It's been seven years, and y'know what?
I still get a thrill
when I look at myself in the mirror
and see girl, not boy.- Kate Bornstein, The Seven Year Itch
CONTENTS:
Preface
In October, 1998, I web-published an essay called "Men Trapped in Men's Bodies: An Introduction to the Concept of Autogynephilia." My intention was to introduce a theory, formulated by psychologist Ray Blanchard, that I had found to be personally meaningful during my own transition. My essay quickly became a topic of intense controversy among transsexuals and other transgendered persons. Some found my description of Blanchard's ideas to be enlightening, even liberating. They reported relief at having at last found a theory that described their experiences in comprehensible terms. But others felt mischaracterized by Blanchard's theory, or by my explanation of it. They declared that Blanchard's formulation, which categorized gender dysphoric males as either "autogynephilic" or "homosexual," most definitely did not describe their experiences. Many were angered and offended by my public advocacy of a theory that seemed to deny or devalue their feelings and identities. The reactions of this latter group left me feeling defensive, perplexed, and deeply troubled.
After eighteen months of reading, listening, and reflecting on these
issues, I feel it is time to revise my essay. I have come to believe that my
original exposition suffered from a lack of balance and critical
perspective. Although I stand by much of what I originally wrote, there is
also much I would now change. This revision will probably still displease
some people; but at least it will provide a more accurate summary of my
current view of Blanchard's theory.
Introduction
Male-to-female transsexuals are popularly characterized as "women
trapped in men's bodies," i.e., male-bodied persons who are very feminine,
overtly or otherwise. And clearly there are some transsexuals for whom
this is an accurate description. But there are also some of us
male-to-female transsexuals to whom this popular description does not
so obviously apply. Many of us transitioned in our 30's, 40's, or even later,
after having lived outwardly successful lives as men. Often we were not
especially feminine as children, and some of us are not especially
feminine after transition, either. Many of us were, or occasionally still
are, married to women; often we have fathered children. A sizable number
of us identify as lesbian or bisexual after reassignment. Many of us have a
past or current history of sexual arousal in association with cross-
dressing or cross-gender fantasy. Yet there is no doubt that we experience
gender dysphoria -- a term that denotes dissatisfaction with the sexed
body -- as intensely as our more outwardly feminine transsexual sisters.
And we pursue sex reassignment surgery every bit as avidly, too.
It is not difficult to understand why biologic males who have been
extremely feminine ever since childhood, and who are sexually attracted
to men, would seek sex reassignment surgery. It is more difficult to
understand why those of us who are attracted to women, who have been
fairly successful as men, and who do not appear remarkably feminine
would do so. What force could be powerful enough to make us give up our
whole place in the world -- to make us risk estrangement from our
families, loss of our jobs, and rejection by our friends?
Some of us eventually discover that there is one force within ourselves
sufficiently powerful to sweep aside all objections. For some of us, it is a
force whose daemonic intensity has haunted and bedeviled us nearly all
our lives. That force is, of course, sexual desire -- our sexual desire to
feminize our bodies.
Sexuality and Transsexuality
Naturally, it flies in the face of conventional wisdom to assert that
transsexuality has anything to do with sexual desire. It is widely believed
that, while sexual preference may be about sex, transsexuality is about
gender. Supposedly we transsexuals transition because we are
uncomfortable with our assigned gender role, and we desire to live in the
opposite gender role. In fact, in some circles, it is no longer politically
correct to talk about "sex reassignment surgery"; the preferred term is
now "gender reassignment surgery" or even "gender confirmation surgery."
This is to emphasize -- according to the conventional wisdom -- that the
quest for the sought-after gender role is primary, and that genital surgery
is not an end in itself, but is merely a confirmation of the desired gender
transition.
Some people, however, are inclined to doubt the conventional wisdom.
Some are clinicians working with transsexual clients, who find that the
conventional wisdom often fails to explain much of what they observe.
And some are transsexuals themselves -- unusually candid transsexuals,
who are not shy about saying that sexual desire was a significant
motivation in their transitions. To understand what these people are
getting, it is helpful to become acquainted with a seven-syllable word
derived from Greek: "autogynephilia."
Blanchard's Theory
The term autogynephilia was coined in 1989 by Ray Blanchard, a
clinical psychologist at the Clarke Institute of Psychiatry in Toronto.
Blanchard defined autogynephilia as "the propensity to be sexually aroused
by the thought or image of oneself as a woman." In a remarkable series of
papers (Blanchard, 1985, 1988, 1989a, 1989b, 1991, 1993a, 1993b,
1993c; Blanchard et al, 1987), he explored the role of autogynephilia in
the erotic lives of hundreds of male gender dysphoric patients.
Like many researchers before and since, Blanchard was interested in
studying the typology of male-to-female transsexualism. Clinicians had
observed for years that males who sought sex reassignment were not a
homogeneous group. Several different categories of male-to-female
transsexualism had been proposed, invariably based on sexual orientation,
history of sexual arousal to crossdressing, or a combination of these. Many
observers had noted that gender dysphoric males nearly always displayed
at least one of two statistically uncommon erotic preferences: either
sexual attraction to males, or a history of sexual arousal to crossdressing
or cross-gender fantasy.
