Kelley Winters

Autogynephilia: The Infallible Derogatory Hypothesis, Part 1

Filed By Kelley Winters | January 07, 2009 11:00 AM | comments

Filed in: Living, Marriage Equality, Transgender & Intersex
Tags: autogynephilia, Colorado, Denver, Fortune 500, gender identity, gender identity disorder, GLBT, pride, ray blanchard, sigmund freud, transgender, transsexual, women

In the Third Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980, the American Psychiatric Association explained the reasons for removing the diagnostic category of homosexuality: [1]

"The crucial issue in determining whether or not homosexuality per se should be regarded as a mental disorder is not the etiology of the condition, but its consequences and the definition of mental disorder." [2]

This marked a significant shift in diagnostic policy toward the consequence of a condition rather than speculation of its cause. Two decades later, the APA discarded this principle by emphasizing the controversial and inflammatory theory of "autogynephilia" in the supporting text of Gender Identity Disorder diagnosis of the DSM-IV-TR:

"Adult males who are sexually attracted to females, to both males and females, or to neither sex usually report a history of erotic arousal associated with the thought or image of oneself as a woman (termed autogynephilia)." [3]

This statement and its supporting literature, that hypothesize sexual deviance as a cause of transsexualism, have sparked dissent among clinicians and researchers and outrage within the transgender and transsexual community [4-8] While theories around "autogynephilia" seem exceptionally impervious to contrary evidence, the controversy has raised questions about tolerance and bias in American Psychiatry- at what point do bad stereotypes preclude good science?

The term "autogynephilia," meaning "love of oneself as a woman," was first introduced by Dr. Raymond Blanchard of the Clarke Institute of Psychiatry, now known as the Centre for Addiction and Mental Health in Toronto. He is currently chairman of the Paraphilias Subcommittee for the upcoming DSM-V. Blanchard stated that,

"All gender dysphoric males who are not sexually oriented toward men are instead sexually oriented toward the thought or image of themselves as women." [9]

The absolutism in this statement, in the words "all and "instead," seems astonishing. [10] It reduces a broad continuum of sexuality among transwomen to two narrow maligning stereotypes: either "homosexual males" in denial of a "homosexual" identity or pathological narcissistic "males" sexually attracted to themselves This strict dichotomy stands in contrast to the words of Dr. Alfred Kinsey, the father of modern sexology:

"The world is not divided into sheeps and goats. Not all things are black nor all things white. It is a fundamental of taxonomy that nature rarely deals with discrete categories. Only the human mind invents categories and tries to force facts into separated pigeon-holes. The living world is a continuum in each and every one of its aspects. The sooner we learn this concerning sexual behavior the sooner we shall reach a sound understanding of the realities of sex." [11]

Although the phenomenon described by "autogynephilia," arousal to thoughts of being women, has been reported in personal narratives by some transwomen, [12] there is no apparent basis for projecting this stereotype upon all lesbian, bisexual and asexual transwomen. Dr. Blanchard conflates association with causation by using the phrase "erotic arousal in association with the thought or image of themselves as women" interchangeably with "erotically aroused by the thought or image..." [13] However, "association with" is not the same as "aroused by."

What role do birth-assigned women play in their own sexual fantasies? We would not consider it odd or "fetishistic" for non-trans women to be themselves on the stage of their sex lives. Nor would we assume that they are aroused by their self-image as women rather than by their partners. Why are lesbian and bisexual transwomen treated so differently by American psychiatry and psychology? For transwomen born without female anatomy, incongruence of our bodies with our self-identities pose understandable barriers to sexual expression. The desire to surmount these barriers is more accurately described as an adaptive accommodation to a physiological deficiency. Does the image of a female body "interfere" with normal attractions as Blanchard suggests [14] or does it enable them?

Dr. Blanchard's studies of clinical patients reporting "erotic arousal in association with cross-dressing" were presented as "fetishistic cases." [15-16] His findings have been criticized by psychologist and community advocate Dr. Madeline Wyndzen as having never been replicated, excluding control groups of birth-assigned women, and for confounding causation with observational data. [17] For gender dysphoric youth with no access to medical transition procedures, is cross-dressing a "fetishistic" pathology, or is it an adaptive coping strategy to an incongruent body? It seems more plausible that cross-dressing represents an accommodation to conceal or disguise anatomy which poses barriers to lesbian or bisexual expression or fantasy.

