Here is the full text of the letter in response to that insane article.
Puberty is not a disorder
We vigorously object to the normalization of childhood gender identity disorder (GID) promoted by the American Academy of Pediatrics (AAP) in the article “Psychological and Medical Care of Gender Nonconforming Youth,”1 published in the December issue of Pediatrics. The recommendations of the authors to reinforce the delusions of gender identity–confused children, and to prescribe puberty-blocking hormones as though puberty were a disorder, are outrageous. This approach violates the oath physicians take to “do no harm.”
Although some affected children and their parents may report being happier when health professionals, families, friends, and schools affirm their false beliefs, “happiness” is not always consistent with good health. It can also be short-lived.
A recent 30-year study in transgendered adults in Sweden, unquestionably a transgender-affirming culture, should give the AAP and American Psychiatric Association (APA) pause: it showed that individuals who underwent sex reassignment surgery suffered significantly greater morbidity and mortality when compared with matched controls. Shockingly, their suicide mortality rose almost 20-fold above the comparable nontransgender population. The authors concluded, “Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism . . . [emphasis added].”2
There is no adequate body of research on the long-term use of puberty blockers in early adolescence followed by lifelong administration of exogenous testosterone to biological girls or of exogenous estrogen to biological boys. However, there is significant evidence indicating stunted growth and infertility from puberty-blocking hormones, and possible malignancies from chronic use of synthetic hormones.3 Yet, this is what the AAP and APA recommend.
We submit that children who dread the development of secondary sex characteristics are emotionally troubled; puberty is not a disease. In fact, puberty brings relief for the vast majority of children receiving therapy for GID, because hormone surges propel the development of their brains as well as their bodies and they come to identify with their biological sex.4,5 Science and ethics trump the current recommendations of the AAP and APA, which amount to conducting an ideology-driven social experiment on vulnerable children and their families. All physicians must work for the reinstatement of the diagnosis and sound treatment of childhood GID.
Den Trumbull, MD, FCP President of the American College of Pediatricians
Michelle A. Cretella, MD, FCP Vice President of the American College of Pediatricians
Miriam Grossman, MD Psychiatric consultant to the American College of Pediatricians
Contrary to what transgenderite cult members and their crooked enablers say, there is a ton of science to show that “innate gender identity” is fake and that autogynephilia is real. I have previously posted most of these articles and books on various pages of this site but to make them more accessible, I’m going to post them all here on one page. You can download the PDFs from the links.
This is far from “all” the research — there’s plenty more. If there are other articles you’d like to see, I can probably get hold of them and could post them here.
This research could never be published today. It would be seen as extremely “transphobic.” It was actually published in first issue of the “International Journal of Transgenderism” in 1997. It’s just a small cohort study (n=20) but I’ll tell you what, it’s way more solid than any evidence brought forward to date by pro-transgenderism researchers for the existence of an innate “gender identity.” The article is not available in PDF and I’m surprised it is even still up on the journal’s rinky-dink web site. I have added emphases here & there throughout the article. Edit: I just noticed that Stop Trans Chauvinism recently posted this article too!
Hartmann U, Becker H, Rueffer-Hesse C (1997) Self and Gender: Narcissistic Pathology and Personality Factors in Gender Dysphoric Patients. Preliminary Results of a Prospective Study. International Journal of Transgenderism, Volume 1, Number 1, July – September 1997.
Abstract: This paper presents preliminary results concerning the relationship of self and gender in patients requesting or seriously considering sex change. Specific attention is paid on pathological features in regulatory processes of the self-system as well as on personality factors associated with different types of gender disorders. Based on the results of retrospective analyses a prospective study was designed to identify subtypes of gender dysphoric patients based on a scrupulous psychiatric and psychpathological evaluation. The evaluation procedure consists of (i) clinical interviews, (ii) a structural interview according to concepts of Kernberg, and (iii) a set of self-developed and standardized questionnaires. The results indicate significant psychopathological aspects and narcissistic dysregulation in a substantial proportion of patients. Different subtypes of self-(dys)regulation seem to emerge which are discussed with special reference to differential diagnosis and prognostic factors.
Introduction: The two intriguing concepts of self and gender are of major importance for the field of gender dysphoria, but at the same time both are complex and controversial. In recent years, the clinical, etiological, and psychopathological diversity of gender dysphoric patients had to be increasingly recognized by professionals. Looking at the remarkably different gender and developmental backgrounds of individuals with gender problems, many – including DSM-IV – have done away with the term ‘transsexualism’ as a distinct diagnostic category. This nosological shift, however, should be accompanied by improvements in the precision of differential diagnoses and clinical subtyping allowing a better fine-tuning of clinical managment. Existing approaches have mainly been restricted to gender and sexual orientation variables whereas personality and psychopathological factors associated with gender disorders have rather been neglected.
Based on the results of a retrospective analysis of all patients that have consulted our gender dysphoria team at the psychiatric outpatient clinic of Hannover Medical School during a one-year period, a prospective study was designed to identify subtypes of gender dysphoric patients by means of a scrupulous psychiatric and psychological evaluation (Becker & Hartmann 1994). This contribution will concentrate on pathological features in the regulation of the self-system and on some associated personality factors. A number of preliminary empirical results of the first 25 consecutive patients of our prospective study will be presented with a special focus on the results of the psychometric instruments we have employed. Since the number of 5 biological females is too small for statistical comparisons,the data presented here only refer to biological males.