Based on his research, Blanchard concluded that there were really only
two distinct categories of gender dysphoric males: an androphilic
group, those who were sexually aroused primarily by males; and a non-
androphilic group, those who were sexually aroused primarily by the
idea of being women, either currently or in the past. Blanchard called
this latter group autogynephilic -- "sexually aroused by the thought
or image of oneself as a woman."
Two Types of Transsexuals
His studies revealed that gender dysphoric males who were primarily
attracted to men -- those who were androphilic, or homosexual
relative to their biologic sex -- usually reported having been rather
feminine as children (Blanchard, 1988). They presented clinically at a
fairly young age, about 26 years on average (Blanchard et al, 1987). Only
about 15% of them gave any history of sexual arousal with cross-dressing
(Blanchard, 1985). And generally they did not tend to be sexually aroused
by fantasies of simply being female (Blanchard, 1989b).
Blanchard's other category of gender dysphoric males included those
attracted primarily to women (gynephilic, or heterosexual relative
to their biologic sex); those attracted to both women and men (bisexual);
and those with little attraction to other persons of either sex
(anallophilic, "not attracted to other people"). Blanchard (1988)
found that the males in this combined group reported less childhood
femininity than those in the androphilic group; often they seemed to have
been unremarkably masculine as children. They presented for initial
evaluation at a somewhat older age, about 34 years on average (Blanchard
et al, 1987). About 75% of them admitted to a history sexual arousal with
crossdressing (Blanchard, 1985). And, most significantly for Blanchard's
theory, they were far more likely than those in the androphilic group to be
sexually aroused by autogynephilic fantasies, that is, simply by the
fantasy of being women (Blanchard, 1989b).
There is good reason to believe that among the non-androphilic
subjects in the combined group, the actual number with some history of
sexual arousal to crossdressing was probably considerably higher than
75%. In a related study, Blanchard and colleagues (1985) demonstrated
that among gender dysphoric males who were heterosexual relative to
their biologic sex, the tendency to deny sexual arousal to crossdressing
was highly correlated with the tendency to otherwise describe oneself in
a socially approved way, as measured by the Crowne-Marlowe Social
Desirability Scale. Gender dysphoric males who were homosexual relative
to their biologic sex did not show such a tendency. This provided a basis
for believing that some of the combined group subjects might not be
reporting their history accurately. Furthermore, Blanchard and colleagues
(1986) demonstrated using penile plethysmography that many gynephilic
transsexuals who denied sexual arousal to crossdressing actually did
become aroused while listening to spoken descriptions of crossdressing
scenarios. It therefore seems plausible to assume that among the non-
androphilic subjects, a history of sexual arousal with crossdressing or
cross-gender fantasy was probably nearly universal.
Transsexuality as a Paraphilia
Blanchard considered autogynephilia to be a type of paraphilia,
or unusual sexual arousal pattern. Paraphilias are defined in DSM-IV as
"recurrent, intense sexual urges, fantasies, or behaviors that involve
unusual objects, activities, or situations and cause clinical distress or
impairment in functioning" (American Psychiatric Association, 1994; p.
493). Paraphilias are often socially stigmatized, despite that fact that
many are entirely harmless. In one of his later papers, Blanchard (1993b)
amended his formulation somewhat, and suggested that autogynephilia
could also be considered a sexual orientation:
Blanchard (1991) formally distinguished four different types of
autogynephilia in gender dysphoric males, although most of his subjects
demonstrated more than one type. The first type was transvestic
autogynephilia, in which the arousal was to the act or fantasy of wearing
women's clothing. The second was behavioral autogynephilia, in
which the arousal was to the act or fantasy of engaging in some behavior
regarded as feminine; this behavior could range from knitting with other
women to having sexual intercourse with a male. (The later case,
according to Blanchard's formulation, was different from genuine
androphilia, because the arousal was not to the male partner per se, but to
engaging in a behavior regarded as typically female.) The third type was
physiologic autogynephilia, in which the arousal was to fantasies
such as being pregnant, menstruating, or breast-feeding. The fourth type
was anatomic autogynephilia, in which the arousal was to the
fantasy of having a woman's body, or aspects of one such as breasts or a
vulva.
Autogynephilia and SRS
It was entirely predictable, Blanchard felt, that biologic males who
experienced sexual arousal from the idea of having a woman's body would
in fact seek to acquire or inhabit such a body. And his research
subsequently confirmed that his subjects with the anatomic type of
autogynephilia were the ones most interested in physical transformation,
that is, in sex reassignment surgery. He summarized his theory this way
(Blanchard, 1991):
I continue to regard this as one of the most brilliant and insightful
analyses in the entire clinical literature devoted to transsexuality.