Dr. Blanchard's studies omitted control groups of birth-assigned women and the roles that fashion, clothing and lingerie play in their sexual expression and fantasy. For birth-assigned women, sexual expression is accompanied by a $300 billion fashion industry in the U.S. [18] but without diagnosis of fetishistism or pathology. Dr. Sigmund Freud, however, noted how fashion accompanies sexuality with a metaphorical remark:

"In the world of everyday experience, we can observe that half of humanity must be classed among the clothes fetishists. All women, that is, are clothes fetishists. ... For them clothes take the place of parts of the body, and to wear the same clothes means only to be able to show what the others can show, means only that one can find in her everything that one can expect from women, an assurance which the woman can give only in this form." [19]

Freud's observations on the role of clothing in the expression of womanhood seem relevant to Blanchard's presumption of "autogynephilic" pathology in transwomen for whom "clothes take the place of parts of the body" - parts that nature did not provide.

What of transwomen who attest attraction to women and frequently are in very long term relationships, partnerships and marriages with women? Blanchard's theory of "autogynephilia," like Dr. Magnus Hirschfeld's "automonosexualism," [20] implies that all transwomen not exclusively attracted to men are incapable of genuine attraction to other women. [21] However, clinical literature has long reported 20 to 30 percent of transsexual women attracted primarily or exclusively to other women [22-23]. These early figures were likely understated, as attraction to women posed barriers to access to hormonal and surgical transition care. Nonclinical surveys report higher rates of same-sex orientation (with regard to affirmed identity, not assigned birth-sex) [24-25] It seems paradoxical that these women are labeled as "autogynephiles" on the basis of their attraction to women, while that very label contradicts the validity of their attraction to women.

How does the "autogynephilia" hypothesis, that "all" transwomen are attracted to men or "instead" to themselves, explain the existence of long-term relationships with other women? Here in Colorado, writer Laurie Cicotello related the story of her remarkable family. In 1997, Ms. Cicotello testified before the Colorado legislature with her father, Dana, a transwoman, educator and advocate respected throughout the transgender community. They spoke in opposition to an anti-gay and lesbian marriage bill that would have threatened her parents' legal same-sex marriage of forty years at the time of this writing. Laurie described how she stood with her parents later that year, hands clasped together over their heads, before fifty-five thousand people at the Denver PrideFest Rally. In a state known in the 90s for religious intolerance of GLBT diversity, Dana proclaimed to the crowd, "I've got your family values, right here!"[26]

Theories of "autogynephilia" not only associate hurtful stereotypes of sexual deviance with transwomen, they presume "erotic anomalies" or self-focused deviance to be the cause of gender dysphoria and the motivation for transition, with both nature and nurture playing secondary roles. Speaking of lesbian, bisexual and asexual transwomen not primarily attracted to men, Dr. Blanchard states:

"This hypothesis asserts that the various discriminable syndromes of non-homosexual gender dysphoria are the results of autogynephilia interacting with additional constitutional or experiential factors." [27]

Bailey and Triea recently supported this view that "nonhomosexual transsexuals experience erotic arousal at the idea of becoming a woman, and this arousal motivates them to become women." [28] However, they nor Blanchard offer evidence of a causal relationship between a sexual affinity for one's-self and gender dysphoria (intense distress with one's assigned birth-sex or natal anatomy.) This body of theory seems to proffer the circular reasoning that:

If "autogynephilia" is associated with all lesbian and bisexual transsexual women, then it must be the cause of gender dysphoria for them.


If "autogynephilia" is the cause of gender dysphoria in lesbian and bisexual transsexual women, then all of them must be "autogynephilic."

Proponents of these stereotypes of sexual deviance have not asked the fundamental questions about how gender identity forms in all human beings, transgender and cisgender. They neglect to include control groups of birth-assigned women with their limited, clinical samples of transwomen. They most often neglect to include nonclinical samples of transitioned women living full lives in the real world. They fail to consider the similarities between birth-assigned women and transitioned women of all sexual orientations, similarities so profound that the existence of large numbers of transitioned women remains unacknowledged by psychiatric researchers. [29] Moreover, the proven efficacy of social and medical transition in relieving the distress of gender dysphoria and improving quality of lives [30-31] remains unexplained by "autogynephilic" theories of etiology.

