Blanchard's transsexualism typology is a proposed

psychological typology Psychological typologies are classifications used by psychologists to describe the distinctions between people. The problem of finding the essential basis for the classification of psychological types—that is, the basis of determining a broade ...

gender dysphoria Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identitytheir personal sense of their own genderand their sex assigned at birth. The diagnostic label gender identity disorder (GID) was used until ...

transsexualism Transsexual people experience a gender identity that is inconsistent with their assigned sex, and desire to permanently transition to the sex or gender with which they identify, usually seeking medical assistance (including sex reassignmen ...

, and

fetishistic transvestism Transvestic fetishism is a psychiatric diagnosis applied to men who are thought to have an excessive sexual or erotic interest in cross-dressing; this interest is often expressed in autoerotic behavior. It differs from cross-dressing for enter ...

, created by sexologist

Ray Blanchard Ray Milton Blanchard ( ; born October 9, 1945) is an American-Canadian sexologist, best known for his research studies on transsexualism, pedophilia and sexual orientation. He found that men with more older brothers are more likely to be gay tha ...

through the 1980s and 1990s, building on the work of prior researchers, including his colleague

Kurt Freund Kurt Freund (17 January 1914 – 23 October 1996) was a Czech-Canadian physician and sexologist best known for developing the penile plethysmograph (a measurement of sexual arousal in males), research studies in pedophilia, and for the "courts ...

. Blanchard categorized

trans women A trans woman or a transgender woman is a woman who was assigned male at birth. Trans women have a female gender identity, may experience gender dysphoria, and may transition; this process commonly includes hormone replacement therapy and so ...

into two groups: ''

homosexual transsexual ''Homosexual transsexual'' is a taxonomic category used in sexology, psychology, and psychiatry, to classify transgender or transsexual people who are attracted to members of the same biological sex. It classifies trans women attracted to men (a ...

s'' who are attracted exclusively to men and are feminine in both behavior and appearance; and ''autogynephilic transsexuals'' who are sexually aroused at the idea of having a female body. Blanchard's work has attracted significant controversy, especially following the 2003 publication of

J. Michael Bailey John Michael Bailey (born July 2, 1957) is an American psychologist, behavioural geneticist, and professor at Northwestern University best known for his work on the etiology of sexual orientation. He maintains that sexual orientation is heavily ...

's book ''

The Man Who Would Be Queen ''The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism'' is a 2003 book by the American psychologist J. Michael Bailey, published by Joseph Henry Press.Bailey, J. Michael (2003). ''The Man Who Would Be Queen: The Science ...

'', which presented the typology to a general audience. Critics of the typology include sexologists John Bancroft and

Charles Allen Moser Charles Allen Moser (born 1952) is an American physician specializing in transgender health, a clinical sexologist, sex therapist, and sex educator practicing in San Francisco, California. He is the author of numerous academic publications and b ...

, psychologist Margaret Nichols, and biologist and activist

Julia Serano Julia Michelle Serano (; born 1967) is an American writer, musician, spoken-word performer, trans– bi activist, and biologist. She is known for her transfeminist books ''Whipping Girl'' (2007), ''Excluded'' (2013), and ''Outspoken'' (2016). Sh ...

. The

World Professional Association for Transgender Health The World Professional Association for Transgender Health (WPATH), formerly the Harry Benjamin International Gender Dysphoria Association (HBIGDA), is a professional organization devoted to the understanding and treatment of gender identity and ...

(WPATH) objected to the inclusion of a mention of autogynephilia that was added to the

DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatric ...

, calling it an unproven theory. Supporters of the typology include sexologists Bailey,

James Cantor James M. Cantor is an American-Canadian clinical psychologist and sexologist specializing in hypersexuality and paraphilias. A former senior scientist with the Centre for Addiction and Mental Health (CAMH) in Toronto,Anne Lawrence, and bioethicist

Alice Dreger Alice Domurat Dreger () is an American historian, bioethicist, author, and former professor of clinical medical humanities and bioethics at the Feinberg School of Medicine, Northwestern University in Chicago, Illinois. Dreger engages in academic ...

. Supporters argue that the typology explains differences between the two groups in childhood

gender nonconformity Gender variance or gender nonconformity is behavior or gender expression by an individual that does not match masculine or feminine gender norms. A gender-nonconforming person may be variant in their gender identity, being transgender or non-bina ...

, sexual orientation, history of

fetishism A fetish (derived from the French , which comes from the Portuguese , and this in turn from Latin , 'artificial' and , 'to make') is an object believed to have supernatural powers, or in particular, a human-made object that has power over oth ...

, and age of transition. Blanchard's typology broke from earlier ones which "excluded the diagnosis of transsexualism" for arousal in response to

cross-dressing Cross-dressing is the act of wearing clothes usually worn by a different gender. From as early as pre-modern history, cross-dressing has been practiced in order to disguise, comfort, entertain, and self-express oneself. Cross-dressing has play ...

, according to Lawrence. Lawrence stated that, before Blanchard, the idea that arousal in response to cross-dressing or cross-gender fantasy meant that one was not transsexual was a recurring theme in scholarly literature.

Background

Observations suggesting that there exist multiple types of transsexualism date back to the early 20th century.

Havelock Ellis Henry Havelock Ellis (2 February 1859 – 8 July 1939) was an English physician, eugenicist, writer, progressive intellectual and social reformer who studied human sexuality. He co-wrote the first medical textbook in English on homosexuality in ...

used the terms ''eonism'' and ''sexo-aesthetic inversion'' to describe cross-gender feelings and behaviors involving "imitation of, and identification with, the admired object."