When Blanchard theorized that autogynephilic sexual desire can
sometimes lead to a person to seek sex reassignment, he was referring to
sexual desire in a broad sense. Sexual desire can, for example, be
experienced even when there is no overt genital arousal. Blanchard was
quite aware that his theory of autogynephilic transsexuality as an
outgrowth of sexual desire would have to explain why the transsexual
impulse persists even when genital arousal is reduced or absent. Many of
us with a history of sexual arousal to crossdressing or autogynephilic
fantasy report that while our overt sexual excitement diminishes over
time, our desire for sex reassignment surgery usually continues and even
intensifies. And when we autogynephilic transsexuals take estrogen, our
interest in genital sexuality is often diminished, but our desire for sex
reassignment usually is not. Such observations seemed to pose a problem
for Blanchard's theory. He rationalized this apparent contradiction by
suggesting that after a period of time, stimuli which have been
experienced as sexually exciting come to be regarded as rewarding and
desirable in their own right, even when they no longer evoke intense
genital arousal (Blanchard, 1991). Again using the analogy of heterosexual
marriage, he pointed out that husbands often continue to experience
intense emotional connection to their wives, even after their initial
intense sexual attraction has diminished or completely disappeared.
Although this explanation is plausible, we shall see that there are other
explanations as well.
Blanchard's theory does not contradict the statements of many
transsexuals, including autogynephilic ones, that they find sex
reassignment gratifying in many important non-sexual ways. We can
accept these reports as accurate, and still simultaneously accept the idea
that, for some of us, sexual desire was the origin of our transsexual impulse.
Many of us find that learning to embody such feminine traits as
gentleness, empathy, nurturance, and grace improves the quality of our
lives, and simply makes us better human beings. Even those of us who
acknowledge autogynephilic feelings often discover a number of genuine
non-sexual reasons for wanting to undergo sex reassignment. Therefore it
becomes easy, and not necessarily inaccurate, to tell ourselves and
everyone else that we genuinely did want to transition for reasons that
had nothing to do with sexual desire. Yet, many of us would probably have
to admit that sexual desire was at least originally at the heart of our
wish to transition.
Critiques of Blanchard's Theory
Not surprisingly, Blanchard's autogynephilia theory has met with some
criticisms. I will consider four of these: First, while a history of
autogynephilic eroticism and the desire for sex reassignment may
sometimes be correlated, it is difficult if not impossible to demonstrate
that the former invariably motivates or "drives" the latter. Second, a
history of autogynephilic eroticism keeps cropping up in some androphilic
transsexuals as well as in many gynephilic ones; this suggests that
autogynephilia may sometimes be an effect rather than a cause of gender
dysphoria, or an effect of some related phenomenon, such as childhood
gender non-conformity that is experienced as ego-dystonic. Third, while
transsexuals with a history of autogynephilic eroticism usually report
less childhood femininity than do androphilic transsexuals, they often
report more childhood femininity or gender non-conformity than do other
boys. This suggests that long- standing discomfort with the male gender
role may provide part of the impetus to seeking sex reassignment in some
males with a history of autogynephilia, just as it presumably does in many
androphilic transsexuals. Finally, some transsexuals who freely admit to
autogynephilic eroticism report experiencing gender dysphoria long before
they experienced autogynephilia. This suggests that perhaps gender
dysphoria may predispose to the development of autogynephilia, rather
than the reverse, and that some other factor -- possibly whether gender
dysphoria is experienced as ego-syntonic or ego-dystonic -- may
determine whether autogynephilic eroticism develops.
Critique: Autogynephilia as "Motive"
First, concerning motivation: Blanchard's research leaves little doubt
that in some males, a history of autogynephilic arousal, and particularly
anatomic autogynephilia, is correlated with the desire for sex
reassignment. But to go from correlation to attribution of motivation is
more problematic. Blanchard's measures of sexual arousal to
crossdressing (Blanchard, 1985) and of autogynephilia (Blanchard, 1989b)
did not distinguish between past and current sexual feelings. In virtually
every case, his questionnaire items concerning these topics were of the
form, "Have you ever experienced..." (emphasis added). This makes it
likely that some of his subjects with a history of autogynephilic arousal
might no longer have been experiencing autogynephilia at the time they
applied for sex reassignment, and perhaps might not have experienced
autogynephilic sexual desires for many years. It is difficult to plausibly
attribute motive to a desire that is no longer being subjectively
experienced. Blanchard (1991) acknowledged as much when he wrote:
It is especially problematic to suggest, as I have done in past writings,
that autogynephilic eroticism constitutes a motive for seeking sex
reassignment -- except, of course, in the case of the many transsexuals
who freely admit to this themselves. As sociologist C. Wright Mills (1940)
observed, motives are nothing more or less than social communications. It
is speculative, and ultimately unproductive, to theorize that the verbal
explanations we call motives in some way represent, or at times
misrepresent, objective internal psychological states or "drives."