The corollary of "autogynephilia" theory postulates that straight transwomen attracted to men do not possess female gender identities but are merely gay men in denial. They are branded by Blanchard with a maligning label of "homosexual male transsexuals." [32] He asserts that straight and lesbian/bisexual/asexual transwomen are so fundamentally different that they represent two entirely distinct "disorders,"

"The feminine gender identity that develops in homosexual males is different from the feminine gender identity that develops in heterosexual males. In other words, homosexual and heterosexual men cannot ''catch'' the same gender identity disorder in the way that homosexual and heterosexual men can both ''catch'' the identical strain of influenza virus. Each class of men is susceptible to its own type of gender identity disorder and only its own type of gender identity disorder." [33]

Dr. Blanchard's certainty of mutually exclusive transsexual types based on sexual orientation seems peculiar within sexology, where both gender identity [34] and sexual orientation [11] have long been viewed as continuous rather than dichotomous. He based this assumption on differences in "a history of erotic arousal in association with cross-dressing," in ages of presentation for "professional help," and in "degrees of childhood femininity" within clinical populations. Correlating these attributes to the lack or presence of attraction to males, Blanchard concluded that "the main varieties of nonhomosexual gender dysphoria are more similar to each other than any of them is to the homosexual type." [35] However, a recent study of gender-dysphoric MTF subjects reported no significant difference in scores on a gender identity/gender dysphoria questionnaire with regard to sexual orientation. [36] This result is not explained by Blanchard's assumption of fundamentally different gender identities.

Blanchard's analogy of gender variant identities to communicable disease is offensive and perhaps demonstrative of bias. His research does not consider the shame and guilt that force gender dysphoric youth and adults into the closet, often for decades. For example, "degrees of childhood femininity" may indicate degrees of closeted self-expression far more than innate femininity. The doctrine of "autogynephilic" dichotomy neglects different social pressures faced by gender dysphoric youth and adults, based on their sexual orientations. These differences in social oppression would certainly impact their ability to emerge from the closet and express their inner identities.

Inferring gender identity based on age of clinical presentation is especially troubling, given Zucker and Bradley's observation that gender variant youth are "invariably" referred by adults and not by themselves. [37] Admission to clinics that practice gender-reparative therapy (attempting to change one's gender identity or espression) may well indicate parental intolerance rather than gender identity per se. For MTF youth, dates of clinical presentation may likely signify the dates they were caught by their parents in their sisters' clothes and little more. For any closeted population, it is wrong to confuse "onset" with presentation to a mental institution or clinic.

For straight transwomen attracted to men, Dr. Blanchard states that all "homosexual gender dysphorics are sufficiently similar to be treated as one diagnostic group." [38] The statement makes clear the intent of "homosexual gender dysphorics" as a term of mental disorder. However the theory that attraction to men is the sole motivation for transition does not explain why the vast majority of gay males do not transition. It does not explain very low rates of surgical regrets for transwomen, with and without partners or spouses. Nor does it explain very young children who are painfully distressed with their assigned birth-sex or why some transition years before adolescence. What then would differentiate straight transwomen and girls from gay males, if gender dysphoria is hypothesized to exclude any innate sense of gender identity?

Perhaps the model of "homosexual gender dysphoria" assumes that living as transsexual women is somehow socially advantageous to living as gay men. To the contrary, gay men possess greater social status, economic privilege and civil rights protection than transwomen in the U.S. and much of the world. For example, 20 states currently prohibit workplace discrimination based on sexual orientation, while only 12 include protection based on gender identity. 88 percent of U.S. Fortune 500 employers prohibit discrimination based on sexual orientation versus 25 percent that include gender identity. [39] It seems farfetched that "all" straight transwomen who forfeit social status to transition would be driven only by attraction to men.

Go to "Autogynephilia: The Infallible Derogatory Hypothesis, Part 2"

For full citations, please visit Dr. Kelley Winters's site, GID Reform.

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Melanie Davis | January 7, 2009 12:45 PM

Personal Belief = Modern Science.

Seems that intelligent design might just be true.

I have hope for finding conclusive evidence for unicorns now.

Everyday Transperson | January 7, 2009 12:53 PM

Dr. Winters,

This may be a little off topic here, but I wish to raise a point with a quote you made in your article:

"88 percent of U.S. Fortune 500 employers prohibit discrimination based on sexual orientation versus 25 percent that include gender identity."