Our preliminary results indicate significant psychopathological aspects and narcissistic dysregulation in most of our gender dysphoric patients. Among biological males different subtypes of self-(dys-) regulation and corresponding MMPI-profiles seem to emerge. Results of the narcissism inventory indicate that of the 4 main dimensions (the threatened self, the traditional narcissistic self, the ideal self, the hypochondriac self) scales covering aspects of the ‘threatened self’ show the most significant deviations while a number of patients do not have a negative body-self. The implications of these results should be considered when thinking about differential diagnoses and prognostic factors.
Materials and Methods
Table 1:‘Components of evaluation procedure’
Thorough clinical interviews by different team members
Structural interview according to concepts of Kernberg
A set of self-developed and standardized psychometric questionnaires including the MMPI, 16PF, Rosenzweig PFT, Narcissism Inventory, and AGI and CGF by Blanchard.
The main components of our evaluation procedure are summarized in table 1. All patients were interviewed, usually independently by different team members. After that, all patients went through a structured interview – based on concepts of Kernberg (1984) for severe personality disorders – addressing relevant aspects of self-pathology, narcissistic regulation and object-relations. In addition, all patients were asked to fill out a set of both self developed and standardized questionnaires including the MMPI in its short version, the 16PF, the Rosenzweig Picture-Frustration-Study, the Narcissism Inventory (Deneke & Hilgenstock 1989), the Androphilia-Gynephilia-Index and the Cross-Gender-Fetishism scale, both designed by Blanchard (1985, 1989).
Table 2:‘Sociodemographic data’
Mean age (years)
The sociodemographic data show that the mean age of 30 years (range 17 – 45) does not differ in the androphilic and gynephilic groups, which will be compared in most of the following analyses. In the same way educational level and marital status are equal in both groups whereas the vocational situation of gynephilic patients is significantly worse.
Results The results of the other three standardized psychometric instruments will only be touched upon before concentrating on the ‘narcissism inventory’.
A quick look at the clinical scales of the MMPI shows that overall most scores are above the normal T-value-range of 40 to 60 indicating pronounced psychopathological features for the whole group of our patients. On the other hand, only the MF-scale has values above 70 which of course is no surprise in a sample like this, which also applies to the PD-scale. Looking at the two subgroups, one can see that the scores of the gynephilic patients are clearly higher for the so-called ‘neurotic trias’ of Hypochondria, Depression and Hysteria, the most valid scales of the German version of the MMPI. This suggests that the gynephilic patients of our sample have more neurotic symptoms, especially of the somatization and psychosomatic type and it also shows that emotional problems are expressed in a body language.
Scales of the ’16PF’
In the 16PF significant deviations from the normal range – which is marked by the two horizontal lines in figure 2 – can be found in the primary factors C, H, I, O and Q3. This suggests that our gender disordered patients have a significantly lower ego strength, are more emotionally disturbed and have problems in coping with disappointments.The markedly deviant scores in primary factor ‘I’ describe our patients as highly sensitive, with rich inner lives, but also as impatient, demanding, with high expectations and a tendency to avoid responsibilities. Primary factor ‘H’ indicates that the patients of our sample are low in their self-confidence and rather inihibited, cautious and socially introverted. Looking at the differences between our subgroups, one can see that they are of minor importance in this test. The only statistically significant differences or trends are in primary factors ‘L’ (F1,17 = 10.89; p < 0.01) and ‘Q3’ (F1,17 = 3.29; p = 0.08), suggesting that the androphilics have a more sceptical attitude towards other people, try to rely more on their own opinion and have a tendency to be disputatious and resentful. The gynephilics are more spontaneous and guided by momentary impulses and ideas without clearcut future conceptions.
Scales of the ‘PFT’
The Rosenzweig Picture-Frustration-Test is a well-known semiprojective instrument designed to measure the ways of coping with frustration and aggression. The six main categories of the PFT are depicted on figure 3. Again, the two lines mark the normal range between stanines 4 and 6. Figure 3 shows that for both the whole sample and the gynephilic subgroup all scores are well within the normal range while the androphilics do show some deviations. They are relatively low on category ‘Extrapunitivity’ and high on ‘Impunitivity’ suggesting a strong inclination to evade conflicts and to delude themselves about obstacles or the frustrational character of a given situation. Looking at the three reaction types one can see that androphilics are low on obstacle-dominance and very high on need-persistence which confirms the impression that their need-persistence i.e. their emotional pressure to reach a specific goal is so predominant that the obstacles encountered tend to be denied. The low scores on category ‘Extrapunitivity’ inidicate that their assertiveness, their ability to get their way in a constructive manner is below average. The gynephilic group is significantly lower in need-persistence (F1,16 = 3.87; p = 0.06) and higher in obstacle-dominance (F1,16 = 4.02; p = 0.06). Thus, compared to the androphilics they are well aware of the obstacles in their way and even tend to be blocked by them without feeling the intense urge for a quick solution.
The results of the Narcissism Inventory
The ‘Narcissism Inventory’ (NI) is a questionnaire developed at the Hamburg University Medical School in the 1980ies. It was designed to assess a number of theoretically and clinically relevant aspects of the organization and regulation of the narcissistic personality system. It consists of 163 items belonging to 18 scales which cover a wide range of different modes of narcissistic autoregulation. These 18 scales are grouped into 4 main dimensions according to the results of a factor analysis.