Such ideas cannot be empirically tested. It is not possible to objectively
determine what a person's "real" motive might be, or whether a person's
stated motive is genuine. As Mills wrote, "There is no way to plumb behind
verbalization into an individual and directly check our motive-
mongering..." (p. 910). He further observed that when we doubt or challenge
a person's stated motive, all we are really saying is that their explanation
does not fall within the vocabulary of motives that we regard as
usual or plausible in such situations. (My thanks to Dr. Richard Ekins for
recommending Mills' seminal paper.)
With the exception of the passage quoted above, Blanchard does not
himself use the term "motive" in describing the relationship between
autogynephilia and the pursuit of sex reassignment. However, his
discussions of the issue, and especially his statement that non-
androphilic males who seek physical feminization are "driven to achieve
that appearance" by autogynephilia (Blanchard, 1993a; p. 74), leave little
doubt that he sees autogynephilic eroticism as a genuine motivating
factor, and not simply as a correlated feature. While this is consistent
with the self-reports of some transsexuals, autogynephilia is not the only
explanation for gender transition in persons with a history of
autogynephilic arousal, as we shall see.
Critique: Autogynephilia in Androphiles
A second objection to Blanchard's theory is that a history of
autogynephilic eroticism is consistently obtained from some apparently
androphilic transsexuals, as well as from a great many gynephilic ones.
This suggests that autogynephilia is not exclusively a misdirected form of
heterosexuality, although plausibly this might be true some or even most
of the time. The existence of autogynephilic eroticism in androphilic
gender dysphoric males suggests that autogynephilia is only a symptom,
and need not inflexibly define a whole category of persons. In particular,
it suggests that putative dichotomies such as
"younger/feminine/androphilic" versus "older/less
feminine/autogynephilic," while possibly useful as generalizations, are
over-simplifications of a more complicated reality. Does autogynephilia
typically arise by a different mechanism in androphilic transsexuals than
in most gynephilic transsexuals? If so, then perhaps autogynephilia is
sometimes merely an epiphenomenon, more a symptom than a signifier.
The more interestingly possibility is that autogynephilia might arise by
the same mechanism in androphilic and gynephilic transsexuals. At
present we can only conjecture about what such a common mechanism
might be, but one obvious candidate suggests itself: childhood gender
dysphoria that is experienced as ego-dystonic and that partially
interferes with the development of normal erotic interests in other
persons. I will return to this topic later.
Are some genuinely androphilic transsexuals also genuinely
autogynephilic? It is difficult to avoid the conclusion that some are. In his
earliest paper concerning these issues, Blanchard (1985) found that 15%
of his androphilic subjects reported a history of sexual arousal to
crossdressing. Bentler (1976) likewise observed that 23% of his
homosexual (androphilic) transsexual subjects admitted to sexual arousal
with crossdressing. Freund and colleagues (1982) found an even higher
figure: 31% of their androphilic subjects gave such a history. In a later
paper by Blanchard and colleagues (1987), 10% of the androphilic subjects
also reported a history of sexual arousal to crossdressing. Blanchard
(1989b) subsequently described the responses of androphilic and non-
androphilic subjects on the Core Autogynephilia Scale, which measures
sexual arousal to the thought or image of having a female body. The non-
androphilic subjects endorsed more items, an average of 5.4 items out of a
possible 8; but the androphilic subjects endorsed an average of 2.2 items,
hardly a null response. Standard deviations averaged around 3.0 items,
indicating substantial overlap between groups, as well as considerable
anatomic autogynephilia among some of the 117 androphilic subjects.
Leavitt and Berger (1990) studied 81 male-to-female transsexuals
classified as androphilic using Blanchard's own Androphilia Scale; 36% of
these admitted to a history of sexual arousal to crossdressing. Even
considering only those subjects who were actively androphilic (thus
eliminating those who might be "asexual" or anallophilic), 24% of this
group also reported a history of sexual arousal to crossdressing.
Blanchard rationalized the reports of sexual arousal to crossdressing
in androphilic subjects by proposing that some of those who admitted to
autogynephilia were probably not genuinely androphilic, but were really
gynephilic persons who had lied about their sexual orientation in order to
appear more "classically" transsexual (Blanchard, 1985). But if this was
so, why did they not also lie about their sexual arousal to crossdressing?
Blanchard and colleagues (1985) demonstrated that non-androphilic gender
dysphoric males who tended to describe themselves in socially approved
ways were even more likely to deny a history of sexual arousal to
crossdressing than they were to deny current sexual interest in women.
And what about the possibility that some of the androphilic transsexuals
who denied sexual arousal to crossdressing might have in fact
demonstrated such arousal if tested with penile plethysmography -- just
as some of their gynephilic counterparts had done? (Blanchard et al,
1986). Blanchard and colleagues seem not to have considered this
possibility.
The existence of genuinely androphilic transsexuals who are also
genuinely autogynephilic does not, of course, contradict Blanchard's theory
concerning the importance of autogynephilia in the life paths of many
gynephilic transsexuals. But it does call into question the meaning of
autogynephilic eroticism, and it suggests that autogynephilia is only a
symptom, the significance of which may vary from person to person.