Magnus Hirschfeld Magnus Hirschfeld (14 May 1868 – 14 May 1935) was a German physician and sexologist. Hirschfeld was educated in philosophy, philology and medicine. An outspoken advocate for sexual minorities, Hirschfeld founded the Scientific-Humanitarian Com ...

classified transsexuals into four types: "homosexual", "bisexual", "heterosexual", and "automonosexual". Hirschfeld used the term ''automonosexual'' to describe excitement in natal males to the thought or image of themselves as women. Beginning in the 1950s, clinicians and researchers developed a variety of classifications of transsexualism. These were variously based on sexual orientation, age of onset, and fetishism. The idea that there are two types of trans women is a recurring theme in the clinical literature. Prior to Blanchard's studies, the two groups were described as "homosexual transsexuals" if sexually attracted to men and "heterosexual fetishistic transvestites" if sexually attracted to women. These labels carried a

social stigma Social stigma is the disapproval of, or discrimination against, an individual or group based on perceived characteristics that serve to distinguish them from other members of a society. Social stigmas are commonly related to culture, gender, rac ...

of mere sexual fetishism, and contradicted trans women's self-identification as "heterosexual" or "homosexual", respectively. In 1982,

and colleagues argued there were two distinct types of male-to-female transsexuals, each with distinct causes: one type associated with childhood femininity and

androphilia Androphilia and gynephilia are terms used in behavioral science to describe sexual orientation, as an alternative to a gender binary homosexual and heterosexual conceptualization. Androphilia describes sexual attraction to men or masculinity; gy ...

(sexual attraction to men), and another associated with fetishism and

gynephilia Androphilia and gynephilia are terms used in behavioral science to describe sexual orientation, as an alternative to a gender binary homosexual and heterosexual conceptualization. Androphilia describes sexual attraction to men or masculinity; gyn ...

(sexual attraction to women). Freund stated that the sexual arousal in this latter type could be associated, not only with crossdressing, but also with other feminine-typical behaviors, such as applying make-up or shaving the legs. Blanchard credited Freund with being the first author to distinguish between erotic arousal due to dressing as a woman (

transvestic fetishism Transvestic fetishism is a psychiatric diagnosis applied to men who are thought to have an excessive sexual or erotic interest in cross-dressing; this interest is often expressed in autoerotic behavior. It differs from cross-dressing for enter ...

) and erotic arousal due to fantasizing about being female (which Freund called ''cross-gender fetishism''). In 1989, Blanchard stated that when he began his studies, researchers had "identified a homosexual type of gender identity disturbance

hich Ij ( fa, ايج, also Romanized as Īj; also known as Hich and Īch) is a village in Golabar Rural District, in the Central District of Ijrud County, Zanjan Province, Iran Iran, officially the Islamic Republic of Iran, and also ...

occurs in homosexuals of both sexes. There is general agreement, moreover, on the clinical description of this syndrome as it appears in males and females". According to Blanchard, there was consensus "that gender identity disturbance also occurs in males who are not homosexual but only rarely, if at all, in nonhomosexual females". Blanchard also stated "there is no consensus, however, on the classification of nonhomosexual gender identity disorders. Authorities disagree on the number of different syndromes, the clinical characteristics of the various types, and the labels used to identify them". Blanchard's research and conclusions came to wider attention with the publication of popular science books on transsexualism, including ''Men Trapped in Men's Bodies'' by sexologist and trans woman Anne Lawrence and ''The Man Who Would Be Queen'' by sexologist

, both of which based their portrayals of male-to-female transsexuals on Blanchard's taxonomy. The concept of autogynephilia in particular received little public interest until Bailey's 2003 publication of ''The Man Who Would Be Queen'', though Blanchard and others had been publishing studies on the topic for nearly 20 years. Bailey's book was followed by peer-reviewed articles critiquing the methodology used by Blanchard.

Research

Blanchard conducted a series of studies on people with gender dysphoria, analyzing the files of cases seen in the Gender Identity Clinic of the

Clarke Institute of Psychiatry The Centre for Addiction and Mental Health (College Street site) is a psychiatric hospital in Toronto, Ontario. It is located at 250 College Street, just east of Spadina Avenue. Much of its work focuses on forensic psychology, sex addiction, drug ...

and comparing them on multiple characteristics. Studying patients who had felt like a woman at all times for at least a year, he started with Hirschfeld's four types (based on sexual attraction to men, women, both, or neither), and then classified the patients accordingly based on their scores on measures of attraction to men and attraction to women. Blanchard then compared these four groups regarding how many in each group reported a history of sexual arousal together with cross-dressing. 73% of the heterosexual, asexual, and bisexual groups said they did experience such feelings, with these three groups being statistically indistinguishable from one another, but only 15% of the homosexual group did. He concluded that asexual and bisexual transsexualism were variant forms of heterosexual transsexualism, with tranvestism being a related phenomenon. He argued that the common feature among all these individuals was erotic arousal to the thought or image of oneself as a woman, and he coined the term ''autogynephilia'' to describe this. Blanchard reported finding that heterosexual male-to-females were significantly older than homosexual male-to-females (i.e., male-to-females attracted to males): the heterosexual male-to-females said they felt their first cross-gender wishes around the time they first cross-dressed, whereas the homosexual group said their cross-gender wishes preceded cross-dressing (more than 3 years on average). Where fetishistic arousal was acknowledged by over 80% of the heterosexual male-to-females, fewer than 10% of the homosexual group did. The age at which trans women referred themselves to explore sex reassignment and their self-ratings of childhood femininity were also studied. The androphilic (homosexual) group usually reported that they were quite feminine in childhood, and they first presented clinically at an average age of 26. The other group, made up of heterosexual, bisexual, and analloerotic patients, reported less childhood femininity—some may not have been especially masculine, but few, if any, had been extremely feminine—and presented clinically at the average age of 34. Blanchard and colleagues conducted a study in 1986 using

phallometry Penile plethysmography (PPG) or phallometry is measurement of blood flow to the penis, typically used as a proxy for measurement of sexual arousal. The most commonly reported methods of conducting penile plethysmography involve the measurement o ...

