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How do I change so that debugging doesn't happen on localhost:randomNumber but on a custom domain like my.testsite.com:randomNumber?
I've added the domain to the hosts file and I can manually change the url when debugging from localhost to my.testsite.com, but can I make VS start at my.testsite.com from the get-go instead of localhost?
Yes... you do that in the project options. You can specify a custom startup URL as well as a fixed port if you want. The built-in VS server will follow whatever you type there, then your hosts file will take care of the mappings for you.