Critique: Gender Non-Conformity in Autogynephiles
A third criticism of Blanchard's theory is that it fails to take into
account another explanation for seeking sex reassignment, one that is
frequently given by some transsexuals with a history of autogynephilic
eroticism. This is their feeling of long-standing discomfort with the male
gender role. Typically these transsexuals report a history of childhood
gender non-conformity, which was usually less dramatic than that
reported by androphilic transsexuals, but which was present nonetheless.
However, unlike their androphilic counterparts, these individuals usually
experienced their childhood gender non-conformity as ego-dystonic, and
attempted to repress it. What are we to make of such self-reports?
For his part, Blanchard does not seem to believe that gynephilic
transsexuals experience or display much femininity or gender non-
conformity early in life. He described such persons as being "without
outward signs of effeminacy" as children (Blanchard, 1990; p. 57), and he
approvingly agreed with Person and Ovesey's contention (1974) that
heterosexual transsexuals "are not effeminate in childhood"
(Blanchard, 1988; p. 192).
But other experienced clinicians see autogynephilic persons,
transsexual or otherwise, as experiencing a kind of genuine femininity,
feminine self-image, or discomfort with the male gender role, which they
seek to express for non-sexual reasons as well as for sexual ones.
Langevin (1985), another clinician from the Clarke Institute, expressed
the view that in some males with a history of sexual arousal to
crossdressing, the crossdressing "is over-determined in that it serves
orgasmic and gender needs. As drive level diminishes with age and sexual
curiosity decreases, the gender need may remain strong and stable so that
they now apply for surgery" (p. 214). Johnson and Hunt (1990) suggested
that autogynephilic transsexuals experience real gender conflicts, just as
androphilic transsexuals do; the former simply resolve these later in life.
Levine (1993) thought that "crossdressing and ... autogynephilic fantasy
are the external and internal manifestations of the same phenomenon --
the conscious experience of the self as at least partially female" (p. 135).
Blanchard's only paper that looked at childhood femininity in males
seeking sex reassignment (Blanchard, 1988) considered retrospective
self-reports by small numbers of androphilic, gynephilic, bisexual and
asexual transsexuals. Because his aim was to explore similarities
between the last three groups, Blanchard looked at only 64 of his pool of
256 subjects, selecting the 16 most prototypical examples within each of
the four groups. Among these 64, the 16 exclusively androphilic subjects
reported significantly more childhood femininity than those in the other
three groups, who were not significantly different from each other. The
limitations of this study should be obvious. Would the results have been
the same if all the subjects had been included? How did the members of
the three non-androphilic groups compare to male controls? Even if they
reported less childhood femininity than the androphilic males, the non-
androphilic males might still have reported substantially more childhood
femininity than non-transsexual males. How much variability in childhood
femininity existed within each group? Perhaps some of the gynephilic
transsexuals were very feminine individually, even if the group as a whole
was not.
Evidence from other sources is inconsistent concerning the extent of
childhood femininity in non-androphilic transsexuals. Johnson and Hunt
(1990), in a study of 25 male-to-female transsexuals, found a significant
negative relationship between gynephilia and self-reported childhood
femininity. But other researchers have found that some gynephilic
transsexuals report substantial childhood femininity. Buhrich and
McConaghy (1977) explored this topic in 12 late-onset transsexuals with a
clear history of fetishistic arousal. Of these, All these studies of childhood femininity in transsexuals relied on
self-reports, and were thus subject to potential distortion, deliberate or
otherwise. And there is reason to believe that gynephilic transsexuals may
be more prone to such distortion than androphilic transsexuals. Blanchard
and colleagues (1985) found that gynephilic gender dysphoric males who
tended to describe themselves in socially approved ways also tended to
report significantly more childhood femininity; androphilic males showed
a much smaller and non-significant tendency to do this. Still, the
hypothesis that at least some gynephilic transsexuals may experience
significant childhood femininity or gender non-conformity, and that this
may provide some impetus to gender transition, is virtually impossible to
refute.
Critique: Gender Dysphoria Preceding
Autogynephilia
A final objection to Blanchard's theory is that some transsexuals who
freely admit to autogynephilic eroticism also consistently report that
they experienced gender dysphoria long before they experienced
autogynephilic arousal. This suggests that perhaps sometimes gender
dysphoria may predispose to the development of autogynephilia, rather
than the reverse. The term gender dysphoria denotes dissatisfaction with
the sexed body and one's assigned sex (Laub and Fisk, 1974), with or
without dissatisfaction with the gender role of that sex. Blanchard and
colleagues (1987) suggested that in non-androphilic transsexuals,
autogynephilic eroticism was primary, and was a "predisposing condition"
(p. 149) for the later development of gender dysphoria . But the reverse
could as easily be true, with gender dysphoria predisposing certain males
-- mostly gynephilic, but perhaps some androphilic -- to the development
of autogynephilia. Since we do not really understand how any erotic
preference develops, we can only conjecture about how gender dysphoria
might lead to autogynephilia. But one possibility is that cross-gender
wishes may become eroticized when they are experienced as ego-dystonic
and consequently partially interfere with the development of normal
erotic interests in other persons.