4 dimensions of the ‘Narcissism inventory’
These 4 dimenions are called the ‘threatened self’, the ‘classic narcissistic self’, the ‘idealistic self’ and the ‘hypochondriac self’. On figure 4 the results of these 4 dimensions are depicted for our sample. In interpreting the t-values it must be taken into account that we do not yet possess norms for a normal, non-clinical sample but only for a clinical sample consisting of individuals with diagnoses ranging from psychosomatic disorders and neurotic depression to narcissistic personality. Naturally, this circumstance erects narrow limits to an interpretation referring to the normal population. For the inspection of the scores in this diagram it implies that a t-score of 50 is average compared to a patient sample and scores above 50 can be viewed in our preliminary analysis as a clinically substantial finding.
Figure 4 shows that overall the highest scores can be found in the dimensions ‘the threatened self’ and ‘the idealistic self’, the first indicating a marked instability of the self-system with fluent transitions between an arduously maintained and a progressive decompensation. An analysis of the single scales of the ‘threatened self’ shows high scores in ‘derealization/depersonalisation’, ‘archaic retreat’ and – expectedly – ‘negative body image’. This dimension has significant correlations up to .7 to a number of MMPI-scales such as depression, psychopathic deviate, paranoia and psychasthenia and also to the 16PF-scales emotional disturbance and sensitivity. The value of the dimension ‘the idealistic self’ goes back to high scores in the scales ‘object-devaluation’ and ‘symbiotic self-protection’.
Looking once more at differences between the subgroups the diagram shows that androphilic patients are higher in ‘the threatened self’ and especially ‘the idealistic self’. Among the single scales statistically significant differences can be found in ‘derealisation/depersonalisation’ (F1,18 = 7.23; p < 0.05), ‘archaic retreat’ (F1,18 = 3.39; p = 0.08) and ‘symbiotic self-protection’ (F1,18 = 6.85; p < 0.05), all with higher scores for the androphilics. Gynephilic patients are higher (but not statistically significant) in the dimensions ‘the hypochondriac self’ and the ‘classic narcissistic self’ which is largely due to high scores in the scale ‘narcissistic rage’.
Subgroups of patients according to self-regulatory mechanisms
Using the 4 dimensions of the Narcissism Inventory we have performed a cluster analysis of our cases to see how this statistical procedure groups our patients and to compare this solution to our clinical impression. We have used the Ward algorithm and after a careful analysis of the cluster agglomeration schedule have decided for the 4-cluster-solution. The main features of these clusters were then determined by univariate and multivariate statistical procedures. The main cluster characteristics relating to narcissism are summarized in table 4. The number of cases is small, especially in clusters 3 and 4, allowing only a tentative interpretation but on the other hand all clusters have a good correspondence to our clinical opinion.
Table 3:‘Main characteristics of clusters’
Narcissistic pathology primarily in object relations.
Severe narcissistic pathology in all 4 dimensions of NI.
No narcissistic pathology.
Narcissistic pathology only in dimension ‘The hypochondriac self’.
No significant psychopathology.
Significant psychophatology and emotional disorders.
Marked social isolation and introversion.
Tendency for somatization.
Strong need-persistence, denial of obstacles.
Strong need-persistence, high impunitivity.
Obstacle-dominance high, ego-defense and need-persistence low.
The 9 cases combined in cluster 1 have high scores only in ‘the idealistic self’ which means they have a marked narcissistic pathology primarily in their object-relations. Their prevailing self-regulation patterns indicate that they have a profound fear of being disappointed and hurt by others. To protect themselves against this they tend to emphasize their autonomy and their moral superiority. There is a strong ambivalence between a longing for another person and impulses to avoid and escape any close relationship. The cases of cluster 1 also have a strong tendency to identify themselves with specific highly valued personal ideas, a self-regulation mode serving the purpose to stabilize and protect the self. As you can see from the second slide, they do not show significant psychopathology in the MMPI or 16PF, but in the PFT have a strong need-persistence and tend to deny any obstacles in their way.
The 5 cases grouped into the second cluster have by far the most significant psychopathology, emotional disorders and severe narcissistic dysregulation in all 4 dimensions. In these individuals their auto-regulation-modes are always on the edge of decompensation and the gender dysphoria appears as only one facet in a profoundly disturbed personality.
The two small clusters 3 and 4 differ from the larger clusters in a respectively particular manner. The cases in cluster 3 have no narcissistic and general psychopathology but are socially isolated and introverted, they feel socially unattractive and live more or less in disguise. They have a strong need-persistence, tend to play obstacles or frustrations down and hope that the desired sex change will turn their lives to the better.
The patients in cluster 4 do not seem to have a true gender dysphoria but rather a disturbed body-relation which is more of the hypochondriac, dysmorphophobic or somatization type. Accordingly, they do not reject their body and do not have a negative body-self in the NI. They feel easily blocked by conflicts or frustrations, which seem to be expressed in a body-language.
