Autogynephilia: Frequently-Asked Questions
By Anne A. Lawrence, M.D.
(Photo shows Anne Lawrence with
Ray Blanchard at the annual meeting of the International Academy of Sex
Research, 2005)
"I am by no means predisposed to think that voluptuous
pleasure is the essential thing in this world. Man is more than a creature
limited to his genitals. But they, those unavowable parts of him, teach him
his secret." -- Georges Bataille (1)
"The erotic is a resource within each of us that lies in a deeply female and spiritual plane.... Our erotic knowledge empowers us, becomes a lens through which we scrutinize all aspects of our existence....
"We have been raised to fear the yes within ourselves, our
deepest cravings. But when we begin to live from within outward, in touch
with the power of the erotic within ourselves, and allowing that power to
inform and illuminate our actions upon the world around us, then we begin
to be responsible to ourselves in the deepest sense." -- Audre
Lorde (2)
(Note: These questions and answers address only the transsexualism of
biologic males. Therefore, for the sake of brevity, I will sometimes
refer to biologic males simply as males; and male-to-female
transsexuals, and transsexualism, simply as transsexuals, and
transsexualism.)
Contents:
- Briefly, what is the evidence that there are two different
"career paths" for transsexuals?
- Is there any operational method for distinguishing
between autogynephilic and homosexual transsexuals?
- Does any history of autogynephilic arousal in a
transsexual automatically make that person an "autogynephilic
transsexual"?
- How early in life can autogynephilia develop?
- Do natal women experience autogynephilia, too?
- Is it possible for autogynephilic transsexuals to transition
very early in life?
- Is autogynephilia always associated with gender
dysphoria?
- Does autogynephilia sometimes cause gender dysphoria?
Or is it the other way around?
- If autogynephilic transsexuals experience gender
dysphoria, why attribute their transitions to sexual motives? Isn't the
pain of gender dysphoria reason enough to transition?
- Why should we prefer Blanchard's theory over the simpler
explanation that gender dysphoria is the common etiologic factor in both
of his supposed types?
- Some of us who fit the autogynephilic pattern are clear
in our own minds that sexual desire had nothing to do with our decisions
to transition. We transitioned in order to express our inner personal
identities as women. Why do you disregard our experiences?
- What exactly do you mean when you say that there is
more to sexuality than just genital sex acts and orgasm?
- Pursuing sex reassignment for sexual reasons sounds
selfish, perverted, and very crazy. How can you justify it?
- What do you mean when you say that autogynephilic
eroticism poses an existential dilemma?
- You have reportedly said that gender transition for an
autogynephilic transsexual is sometimes comparable to
"lifestyle" BD/SM for a sadomasochist. Do you really believe
this?
- Your samples from the 1996 and 1998 New Women's
Conferences were small, and unrepresentative. Doesn't this invalidate any
conclusions you might draw from them?
- None of the men in Blanchard's sample population had
even begun to transition at the time they were interviewed. How can
studying them tell us anything about transsexuals who actually do
transition?
- Why do you and Blanchard keep insisting that
transsexualism is somehow related to sexual orientation? Don't you know
that gender identity and sexual orientation are independent of each
other?
- Blanchard's theory ignores the fact that people's sexual
orientation often changes after surgery. Before I transitioned, I was
attracted to women, and had no sexual interest in men. But since
transition, I've lost interest in women, and suddenly find myself attracted
to men instead. Don't experiences like mine call Blanchard's theory into
question?
- If autogynephilia really is a paraphilia, shouldn't it be
treated with psychotherapy, rather than with hormones and SRS?
- There is a paraphilia called apotemnophilia, in which
people are sexually aroused by the idea of having an amputated limb. We
certainly don't treat such people by surgically amputating their legs. So, if
some transsexuals really have a paraphilia, isn't it is equally wrong to
treat them surgically?
- A 1995 study by Zhou et al in the journal Nature
demonstrated a biologic marker for transsexualism: a female-sized
hypothalamic nucleus, the BSTc. This marker was present in both
androphilic and gynephilic transsexuals. Doesn't this demonstrate that
Blanchard's distinction is artificial?
- Blanchard describes transsexuals who are attracted to
men as "homosexual," and those who are attracted to women as
"heterosexual." Obviously he thinks of us in terms of our
biological gender, and ignores the way we think of ourselves. Doesn't this
show that he is biased against transsexuals?
- Blanchard works at the Clarke Institute, which imposes
lengthy and difficult requirements for obtaining hormones and surgery.
Obviously people at the Clarke want to make it hard for us to transition.
Isn't Blanchard's theory just another way of making SRS harder for some
of us to get -- by promoting the idea that autogynephilic transsexuals
aren't "genuine" transsexuals?
- Your phrase "men trapped in men's bodies"
seems calculated to make people think of us autogynephilic transsexuals
as freaks or perverts. Why did you have to include that unfortunate
expression?
- Your essay on autogynephilia has disturbed a lot of
transsexuals, who are now having doubts about the legitimacy of their
transitions. Why do you insist on upsetting your transsexual
sisters?
- Even if you believe Blanchard's theory, why do you have to
make such a big deal about it? Can't you see that you're playing right into
the hands of people like Janice Raymond?
- Is it true that you really are Janice Raymond?
1. Briefly, what is the evidence that there are two different "career paths" for transsexuals?
-
Men who request sex reassignment nearly always have one of two very unusual symptom complexes, but rarely both at once. One set of symptoms, the rarer of the two, involves pervasive feminine attitudes and behaviors, which are present from early childhood, and which are so strong that they are nearly impossible to conceal. Males with these symptoms are almost always sexually attracted exclusively to males. The other set of symptoms, the more common of the two, involves sexual arousal to cross-dressing or cross-gender fantasy. Men with these symptoms are almost never sexually attracted exclusively to men: they may be attracted to women, to women and men, or to neither sex.
Both of these unusual sets of symptoms -- pervasive femininity with exclusive androphilia, and sexual arousal to cross-gender fantasy or behavior -- are plausibly related to the desire to change sex. Both are rare enough that their association with transsexualism is unlikely to be accidental. While individuals with both symptoms undoubtedly exist, they are uncommon. The two types plausibly may have different implications for clinical course and treatment.