It is true that, on average, gynephilic transsexuals report
crossdressing for the first time -- often with sexual arousal -- almost
simultaneously with experiencing their first cross-gender wish
(Blanchard et al, 1987). This suggests a close link between autogynephilia
and gender dysphoria. But this observation is not inconsistent with
reports by some non-androphilic transsexuals that their feelings of
gender dysphoria preceded their feelings of autogynephilic eroticism by
several years. Seil (1996) has suggested that the principal distinction
between the mostly-androphilic, mostly-early-transitioning group of
transsexuals, and the mostly-gynephilic, mostly-late-transitioning group,
is that former experience their gender dysphoria as ego-syntonic, while
for the latter it is ego-dystonic. It is temping to hypothesize that
autogynephilia may develop when ego-dystonic cross-gender feelings
partially interfere with the development of normal erotic interests in
other persons. This is consistent with the long-standing observation that
autogynephilia partially competes with sexual interests in other persons
(Blanchard, 1992). It would also explain the consistent finding of
autogynephilic eroticism in some androphilic transsexuals, as previously
noted.
Blanchard's Theory in Perspective
Although Blanchard's theory of autogynephilia has a few weaknesses
and limitations, as we have seen, I find little reason to doubt the theory's
fundamental soundness. In my opinion, it remains an impressive
formulation, of great descriptive and predictive value. If nothing else, the
way it has been embraced by hundreds of transsexual women, most of
whom never before felt that their experience had been adequately
described, is testimony to its value. But it is important to remember that
some aspects of Blanchard's theory do allow for alternative explanations.
And there are also a few well-documented observations that his theory
cannot adequately explain, except by the unsatisfying explanation that
persons who do not conform to the theory's predictions must be reporting
inaccurately, or deliberately lying.
It is also important not to over-generalize from Blanchard's theory. He
indisputably found statistical correlations, and highly significant ones,
between several of the variables he examined. But this does not imply that
the patterns he discovered will necessarily hold true in any particular
individual case. It may be true in general that transsexuals who are
primarily androphilic tend to transition earlier, to be more feminine as
children, and to be less aroused by cross-gender fantasy that those who
are primarily gynephilic. But I have no doubt that there are some
gynephilic transsexuals who transition early, who are quite feminine as
children, and who display little or no autogynephilic arousal. Likewise, I
have no doubt that there are some androphilic transsexuals who
transition late, who are not especially feminine as children, and who
display substantial autogynephilic arousal.
We should also remember that theories like Blanchard's are simply
scientific models for describing and predicting human behavior.
Such theories say, in effect, that humans generally behave as if this
or that were true. Blanchard's theory was designed to describe and predict
individual behaviors; it was not designed to, and it cannot be expected to,
describe or predict all the possible subjective experiences,
interpretations, or meanings of those behaviors for the transsexual
persons who engage in them. These highly personal, intrapsychic aspects
of the transsexual journey are really beyond the scope of behavioral
science, at least in its current form, and are perhaps better addressed in
philosophical or spiritual terms. What is remarkable about Blanchard's
autogynephila theory is that for some of us -- though certainly not for all
-- it really does seem to "get inside our heads," and to provide an
amazingly accurate description of our subjective experiences -- a mirror
of what gender dysphoria and the process of seeking sex reassignment
actually feels like to us.
More Support for the Theory
Despite nearly a decade of work, Blanchard never tested his ideas about
autogynephilia in a group of postoperative male-to-female transsexuals. I
explored the topic among a group of postoperative transsexual women at
the 1996 and 1998 New Woman's Conferences, using an anonymous survey
method. In 1996, ten of thirteen post-op women agreed that "self-
feminization was erotic" for them (Lawrence, 1997). And seven of thirteen
agreed that "self-feminization had been their primary erotic fantasy prior
to transition." In 1998, five of eleven women agreed that before surgery,
their "favorite erotic fantasy was that they had, or were acquiring, some
features of a woman's body" (Lawrence, 1998). Additional evidence for the
importance of autogynephilic fantasy in transsexuals who have undergone
surgery comes from Maryann Schroder's unpublished Ph.D. thesis, "New
Women" (Schroder, 1995). Five of her seventeen postoperative subjects
described having been aroused by autogynephilic sexual fantasies prior to
surgery. I have subsequently collected a great many individual narratives
by transsexual women, attesting to the importance of autogynephilic
eroticism in their life paths.
Why Has Autogynephilia Been Ignored?
Why is it that autogynephilia has received so little attention, even
though it is readily reported by some transsexual women? I think there
are several reasons. Among many transsexuals, autogynephilia is often
considered not to be a respectable topic for discussion. Some transsexuals
have a passionate dislike for the policies of the Clarke Institute, and tend
to dismiss almost reflexively any research performed by its clinicians.