Conclusion: At this stage, the provisional status of our data only permits some few conclusions. The central findings of this questionnaire analysis support the view of a great heterogeneity of gender disordered males which not only extends to the already well known gender and sexuality variables but also to general personality pathology and especially the different modes of self-regulation. We could identify a significant narcissistic pathology in most of our patients, but the regulation-modes afflicted by this pathology differ widely. The cluster analysis has yielded an interesting and clinically reasonable subtyping of our patients with two larger subgroups of which one is marked by severe narcissistic and personality pathology where the gender dysphoria appears as only one facet in this profound pathology, as a rather desperate attempt at stabilizing a fragmented self.In the other larger cluster there is no substantial personality pathology, but one might speculate that the gender dysphoria is part of a deeper problem in object-relations, for which the transsexual wish probably serves as an imagined solution. The data analysis has indicated that the sexual orientation does account for some variance in our sample, but in a multivariate view it does not seem to be a significant predictor. Thus, by our preliminary analysis the notion that gynephilics have more substantial personality and gender pathology could not be confirmed. However, the complete analysis of our data including the developmental and biographic variables as well as the results of the structured interview appears to be promising and may change this impression.
In closing, the cumulative evidence of our study so far is consistent with the view that gender dysphoria is a disorder of the sense of self as has been proposed by Beitel (1985) or Pfäfflin (1993). The central problem in our patients is about identity and the self in general and the transsexual wish seems to be an attempt at reassuring and stabilizing the self-coherence which in turn can lead to a further destabilization if the self is already too fragile. In this view the body is instrumentalized to create a sense of identity and the splitting symbolized in the hiatus between the rejected body-self and other parts of the self is more between good and bad objects than between masculine and feminine. The results obtained so far confirm the conviction that we have to maintain a clinical perspective in the field of gender dysphoria and must continue to improve our understanding of this enigmatic and fascinating problems.
Becker H, Hartmann U. (1994): Geschlechtsidentitätsstörungen und die Notwendigkeit der klinischen Perspektive. Ein Beitrag aus der psychiatrischen Praxis. Fortschritte der Neurologie Psychiatrie 62: 290 – 305.
Kernberg O. (1984): Severe Personality Disorders. Yale University Press: New York.
Deneke FW, Hilgenstock, B. (1989): Das Narzißmus-Inventar. Huber:Bern.
Blanchard R. (1985); Research methodes for the typological study of gender disorders in males. In: Gender Dysphoria. Development, Research, Managment. Steiner, BW ed. Plenum: New York.
Blanchard R. (1989): The concept of autogynephilia and the typology of male gender dysphoria. The Journal of Nervous and Mental Disease 177: 616 – 623.
Beitel A. (1985): The spectrum of gender identity disturbances. An intrapsychic model. In: Gender Dysphoria. Development, Research, Managment. Steiner, BW ed. Plenum: New York.
Pfäfflin F. (1993): Transsexualität. Beiträge zur Psychopathologie, Psychodynamik und zum Verlauf. Enke: Stuttgart 1993.
For many years, they have been sexually aroused by the thought of “being women” and impersonating women. Intermittently or occasionally, from a very young age, most of them have secretly put on various articles of women’s clothing, became sexually aroused and then masturbated in response to this dressing-up. Many men collect several pieces of women’s clothing, a “complete outfit” perhaps. Most eventually begin secretly to venture out “en femme,” perhaps to a neighboring town for shopping or a “make-over” at the department store’s cosmetics counter. These expeditions also lead to heavy masturbation, and if any store clerk happens to say “ma’am,” or if no-one throws them out of the women’s restroom, it really puts the icing on the cake. Many of these men enjoy pornography and pornographic writing centered around “forced feminization” fantasies, in which a dominant woman forces a manly man to become a submissive sissy, sometimes even a simpering fellatio expert. The men feel deeply conflicted and guilty about all these antics, and periodically will “purge” all artifacts of transvestism, and vow never to do such things again.
Based on his research with non-homosexual MtF transsexuals and other non-homosexual cross-dressing men, many of whom also develop cross-gender identities of some strength (Docter & Prince, 1997), Docter observed that:
Among our subjects, 79% did not appear in public cross dressed prior to age 20; at that time, most of the subjects had already had several years of experience with cross dressing. The average number of years of practice with cross dressing prior to owning a full feminine outfit was 15. The average number of years of practice with cross dressing prior to adoption of a feminine name was 21. Again, we have factual evidence indicative of the considerable time required for the development of the cross-gender identity.
In short, autogynephilic eroticism, as evidenced by erotic cross-dressing, precedes cross-gender identity by years or decades in non-homosexual MtF transsexuals. These transsexuals do not have female core gender identities nor do they have well developed cross-gender identities that precede and act as the driving force behind their desires to turn their bodies into facsimiles of women’s bodies. Rather, non-homosexual MtF transsexuals gradually develop cross-gender identities after years or decades of erotic cross-dressing, accompanied by the autogynephilic wish to turn their bodies into facsimiles of women’s bodies.
In the past few years, “transgenderism” has become very popular. It is widely celebrated. With all the “support” they find on the web from other hardcore autogynephiles and other transgenderism activists, not to mention the mass media, secretive male transvestites are “coming out” in droves and being put on the fast-track to synthetic “estrogen” prescriptions and possibly gender mutliation surgery. Every aspect of this “transition” is also exciting, and not just sexually — every “ma’am” and every reciprocation of “feminine” gestures by others feels tremendously “validating.” They also DEMAND such validation from everyone else — ESPECIALLY from women.
Question: But how do autogynephiles reconcile this reality: they have enjoyed their lives as men and despite a troubling concern for “femininity” have generally had a coherent and often strong “male” identity. Yet in order to proceed with transsexualization, they are required to claim a lifelong “female gender identity.”