Over the years, the terms used to describe these two types of transsexualism have varied: classic vs. transvestic, primary vs. secondary, true vs. marginal, core vs. non-core, homosexual vs. autogynephilic. But the clinical distinction has been an enduring one.
2. Is there any operational method for distinguishing between autogynephilic and homosexual transsexuals?
-
Here is a test devised by clinical psychologist Michael Bailey, Ph.D., from Northwestern University -- one that I suspect is only slightly tongue in cheek. I agree with most of his items, though not all. The test is from Bailey's forthcoming book on sexual difference, and is reproduced here in its entirely, with his permission:
"Once you have learned about the distinction between autogynephilic and homosexual transsexuals, and seen several of each, distinguishing the two is easy. If Blanchard and I saw the same 100 transsexuals, I would be surprised if we disagreed on more than two. But most readers will not have met a single transsexual of either type, and even most clinicians who see gender patients are not used to thinking about them this way. In any case, you cannot simply ask someone "which type are you?" I have devised a set of rules that should work even for the novice (though admittedly, I have not tested them empirically). Start at zero. Ask each question, and if the answer is "yes," add the number next to the question. If the sum gets to +10, stop; the transsexual you're talking to is autogynephilic. If the sum gets to -10, she is homosexual.
+10 At least three times, have you become sexually aroused enough when wearing women's clothing in private that you masturbated? +10 Have you been married to, and had biological children with, a woman? +9 Have you been married to a woman, without children? +10 If I had observed your childhood behavior, would you have appeared about as masculine as other boys? +10 Are you nearly as attracted to women as to men? Or more attracted to women? Or equally uninterested in both? (If "yes" to any of these) +9 Is your sexual preference (to men, women, both, or neither) difficult for you to decide? +9 Were you over the age of 40 when you began to live full time as a woman? +9 Were you a virgin (no oral, vaginal or anal sex with another person) until after the age of 20? +7 Do you refer to yourself as "transgendered?" +6 Have you often felt envious when looking at sexy women? +10 Have you ever been in the military or worked as a policeman, truck driver, or something equally stereotypically masculine? (use your judgment) +9 Have you worked at any of the following occupations: computer programmer, businessman, lawyer, scientist, engineer, or physician? -8 (If the previous two questions are answered "no") Have you ever worked as a hairstylist, beautician, female impersonator, lingerie model, or prostitute? -9 Does this describe you? "I find the idea of having sex with men very sexually exciting, and the idea of having sex with women not at all appealing." +9 (If the answer to the previous question is "no") -8 Is your ideal sex partner a straight man? +8 (If the answer to the previous question is "no") -9 Have you had sex with many men and no women (or only one woman to see what it was like)? -7 Would you like to look at pictures of really muscular men with their shirts off? +5 (If the answer to the previous question is "no") -8 Were you under the age of 25 when you began living full time as a woman? -8 If you saw an elegantly dressed and sexy woman on one sidewalk, and a muscular, naked man on another, which would you look at? (Man) +8 (If the answer to the previous question was "woman") -7 If you could spend only one hour with a very attractive man, which would you like to do more: dance with him or suck his penis? (Penis) +5 (If the answer to the previous question is "dance") "Interviewer, ask yourself:
-8 If you didn't already know that the person was transsexual, would you have never suspected that she was not a natural-born woman? +9 (If the person has been on hormones for at least 6 months) Do you find it difficult to imagine that this person could ever pass as a woman? -6 Would some of your male friends find this person sexy? -3 (Male Interviewers) Is this person flirting with you? +8 (Female Interviewers) Is this person flirting with you?
"Finally, this interview could be invalid if you suspect that the transsexual may be autogynephilic and either (a) worried you will think badly of her or will deny her a sex change if you know the truth, or (b) obsessed with being a "real" woman. As far as mistakes, it is more likely that the interview would identify an autogynephilic transsexual as homosexual than vice versa."
3. Does any history of autogynephilic arousal in a transsexual automatically make that person an "autogynephilic transsexual?"
-
That would be an overstatement. Although the correlations between autogynephilic sexual arousal and other parts of the autogynephilic symptom cluster seemed to be very strong among Blanchard's gender dysphoric males, they were not perfect. For example: Blanchard found that 10 - 15% of his homosexual subjects gave a history of sexual arousal with crossdressing, compared to 66 - 87% of his non-homosexual subjects. While this is a very significant difference, it is certainly not absolute. Even if we hypothesize that some non-homosexual subjects tried to make themselves look more acceptable, by either lying about their arousal to crossdressing, or by pretending to be exclusively homosexual, the correlation is not likely to approach 100%.
While the extension of Blanchard's theory from gender dysphoric males to transsexuals (pre-op or post-op) is logical, and is widely used clinically, it has yet to be validated in a formal study. Even if it is, its predictions will never be absolute. There will always be exceptions.
4. How early in life can autogynephilia develop?
-
Apparently quite early. Stoller reported the case of a child, "Mac," who wore his mother's clothes and became sexually aroused (with penile erection) at age two, and who was first seen clinically at age three (3). Zucker and Blanchard reported a similar case, "Dan," who cross-dressed in his mother's or sisters' clothes and became sexually aroused (again with penile erection) starting at age two, and who was also first seen clinically at age three (4). Both of these children were in other ways unremarkably masculine.
5. Do natal women experience autogynephilia, too?
-
Here's what Blanchard had to say when I asked him that very question:
"There are many human behaviors that look like the same thing, but really aren't. I do not think that genuine autogynephilia occurs in genetic women. Genetic women might 'feel sexy' when preparing their toilet, especially if they are making a major production of it, but I do not think the simple thought of having a vagina, for example, is arousing to them in and of itself." (5)
I find his analysis persuasive.
6. Is it possible for autogynephilic transsexuals to transition very early in life?
-
Definitely. Although late transition is more common for autogynephilic transsexuals, I've talked with several who transitioned in their mid-twenties. In fact, one of the reasons I want to increase consciousness about the phenomenon of autogynephilia is to let persons who have experienced it know that it does not preclude the diagnosis of transsexualism. If this becomes more widely understood, we may see even more early-transitioning autogynephilic transsexuals. On the whole, I think that would be a positive development.