Therefore, Blanchard's ideas are not often talked about; and when they are
raised, they tend to get shouted down. Shame is undoubtedly another
deterrent. It is probably just too threatening for many transsexuals to
admit that they have had autogynephilic fantasies, and especially to admit
that autogynephilic sexual desire may have been one of their motives for
seeking sex reassignment. Most of us transsexual women want to be seen
as "real" women, and this usually requires explaining our desire to
transition as an outgrowth of our intrinsic internal femininity.
Transsexuals who admit that their transitions were motivated by
autogynephilic sexual desire may not be seen as real women, and may not
even be seen as real transsexuals.
Therapists and surgeons probably have their own reasons for ignoring
autogynephilia. Most therapists are accustomed to thinking about
transsexuality using more traditional, gender-based formulations. The
idea that there can be sexual motivations for transition may seem
inconsistent with their paradigm; accordingly, they may think that
autogynephilic sexual desire in transsexuals is rare and aberrant. And
since their clients are often unwilling to talk about the subject, who can
blame the therapists for thinking so? Moreover, most therapists and
surgeons would probably find it difficult to acknowledge that when they
give approval for sex reassignment surgery, or perform it, they are
sometimes simply helping a transsexual woman act out her own paraphilic
sexual script.
Is Autogynephilia an "Acceptable" Motive?
Personally, however, I do not find the idea that transsexual women
sometimes seek reassignment surgery for sexual reasons to be especially
problematic, even when their sexuality is essentially paraphilic. The real
question is not what one's motivation is, but whether sex reassignment
surgery improves the quality of one's life. The overall level of
satisfaction following sex reassignment surgery is extremely high. And
the evidence seems to demonstrate that those transsexual women whom
one would expect to be autogynephilic -- late onset and sexually attracted
to women -- tend to do about as well after surgery as those who present
younger, and who are sexually attracted to men.
No one should be shocked to learn that there are people who want to
modify their bodies, surgically and hormonally, primarily to enhance their
sexual attractiveness to themselves or to others. This is a multi-billion
dollar industry in the United States alone, and most of it does not involve
transsexuals. We routinely cut, color, tattoo, pierce, augment, reduce, lift,
tuck, rearrange and contour parts of our bodies to express our sexuality
and to enhance our sexual satisfaction. Nor is this unique to modern
Western culture, as any anthropologist can tell you. I am not suggesting
that we should be complacent about SRS, or regard it as a casual
undertaking. I am suggesting that, to my mind, having sexual motivations
for seeking sex reassignment surgery does not pose any kind of unique
ethical problem. Sexual motivations underlie a vast range of medical and
surgical procedures which are routinely performed on non-transsexuals,
and which we more or less take for granted.
Spiritual Implications of Blanchard's Theory
Let me close with a few brief comments on the spiritual implications
of Blanchard's autogynephilia theory. The philosopher Friedrich Nietzsche
(1886/1966; p. 86) wrote:
I think there has been an unfortunate tendency to see Blanchard's
autogynephilia theory as pathologizing or degrading the transsexual
experience. I don't see it that way at all. We have grown up hearing that
our sexual desires are evil and unworthy, and many of us have come to
believe it. But I believe, with Nietzsche, that to live fulfilling and
authentic lives as transsexual persons, we must be willing to rechristen
our sexual desire as that which is best and most profoundly human within
us. We must honor our sexual desire as that which moves us most, as that
which makes us feel most truly alive.
We need make no apology for deciding to rebuild our lives around the
most powerful feelings we know. I think it is an act of existential courage
to honor our deepest feelings by giving them a central place in our lives.
By transitioning to live as women, we can give tangible expression to our
sexual feelings -- feelings that many of us have tried too long to suppress
and deny. And although our paths can be challenging, the benefits in terms
of vitality and inner peace can be profound.
Although I usually write about transsexuality as a physician and a
scientist, I can also appreciate and embrace the views of authors like
Susan Stryker (1994) and Rachel Pollack (1992), who write about the
transsexual journey from a more spiritual perspective. To me, the erotic
desire at the core of autogynephilic transsexuality seems like just
another aspect of what Rachel calls the "divine force" that leads us to
abandon ourselves to our bodies' desire, and what Susan refers to as the
"enlivening power" of our identification with Nature's dark, creative
chaos.
When we recognize and honor the autogynephilic feelings within
ourselves, we do not declare ourselves sick or debased. Rather, we affirm
that a life built on passion and authenticity is truly a life worth living.
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Blanchard, R. (1985). Typology of male-to-female transsexualism. Archives
of Sexual Behavior, 14, 247-261.
Blanchard, R. (1988). Nonhomosexual gender dysphoria. Journal of Sex
Research, 24, 188-193.
Blanchard, R. (1989a). The classification and labeling of nonhomosexual
gender dysphorias. Archives of Sexual Behavior, 18, 315-334.
Blanchard, R. (1989b). The concept of autogynephilia and the typology of
male gender dysphoria. Journal of Nervous and Mental Disease, 177, 616-
623.