Answer: they brood about it endlessly, and cherry-pick various aspects of their lives as clear evidence of actually being “women.” Their period of “questioning” — “should I really transition?” — has much more to do with rationalizing “why they should transition” than why they should not. Their life-narratives inflate the importance of all potential lady-brain indicators — “I had several female friends in childhood! Cooking is fun! A girl 30 years ago told me I was like a ‘lesbian’ trapped in a man’s body! I once had a pink polo shirt! I enjoy silky fabrics! I love shopping!”
After a while, with the encouragement of online transgender “friends,” psychological therapists and others with a vested interest in promoting the “gender identity” lie, they begin to exaggerate the depth and intensity of the emotional pain that they have felt through life at “being the wrong gender” — but that’s not really what the pain was about. Everyone has problems, and everyone feels a little or a lot depressed at some points in life. In this process of cultivating their “female gender identities,” the autogynephiles retroactively attribute all painful emotions and hard times they’ve ever experienced to the cruel joke of having been “assigned male at birth.”
My quandry comes from the fact that unlike a subset of the TG population, I did not know from birth that I felt female—at least not consciously. I always envied girls in dresses and skirts. In high school, I secretly slept in my mom’s old slips and altered an old wedding dress by hand to fit me for a Halloween costume. I sympathized with women and their unique issues. Most of my friends were girls. It was a natural fit. One high school friend once called me a lesbian trapped in a man’s body. At the time, I thought nothing of it. Now, it rings in my head. What did she see that I didn’t?
Over the years, I feel I have suppressed my femininity. I identified as male, but I secretly felt jealous of women. I am envious of the ability to have multiple orgasms in a single session. I want to carry and bear a child despite the 10 months of discomfort and excruciating labor pains at the end. I love the feel of silk and lace against my skin. I want to wear dresses and skirts.
Dr. J. Michael Bailey has very kindly offered to us, free of charge, the full text of his book, The Man Who Would be Queen. You may already be aware of the tremendous towering tizzy of transgender narcissistic rage that ensued upon the book’s publication in 2003. An army of anxious angry autogynephiles set out to UTTERLY DESTROY Dr. Bailey, not only in his professional life as chair of the psychology department at Northwestern University but even harassing his children and family with sexually-violent imagery and words. This book conveyed the notion of autogynephilia to the mainstream mass consciousness for the first time. Needless to say, an obsessed goon-squad of well-to-do middle-aged males (i.e. the cultish clique of paraphilic femininity fantasists) could not tolerate this book’s existence, and tried to kill it with fire.
It’s interesting to see how harshly the male transgenderites try to discredit autogynephilia, make it seem like a “bigoted” dirty joke. At the same time, you need only to read their own writings to see that autogynephilia is totally their driving force. Indeed, the vast majority of male transgenderites are hardcore autogynephiliacs. They cultivate their “female gender identity” and only develop it after endless sexualized cross-dressing. In other words, they are classic transvestite fetishists who in many cases have taken things too far.
A transgenderite sympathizer in San Francisco called Charles Moser decided to discredit autogynephilia by trying to show that real women have autogynephilia too. He also wanted to suggest that even if the cocks-in-frocks do have autogynephilia, it only means OMG they really are women!!1!!
Of course, women don’t have autogynephilia. This hasn’t stopped the male trans bros from squealing with delighted “feminine” giggles over Moser’s “findings” that “93% of women have autogynephilia.” They treat this study as though it were a proven scientific reality. However, it is about the weakest scientific evidence I’ve seen in a damn long time. It’s joke science, worthless!
Moser worked at a major hospital in San Francisco. He thought it would be a good idea to approach various women at the hospital to see what turned them on sexually.
“A convenience sample of female professional employees of an urban hospital was obtained. On two successive days in June, 2005, the questionnaire was distributed by the author, female staff members were approached in either the nurse’s station or staff lounge on several different floors during either day or evening shifts (weekdays).”
“Convenience sampling” is a methodology considered to be at extremely high risk of bias, and it would be absurd to generalize the responses of 29 female hospital employees in San Francisco to the general population. Moser approached and creepily handed out 51 intrusive questionnaires to women passing by, and got 29 back. The high 43% non-response rate makes it unlikely the responses even reflected the hospital’s female population. (Moser also admits: “Many individuals entered and left during the discussion of the project, so the exact number of individuals who heard the announcement of the study cannot be determined.”)
A crap and meaningless study! In addition to the high sampling bias, Moser’s questionnaire was designed really poorly:
Anne Lawrence wrote a critique in response to Moser’s study. Lawrence’s key points were as follows:
“Moser claimed to have documented at least occasional autogynephilic sexual arousal in 27 (93%) of 29 female hospital employees he surveyed, and frequent autogynephilic arousal in 8 (28%). However, many of the items in Moser’s scale bear little resemblance to the items Blanchard used to assess autogynephilia, and even those items that do bear some resemblance to Blanchard’s do not adequately assess the essential element of autogynephilia—sexual arousal simply to the thought of being a female — because they do not emphasize that element. Consequently, although Moser may have found something superficially resembling autogynephilia in women, there is little reason to think that he documented genuine autogynephilic arousal in women.”
If you see Lawrence’s comparison of the two scales (article below), you can get a sense of how crooked and/or stupid Moser must be. The dress-up boys sure love him, though.
Excerpt from: Lawrence AA. Autogynephilia: A Paraphilic Model of Gender Identity Disorder. Journal of Gay & Lesbian Psychotherapy 10/2008; 8(1).
Blanchard’s theory of autogynephilia helps to explain several otherwise puzzling observations about MtF transsexualism.