(a measure of blood flow to the penis), demonstrating arousal in response to cross-dressing audio narratives among trans women. Although this study is often cited as evidence for autogynephilia, the authors did not attempt to measure subjects' ideas of themselves as women. This study has been cited by proponents of the theory to argue that gynephilic trans women who reported no autogynephilic interests were misrepresenting their erotic interests. The authors concluded that gynephilic gender identity patients who denied experiencing arousal to

were still measurably aroused by autogynephilic stimuli, and that autogynephilia among non-androphilic trans women was negatively associated with tendency to color their narrative to be more socially acceptable. Blanchard theorized that homosexual transsexualism was an extreme expression of homosexuality, considering there to be a

continuum Continuum may refer to: * Continuum (measurement), theories or models that explain gradual transitions from one condition to another without abrupt changes Mathematics * Continuum (set theory), the real line or the corresponding cardinal number ...

of phenomena from homosexuality alone, through gender dysphoric homosexuality, to transsexual homosexuality. Anne Lawrence argued that autogynephilic transsexualism shared a continuum with less severe forms of autogynephilia, such as partial autogynephilia. Bailey and his book, and Blanchard and his research, have since attracted intense criticism. Some writers have criticized autogynephilia as being

transphobic Transphobia is a collection of ideas and phenomena that encompass a range of negative attitudes, feelings, or actions towards transgender people or transness in general. Transphobia can include fear, aversion, hatred, violence or anger tow ...

. Thomas E. Bevan writes that the concept is insufficiently operationalizable and therefore does not qualify as a

scientific theory A scientific theory is an explanation of an aspect of the natural world and universe that has been repeatedly tested and corroborated in accordance with the scientific method, using accepted protocols of observation, measurement, and evaluatio ...

hypothesis A hypothesis (plural hypotheses) is a proposed explanation for a phenomenon. For a hypothesis to be a scientific hypothesis, the scientific method requires that one can test it. Scientists generally base scientific hypotheses on previous obse ...

. Blanchard's findings have also been criticized on the grounds that they lack

reproducibility Reproducibility, also known as replicability and repeatability, is a major principle underpinning the scientific method. For the findings of a study to be reproducible means that results obtained by an experiment or an observational study or in a ...

and that they fail to control for the same traits occurring in

cisgender Cisgender (often shortened to cis; sometimes cissexual) is a term used to describe a person whose gender identity corresponds to their sex assigned at birth. The word ''cisgender'' is the antonym of ''transgender''. The prefix ''wiktionary:cis ...

women. Trans author and biologist

criticizes the conclusion of the 1986 phallometry study as

unfalsifiable Falsifiability is a standard of evaluation of scientific theories and hypotheses that was introduced by the Philosophy of science, philosopher of science Karl Popper in his book ''The Logic of Scientific Discovery'' (1934). He proposed it as t ...

. Clinical sexologist

writes that the 1986 study had methodological problems and that the reported data did not support the conclusion, stating that the measured arousal to cross-dressing situations was minimal and consistent with subjects' self-reported arousal. According to a 2016 review, structural

neuroimaging Neuroimaging is the use of quantitative (computational) techniques to study the structure and function of the central nervous system, developed as an objective way of scientifically studying the healthy human brain in a non-invasive manner. Incre ...

studies seem to support Blanchard's prediction that androphilic and gynephilic trans women have different brain

phenotype In genetics, the phenotype () is the set of observable characteristics or traits of an organism. The term covers the organism's morphology or physical form and structure, its developmental processes, its biochemical and physiological proper ...

s. The authors state that more independent studies of gynephilic trans women are needed to fully confirm Blanchard's hypothesis, as well as "a specifically designed comparison of homosexual MtF, homosexual male, and heterosexual male and female people".

Autogynephilia

Autogynephilia (derived from Greek for 'love of oneself as a woman') is the term Blanchard coined for "a male's propensity to be

sexually aroused Sexual arousal (also known as sexual excitement) describes the physiological and psychological responses in preparation for sexual intercourse or when exposed to sexual stimuli. A number of physiological responses occur in the body and mind ...

by the thought of himself as a female", intending for the term to refer to "the full gamut of erotically arousing cross-gender behaviors and fantasies". Blanchard states that he intended the term to subsume ''

transvestism Transvestism is the practice of dressing in a manner traditionally associated with the opposite sex. In some cultures, transvestism is practiced for religious, traditional, or ceremonial reasons. The term is considered outdated in Western ...

'', including for sexual ideas in which feminine clothing plays only a small or no role at all. Other terms for such cross-gender fantasies and behaviors include ''automonosexuality'', ''

eonism Henry Havelock Ellis (2 February 1859 – 8 July 1939) was an English physician, eugenicist, writer, Progressivism, progressive intellectual and social reformer who studied human sexuality. He co-wrote the first medical textbook in English on ho ...

'', and ''

sexo-aesthetic inversion Henry Havelock Ellis (2 February 1859 – 8 July 1939) was an English physician, eugenicist, writer, Progressivism, progressive intellectual and social reformer who studied human sexuality. He co-wrote the first medical textbook in English on ho ...

''.

Development

Blanchard arrived at his theory of autogynephilia mainly by interpreting

self-report A self-report study is a type of survey, questionnaire, or poll in which respondents read the question and select a response by themselves without any outside interference. A ''self-report'' is any method which involves asking a participant abou ...

s by trans women. In a series of studies at the Clarke Institute of Psychiatry in the late 1980s, he gave questionnaires to gender-dysphoric patients, classing participants as "heterosexual", "asexual", "bisexual", or "homosexual" based on the results of two such questionnaires, the Modified Androphilia and Modified Gynephilia Scales. Blanchard assessed autogynephilia by asking about erotic arousal in association with the fantasy of having various female features such as a vulva or breasts, and the fantasy of being admired as a female by another person. Based on the results, Blanchard writes that the "heterosexual", "asexual", and "bisexual" groups were found to be more similar to each other than any was to the "homosexual" group, concluding that non-homosexual transsexuals, along with transvestites, shared a "history of erotic arousal in association with the thought or image of oneself as a woman". Following controversy over the portrayal of trans women in ''The Man Who Would Be Queen'', Blanchard distinguished between "the existence or nonexistence of autogynephilia", which he described as "settled", and "theoretical statements involving autogynephilia". Examples of the latter included: (1) all gender-dysphoric males (including MTF transsexuals) who are not attracted to males are instead autogynephilic; (2) autogynephilia does not occur in natal females; (3) the desire for sex reassignment among some natal males is a form of internalized pair-bonding; (4) autogynephilia is a type of heterosexual impulse that also competes with heterosexuality; and (5) autogynephilia is a type of ''erotic target location error''. Blanchard wrote that the accuracy of these theories needed further empirical research to resolve. Blanchard provides specific case examples to illustrate the autogynephilic sexual fantasies that people reported:

Types

Blanchard identified four types of autogynephilic sexual fantasy, but stated that co-occurrence of types was common. * Transvestic autogynephilia: arousal to the act or fantasy of wearing typically feminine clothing * Behavioral autogynephilia: arousal to the act or fantasy of doing something regarded as feminine * Physiologic autogynephilia: arousal to fantasies of body functions specific to people regarded as female * Anatomic autogynephilia: arousal to the fantasy of having a normative woman's body, or parts of one According to Blanchard, the transvestic-fetishistic type has tended to overshadow the others. He states that anatomic autogynephilia is more associated with gender dysphoria than transvestic autogynephilia. In a later study, a different pattern was reported in a sample of non-transgender autogynephilic men, where higher degrees of anatomic autogynephilia were associated with less gender dysphoria; here, it was instead interpersonal/behavioral and physiological autogynephilia that predicted gender dysphoria. The men in this latter sample were significantly more gender dysphoric than the non-transgender male baseline. Blanchard in 1993 and Lawrence in 2013 report that some natal males exhibit ''partial autogynephilia'', being sexually aroused by the image or idea of having ''some'' but not ''all'' normative female anatomy, such as having breasts but retaining their penis and testicles. Other authors have distinguished between behavioral autogynephilia and interpersonal autogynephilia, with the latter being arousal to being seen or admired as a woman or to having sex with men.

Gender dysphoria and transition

The exact nature of the relationship between autogynephilia and

is unclear, and the desire to live as a woman often remains as strong or stronger after an initial sexual response to the idea has faded. Blanchard and Lawrence argue that this is because autogynephilia causes a female gender identity to develop, which becomes an emotional attachment and something aspirational in its own right. Lawrence writes that some transsexual women identify with autogynephilia, many of these feeling positively and some negatively as a result, with a range of opinions reflected as to whether or not this played a motivating role in their decision to transition. In the first peer-reviewed critique of autogynephilia research,

found no substantial difference between "autogynephilic" and "homosexual" transsexuals in terms of gender dysphoria, stating that the clinical significance of autogynephilia was unclear. He writes that "although autogynephilia exists, the theory is flawed", and that "many MTFs readily admit that this construct describes their sexual interest and motivation. Nevertheless, it is not clear how accurately lanchard's theorypredicts the behavior, history, and motivation of MTFs in general". Moser states that "many of the tenets of the theory are not supported by the existing data, or both supporting and contradictory data exist". In a re-evaluation of the data used by Blanchard and others as the basis for the typology, he states, "it is not clear that autogynephilia is always present" in gynephilic trans women or "always absent" in androphilic trans women, that autogynephilia is significantly different than other

paraphilia Paraphilia (previously known as sexual perversion and sexual deviation) is the experience of intense sexual arousal to atypical objects, situations, fantasies, behaviors, or individuals. It has also been defined as sexual interest in anything ot ...

s, and that there is "little reason to suggest that autogynephilia is the rimarymotivation" for gynephilic trans women to seek

sex reassignment surgery Gender-affirming surgery (GAS) is a surgical procedure, or series of procedures, that alters a transgender or transsexual person's physical appearance and sexual characteristics to resemble those associated with their identified gender, and alle ...

(SRS). He concludes that the types identified by Blanchard and others may be primarily correlational, not causative, in which case "autogynephilia just becomes another trait" of some trans women, rather than their defining characteristic. In a 2011 study presenting an alternative to Blanchard's explanation, Larry Nuttbrock and colleagues reported that autogynephilia-like characteristics were strongly associated with a specific generational cohort as well as the ethnicity of the subjects; they hypothesized that autogynephilia may become a "fading phenomenon". Blanchard has suggested that "non-homosexual" trans women may deny autogynephilia in order to be seen as more socially acceptable and in order to secure a favorable recommendation for sex reassignment. While some trans women report autogynephilic arousal after their gender transition, many others do not. Blanchard and Lawrence argue that such trans women are nonetheless autogynephiles. Lawrence also argues that self-identified homosexual (androphilic) trans women who report histories of autogynephilia are mistaken. Moser disputes this, arguing that if such misrepresentations were common, the self-reported data on which the theory itself is based would be "similarly suspect". According to Moser: "It appears that substantial minorities of homosexual MTFs are autogynephilic and non-homosexual MTFs are not."

Sexual orientation

Blanchard and Lawrence have classified autogynephilia as a

sexual orientation Sexual orientation is an enduring pattern of romantic or sexual attraction (or a combination of these) to persons of the opposite sex or gender, the same sex or gender, or to both sexes or more than one gender. These attractions are generall ...

. Blanchard wrote in 1993 that "autogynephilia might be better characterized as an orientation than as a paraphilia". Blanchard attributed the notion of some cross-dressing men being sexually aroused by the image of themselves as female to

, who stated, "They utomonosexualsfeel attracted not by the women outside them, but by the woman inside them."Hirschfeld, M. (1948). ''Sexual anomalies.'' New York: Emerson. Blanchard and Lawrence argue that just like more common sexual orientations such as heterosexuality and homosexuality, it is not only reflected by penile responses to erotic stimuli, but also includes the capacity for pair bond formation and romantic love. Later studies have found little empirical support for autogynephilia as a

sexual identity Sexual identity is how one thinks of oneself in terms of to whom one is romantically and/or sexually attracted.
''Sex ...

classification, and sexual orientation is generally understood to be distinct from gender identity. Elke Stefanie Smith and colleagues describe Blanchard's approach as "highly controversial as it could erroneously suggest an erotic background" to transsexualism.

