Conservatives who think it means something to do with "trans" and that's all they know. Ask a conservative man if he's "cisgendered" and many will say "no" because they don't' know the actual meaning of the word. They don't know that saying "no" to being cisgendered means they are trans.
A man who goes to great lengths to avoid risk, embarassment, or exposure. i.e., if the belt should break, the suspenders will keep his pants on. Not quite paranoid, but on his way there. Can also be said of a man with something to hide. (or less than something as the case may be)
Lars, a real belt-and-suspenders man, saves every single email he sends and receives and archives them to CD, claiming "you just can't be too careful".