First, it convincingly explains why some men who are attracted to women, who have been fairly successful as men, and who appear unremarkably masculine would wish to undergo sex reassignment. Why would men who have been successful fighter pilots, construction workers, or captains of industry—men who seem not the least bit feminine, and who appear entirely comfortable being men—want to undergo sex reassignment? Attributing this solely to some long-hidden inner femininity might seem implausible. But if these individuals found the idea of being a woman sexually appealing, then their motivation would be easier to understand. The phenomenon of a middle-aged man risking his career, his reputation, and his marriage for the sake of a sexual obsession is well known. By proposing that certain types of MtF transsexualism can have sexual motivations, rather than (or in addition to) gender motivations, Blanchard’s autogynephilia theory helps to explain this phenomenon.
Second, Blanchard’s theory helps to explain the relationship between transsexualism and transvestism. Transvestism is considered to be a paraphilia, or unusual pattern of sexual arousal, in the DSM-IV-TR (APA, 2000) and has always been classified as such in the DSM. However, clinicians have long recognized that some men who previously considered themselves transvestites eventually decide to seek sex re-assignment surgery (SRS) and live full-time as women. If transvestism is purely an erotic phenomenon and transsexualism is purely a gender identity phenomenon, then there is no obvious explanation for this progression. But if both transvestism and some forms of MtF transsexualism are manifestations of autogynephilia—an erotic condition that also influences gender identity—then this progression is explained convincingly.
Third, Blanchard’s autogynephilia theory helps explain why transvestism and transsexualism are often associated with other unusual erotic interests. Sexual scientists have observed for decades that unusual sexual interests— sadomasochism, bondage, autoerotic asphyxia, interest in leather and rubber, exhibitionism, voyeurism, infantilism, pedophilia—frequently do not occur in isolation, but instead tend to co-occur. Males who have one unusual sexual interest are far more likely to have one or more other unusual sexual interests than would be expected simply by chance (Abel & Osborn, 1992; Wilson & Gosselin, 1980). And other unusual erotic interests are very common among transvestites and some MtF transsexuals. Wilson and Gosselin (1980) found that 63% of their sample of transvestites and transsexuals also described fetishistic or sadomasochistic interests. Blanchard and Hucker (1991) reported that transvestism accompanied many cases of autoerotic asphyxia. Abel and Osborn (1992) documented the co-occurrence of transvestism and transsexualism with other paraphilias. If transsexualism and transvestism are purely gender-identity-based phenomena, then these associations makes no sense. But if transsexualism and transvestism sometimes represent unusual sexual interests—as Blanchard’s autogynephilia theory proposes—then their association with other uncommon sexual interests does make sense.
Finally, the concept of autogynephilia helps to explain the unusual sexual fantasies that some transvestites and MtF transsexuals have concerning men, and the late development of sexual interest in male partners by some MtF transsexuals. Many heterosexual transvestites and formerly heterosexual MtF transsexuals have sexual fantasies about men, but usually these are not quite like the fantasies of genuine androphiles (Blanchard, 1989b). In the transsexual and transvestite fantasies, there is little emphasis on the specific characteristics of the imagined male partner. Often the imagined partner is faceless or quite abstract, and seems to be present primarily to validate the femininity of the person having the fantasy, rather than as a desirable partner in his own right (Blanchard, 1991). It is also fairly common for heterosexual transvestites to engage in sex with men when cross-dressed. Why don’t they do this at other times? Apparently, because the attraction is not to the male partner per se, but to the way in which acting like a woman in relationship to a man is sexually gratifying. Autogynephilia also explains why some transsexuals who were never interested in having sex with men before transition develop this interest after undergoing SRS. It is not because they have miraculously changed their underlying sexual orientation and now find men’s bodies arousing. Rather, it is because they can finally actualize their autogynephilic fantasy of having sex with a male.
Why is that so many men with the obsessive, autogynephiliac fantasy that they are “women trapped in men’s bodies” decide to bail out on their marriages, especially when they have young children at home? Why do they think that their kinky fetishizing is more important than their families’ well-being?
They are EXTREME NARCISSISTS. Their “gender identity” is based on erotic fantasies of themselves “as women” and masturbation! Nice “identity”!
This happens plenty often when there aren’t any children in the family. It also happens when the children are grown up. Very often, though, it seems that there are kids still living at home.
Sometimes these men leave their families completely; other times they put their families through the torture of “trying to make it work,” which seldom turns out well because the real woman in the marriage doesn’t want to fulfill the man’s fantasy of becoming a “lesbian,” help him go shopping, etc. and it’s usually not too long anyway before the dude is out looking for a boyfriend who will sweep him off his high-heeled size 13 feet in a whirlwind romantic adventure of epic sex role stereotyping. Until that happens, though, he usually claims that everything is really great and the family has adjusted well.
It’s a horrible experience for his wife, whether or not there are children. The young children of the tranny-man must also really be traumatized by his insane actions and behavior. Here are a few examples of these disgraceful fathers.