Gynandromorphophilia Sexual attraction to transgender people has been the subject of scientific study and social commentary. Psychologists have researched sexual attraction toward trans women, cross dressers, non-binary people, and a combination of these. Publicati ...

, an attraction to people with both male and female anatomy, has been cited as the inverse of autogynephilia, and has been reported as associated with it. Autogynephilic men are usually attracted to women and not to men. Blanchard and Lawrence state that autogynephiles who report attraction to men are actually experiencing "pseudobisexuality", in which the person, rather than being attracted to both the male and female

s, is aroused by a male partner validating their status as an attractive woman; this coexists with the person's basic attraction to women. According to Blanchard, "An autogynephile does not necessarily become sexually aroused every time he pictures himself as female or engages in feminine behavior, any more than a heterosexual man automatically gets an erection whenever he sees an attractive woman. Thus, the concept of autogynephilia—like that of heterosexuality, homosexuality, or

pedophilia Pedophilia ( alternatively spelt paedophilia) is a psychiatric disorder in which an adult or older adolescent experiences a primary or exclusive sexual attraction to prepubescent children. Although girls typically begin the process of puberty a ...

—refers to a ''potential'' for sexual excitation."

Erotic target location errors

Blanchard conjectured that sexual interest patterns could have inwardly instead of outwardly directed forms, which he called erotic target location errors (ETLE). Autogynephilia would represent an inwardly directed form of gynephilia, with the attraction to women being redirected towards the self instead of others. These forms of erotic target location errors have also been observed with other base orientations, such as pedophilia, attraction to amputees, and attraction to plush animals. Anne Lawrence argued that these phenomena provide further support for autogynephilia typology:

Cisgender women

The concept of autogynephilia has been criticized for assuming that only trans women experience sexual desire mediated by their own gender identity. Francisco J. Sánchez and

Eric Vilain Eric Vilain is a physician-scientist and professor in the fields of Disorders/Differences of Sex Development (DSDs) and precision medicine. He has been the director of the Center for Genetic Medicine Research at Children’s National Medical Cent ...

state that, as with nearly all paraphilias, characteristics consistent with autogynephilia have only been reported among men, while Serano states that autogynephilia is similar to sexual arousal in cisgender women. Jaimie Veale and colleagues reported in 2008 that an online sample of cisgender women commonly endorsed items on adapted versions of Blanchard's autogynephilia scales, although they stated that it is unlikely that these women experienced autogynephilia in the way that Blanchard conceptualized it. Moser created an ''Autogynephilia Scale for Women'' in 2009, based on items used to categorize MtF transsexuals as autogynephilic in other studies. A questionnaire that included the ASW was distributed to a sample of 51 professional women employed at an urban hospital; 29 completed questionnaires were returned for analysis. By the common definition of ever having erotic arousal to the thought or image of oneself as a woman, 93% of the respondents would be classified as autogynephilic. Using a more rigorous definition of "frequent" arousal to multiple items, 28% would be classified as autogynephilic. While Blanchard stated that "autogynephilia does not occur in women", Moser writes that both studies found "significant numbers of women" scoring as autogynephilic, using measures similar to Blanchard's. Lawrence criticized Moser's methodology and conclusions and stated that genuine autogynephilia occurs very rarely, if ever, in cisgender women as their experiences are superficially similar but the erotic responses are ultimately markedly different. Moser responded that Lawrence had made multiple errors by comparing the wrong items. Lawrence argues that the scales used by both Veale et al. and Moser fail to differentiate between arousal from wearing provocative clothing or imagining that potential partners find one attractive, and arousal merely from the idea that one is a woman or has a woman's body. In a 2022 study, Bailey and Kevin J. Hsu write that "it remains unknown whether any natal females experience autogynephilia" based on an application of Blanchard's original Core Autogynephilia Scale to four samples of "autogynephilic natal males", four samples of "non-autogynephilic natal males" and two samples of "natal females". Serano and Veale argue that because Bailey and Hsu compared "natal females" with "natal males" pre-selected for autogynephilia, their results were artificially skewed against finding autogynephilia among cisgender women. They write that it unsurprising that few cisgender women would respond positively to Blanchard's Core Autogynephilia Scale since "Blanchard crafted these questions specifically with AMAB ssigned male at birthtrans people in mind". Serano and Veale also criticize Bailey and Hsu for omitting Blanchard’s Cross-Gender Fetishism Scale and Autogynephilic Interpersonal Fantasy Scale, both of which played a central role in Blanchard's original conception of autogynephilia; they speculate that the "natal female" samples may have seemed more "autogynephilic" had they been given these surveys. According to Serano and Veale, Blanchard considered the "anatomic autogynephilia" studied by Bailey and Hsu to be only a small subset of autogynephilia in general. Moser criticizes Bailey and Hsu for "compar ngthe scores of women AFAB ssigned female at birthwith 'erotic crossdressers' (not individuals who have transitioned from male to female)", saying their finding "does little to support or refute the question of whether autogynephilia exists in women AFAB or not".

Homosexual vs. autogynephilic transsexuals

Blanchard studied two groups of

: those who came out as transgender earlier in life and were mostly if not exclusively attracted to men (

androphilic Androphilia and gynephilia are terms used in behavioral science to describe sexual orientation, as an alternative to a gender binary homosexual and heterosexual conceptualization. Androphilia describes sexual attraction to men or masculinity; g ...

), and those who came out later in life and were mostly if not exclusively attracted to women (

gynephilic Androphilia and gynephilia are terms used in behavioral science to describe sexual orientation, as an alternative to a gender binary homosexual and heterosexual conceptualization. Androphilia describes sexual attraction to men or masculinity; gyn ...

), in order to understand what made them different from one another. He uses the terms ''homosexual'' and ''non-homosexual'' for these two groups, relative to the person's

sex assigned at birth Sex assignment (sometimes known as gender assignment) is the discernment of an infant's sex at or before birth. A relative, midwife, nurse or physician inspects the external genitalia when the baby is delivered and, in more than 99.95% of bi ...

