sex drive. If any male tries to transition to female medically solely for a kink, they will find themselves ostracized and without a mate or sex drive. It becomes their nightmare. We would expect detransition rates to be very high but that's not the case. Instead, anti-androgens are taken with practically all hormone replacement therapies (HRT). For some, simply shedding some masculine characteristics and attaining a more androgynous appearance could keep dysphoria at bay, something that makes no sense if it was simply a fetish.
If somebody wants to be a sexy nurse, they can just buy a costume instead of going through medical school to visit random patients for 40 hours a week. If a guy wants to have sex with other guys, there are ways to do so, especially with gay acceptance at an all time high. Go to a gay bar. Trying to transition to a girl to attract guys is an ineffective and indirect route. Trying to transition medically for the sake of a fetish is signing up for a world of pain for something can be satisfied privately on the weekends.
The definition of paraphilia has been redefined in DSM V to mean 'persistent and intense atypical arousal pattern accompanied by clinically significant stress or impairment'. In my experience, transgender people who got turned on with feminization or crossdressing who transitioned lose their attraction to those things after it gets normalized. That's not very persistent. It's also not very impairing in the sense that arousal occurs from other sources for every transgender person I've come across (their ability to be aroused does not require a specific kink). The thought process of MtF people seem to suggest that a fetish for crossdressing is a normal phase that many transgender people go through.
But that's not even needed. In Blanchard's world there are only two types of male to female transgender people, and none of the reasons really involve identification with another gender or gender dysphoria, which is insane. It might be nice to 'solve' such complicated issues with such simple and neat little boxes, but it doesn't correlate with reality.
Here's an alternate explanation that is worth considering: A straight biological male before hormones is attracted to femininity. It may be a part of why a man might want to be a woman. Wearing clothes that are taboo to wear, feels different, and reminds the man of women probably would turn many guys on. On the other hand, there is also a pull to dress oneself make oneself pretty and presentable both for oneself and others just like cisgender females. Add in possible gender dysphoria which may be extreme or not exist at all.
It's possible to find a girl's form pretty aesthetically, as if it was a piece of fine art. It's also possible to be incredibly turned on by a pretty girl, or to prefer her form because one finds their own form disgusting. There are different possible reasons for wanting one thing. A similar idea works for crossdressing. It's possible to dress for purely fetish reasons or purely fashion reasons, or a mix of both. When it's purely one thing then the motivations are probably more obvious, but when it's a complex mix of both it's silly to say it's 'just a fetish'.
Finally, I want to highlight just how anti-trans Blanchard is. He said that the male partner of a straight MtF is 'usually a vague, anonymous figure rather than a real person and probably has little excitatory function beyond that of completing the fantasy of vaginal intercourse in the female role'. Blachard believes that since straight MtF have their core identity built on autogynephilia (fetish), MtFs are 'focused upon an imaginary partner who is faceless or quite abstract, and seems to be present primarily to validate the femininity of the person having the fantasy, rather than as a desirable partner in his own right'. The quote just now is from Lawrence, Blanchard's partner in crime (although Blanchard himself echos these beliefs). From what I could see, the straight MtF relationships actually tend to be more stable than homosexual MtF relationships. Since Blachard says that straight MtF suffer in their relationships because the foundations of their relationships are based on a fetish and the ones from homosexual MtF are not, we would expect the exact reverse by a large margin.
Is it still possible that many MtF transition due to a fetish which then manifests in ways which destroys their ability to enjoy that fetish via a super long and convoluted process? ...I guess, but there's no evidence to suggest that.
Often the difference between a fetish and a larger gender identity issue is that identity issues affects a person's life outside of sex. What starts as a sexual fantasy can change how one views themselves, affecting their life in other ways. This is because sexual experience is often private and personal, making it a safe place to explore things that one might not consider exploring in other parts of life. It's possible for one's brain, feelings, and opinions to change through self discovery, and that self discovery can come from many different things. The source isn't always the reason behind the new discovery just because it was discovered from it.
Finally, there is a growing pile of serious critique against Blanchard (http://juliaserano.blogspot.com/2015/07/the-real-autogynephilia-deniers.html). My favorite is the study of autogynephilia in cis-women, and based on a self-reported survey similar to Blanchards. almost a quarter of women would be autogynephilic. If people accuse the 'liberal media' of being biased for 'the standard transgender narrative', then Blanchard's study and conclusions were heavily biased due to this obvious bias against transgender men. I'm almost waiting for the day where Blanchard just yells 'IT'S ALL JUST A FETISH, OKAY?', while people are contemplating suicide from hatred of their own bodies... over a fetish? That must be a hell of a fetish.
Unlike Blanchard I will say this: Dress publicly for sexual or non-sexual reaons in private or public if you want. Roleplay online for arousal, curiosity, or comfort if you want. Mull over the idea of what it means to be a woman every day and reflect on whether that would be wonderful in every way or if it's wonderful because it's sexy. It's all okay. Be mindful of the consequences of your actions, don't harm others, and try to enjoy life by living for yourself instead of others. Your time on this earth is limited.
Sources:
http://www.tandfonline.com/doi/pdf/10.1080/00918369.2010.486241
https://www.reddit.com/r/asktransgender/comments/3ewh26/im_a_gender_therapist_at_an_informed_consent/
http://juliaserano.blogspot.com/2015/07/the-real-autogynephilia-deniers.html
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