My need for transition
Why do I enjoy shopping in the women’s department? Why do I love dresses so much? Why am I so very feminine in my perceptions of myself? Why do I still love to look at myself in the mirror with a dress on and why do I have this overwhelming need to wear dresses and women’s clothing? Why did I suppress it so much and deny this part of myself? Why after all these years am I still dealing with this a seemingly innocent act of trying on one item of my sister’s clothing that has become a main focus in my life. Why do I feel I am a woman? I wish I had the answers. All I know is that I have feelings that are more common to girls. I feel I am a teenage girl looking forward to blossoming and enjoying becoming a young woman. These are strange words to hear from a middle aged male who is a husband and a father and has a life with responsibility and great pressure. I am not looking to escape. In fact I want to keep my family intact and still maintain my responsibility and still provide the love I have in my heart for both my wife and son. I have such tremendous feelings of guilt and I just don’t know what to do but I know if I don’t consider addressing these feelings and staying true to the course of transitioning I most certainly will die. I can not keep denying myself this wonderful gift of femininity. I need help and support and encouragement. I went for way too long hiding this and denying it and now I feel the floodgates have opened and it is my time. It is what I have always wanted in my life. The opportunity to express the true me. If I can’t do this then I will most certainly give up my hope of ever finding happiness and understanding who I am.
My husband’s sex change
He didn’t seem the same. He didn’t act the same. His values seemed to change along with his personality.
“What if you knew that doing this would destroy one or all of the children?” I asked him. Ice cold, the man I had once thought a wonderful father replied, “I would do it anyway.”
Of birthdays and presents
Sunday marked my first Second Birthday. It was the anniversary of my first time out in public as my true self. I celebrated by wearing my one and only pair of Victoria’s Secret panties, jeans and a plain T shirt. Then I got a large piece of my birthday cake from my other birthday. I sat down and watched the documentary ‘American Transgender” which I had recorded. The Itty Bitty Titty fairy also brought me a gift, sore and itchy boobs.
Later in the day we took the dog and the kids to the church carnival.
It’s called Fiesta with Friends. But this year it wasn’t much of a fiesta. We couldn’t pinpoint why but none of us felt any energy and excitement. Our boys had even gotten free tickets for the rides that they didn’t feel like using. Even the weather wouldn’t cooperate. It was overcast and grey. The only bright spot was our Corgi. It seemed like everyone had to come over and pet him.
I decided later that this carnival signified the end of part of all our lives. My daughter graduates high school and my older son moves on to a high school but one closer to our new home. We are pulling our youngest son out of the school because of the bullying and our increasing dissatisfaction with how the school has been run the last few years.
Don’t fight your true will
And, slowly, something strange happened. —I’m back home again, my real home where I belong—with my wife and children. My wife and I are more in love than we’ve ever been I believe. I’m home again and my wife and children accept me just as I am: as a woman. I’d not have believed that possible when I first returned to town.
I’ve been full-time about three months. I’ve been on hormones 9 weeks. The morning I voted in the presidential election, two days ago now, I overheard a hushed conversation: “That person’s name is ?!” Like they could not believe I was born in a male body.
But I had just showered and cleaned up—and I looked good.
In short, autogynephilic eroticism, as evidenced by erotic cross-dressing, precedes cross-gender identity by years or decades in nonhomosexual MtF transsexuals. These transsexuals do not have female core gender identities nor do they have well developed cross-gender identities that precede and act as the driving force behind their desires to turn their bodies into facsimiles of women’s bodies. Rather, nonhomosexual MtF transsexuals gradually develop cross-gender identities after years or decades of erotic cross-dressing, accompanied by the autogynephilic wish to turn their bodies into facsimiles of women’s bodies. In this sense, cross-gender identity in nonhomosexual MtF transsexuals is a secondary phenomenon or epiphenomenon.
One of the most important contributions made by Dreger’s article is her description of the extraordinary lengths to which some of Bailey’s male-to-female (MtF) transsexual opponents went in their attempts to discredit him, his book, and his ideas. By Dreger’s account, their campaign against Bailey continued for at least two years after the publication of The Man Who Would Be Queen (TMWWBQ; Bailey, 2003). Examination of the Internet sites maintained by some of Bailey’s principal transsexual opponents suggests that the campaign against him remains ongoing. The attacks, as described by Dreger, went far beyond writing scathing reviews of TMWWBQ. They included orchestration of charges of professional misconduct against Bailey, filed with Northwestern University and the Illinois Department of Professional Regulation; attempts to turn Bailey’s colleagues against him; attacks directed against Bailey’s children; and efforts to discredit or silence nearly anyone who openly supported him. Dreger’s article suggests that many of Bailey’s opponents intended not only to discredit Bailey’s book, but also to destroy its author. The duration, intensity, and sheer savagery of the campaign waged by many of Bailey’s MtF transsexual opponents is astonishing, especially given that Bailey’s book sold only about 4200 copies and probably would have received little attention, in either its print or Internet versions, were it not for the publicity that his opponents themselves created. One could imagine that Kohut (1972) was describing the campaign conducted by some of Bailey’s MtF transsexual opponents when he wrote the following:
[There is a] need for revenge, for righting a wrong, for undoing a hurt by whatever means, and a deeply anchored, unrelenting compulsion in pursuit of all these aims…. There is utter disregard for reasonable limitations and a boundless wish to redress an injury and to obtain revenge…. The fanaticism of the need for revenge and the unending compulsion of having to square the account after an offense are…not the attributes of an aggressivity which is integrated with the mature purposes of the ego…. Aggressions employed in the pursuit of maturely experienced causes are not limitless…. The narcissistically injured [person], on the other hand, cannot rest until he has blotted out [the]…offender who dared to oppose him, [or] to disagree with him. (pp. 380, 382, 385) These excerpts are taken from Kohut’s description of narcissistic rage, a concept that I believe is central to understanding many of the attacks against Bailey and their implications.