Blanchard, R. (1990). Gender identity disorders in adult men. In R. Blanchard
& B. Steiner (Eds.), Clinical Management of Gender Identity Disorders in
Children and Adults. Washington, DC: American Psychiatric Press; 49-76.
Blanchard, R. (1991). Clinical observations and systematic studies of
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Blanchard, R. (1992). Nonmonotonic relation of autogynephilia and
heterosexual attraction. Journal of Abnonmal Psychology, 101, 271-276.
Blanchard, R. (1993a). The she-male phenomenon and the concept of
partial autogynephilia. Journal of Sex and Marital Therapy, 19, 69-76.
Blanchard, R. (1993b). Partial versus complete autogynephilia and gender
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Blanchard, R. (1993c). Varieties of autogynephilia and their relationship to
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Blanchard, R., Clemmensen, L., & Steiner, B. (1985). Social desirability
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Blanchard, R., Clemmensen, L., & Steiner, B. (1987). Heterosexual and
homosexual gender dysphoria. Archives of Sexual Behavior, 16, 139-152.
Blanchard, R., Rachansky, I., & Steiner, B. (1986). Phallometric detection of
fetishistic arousal in heterosexual male cross-dressers. Journal of Sex
Research, 22, 452-462.
Doorn, C., Poortinga, J., & Verschoor, A. (1994). Cross-gender identity in
transvestites and male transsexuals. Archives of Sexual Behavior, 23,
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Freund, K., Steiner, B., & Chan, S. (1982). Two types of cross-gender
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Johnson, S., & Hunt, D. (1990). The relationship of male transsexual typology
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Lawrence, A. A. (1997, June). Life after surgery: Questions and answers from the 1996 New Woman's
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Sex and Gender Issues, Philadelphia, PA., June 20.
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Nietzsche, F. (1886/1966). Beyond Good and Evil. New York:
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Schroder, M. (1995). New women: Sexological outcomes of gender
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Seil, D. (1996). Transsexuals: The boundary of sexual identity and gender.
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© 2000 by Anne A. Lawrence, M.D., Ph.D. All rights
reserved. autogynephilia might be better characterized as an
orientation than as a paraphilia. The term orientation encompasses
behavior, correlated with sexual behavior but distinct from it, that may
ultimately have a greater impact on the life of the individual. For
homosexual and heterosexual men, such correlated behavior includes
courtship, love, and cohabitation with a partner of the preferred sex; for
autogynephilic men, it includes the desire to achieve, with clothing,
hormones, or surgery, an appearance like the preferred self-image of their
erotic fantasies. (p. 306)
Autogynephilia takes a variety of forms. Some men are most
aroused sexually by the idea of wearing women's clothes, and they are
primarily interested in wearing women's clothes. Some men are most
aroused sexually by the idea of having a woman's body, and they are most
interested in acquiring a woman's body. Viewed in this light, the desire
for sex reassignment surgery of the latter group appears as logical as the
desire of heterosexual men to marry wives, the desire of homosexual men
to establish permanent relationships with male partners, and perhaps the
desire of other paraphilic men to bond with their paraphilic objects in
ways no one has thought to observe." (pp. 245-246)
in later years, however, autogynephilic sexual arousal may
diminish or disappear, while the transsexual wish remains or grows even
stronger. Such histories are often produced by gender dysphoric patients,
but one does not have to rely on self-report to accept that the
transsexual motive may attain, or inherently possess, some independence
from autogynephilia. (p. 248; emphasis added)
This viewpoint seems to have been largely ignored in Blanchard's
subsequent papers, however.
11 of 12
"always wanted to be a girl;"
Similarly, Doorn et al (1994) studied childhood gendered
behaviors in early-onset and late-onset transsexuals; the former were
younger, and more likely to be androphilic. The early-onset transsexuals
reported more frequent feminine play preferences as children, compared
to the late-onset transsexuals; but the late-onset transsexuals had more
frequent feminine play preferences than did a comparison of
transvestites, or a group of normal male controls. There was also
substantial variability in play preferences within all groups.
10 of 12 cross-dressed prior to puberty;
8 of 12 avoided rough and tumble sports;
10 of 12 preferred girls'
company and games;
7 of 12 were called "sissy" at school.
The great epochs of our life come when we gain the courage
to rechristen our evil as what is best in us.
Nietzsche's observation is directly relevant to our individual responses to
the autogynephilic eroticism that, for many of us, lies at the core of our
transsexual desire. One of the most negative consequences of our Judeo-
Christian heritage is our tendency to see anything sexual as evil,
degraded, and unworthy. Other high cultures have taken a more balanced
view of life. The Greeks, whom Nietzsche revered, understood the
importance of expressing and integrating both the Apollonian and the
Dionysian aspects of life. Likewise, many non-Western cultures have
understood that sexual desire is the wellspring of our creativity, and of
our emotional and physical vitality. They have understood that sexuality
can be our most direct pathway to transcendence, and to the spiritual
dimensions of life.
American Psychiatric Association. (1994). Diagnostic and
Statistical Manual of Mental Disorders (4th edition). Washington,
DC: Author; 522-523.
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