Well, that may be a well defended argument on paper and in the corporate circles, but how much of that 88 percent and 25 percent is actually practiced in these companies ?? Are those percentages backed up by research and proof that these companies actually practice what they preach ??

Sure the current trend these days is for companies to grease palms with HRC and apparently buy their way to a 100 percent rating on the CEI index and of course be lauded by SHRM as a result, but increasing reports of GLBT employee harassment and discrimination is slowly but surely proving these statistics to be not very credible, which then these statistics may only apply to the "GL" corporate executive arena......

So while I applaud your research as to the DSM, I must disagree with your statistics concerning factual "protections" for GLBT employees in corporate America. (true protections and not policy and later business as usual when no one is watching).

Thank you for your time.

I'm living proof that companies who get 100% from HRC don't deserve it. I was told that a medically necessary procedure (not SRS) was nothing more than a transsexual procedure, yet other employees can get the same procedure done if their doctors say it's necessary. It's now 2009 and they may think the issue is over, but not as far as I'm concern.

I am living proof that Blanchard and Bailey's theory of autogynephilia is complete BS. I am not in any way, shape, or form attracted to men sexually. There are a lot of others like me in the T community. If that nonsense is immortalized in the DSM5, then it, too, will be BS. The only problem is that it will be a BS book that will determine how patients are treated. Autogynephilia is about as true as intelligent design.

And, Monica, that HRC employers list is BS, too. I'm surprised you ever believed it. If an employer shows themselves to be T friendly in one of several categories, then they are unequivocably considered T friendly on the list. It's nonsense, and is about as reliable as anything else that comes from HRC.

I went to Out For Work two years ago, which was partly sponsored by HRC and featured a presentation by an HRC official about the Corporate Equality Index. They had about six categories applicable to sexual orientation, all of which needed to be fulfilled in order to get 100%, but the transgender section only needed one out of five to get full points. I confronted the speaker after the presentation, who gave the explanation that HRC was starting small because transgender protections were a little more "out there" than GLB protections, and they would add more requirements each year to inspire the companies with 100s to implement more beneficial policies if they hadn't already in order to keep their 100% status.

Which is kinda the same argument they used with ENDA, go figure.

Caillean McMahon | January 7, 2009 3:09 PM

The use of sexual orientation as a diagnostic tool for AG presupposes that gender identity and sexual orientation are linked ego functions. Sine the early 1950's, even analytical psych began to see them separately.

Linking them again for this purpose is a huge step backwards.

Further, given the myriad of theories and possible etiologies that would produce a funtionally female central nervous system, any attempt to bend gender diaagnostics into an "either/or" paradigm is a huge oversimplification. The logic twists, the overly broad diagnostics, the rigid binary are all flaws in the current criteria used for AG/GID by the Clarke Institute Coterie.

Does AG exist? Probably.
Are the current criteria viable? No

Problem is that the gender spectrum does not fit into an "either GID or AG" model. There are going to have to adddress other variations and exceptions.

All men who say they are straight & spend significant amounts of time obsessing over transsexual women (whether in bars, online or in their professional endeavors) are either in denial about their homosexuality or in denial about their autogynophilia.

Say - this is fun!

Because trans women aren't women, Kathy?

give me a break.

No - we are. Some may be a tad humor impaired, though. Using the format of someone's offensive argument to describe the offender is classic. Comedy gold, Jerry!

Oh nevermind.

I see what you did there. ;)

Nerissa Belcher | January 7, 2009 10:09 PM

Am I missing something? Is autogynophilia supposed to be a bad thing? The alternative for a MTF TS would be to hate the idea of oneself as female. Imagine a bright young college student who wanted to be a doctor. If the student told people she really despised the idea of being a doctor most people would wonder why she was making the effort.

I see anti-female sexism at play here. I.E. it appears the "experts" think a person is normal if they hate being female but pathological if they enjoy being female. Sorry to poke a hole in their delusional bubble but I and many other TSs enjoy feminine things. Gasp! Even to include nails, heels, skirts, etc.

Oh yes, I vastly prefer men as sexual partners over women. So much for only those of us who prefer women as being autogynophilic.

