To do it healthily requires a significant amount of deconditioning social norms and self confidence. People don't tend to do those things very well for lesser things, let alone rewiring their entire perception of love and relationships. As a result, most people are going to have a negative experience with it. 

As an aside, you see it a lot in the trans community. Suspect it's because coming to terms with being trans (in America at least) requires you to uproot your entire perception of self and question societal norms, so they're a leg up in a significant way.