7. Is autogynephilia always associated with gender dysphoria?
-
Gender dysphoria can be defined as "persistent discomfort with [one's] sex, or [a] sense of inappropriateness in the gender role of that sex" (6). It is a convenient but imprecise diagnosis, encompassing many combinations of body dysphoria, gender identity disturbance, sex role discomfort, and atypical sexual preference.
Obviously not all gender dysphoric males are autogynephilic. Likewise, not all autogynephilic males are gender dysphoric. Many, perhaps most, autogynephilic males can compartmentalize or otherwise manage their autogynephilia -- at least for a time. Their condition does not rise to the level of "persistent discomfort," and they do not seek sex reassignment. We call such persons cross-dressers, transvestites, or transvestic fetishists.
8. Does autogynephilia sometimes cause gender dysphoria? Or is it the other way around?
-
No one knows for sure. It seems probable that there is no single causal or temporal relationship between gender dysphoria and autogynephilia. Some clinicians seem to think that in autogynephilic transsexuals, autogynephilia often comes first, with severe gender dysphoria and clinical transsexualism developing later. Other commentators -- often transsexuals themselves -- suggest that some sort of gender dysphoria may be primary, and that autogynephilic eroticism may develop when gender dysphoria interferes with "normal" sexual interests. I suspect that this latter explanation is true at least part of the time. It seems most consistent with my own experience, and with the reports of many others.
It also seems plausible to me that life-long inability to feel right about one's body or role in sexual situations might often lead to "persistent discomfort." The discrepancy between what one desperately wants and what really exists could easily become intolerable. Any situation that aroused sexual feelings might then produce intense sadness and longing, protective dissociation from one's own body, or retreat into autogynephilic fantasy. I experienced one or more of these symptoms virtually every time I had a sexual thought, or participated in a sexual act. To say that this created "persistent discomfort" would be an understatement.
Of course, there is much more to life than sex. But we are sexual beings, and our sexuality is intrinsically linked to our sense of self. Nor are persons with normal male levels of testosterone able to avoid sexual feelings for very long. When those feelings collide with autogynephilia, with an unacceptable male body and male role expectation, gender dysphoria seems like a predictable result.
9. If autogynephilic transsexuals experience gender dysphoria, why attribute their transitions to sexual motives? Isn't the pain of gender dysphoria reason enough to transition?
-
Gender dysphoria certainly can be unbearably painful, and it undoubtedly is a factor in most transitions. If sexual desire is often the carrot motivating transition, gender dysphoria is usually the stick. But for autogynephilic transsexuals, I think that the distinction between sexual desire and gender dysphoria is usually somewhat academic. In my opinion, it is more useful to think of them as being different sides of the same coin.
10. Why should we prefer Blanchard's theory over the simpler explanation that gender dysphoria is the common etiologic factor in both of his supposed types?
-
Clinicians prefer theories that explain more observations. Blanchard's theory that homosexual and autogynephilic transsexuality comprise two distinct types was originally suggested by clinical observations. Does his theory really have greater explanatory value than one that lumps the two types together? I think it does.
The concept of autogynephilia explains the observation that non-homosexual transsexualism usually has a very different clinical course than homosexual transsexualism. It may also have implications for treatment. There continue to be studies suggesting an increased likelihood of postoperative regrets in transsexuals who are "non-core," (i.e., autogynephilic). Years ago, most experts believed that SRS was a much riskier proposition for non-homosexual transsexuals. Nowadays, that is not so widely accepted; and some clinicians think that autogynephilic transsexuals may actually be at lower risk for certain problems. Until these issues are clarified, it seems useful to hold on to the concept of autogynephilia, or something like it.
The theory of autogynephilia also explains the relationship between transsexuality and other cross-gender phenomena such as transgenderism, transvestic fetishism, and heterosexual crossdressing. For this reason, psychologist Michael Bailey has called autogynephilia the "Unified Field Theory of transgenderism." In addition, by emphasizing that autogynephilic transsexuality is a type of paraphilia, Blanchard's theory predicts the greater prevalence of still other paraphilias (notably sexual masochism) among autogynephilic transsexuals.
By recognizing autogynephilic transsexualism as a distinct entity, we also emphasize that persons with a history of autogynephilic arousal can be appropriate candidates for SRS. Historically, many autogynephilic persons believed that they could not really be transsexual. They thought that because they had been sexually aroused by the idea of being women, they could not qualify for SRS, or would not be helped by it. Some clinicians who should know better still think that way. It is vital that autogynephilic persons and their caregivers understand that autogynephilia does not preclude the diagnosis of transsexualism, and that transition and SRS often provide effective palliative treatment for autogynephilic transsexuals.
11. Some of us who fit the autogynephilic pattern are clear in our own minds that sexual desire had nothing to do with our decisions to transition. We transitioned in order to express our inner personal identities as women. Why do you disregard our experiences?
-
I think that statements like the above are based on a false dichotomy. It is entirely possible to transition in order to express one's inner sense of self, and simultaneously to have motivations that are primarily sexual. In fact, I suspect that this is probably the most common situation. While some autogynephilic transsexuals may transition for reasons completely unrelated to sexual desire, I am inclined to doubt that this is usually the case.
It is hardly surprising that some transsexuals with a history of autogynephilic arousal would want to deny that their transitions had anything to do with sexuality. We live in a sex-negative culture, and there is little social support for affirming one's sexuality. Shame, and a desire to distance oneself from anything that seems "too male," are other possible contributing factors. In some cases, denial of sexual motives is probably both accurate and appropriate. But in other cases, I suspect that transsexuals who deny that sexuality played a part in their transitions are being less than honest with themselves.
There are a few common strategies autogynephilic transsexuals use when they deny having sexual motives. One of these is to define sexuality very narrowly: "What? You think I'd give up my career and my family for better sex? That's ridiculous!" "Even if I knew I'd never have another orgasm, I still would have transitioned." Well, I could honestly say the same things; but statements like these miss the point. There is a lot more to sexuality than just genital sex acts and orgasm.