I think, and Dr. Winters can speak for herself, that there is a space between saying that a significant group of transwomen are solely motivated by their sexual attraction to women and hating women or being a woman.

"Am I missing something? Is autogynophilia supposed to be a bad thing?"

Sex positivity and self-mage positivity are not bad things. The trouble is that the theory of Autogynephilia is seriously flawed, doesn't take into account the behaviour of sex-positive birth-assigned females as a control group, overlooks some big factors such as the body's production of testosterone, and makes sweeping and incorrect assumptions.

"I see anti-female sexism at play here."

I believe this to be one the motives of many of the proponents of the theory, to insinuate that anyone who is trans and has any sexual appetite at all or adventurousness is "disordered." It's not far removed from the invention of "nymphomania" to stigmatize sexual pleasure in women.

"Does the image of a female body "interfere" with normal attractions as Blanchard suggests [14] or does it enable them?"

THANK YOU!!! This is something I've been trying to express to people for years now.

Blanchard is looking at the few transwomen he has seen, and figured "oh, [she]'s only turned on when [she] wears women's clothing" and making the assumption that she's turned on by the clothes. He pointedly ignores the fact that it's not the clothes that is turning her on.

I see this in myself. The only way I can get turned on is if I do mental tricks that allow me to ignore my obviously male anatomy. But it's not turning me on, it's just protecting me from the barriers that keep me from getting turned on, namely, the body dysmorphia.

Ultimately, I have a female sexuality - one that would be normal for *any* woman, cisgender or not. That my current anatomy is a barrier is obvious to me, and should not be equated to Blanchard's half-baked 'theory' (in quotes because it was arrived at beyond the means of the scientific method). I have a female sexuality, because I AM A WOMAN. Period. What sex I was born into does not matter in that one whit, because as sex educators and authors of good sex guides tell us, OUR SEXUALITY COMES FROM OUR BRAIN, NOT OUR GENITALS!

The reason Blanchard, and his evil twin, are listened to is because no one has done studies to refute their work, and the field of study is so bereft of research that they are automatically seen as the "experts" in the field by the rest of the scientific community.

Right or wrong, modern medical, psychiatric and scientific thought is study driven. Anyone who has a set of credentials, can write a half coherent argument, and can present some type of case history for their study, can put forward the most outrageous claim, and have it accepted by others simply because it was published.

Rather than writing articles pooh poohing Blanchard's work, go out and disprove it. Back at the time of Blanchard's work, so little was known about Transexualism that he could have written that we were all in love with goats and would have been believed. There are by now enough documented case histories to disprove autogyniphilia that all it would take is an enterprising grad student a little web time to create a valid study.

If you are going to take potshots at Blanchard, use live rounds, instead of firing blanks.

I vaguely recall a paper at least was presented about autogynephilia and autoandrophilia in otherwise cis-folk suggesting these were common sexual experiences amongst the general population. alas it's 2 in the morning so I cant chase it up right now.

Marja Erwin | January 10, 2009 7:41 AM

I am a trans lesbian and was originally sympathetic to the theory. By the time I started transitioning, I barely remembered any trans feelings before puberty, but did remember fantasies which could be considered AGP. I focused on earlier feelings in the course of my therapy, which may overstate their importance. At age 3 or 4, I had asked my mother if she wanted a daughter; at age 8 or 9 I had discussed the idea of transition with a classmate when she and I were talking about the arbitrariness of gender roles; between ages 11 and 13 I was very scared of the approach of puberty and wished to grow up as a woman, not a man. So, overall, it seems that my trans feelings go back before puberty and before any fantasies which could be considered AGP.

If AGP fantasies are more clearly defined, yes, I suspect that trans women - straight ones included - will tend to imagine ourselves as women, and many trans women will have some kind of feminization and/or female-ization fantasy. (Depending on the relative importance of gender roles and body map.)

But correlation does not imply causation. It's easy to see how transsexualism could create fantasies which could be considered AGP. The correlation could work either way, and the timeline of individual cases is important.

Two other equally-important problems are to find how common various "trans" feelings are among the cis population, and how much childhood gender presentation has to do with adult gender identity. Certainly many trans women are butch, and many of us didn't seem very feminine as kids, and many trans men are femme and didn't seem very masculine as kids, while many cis kids cross-dress and the like.

P.S. your captchas are buggy.