, not their current gender identity. He proposed that many late-transitioning trans women were driven to do so not by

, but by an extreme

characterized by an erotic interest in oneself as a woman (autogynephilia). Blanchard said that one type of gender dysphoria/transsexualism manifests itself in individuals who are almost if not exclusively attracted to men (homosexual transsexuals averaged a

Kinsey scale The Kinsey scale, also called the Heterosexual–Homosexual Rating Scale, is used in research to describe a person's sexual orientation based on one’s experience or response at a given time. The scale typically ranges from 0, meaning exclusive ...

measurement of 5–6 and six is the maximum, or a 9.86±2.37 on the

Modified Androphilia Scale Androphilia and gynephilia are terms used in behavioral science to describe sexual orientation, as an alternative to a gender binary homosexual and heterosexual conceptualization. Androphilia describes sexual attraction to men or masculinity; g ...

), whom he referred to as ''homosexual transsexuals'', adopting Freund's terminology. The other type he defined as including those who are attracted almost if not exclusively to females (gynephilic), attracted to both males and females (bisexual), and attracted to neither males nor females (''analloerotic'' or asexual); Blanchard referred to this latter set collectively as the ''non-homosexual transsexuals''. Blanchard says that the "non-homosexual" transsexuals (but not the "homosexual" transsexuals) exhibit ''autogynephilia'', which he defined as a

paraphilic Paraphilia (previously known as sexual perversion and sexual deviation) is the experience of intense sexual arousal to atypical objects, situations, fantasies, behaviors, or individuals. It has also been defined as sexual interest in anything ot ...

interest in having female anatomy. According to the typology, autogynephilic transsexuals are attracted to femininity while homosexual transsexuals are attracted to masculinity. However, a number of other differences between the types have been reported. Homosexual transsexuals usually begin to seek sex reassignment surgery in their mid-20s, while autogynephilic transsexuals usually seek clinical treatment in their mid-30s or even later. Anne Lawrence states that autogynephilia tends to appear along with other paraphilias. J. Michael Bailey argued that both "homosexual transsexuals" and "autogynephilic transsexuals" were driven to transition mainly for sexual gratification, as opposed to gender-identity reasons. Anne Lawrence, a proponent of the concept, argues that homosexual transsexuals pursue sex reassignment surgery out of a desire for greater social and romantic success. Lawrence has proposed that autogynephilic transsexuals are more excited about sexual reassignment surgery than homosexual transsexuals. She states that homosexual transsexuals are typically ambivalent or indifferent about SRS, while autogynephilic transsexuals want to have surgery as quickly as possible, are happy to be rid of their penis, and proud of their new genitals. According to Blanchard, most homosexual transsexuals describe themselves as having been very feminine from a young age. Lawrence argues that homosexual transsexuals are motivated by being very feminine in both behavior and appearance, and by a desire to romantically and sexually attract (ideally very masculine) men, while autogynephilic transsexuals are motivated by their sexual desire and romantic love for being women. Lawrence also states that homosexual transsexuals who seek sex reassignment pass more easily as women. According to Bailey and Lawrence, transsexuals who are active on the internet are overwhelmingly autogynephilic.

Trans men

The typology is largely about trans women. Richard Ekins and Dave King state that female-to-male transsexuals (

trans men A trans man is a man who was assigned female at birth. The label of transgender man is not always interchangeable with that of transsexual man, although the two labels are often used in this way. ''Transgender'' is an umbrella term that incl ...

) are absent from the typology, while Blanchard, Cantor, and Katherine Sutton distinguish between gynephilic and androphilic trans men. They state that gynephilic trans men are the counterparts of androphilic trans women, that they experience strong childhood gender nonconformity, and that they generally begin to seek sex reassignment in their mid-20s. They describe androphilic trans men as a rare but distinct group who say they want to become gay men, and, according to Blanchard, are often specifically attracted to gay men. Cantor & Sutton state that while this may seem analogous to autogynephilia, no distinct paraphilia for this has been identified.

Inclusion in the DSM

In 1980 in the DSM-III, a new diagnosis was introduced, that of "302.5 Transsexualism" under "Other Psychosexual Disorders". This was an attempt to provide a diagnostic category for

gender identity disorder Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identitytheir personal sense of their own genderand their sex assigned at birth. The diagnostic label gender identity disorder (GID) was used unti ...

s. The diagnostic category, ''transsexualism'', was for gender dysphoric individuals who demonstrated at least two years of continuous interest in transforming their physical and social gender status. The subtypes were asexual, homosexual (same "biological sex"), heterosexual (other "biological sex") and unspecified. This was removed in the

DSM-IV The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...

, in which gender identity disorder replaced transsexualism. Previous taxonomies, or systems of categorization, used the terms ''classic transsexual'' or ''true transsexual'', terms once used in

differential diagnoses In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease or condition from others that p ...

. The

DSM-IV-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...

included autogynephilia as an "associated feature" of

Simultaneously published in: and as a common occurrence in the

disorder, but does not classify autogynephilia as a disorder by itself. Moser advances three reasons to question the inclusion of autogynephilia as a sign of a clinical disorder: (1) a focus on autogynephilia may have overshadowed other factors involved in gender dysphoria, creating "a new stereotype" which patients seeking sex reassignment must adhere to; (2) some proponents of the theory suggest that trans women who do not report sexual interest consistent with their typing according to the theory are mistaken or "in denial", which is disrespectful and potentially harmful; and (3) the theory could imply that "all gender manifestations resecondary to sexual orientation". The paraphilias working group on the

, chaired by Ray Blanchard, included both ''with autogynephilia'' and ''with autoandrophilia'' as specifiers to transvestic disorder in an October 2010 draft of the DSM-5. This proposal was opposed by the

(WPATH), citing a lack of empirical evidence for these specific subtypes. ''With autoandrophilia'' was removed from the final draft of the manual. Blanchard later said he had initially included it to avoid criticism: "I proposed it simply in order not to be accused of sexism ..I don't think the phenomenon even exists." When published in 2013, the DSM-5 included ''With autogynephilia'' (sexual arousal by thoughts, images of self as a female) as a specifier to ''302.3 Transvestic disorder'' (intense sexual arousal from cross-dressing fantasies, urges or behaviors); the other specifier is ''With

'' (sexual arousal to fabrics, materials or garments).