Another way some autogynephilic transsexuals deny having sexual motives is by emphasizing their supposedly lifelong internal femininity -- which they believe is unrelated to sexuality. They then say that they transitioned primarily to express this hidden feminine identity. In some cases they are probably correct. But I suspect that in many cases, this internal femininity is nothing other than a direct outgrowth of autogynephilic sexual desire.
Do we autogynephilic transsexuals typically demonstrate many non-sexual feminine tendencies early in life? Although there are undoubtedly some exceptions, I think the answer is that usually we do not. Many of us may have been bookish, or not especially assertive, or disinterested in sports. Perhaps we even played with dolls a time or two. We love to emphasize things like these -- which are actually commonplace among natal males -- as evidence of our internal femininity. It is only natural that we should look for such early corroborative signs as we retrospectively try to make sense of our lives. But in reality, outside of our sexual interest in feminization, our histories are often well within the norm for non-transsexual males. And they are nearly always dramatically different from the histories of homosexual transsexuals, whose femininity is usually pervasive, and very obvious.
I suspect that what is actually most feminine about many of us autogynephilic transsexuals, at least in the beginning, is our autogynephilic image of ourselves -- our sexual fascination with the idea of becoming women. While most of us eventually do develop a broader kind of internal femininity, this often comes much later, and primarily as an outgrowth of our autogynephilia. I certainly don't mean to disparage this secondary femininity that some of us develop. Although it looks a bit different from the femininity of most natal women, I nonetheless believe it is real. Often it saves our lives. In fact, I think that developing a viable feminine persona constitutes one of the best, and most creative, responses to the existential dilemma that autogynephilic sexuality poses for our lives.
But when we transition in order to express this kind of internal femininity, we really are operating from sexual motives, at least in my opinion. By living in role, by bringing our admittedly secondary femininity into the real world, we can at last give concrete expression to our sexuality in the largest sense of that word. And we can do so in a way that carries at least the possibility of reclaiming our bodies, and our desires.
12. What exactly do you mean when you say that there is more to sexuality than just genital sex acts and orgasm?
-
Psychologist Heino Meyer-Bahlburg alluded to the multiple manifestations of sexual desire when he recently wrote:
"...there are many diverse aspects of sexuality from which people draw pleasure, ranging from the awareness of attraction and beauty to the excitement of flirtation and courtship to the experience of orgasm and subsequent relaxation, interwoven with all the nonsexual aspects of sexual motivation." (7)
Our sexuality is intrinsic to our sense of self. Of course we are built, hormonally and neurologically, for genital pleasure, and we have a natural desire to experience that pleasure. Perhaps this applies particularly to those of us who have experienced normal male levels of testosterone: we are no strangers to pure lust. But sexuality is more than this.
While genital arousal is often temporary, sexual love can last a lifetime. Most of us have had the experience of continuing to love a sexual partner whom we no longer find sexually exciting in a purely genital sense. I think that something akin to this happens with our internal images of ourselves as feminine, or feminized, persons: we come to cherish those images, even if they lose some or all of their capacity to arouse us genitally. We find the idea of being feminine persons comforting -- and compelling -- at a deep level. For some of us, the feelings we associate with our internal feminine selves become the strongest feelings we know. Eventually, often in mid-life, many of us experience a need to honor our strongest feelings by giving them a central place in our lives. The result is gender transition -- a process that, in this scenario, is a direct outgrowth of our sexual feelings.
For some of us, sexuality also includes the desire to find a satisfying categorical sexual identity and presentation to take into the social world. I longed for this all my life. For many of us, maleness and masculinity, and femaleness and femininity, are natural categories. We have a desire to wholeheartedly inhabit one of these categories -- to experience the myriad rewards that come from having a congruent polarity, and from feeling our polarity interact with that of others. For me, wanting this was an aspect of sexual desire. When I tried to live as a man, I felt no comforting affinity bred of similarity with either men or women; and likewise no exciting tension bred of otherness with either. Of course, I did become close to particular intimate partners, invariably women. And I did feel a very unsatisfying tension with both men and women, born of estrangement from the former, and envy of the latter. But I saw that there was more, and I longed to experience it. Having finally done so, I can now describe it better.
One of the best parts of my life now is my feeling of affinity with other women. This is not a genital feeling, but it is a sexual one; it is too visceral an experience to be anything else. Before transition, I experienced it as a desire to inhabit "women's space," physically and emotionally. Now it takes its form in the unspoken communication of a look, or in shared laughter. It is the tensionless physical acceptance I experience in the women's shower at the pool, or when squeezed in next to another woman in the airport shuttle. To be "just another woman" in settings like these is deeply affirming . For me, this is an aspect of sexuality, and my longing to experience it was an aspect of my sexual desire.
And with men? Nowadays in my social relations with men, I have many experiences that validate my womanhood; these are, at some level, "sexy." But they are only indirectly related to the visceral satisfaction of being not male, and of being able to define and measure myself in relation to a category that is, at last, unequivocally other. I believe that this, too, is an aspect of sexuality.
For another, far more poetic, expression of what sexuality means in the broadest sense, I recommend Audre Lorde's essay "Uses of the Erotic: The Erotic as Power." A complete citation for this work appears as the second reference at the end of these questions and answers.
13. Pursuing sex reassignment for sexual reasons sounds selfish, perverted, and very crazy. How can you justify it?
-
Since I prefer to define sexuality broadly, to me it sounds creative, heroic, and lifesaving. As we transition, we autogynephilic transsexuals create for ourselves our own unique transsexual femininity. This functions as a kind of protective exoskeleton for the most vital part of ourselves, our sexuality. It allows us to cast off some of our shame, and take our vital centers into the real world, allowing them to live and breathe and be seen. Gender transition is an elegant and creative solution to the existential dilemma posed by autogynephilic sexuality.
