> So apparently when a doctor in a white coat tells these people they definitely don't have Tourettes, the behavior stops?

I don't know if there's a general term for this, but there seem to be a category of syndromes where if you're high-functioning with the syndrome, then it's possible to suppress the symptoms, and whether you're expected to suppress the symptoms depends on whether a doctor "grants you the privilege" of a diagnosis of having the disease.

For example, Hikikomori in Japan—these people almost certainly have Social Anxiety Disorder, but it's their parents/caregivers that enable them to live as recluses, and they only tend to do this if they believe their child has some sort of clear mental illness. If they take their child to a psychiatrist and the psychiatrist says "nope, no social anxiety, they just like staying home to play video games", then the parents would likely stop enabling the child to stay in their room all the time, and instead would force them to go out. Even if it turns out that the child really just has high-functioning Social Anxiety Disorder, to the point where it's "masked" from a signs-and-symptoms based diagnosis; and so is still markedly suffering when made to go out in public. Without the diagnosis, they're no longer allowed to be free from social approbation when they avoid people.

I would think a similar thing could be at play in "high-functioning", able-to-be-suppressed-with-constant-effort Tourettes cases: without the diagnosis (or rather, with a negative diagnosis), nobody around you will tolerate a Tourettes outburst from you, so you just have to "suck it up" and mask it as hard as you can. Also, given the negative diagnosis, your supporters will likely no longer associate the more subtle symptoms with Tourettes, as they now "know" you don't have it; so they'll mentally categorize those tics, if they do show up, as being something else.

In such cases, you'd also expect that if someone had always known such symptoms were socially-unacceptable and so had always been actively suppressing them, then finding out that there's a disease they might have where presenting these symptoms would be considered socially-acceptable in the context of having that disease, would mean they'd suddenly be willing to start 1. claiming they have the disease, and 2. presenting the symptoms—but only after people know and understand their claim to have the disease, as the whole point is to be able to finally "let out" the symptoms while avoiding social approbation for them.

> So a sudden swing in the sex ratio for a disease that's long been presumed to have some kind of male-associated underlying genetic basis that lines up with a prominent female influence seems like pretty strong evidence for their theory.

Charitable interpretation: women are underdiagnosed with Tourettes, because some combination of hormonal and social factors generally leads to them generally being higher-functioning — i.e. "leaking" the symptoms less. But actually, they're still being impacted, just silently (i.e. their dopamine is being drained faster by having to "fight the urge", much like someone with OCD.)

This is the current hypothesis for the gender disparity in diagnosis of childhood ADHD. It's very underdiagnosed in girls (which we know because a lot of these undiagnosed girls become adult women who go to a psychiatrist and find out they have adult ADHD, and then think back and realize they've always had the internal experience of ADHD but were never diagnosed.) We think this is because girls are more trait-conscientious, which leads to them being more motivated to not let (socially-unacceptable) hyperactivity symptoms "leak", while still internally suffering from those symptoms, and visibly suffering from the more socially-acceptable symptoms (which alone aren't usually enough for people to put two and two together and send them to a psychiatrist for diagnosis.)

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All that being said, yeah, I don't think this is really "high-functioning Tourettes." That isn't quite how Tourettes works; there's a lot of involuntary stuff in Tourettes that absolutely cannot be suppressed no matter how much you might want to, and

But there are a number of etiologies with related symptom profiles. My guess about what actual "property" these girls are actually noticing about themselves, is that they're high-functioning on the autistic spectrum (another thing underdiagnosed in women!) and so find that stimming behaviors — which can look a lot like Tourettes motor tics, but are actually voluntary, just highly preferred to be executed when possible — help to calm certain sensory processing problems they have.