Criticism

General

Advocates for the

transgender A transgender (often abbreviated as trans) person is someone whose gender identity or gender expression does not correspond with their sex assigned at birth. Many transgender people experience dysphoria, which they seek to alleviate through tr ...

community have challenged Blanchard's and Bailey's explanation of transgender women's motivations to seek sex reassignment. Trans activists and scholars have argued that the theory unduly sexualizes trans women's gender identity. Philosopher

Matt Drabek Matt may refer to: *Matt (name), people with the given name ''Matt'' or Matthew, meaning "gift from God", or the surname Matt *In British English, of a surface: having a non-glossy finish, see gloss (material appearance) *Matt, Switzerland, a mu ...

writes that Blanchard's work threatens to undo the advances made by

feminist Feminism is a range of socio-political movements and ideologies that aim to define and establish the political, economic, personal, and social equality of the sexes. Feminism incorporates the position that society prioritizes the male po ...

queer ''Queer'' is an umbrella term for people who are not heterosexual or cisgender. Originally meaning or , ''queer'' came to be used pejoratively against those with same-sex desires or relationships in the late 19th century. Beginning in the lat ...

, and transgender advocacy groups in separating gender identity and sexual orientation from biological sex.

Arlene Istar Lev Arlene Istar Lev is a North American clinical social worker, family therapist, and educator. She is an independent scholar, who has lectured internationally on topics related to sexual orientation and gender identity, sexuality, and LGBT, LGBTQ fa ...

says, "Many

transwomen A trans woman or a transgender woman is a woman who was assigned male at birth. Trans women have a female gender identity, may experience gender dysphoria, and may transition; this process commonly includes hormone replacement therapy and so ...

find Blanchard's theories insulting, and his insistence that these are evidence-based scientific truths, has only further enraged both the professional and activist communities". According to

Simon LeVay Simon LeVay (born 28 August 1943 in Oxford, England) is a British-American neuroscientist. He received a bachelor's degree in natural sciences from the University of Cambridge in 1966, a Ph.D. in Neuroanatomy at the University of Göttingen in ...

, some fear that the concept of autogynephilia will make it harder for gynephilic or "non-classical" MtF transsexuals to receive sex reassignment surgery. Blanchard, Bailey, and Lawrence have each argued that any trans woman who would benefit from SRS should receive it.

Serano

Critics of the theory include

transfeminist Transfeminism, also written trans feminism, has been defined by scholar and activist Emi Koyama as "a movement by and for trans women who view their liberation to be intrinsically linked to the liberation of all women and beyond." Koyama not ...

s such as

and

Talia Mae Bettcher Talia may refer to: * Talia (given name) * Talia (surname) * Talia, Lebanon, a town * Talia, South Australia, a locality in the District Council of Elliston * Talia Station, a pastoral lease in South Australia * Talia (grape), an alternative nam ...

. Serano writes in the ''

International Journal of Transgenderism The ''International Journal of Transgender Health'' (IJTH) is a quarterly peer-reviewed academic journal covering research on gender dysphoria and gender incongruence, the medical treatment of transgender individuals, social and legal acceptance ...

'' that there were flaws in Blanchard's original papers, including that they were conducted among overlapping populations primarily at the Clarke Institute in Toronto without nontranssexual controls, that the subtypes were not empirically derived but instead were "

begging the question In classical rhetoric and logic, begging the question or assuming the conclusion (Latin: ') is an informal fallacy that occurs when an argument's premises assume the truth of the conclusion, instead of supporting it. For example: * "Green is t ...

that transsexuals fall into subtypes based on their sexual orientation," and that further research had found a non-deterministic correlation between cross-gender arousal and sexual orientation. She states that Blanchard did not discuss the idea that cross-gender arousal may be an effect, rather than a cause, of gender dysphoria, and that Blanchard assumed that correlation implied causation. She describes the typology as flawed, unscientific, and needlessly stigmatizing. Serano also states that the wider idea of cross-gender arousal was affected by the prominence of

sexual objectification Sexual objectification is the act of treating a person solely as an object of sexual desire. Objectification more broadly means treating a person as a commodity or an object without regard to their personality or dignity. Objectification is most ...

of women, accounting for both a relative lack of cross-gender arousal in transsexual men and similar patterns of autogynephilic arousal in non-transsexual women. She criticised proponents of the typology, claiming that they dismiss non-autogynephilic, non-androphilic transsexuals as misreporting or lying while not questioning androphilic transsexuals, describing it as "tantamount to hand-picking which evidence counts and which does not based upon how well it conforms to the model", either making the typology unscientific due to its unfalsifiability, or invalid due to the nondeterministic correlation that later studies found. Serano says that the typology undermined lived experience of transsexual women, contributed to pathologisation and sexualisation of transsexual women, and the literature itself fed into the stereotype of transsexuals as "purposefully deceptive", which could be used to justify discrimination and violence against transsexuals. According to Serano, studies have usually found that some non-homosexual transsexuals report having no autogynephilia.

Bettcher

Talia Mae Bettcher, based on her own experience as a trans woman, has critiqued the notion of "autogynephilia," and "target errors" generally, within a framework of "erotic structuralism," arguing that the notion conflates essential distinctions between "source of attraction" and "erotic content," and "(erotic) interest" and "(erotic) attraction," thus misinterpreting what she prefers to call, following Serano, "female embodiment eroticism." She maintains that not only is "an erotic interest in oneself as a gendered being," as she puts it, a non-pathological and indeed necessary component of regular sexual attraction to others, but within the framework of erotic structuralism, a "misdirected" attraction to oneself as postulated by Blanchard is outright nonsensical.