14. What do you mean when you say that autogynephilic eroticism poses an existential dilemma?
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We autogynephilic proto-transsexuals must eventually confront the fact that the strongest feelings we know are tied to fantasies of being someone we are not. The emotions and desires that make us feel most alive seem as though they can never be actualized or expressed. The love and pride we should feel for our own bodies are absent: at worst, our bodies disgust us; at best, they are unsatisfactory, and make us long for something different. Our attempts at intimacy are undermined by the fact that who we seem to be to others is vastly different from our idealized internal selves, which ache to be touched and loved and genuinely seen.
Our choices are unenviable. Trying to accommodate or compartmentalize our paraphilia sometimes works, at least for a while. Many strategies are available, and most of us try several. Crossdressing can be exhilarating, although it provides little lasting comfort to those of us who desperately want female bodies. Putting ourselves in all-male surroundings can temporarily facilitate our denial or repression by removing the reminders of who we desire to be. Throwing ourselves into our work, our hobbies, or our art provides satisfaction of a kind, and helps us forget what stirs us most. Habitual resort to fantasy in sexual situations is tempting, since it provides us with a brief respite from our unhappy reality. But continual retreat into fantasy inevitably leads to shame. It also precludes real connection to others, and results in isolation, emptiness and despair. Still, many of us never even consider our other option, transitioning; or if we consider it, we do not go forward. We let our dreams languish. That is the safe choice, the easy choice. It is the choice that lets us keep our families, our possessions, and our reputations. If the price we pay is constant longing or emotional deadness, we can at least console ourselves that many others around us are paying the same price, in their own way. That is the choice I made for thirty years -- and it would have been frighteningly easy to have kept on making that same choice for thirty more.
But, thanks to medical technology and our time in history, we autogynephiles do have another choice. We can honor our strongest feelings by essentially rebuilding our lives around our paraphilia. It is our peculiar blessing that we are able to do so -- most paraphilias do not really permit this option. The practical problems are, of course, huge. If we try to live as women, we risk losing everything: our friends, our jobs, our families and our reputations. The discrepancy between the bodies we can construct and the bodies we desire is frequently a source of disappointment. But the greatest problem we face is that, in most cases, we must create our womanhood from the ground up. To make our transitions work, we must try to become women, or the best facsimile we can create. It's much like learning a second language as an adult: difficult, time-consuming, and often frustrating. But it has to be done. It is the labor of a lifetime; and although we may become fluent in our second language, we rarely lose our accents, or pass as native speakers. But if we persist, we earn -- at least in my opinion -- the right to call ourselves women.
Although our losses are often great, the rewards for our efforts are many. The most obvious of these is that we can give expression to our most intense feelings: we get to move through life feeling truly alive. Part of this, undeniably, is the palpable sexual frisson we feel when we see our own images, or when someone treats us as the women we have always wished to be. Part of it is the satisfaction of knowing that we have actively created our lives, and have not been mere passive victims of a fate we did not choose. And beyond this, we get to live as women, which is its own reward. Many of us find that it is better and richer than we ever could have dreamed. It becomes our entrance ticket to true humanity. It is so good that it becomes easy for us to forget the path by which we came. Many of us do forget.
So that is our choice: to live safe, respectable lives and lose our souls; or to honor our strongest feelings and risk losing everything else, in pursuit of self-made womanhood. That is our existential dilemma.
15. You have reportedly said that gender transition for an autogynephilic transsexual is sometimes comparable to "lifestyle" BD/SM for a sadomasochist. Do you really believe this?
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Consider the following quotation:
"I'm happier now than I ever have been. Most people I meet are living their lives dreaming dreams of what they wish could happen to them, what they wish they could be, and they're not pursuing those dreams. I pursued my dream. I've gone for what I really wanted in my life, and I've gotten it." (8)
It sounds like a typical comment from a postoperative transsexual, doesn't it? But it was actually written by a non-transsexual woman, living as a permanent submissive in a lifestyle BD/SM relationship.
I think the analogy is obvious: sometimes one's paraphilic sexuality is sufficiently compelling that one decides to build one's whole life around it. Of course, both transsexuality and lifestyle BD/SM are more complex than this comparison suggests. Even in the qualified form above, the analogy should be seen as a kind of rhetorical oversimplification. But it does serve to remind us that in many cases, sexual desire underlies gender transition.
16. Your samples from the 1996 and 1998 New Women's Conferences were small, and unrepresentative. Doesn't this invalidate any conclusions you might draw from them?
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I don't think so. My questions at NWC 6 and 8 were exploratory, and were simply designed to see whether a history of autogynephilic arousal was easy to elicit. As it turned out, it was very easy. But I do agree that the NWC populations are too small, and probably too unrepresentative, to tell us anything about the prevalence of autogynephilic eroticism in transsexuals generally. I stated this clearly in my paper presenting the 1996 data. We need better studies, with larger sample sizes. I hope to participate in performing these.
17. None of the men in Blanchard's sample population had even begun to transition at the time they were interviewed. How can studying them tell us anything about transsexuals who actually do transition?
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The premise underlying this question is untrue. We actually have no idea how many, if any, of Blanchard's subjects had begun to transition at time they were interviewed. All we know is that they had not completed transition. I fully agree, however, that Blanchard's theories need to be confirmed in a large postoperative population.
18. Why do you and Blanchard keep insisting that transsexualism is somehow related to sexual orientation? Don't you know that gender identity and sexual orientation are independent of each other?
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The idea that gender identity and sexual orientation are two entirely independent aspects of personality has been immensely useful in explaining homosexuality and transsexualism to unsophisticated lay audiences. Unfortunately, it is not a concept that stands up very well to detailed scrutiny.
Sexual orientation is itself "gendered," just as dress and behavior are. There is one expected sexual orientation for biologic males, gynephilia; and another for biologic females, androphilia. Therefore, it is perhaps not too surprising that sexual orientation actually correlates rather well with other gendered behaviors and personality traits. For instance: a large majority of gay men report having been rather feminine boys during their childhood. And while most gay men defeminize by adulthood, many remain more feminine than average straight men in ways other than just their sexual orientation. The analogous situation holds true for lesbians: a higher prevalence of masculine behaviors during childhood, with some persistence into adulthood.
