Nothing about Randy Stair is easily understood. The whole "I'm a female trapped in this male body so I have to kill and die so I can become a female ghost to be with my ghost love interest and run the Ghost Squad" just defies most peoples scope of understanding.
Randy was fucked up mentally, that is a given. I truly think he was very confused about himself, his sexuality, etc. He talked about being a female trapped in a male form. But if you go through the mountain of content he left behind, you will find little things that suggest he may have hated any form of body, hated normal bodily functions, etc.
Just very strange all around. Who knows whether he truly believed in this Ghost Squad or just hoped that this is what would happen after he died?
But the EGS was indeed his fantasy world.