Editors' note: This is part two of a two part series on autogynephilia. Part 1 is here.
Dr. Blanchard's taxonomy of "autogynephilia" and "homosexual transsexualism" follows a long tradition of dividing transsexual women into categorical buckets based on sexual orientation. A premise in American psychiatry/psychology has traditionally held that male-to-female transsexualism is a phenomenon of effeminate male homosexuality, while the label of "transvestism" is associated with heterosexual men. Hence, diagnostic nomenclature and research literature have for decades favored candidates for surgical transition care who would have heterosexual outcomes (i.e., transwomen attracted to men). 
In the 1960s, Dr. Harry Benjamin's defined two types of so-called "true transsexuals" as distinct from "transvestites" and "non-surgical transsexuals," based on Kinsey's scale of sexual orientation. Those attracted to men were labeled "high intensity," resembling Blanchard's "homosexual" label. Benjamin described asexual, "auto-erotic" and some bisexual individuals as "low intensity" or "nonsurgical transsexual." He labeled transsexual women attracted to women mostly as "transvestites,"  and the belief that those termed "transvestites" were not gender dysphoric or attracted to men held until the 1980s.
While Benjamin emphasized that his six types of MTF transsexualism "are not and never can be sharply separated," psychiatrist. Robert Stoller insisted on exclusive division of transsexualism from "transvestism." Stoller considered a single episode of cross-dressing associated with sexual arousal sufficient to exclude a diagnosis of transsexualism  and therefore denial of access to transition medical care. (Like Blanchard today, Stoller conflated "association" with erotic causation in his literature.) This view was reflected in the DSM-III-R,  where concurrent diagnosis of Transvestic Fetishism and GID of Adolescence or Adulthood, Nontranssexual Type (GIDAANT) or Transsexualism were not allowed .
In the real world, however, large numbers of transsexual women, who were attracted to women and applied for corrective transition surgeries, refuted the theory that assumed transsexual women to be gay men. They were called such uncomplimentary names as "transvestic transsexuals," , "aging transvestites"  and "non-transsexual men applying for SRS"  Where researchers in other scientific discliplines might have questioned the premise in view of contrary data, psychiatric researchers leapt to an incredible assumption: that there must be an additional independent "etiology" or cause for MTF transsexualism. Early on, this second "etiology" was described as a "regression" of transvestism into transsexualism, inexplicably "provoked" by stress.  In the late 1970s, Person and Ovesey offered a Hitchcockian psychoanalytic explanation of this process:
At times of stress, ... transvestites frantically step up the pace of acting out. Should such reparative measures fail, they regressively fall back on the more primitive fantasy of symbiotic fusion with the mother. It is at this point that transsexual impulses break out and may go on to full-blown transsexual syndrome (secondary transsexualism)." 
Blanchard's theory of "autogynephilia," later emerged to fill this role. But is this science, or is this a defensive response to contradicting evidence?
Deogracias, et al., recently proposed that the similarity of transwomen, regardless of sexual orientation, supports a "concept of equifinality," meaning that the same effect or end state can result from completely different causes.  I am very skeptical of this opinion. Data that contradict a hypothesis most likely call the validity of the hypothesis into question. We in the physical sciences and engineering often use the principle of Occam's Razor to discern credible from unlikely theories. Contrary to the notion of equifinality, it asserts that simpler parsimonious theories are more likely to be true than twisted complex theories, if all other considerations are equal. Are we to believe that the same effect, gender dysphoria, comes from not one but two unrelated causes depending upon the sexual orientation of the person? Perhaps Occam's Razor would be a good Rx for the behavioral sciences as well. 
Moreover, a corner-stone of scientific methodology is the falsifiability of hypotheses -- the possibility that a hypothesis may be refuted by evidence or experiment. Theories are widely considered to be scientific only if they are falsifiable. By capriciously spawning a new independent theory of "autogynephilia" to explain the existence of transwomen who were not exclusively attracted to men, these researchers rendered the original hypothesis of "homosexual male" transsexualism to be unfalsifiable. In my view, this does not suggest equifinality. Rather, it is evidence of a dubious hypothesis that conveniently metastasizes in the face of contradicting data. It is evidence that the development of gender identity in all people, trans and cisgender alike, is not yet understood.