By extension, we might also expect to find that sexual orientation would correlate with other gendered behaviors and personality characteristics among transsexuals. In particular, it should perhaps not surprise us that natal male transsexuals who are androphilic tend to be more feminine than those who are gynephilic -- the same pattern observed among males who are not transsexual.
19. Blanchard's theory ignores the fact that people's sexual orientation often changes after surgery. Before I transitioned, I was attracted to women, and had no sexual interest in men. But since transition, I've lost interest in women, and suddenly find myself attracted to men instead. Don't experiences like mine call Blanchard's theory into question?
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If any non-transsexual person were to give such a history of a sudden reversal in sexual orientation, most people would probably be skeptical. But people often seem to uncritically accept stories like these from transsexuals, perhaps because they believe that the resulting "heterosexuality" is somehow natural. However, given everything we know about the development of sexual orientation, and its stubborn resistance to any attempt to change it (witness the failures of "reparative therapy" for homosexuality), I am not convinced that we should take such reports by transsexuals at face value.
We should first be clear to define our terms. As Kurt Freund pointed out, androphilia and gynephilia are most usefully defined in terms of preference for a particular body type: for an "identifiable male or female body shape, particularly the type of external genitals" (9). I do not think there is persuasive evidence that sexual orientation, defined in this way, does demonstrably change with transition or surgery.
I am certainly willing to believe that transsexuals who had no sexual interest in men prior to transition are sometimes very interested in having sex with them after transition and surgery. But I think that this newfound interest in men is more about validation in the female role than it is about a genuine change in preference for body type. Many transsexual women have said as much about themselves. There is also suggestive evidence that goes beyond self-reports. Blanchard observed that:
"...bisexual subjects are more likely than all others to report sexual stimulation from the fantasy of being admired, in the feminine persona, by another person. This suggests that bisexual gender dysphorics' interest in male sexual partners is mediated by a particularly strong desire to have their physical attractiveness as women validated by others. This "bisexual" behavior need not reflect an equal erotic attraction to the male and female physiques (and would perhaps be better characterized as pseudobisexuality)." (emphasis in the original) (10)
Isn't it interesting that while transsexuals who were attracted to women prior to transition often claim that their sexual orientation changed dramatically after surgery, transsexuals who were attracted to men before transition almost never report this?
20. If autogynephilia really is a paraphilia, shouldn't it be treated with psychotherapy, rather than with hormones and SRS?
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Unfortunately, psychotherapy is notoriously ineffective at reducing any type of paraphilic sexual desire. Despite occasional case reports to the contrary, neither traditional psychotherapy nor behavioral modification has an enviable track record in this area. The possible exceptions lie in control of paraphilic sex offending; and here the emphasis is not so much on "cure" as it is on "relapse prevention." While it may be possible for highly motivated individuals to control socially unacceptable behaviors, it is much less clear that paraphilic desires can really be modified or eliminated. This takes us back to the existential issues discussed in Question 14 above.
Arguably the most successful treatment for many paraphilias is pharmacologic reduction of libido. The drugs commonly used to affect this reduction are the anti-androgens medroxyprogesterone and cyproterone. I think part of reason that gender transition is such an effective treatment for autogynephilic transsexualism is that the estrogenic and antiandrogenic medications used to achieve physical feminization reduce testosterone levels, and therefore cause a reduction in libido. This can provide subjective relief from the gender dysphoria that accompanies autogynephilic sexual desire.
21. There is a paraphilia called apotemnophilia, in which people are sexually aroused by the idea of having an amputated limb. We certainly don't treat such people by surgically amputating their legs. So, if some transsexuals really have a paraphilia, isn't it is equally wrong to treat them surgically?
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You are probably thinking I invented this one; but, surprisingly, the apotemnophilia question comes up rather frequently, and it cannot easily be dismissed.
It is hard for me to construct a completely persuasive argument why performing SRS on an autogynephilic transsexual is in principle different than amputating the leg of an apotemnophile. Most of the issues I can raise to justify SRS for autogynephiles, vs. amputations for apotemnophiles, are pragmatic rather than philosophic. And I think that pragmatism and history, more than principle, explains why autogynephiles can get surgery, while apotemnophiles can't.
Interestingly, almost the same argument as the one above was once raised with the early classic homosexual transsexuals: how can one justify amputating perfectly normal structures? The answers here were easier. The apotemnophile's leg was essential for ambulation, so performing surgery on him would result in a loss of function. Therefore it was unacceptable, since everyone -- except perhaps the apotemnophile himself -- agreed that sexual pleasure was less important than having a functional leg. But the classic transsexual's genitalia were already non-functional: she used them neither for reproduction (since she wanted only men as partners), nor for sexual pleasure (since she wouldn't allow her penis to be touched during sex). So performing SRS on her could actually improve function: at least after vaginoplasty, sex would theoretically be more satisfying.
The other reason surgery was considered acceptable for classic transsexuals, but not for apotemnophiles, was that performing SRS cured perversion -- something homosexuality was considered to be, prior to 1973. Performing surgery on an apotemnophile would only cater to his perversion. This side benefit -- changing unhappy homosexual men into happy heterosexual women -- made everyone feel better about performing vaginoplasties. So historically, SRS for classic transsexuals became quasi-acceptable.
The problem, of course, was that if classic homosexual transsexuals could qualify for surgery, any transsexual could -- all that was necessary was to lie. And a good deal of lying occurred. After a time, the liars reached critical mass, and evidence began to accumulate that those transsexuals who had lied about their sexual feelings and orientations were actually doing rather well after SRS.
This takes us to the present day. There is now persuasive evidence that SRS is an effective treatment for transsexuals who have the paraphilia known as autogynephilia. And although nobody wants to argue in the abstract that surgical accommodation of paraphilias is a good idea, as a practical matter the issue is settled. If someone did want to try to prevent the surgical treatment of autogynephiles, the only way to do so would be to stop all SRS, since autogynephiles could simply start lying again. But given the interlocking interests of transsexuals, therapists and surgeons, and the world-wide availability of SRS, it is inconceivable that surgical sex reassignment could ever be done away with. The genie will not go back into the bottle.