Disputed terminology

Blanchard's terminology has been described as confusing and controversial among transsexuals seeking sex reassignment surgery and as archaic. Frank Leavitt and Jack Berger write: "Transsexuals, as a group, vehemently oppose the

label and its pejorative baggage. As a rule, they are highly invested in a heterosexual life-style and are repulsed by notions of homosexual relations with males. Attention from males often serves to validate their feminine status." Trans sociologist and sexologist Aaron Devor wrote, "If what we really mean to say is attracted to males, then say 'attracted to males' or androphilic ... I see absolutely no reason to continue with language that people find offensive when there is perfectly serviceable, in fact better, language that is not offensive." Still other transsexuals are opposed to any and all models of diagnosis which allow medical professionals to prevent anyone from changing their sex, and seek their removal from the DSM. Linguist

Bruce Bagemihl Bruce Bagemihl is a Canadian biologist, linguist, and author of the book ''Biological Exuberance: Animal Homosexuality and Natural Diversity''. Life and career He completed his BA at the University of Wisconsin–Milwaukee in 1981, and served on th ...

criticized the use of the terms "homosexual" and "non-homosexual" to refer to transsexuals by their assigned sex. In 2008, sexologist John Bancroft expressed regret for having used this terminology, which was standard when he used it, to refer to transsexual women, and that he now tries to use words more sensitively.

''O'Donnabhain v. Commissioner''

In the 2010 U.S. Tax Court case ''O'Donnabhain v. Commissioner'', the Internal Revenue Service cited Blanchard's typology as justification for denying a transgender woman's

tax deduction Tax deduction is a reduction of income that is able to be taxed and is commonly a result of expenses, particularly those incurred to produce additional income. Tax deductions are a form of tax incentives, along with exemptions and tax credits. T ...

s for medical costs relating to treatment of her gender identity disorder, claiming the procedures were not medically necessary. The court found in favor of the plaintiff, Rhiannon O'Donnabhain, ruling that she should be allowed to deduct the costs of her treatment, including sex reassignment surgery and

hormone therapy Hormone therapy or hormonal therapy is the use of hormones in medical treatment. Treatment with hormone antagonists may also be referred to as hormonal therapy or antihormone therapy. The most general classes of hormone therapy are oncologic horm ...

. In its decision, the court declared the IRS's position "at best a superficial characterization of the circumstances" that was "thoroughly rebutted by the medical evidence".Case backs need for sex-change surgery - The Boston Globe
/ref>

Transphobia

Julia Serano has written that

trans-exclusionary radical feminist Feminist views on transgender topics vary widely. Third-wave feminists and fourth-wave feminists tend to view the struggle for trans rights as an integral part of intersectional feminism. Former president of the American National Organization f ...

s, or "

gender critical Feminist views on transgender topics vary widely. Third-wave feminists and fourth-wave feminists tend to view the struggle for trans rights as an integral part of intersectional feminism. Former president of the American National Organization f ...

s, started embracing Blanchard's autogynephilia theory starting in the 2000's. One early proponent of the autogynephilia theory was

radical feminist Radical feminism is a perspective within feminism that calls for a Political radicalism, radical re-ordering of society in which male supremacy is eliminated in all social and economic contexts, while recognizing that women's experiences are al ...

Sheila Jeffreys Sheila Jeffreys (born 13 May 1948) is a former professor of political science at the University of Melbourne, born in England. A lesbian feminist scholar, she analyses the history and politics of human sexuality. Jeffreys' argument that the "se ...

. The concept has been used to imply that trans women are sexually deviant men. The autogynephilia theory became popular on "gender critical" websites such as 4thWaveNow,

Mumsnet Mumsnet is a London-based internet forum, created in 2000 by Justine Roberts for discussion between parents of children and teenagers. History and finances Mumsnet was created in 2000 by Justine Roberts, who came up with the idea of a webs ...

, and the

Reddit Reddit (; stylized in all lowercase as reddit) is an American social news aggregation, content rating, and discussion website. Registered users (commonly referred to as "Redditors") submit content to the site such as links, text posts, images ...

community r/GenderCritical. According to an October 2018 review of anti-

LGBT ' is an initialism that stands for lesbian, gay, bisexual, and transgender. In use since the 1990s, the initialism, as well as some of its common variants, functions as an umbrella term for sexuality and gender identity. The LGBT term is a ...

activities by the

Southern Poverty Law Center The Southern Poverty Law Center (SPLC) is an American 501(c)(3) nonprofit legal advocacy organization specializing in civil rights and public interest litigation. Based in Montgomery, Alabama, it is known for its legal cases against white su ...

, both Ray Blanchard and J. Michael Bailey have written articles for 4thWaveNow, which it describes as an

anti-trans Transphobia is a collection of ideas and phenomena that encompass a range of negative attitudes, feelings, or actions towards transgender people or transness in general. Transphobia can include fear, aversion, hatred, violence or anger tow ...

website. According to a study of that and other rhetoric, "Bailey and Blanchard's work has long been criticised for perpetuating stereotypes and prejudices against trans women, notably suggesting that LGBQ trans women's primary motivation for transitioning is sexual arousal." The study refers to autogynephilia as a discredited theory. According to the Southern Poverty Law Center, the autogynephilia theory has been promoted by anti-LGBT hate groups. These include

Family Research Council The Family Research Council (FRC) is an American evangelical activist group and think-tank with an affiliated lobbying organization. FRC promotes what it considers to be family values. It opposes and lobbies against: access to pornography, emb ...

(FRC),

United Families International United Families International (UFI) is a United States nonprofit organization founded in 1978 by Susan Roylance. UFI works on an international scale to influence public policy toward "maintaining and strengthening the family". UFI has NGO status w ...

(UFI), and the American College of Pediatricians (ACPeds). In a May 2018 report, the Southern Poverty Law Center referred to Blanchard as an anti-trans psychologist.

Notes

References

External links

{{DEFAULTSORT:Blanchard, Bailey, And Lawrence Theory Men and sexuality Paraphilias Sexology Gender identity Sexual fetishism Sexual orientation Sexuality and society Transgender sexuality Trans women