In recent years, Dr. Blanchard has attempted to draw a distinction between "autogynephilia" as a sexual phenomenon from the other meanings associated with the term, including his own controversial theories.  However, the word "autogynephilia" has evolved far beyond sexual taxonomy and theoretical speculation to carry a negative context of its own. It has become an offensive epithet to many transwomen. For example, Blanchard and collaborators have grouped "autogynephilia" (lesbian, bisexual and asexual transwomen) with pedophilia, fetishism and even apotemnophilia (desire for limb amputation). [14, 15] This reinforces some of the most stigmatizing and dehumanizing false stereotypes that transsexual women bear in society.
In addition, the terms "autogynephilia" and "homosexual transsexual" have become associated with extremely offensive remarks and stereotypes about transsexual and other transgender women. Here are but a few examples from a very controversial book by Dr. J. Michael Bailey of Northwestern University, entitled The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism. 
- "The Man Who Would be Queen" -this maligning description of transsexual women in the book title is accompanied by a cover photo that offensively caricatures them.
- "Men who want to be women are not naturally feminine. There is no sense in which they have women's souls."
- "The autogynephile's main romantic target is herself." - in reference to transsexual women not exclusively attracted to men.
- "Men Trapped in Men's Bodies" - in reference to transsexual women labeled as "Autogynephiles," this chapter title is a quote from Dr. Anne Lawrence. 
- "But they don't have the wrong body, they are mentally ill." - in reference to transsexual women labeled as "autogynephiles," Bailey quotes his undergraduate students.
- "Homosexual transsexuals are a type of gay man." -in reference to straight transsexual women.
- "Homosexual transsexuals are used to living on the margins of society."
- "Homosexual transsexuals might be especially well-suited to prostitution."
Published in 2003, this book promoted inflamed a firestorm of outrage among the transgender community and supportive allies. [18-21] Bailey's remarks about transsexual women are worse than offensive; they are gratuitously cruel.
Finally, "autogynephilia" has been used in a punitive context to discredit critics of these theories and negative stereotypes. For example, Bailey and Triea associated disagreement with the theory of "autogynephilic" motivation as symptomatic of "autogynephilia:"
although most public transsexual activists appear by their histories and presentations to be nonhomosexual MtF transsexuals, they have generally been hostile toward the idea that nonhomosexual transsexualism is associated with, and motivated by, autogynephilia. 
The authors went on to name individuals they termed "transsexual activists" and publicly speculated about their private sexualities. Hence, "autogynephilia" has morphed from a term of taxonomy to a political tool to suppress criticism.
To summarize, the term "autogynephilia" means far more than a description of erotic phenomenon. "Autogynephilia," and its corollary "homosexual transsexualism," have come to represent an over-arching body of derogatory stereotypes that are promoted as science but remain dogmatically resilient to contrary evidence:
- "Homosexual transsexual" maligns all straight transwomen attracted only to men as "homosexual men."
- "Homosexual transsexual" implies that all straight transwomen were motivated to transition by their so-called "homosexuality" or denial of it.
- "Autogynephilia" maligns all lesbian and bi transwomen, who are not exclusively attracted to men, as pathologically narcissistic "men."
- "Autogynephilia" implies that all lesbian and bi transwomen are attracted to themselves instead of other women, which demeans and undermines these relationships and families.
- "Autogynephilia" implies that all lesbian and bi transwomen are motivated to transition primarily by sexual paraphilia or deviance, undermining their legitimacy and dignity as women.
- "Autogynephilia" denies that transwomen who live happy and full lives as women, regardless of sexual orientation, possess an inner feminine gender identity or "essence."
- "Autogynephilia" is a politically punitive epithet for transwomen who criticize psychiatric policies and stereotypes.
- "Autogynephilia" is indelibly associated with cruel dehumanizing epithets of transwomen, such as "man who would be queen," and "men trapped in men's bodies."
The term "autogynephilia" has grown to represent an affront to the human legitimacy and dignity of many transitioned women. It serves no constructive purpose in an evidence-based diagnostic nosology. I strongly urge the American Psychiatric Association to remove this offensive term from the supporting text of the GID diagnosis and refrain from adding it to the nomenclature of paraphilias in the DSM-V.
For full citations, please visit Dr. Kelley Winters's site, GID Reform.