Probably part of the reason that gender transition and SRS provide such an effective treatment for autogynephilic transsexualism is that hormone therapy and castration reduce testosterone levels. Reduction of libido using anti-androgens has consistently been one of the most effective therapies for a variety of paraphilias.
22. A 1995 study by Zhou et al in the journal Nature demonstrated a biologic marker for transsexualism: a female-sized hypothalamic nucleus, the BSTc. This marker was present in both androphilic and gynephilic transsexuals. Doesn't this demonstrate that Blanchard's distinction is artificial?
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The paper by Zhou et al in Nature (11) has always been controversial, in part because its sample size was very small (n=6). Some experts have made no secret of their belief that its results probably will not hold up if anyone tries to repeat the study. If so, it wouldn't be the first time that Dick Swaab's lab reported a gender difference in a hypothalamic nucleus, which could not be confirmed by subsequent investigators. This should not be interpreted as a criticism of Swaab's lab -- it's just the nature of the work, and it happens to others, too.
Four cell groups in the human anterior hypothalamus have frequently been examined for sexual dimorphism. They are usually referred to as interstitial nuclei of the anterior hypothalamus (INAH) 1, 2, 3, and 4. In 1985 (12), and again in 1989 (13), Swaab and collaborators reported sexual dimorphism in a human hypothalamic nucleus they called the SDN-POA (sexually dimorphic nucleus of the pre-optic area), which is identical with INAH 1 (14). But investigators Laura Allen and Roger Gorski in 1989 (15), and Simon LeVay in 1991 (16), were unable to confirm sexual dimorphism in INAH 1. Allen and Gorski did, however, find sexual dimorphism in INAH 2 and INAH 3. LeVay confirmed their finding for INAH 3, but he could not confirm sexual dimorphism in INAH 2. This should provide some idea of the difficulties involved in neuroanatomical studies such as these.
Replicating the Zhou et al study will be difficult, since transsexual brains are hard to obtain. But even if this were done, and the original findings were confirmed, it would not change the clinical utility of Blanchard's model.
23. Blanchard describes transsexuals who are attracted to men as "homosexual," and those who are attracted to women as "heterosexual." Obviously he thinks of us in terms of our biological gender, and ignores the way we think of ourselves. Doesn't this show that he is biased against transsexuals?
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I don't believe that the terms he used reflect any anti-transsexual bias. There is really no entirely satisfactory terminology; arguably Blanchard chose the system which was in most common use at the time he wrote. He was always careful to explicitly reference the terms homosexual and heterosexual to biologic sex. The alternative usage -- applying these terms with reference to a person's internal sense of self -- is superficially appealing; the problems come when that internal sense is unknown, ambiguous, or rapidly alternating. Some would prefer to see androphilic and gynephilic, or their equivalents, used instead, as DSM-IV has done. One disadvantage of that system, however, is that it provides no single term for either expected or variant sexual orientation that can be applied to both sexes.
One benefit of consistently calling pervasively feminine, androphilic transsexuals "homosexual" is that it emphasizes that homosexuality is indeed part of their developmental path. Virtually all the transsexuals Blanchard calls homosexual do go through a phase of gay male identity; this is rare among autogynephilic transsexuals.
In private communications, Blanchard has evidenced a genuine desire to be sensitive to the gender community's feelings about terminology. This is from one of Blanchard's posts to SEXNET, a closed list service for sex researchers; it is quoted here with his permission:
"... [I have] gone out of my way to avoid describing the difference in gender identity between autogynephilic and homosexual transsexuals in language that might be construed as evaluative. Thus, I have avoided language like 'primary' and 'secondary' transsexuals. I certainly understand what people who use those terms are trying to say, but that terminology inevitably suggests that there is one group of 'true' or 'genuine' transsexuals and another group of 'fake' or 'ersatz' transsexuals.
"If there is any group on earth who can help us understand the nature of autogynephilia, is it autogynephilic transsexuals. I have therefore tried-- for motives that could validly be construed as self-serving [rather] than as sensitive -- to avoid language that is likely to get their backs up." (17)
24. Blanchard works at the Clarke Institute, which imposes lengthy and difficult requirements for obtaining hormones and surgery. Obviously people at the Clarke want to make it hard for us to transition. Isn't Blanchard's theory just another way of making SRS harder for some of us to get -- by promoting the idea that autogynephilic transsexuals aren't "genuine" transsexuals?
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You can judge for yourself. Here is a quotation from one of his articles:
"Before concluding, we must comment on one use to which our data must not be put, namely, that of denying heterosexual TSs access to sex reassignment surgery. Previous writers have reported the -- to us, unreasonable -- policy of refusing approval for sex reassignment surgery to patients who report even one episode of erotic arousal in association with cross-dressing. This attitude has been abandoned in some gender clinics in light of data showing that "transvestic" or "secondary" TSs may profit as well from sex reassignment as the idealized "true" or "primary" TS. This finding is fully in accord with our own experience. It is not our intention to breathe new life into a prejudice that protects theory by precluding contrary evidence, and at the possible expense of patients." (18)
This is consistent with sentiments Blanchard has expressed to me in private correspondence.
25. Your phrase "men trapped in men's bodies" seems calculated to make people think of us autogynephilic transsexuals as freaks or perverts. Why did you have to include that unfortunate expression?
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The phrase "men trapped in men's bodies" was actually inspired by some remarks made by Davina Anne Gabriel, during an interview she conducted with Rachel Pollack. At one point, Rachel was saying that before transition, she felt like she was already a woman. Davina, with her characteristic candor, expressed something rather different:
"When I look back on it, and I examine it honestly, I don't really feel that I can say that I felt that I was a woman already; ...the only thing that I feel that I can honestly say ... is that I very intensely desired to be a woman, that I was even almost obsessed with being a woman. But, no, I can't honestly say that I felt like I was already a woman. My experience was very much one of very intensely desiring to be something that I knew that I was not." (emphasis in original) (19)
This self-revelation made a great impression on me, especially coming from Davina, a woman I greatly admired (and still do). It exactly paralleled my own feelings. Moreover, it was something I had never heard any transsexual woman say before -- and have rarely heard any say since. So one of the things I wanted to emphasize in my essay was that the "woman trapped in a man's body" cliche doesn't apply to some of us. In particular, it never applied to me.
As the essay emphasized, the phrase "men trapped in men's bodies" should not be interpreted as disparaging. I also believe everyone has a right to self-define. I wrote:
"I also acknowledge that some persons fitting the above description would emphatically deny that they were ever 'really' men, and I have no quarrel with their self-definition."
26. Your essay on autogynephilia has disturbed a lot of transsexuals, who are now having doubts about the legitimacy of their transitions. Why do you insist on upsetting your transsexual sisters?
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When I discovered Blanchard's writings about autogynephilia, I was overjoyed to find a theory that spoke so strongly to my internal experience. But it took me some time to understand that Blanchard's ideas in no way threatened the legitimacy of my transsexuality, and that they did not preclude the possibility of my making a successful gender transition. Until I resolved these issues in my own mind, I was admittedly somewhat uneasy.
My goal in writing about autogynephilia was to facilitate the transitions of those who might also have discovered autogynephilic feelings within themselves. I hoped to show that autogynephilia was consistent with "genuine" transsexualism, and to explain in practical and philosophical terms why autogynephilia was not incompatible with successful transition. If my essay has had the effect of making some people with autogynephilic feelings doubt that they should transition, this was certainly not my intention.
I believe that persons who find the concept of autogynephilia greatly upsetting should consider discussing their feelings with a qualified gender therapist, or with a sympathetic friend or peer counselor.
27. Even if you believe Blanchard's theory, why do you have to make such a big deal about it? Can't you see that you're playing right into the hands of people like Janice Raymond?
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It has been said that we generally write the works we wish we'd had access to at an earlier point in our lives. That is why I wrote my essay on autogynephilia. I think it's important that younger transsexuals understand that autogynephilic eroticism is not a disqualification from the transsexual journey. It is an issue I feel quite passionate about. That is why I opened my essay with the quote from Audre Lorde:
"I have come to believe ... that what is most important to me must be spoken, made verbal and shared, even at the risk of having it bruised or misunderstood." (20)
I am convinced that an understanding of the concept of autogynephilia will benefit many individual transsexual women, and ultimately the broader transsexual community. I don't feel we need to be afraid of the truth. Yes, some people may distort the truth, or use it to hurt others. I cannot prevent that, even by my silence. Perhaps Lorde's most famous observation was, "Your silence will not protect you." I think she had that one right. In this connection, I also remember Sandy Stone's comment -- contra Raymond, coincidentally -- from "The Empire Strikes Back:"
"...transsexuals know that silence can be a very high price to pay for acceptance." (21)
I think Sandy had that one right, too.
28. Is it true that you really are Janice Raymond?
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Not the last time I looked. However, I have heard rumors of a plot by paranoid feminist academics to colonize transsexual bodies, so I try to be extra careful.
References:
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1. Bataille, G. (1937). Madame Edwarda. Quoted in Perkins M. (1976, 1992). The Secret Record (New York: Rhinoceros) 62.
2. Lorde, A. (1984). Uses of the erotic: The erotic as power. Sister Outsider (Freedom, CA: Crossing Press) 53, 57, 58.
3. Stoller, R. J. (1985). A child fetishist. Presentations of Gender (New Haven: Yale) 93-136.
4. Zucker, K. J., & Blanchard, R. (1997). Transvestic fetishism: Psychopathology and theory. In D. R. Laws & W. O'Donohue (Eds.), Sexual Deviance (New York: Plenum) 263-264.
5. Blanchard, R. Personal communication.
6. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th Edition) (Washington, DC: American Psychiatric Association) 537.
7. Meyer-Bahlburg, H. (1995). Psychoneuroendocrinology and sexual pleasure: The aspect of sexual orientation. In Abramson PR, Pinkerton SD (eds.). Sexual Nature, Sexual Culture (Chicago: University of Chicago) 136.
8. Brame, G. G., Braeme, W. D., & Jacobs, J. (1993). Different Loving (New York: Villard) 179.
9. Freund, K. (1985). Cross Gender Identity in a Broader Context. In B. Steiner (Ed.), Gender Dysphoria (New York: Plenum) 260.
10. Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria. Journal of Nervous and Mental Disease, 177, 622.
11. Zhou, J. N., Hofman, M. A., Gooren, L. J., & Swaab, D. F. (1995). A sex difference in the human brain and its relation to transsexuality. Nature, 378, 68-70.
12. Swaab, D. F.,& Fliers, E. (1985). A sexually dimorphic nucleus in the human brain. Science, 228, 1112-1115.
13. Hofman, M. A., & Swaab, D. F. (1989). The sexually dimorphic nucleus of the preoptic area in the human brain: A comparative morphometric study. Journal of Anatomy, 164, 55-72.
14. Pilgrim, C., & Reisert, I. (1992). Differences between male and female brains: Developmental mechanisms and implications. Hormone and Metabolism Research, 24, 354.
15. Allen, L. S., Hines, M., Shryne, J. E., & Gorski, R. A. (1989). Two sexually dimorphic cell groups in the human brain. Journal of Neuroscience, 9, 687-706.
16. LeVay, S. (1991). A difference in hypothalamic structure between heterosexual and homosexual men. Science, 253, 1034-1037.
17. Blanchard, R. Private communication to SEXNET, July 11, 1998.
18. Blanchard, R., Rachansky, I., & Steiner, B. (1986). Phallometric detection of fetishistic arousal in heterosexual male cross-dressers. Journal of Sex Research, 22, 461.
19. Gabriel, D. A. (1995, Summer). The power and the passion: An interview with Rachel Pollack. TransSisters, 9, 63.
20. Lorde, A. (1984). The transformation of silence into language and action. Sister Outsider (Freedom, CA: Crossing Press) 40.
21. Stone, S. (1991). The empire strikes back: A post-transsexual manifesto. In J. Epstein & K. Straub K (Eds.), Body Guards (New York: Routledge) 299.
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