There is no such thing as a “woman trapped in a man’s body.” This is a fantasy that men use to excuse their behavior because they don’t want to admit they’re sexually aroused by the thought of themselves dressed and behaving stereotypically “as women.” Heterosexual males who claim to be “transgender” or “transsexual” are really in the throes of passionate autogynephilia, “a male’s propensity to be attracted to the thought or image of himself as a woman.” This is most commonly expressed in the form of fetishistic cross-dressing, though there are variations and degrees. Men who decide to “transition” (i.e. transsexuals) are those who have been caught up in all the sexy excitement. The fantasy becomes sort of a fixed idea that takes over everyday life. With the encouragement of their doctors and shrinks (which is always part of the fantasy), these men take the fantasy too far.
No matter how badly their wives and children may be hurt by it (and it’s amazing how often there are young children in these families), these guys are unstoppable and will renounce their families and traumatize their young kids, just for the chance to mutilate their bodies and imitate cartoonish images of women and pierce the veil of (i.e. rape) real women’s space and hang out with other dudes with similar sexy interests and wear wigs on top of their damn bald heads every day and constantly have to shave their faces, arms, chests, backs etc in a usually-futile effort to “pass” as a woman. They insist that they really are women, just because they say so and have taken estrogen and/or had various unnecessary surgeries, or even just because they say so. These men are so obsessed that they rant with extreme shrillness and violent posturing about “zomg haet crimez11!1!!” if anyone calmly tells them what’s really going on in their confused autogynephiliac minds. It is profoundly embarrassing for these fellows to really look within and own the fact that they get a boner (or used to get a boner) when they imagined themselves prancing around in prom gowns or being “forcibly feminized” or using the women’s toilet in a shopping mall while dressed “en femme” (tee-hee!) or taking a walk around the suburban neighborhood at 3 am wearing red high-heels.
A COMMON UNDERSTANDING OF male-to-female transsexualism is that all MtF transsexuals are, essentially, women trapped in men’s bodies. The standard narrative of men who become women goes something like this: “I have always felt that I was born in the wrong body. I have always been feminine in my interests and feelings. My desire to change sex is about my gender identity and not my sexuality.” This narrative, which Dreger (2007) has termed “the feminine essence narrative,” represents both what most laypeople believe to be true as well as what transsexuals are likely to say publicly. The narrative has been extended to an etiological theory, which Lawrence (2007b) has called “the brainsex theory of transsexualism. ” The transsexual advocacy website, transsexual.org, puts this theory succinctly: “A transsexual is a person in which the sex-related structures of the brain that define gender identity are exactly opposite the physical sex organs of the body. ”
The standard, feminine essence narrative, and the associated brain-sex theory, are incorrect, in the sense that they do not represent reality, even if they do correspond with many transsexual individuals’ beliefs and identities. The best scientific evidence (discussed below) indicates that there are two distinct subtypes of MtF transsexuals, and that the feminine essence narrative at best approximates the life history of only one subtype. Paradoxically, this explanation of MtF transsexualism persists because it is the explanation preferred by the other subtype, to which it does not apply at all. The popularity of the feminine essence narrative reflects factors other than the strength of scientific support. Its persistence has likely had negative consequences for both science and transsexuals themselves. .
Two Kinds of Male-to-Female Transsexuals
The classification system of MtF transsexuals that we believe to be correct was developed by the psychologist Ray Blanchard in a series of studies conducted at the Clarke Institute of Psychiatry in Toronto and published between 1985 and 1995. (Blanchard’s relevant oeuvre includes more than 20 articles; we provide only a summary of his conclusions.) Blanchard’s studies reported data on hundreds of transsexual males (that is, males who hoped to become or had become women), as well as other individuals who were male with respect to birth sex and did not desire sex reassignment surgery, but who sometimes presented themselves, or thought of themselves, as female. Participants in these studies were representative of gender patients in Canada, and were probably also quite similar to patients seen in the United States and Western Europe. Blanchard’s goal was to make sense out of the diversity of patients that gender clinics saw.
With respect to sexual orientation, Blanchard studied four groups of seemingly diverse male participants: homosexual (entirely attracted to other males), bisexual, heterosexual, and asexual. In three key studies, Blanchard (1985, 1988, 1989a) showed that homosexual transsexuals were different in a number of respects from members of the three other groups, and that members of the latter groups did not differ much among themselves. These differences included age of presentation at the gender clinic, history of childhood femininity, and most importantly, history of erotic arousal in association with cross-dressing and crossgender fantasy. These findings supported the division of MtF transsexualism into two types: homosexual and non-homosexual. Blanchard’s work provided a parsimonious and compelling taxonomy for the apparent sexual diversity among MtF transsexuals, reducing the four types of MtF transsexuals to two fundamentally distinct subtypes.
Autogynephilic Male-to-Female Transsexualism. Arguably, Blanchard’s most important contribution was recognizing and elaborating the phenomenon that united the three non-homosexual transsexual subtypes: autogynephilia. Autogynephilia is “a male’s propensity to be attracted to the thought or image of himself as a woman” (Blanchard 2005). One common manifestation of autogynephilia is fetishistic cross-dressing, which is an extremely common antecedent to seeking sex reassignment among non-homosexual (but not homosexual) transsexuals (Blanchard, Clemmensen, and Steiner 1987). Some autogynephilic individuals, however, do not cross-dress fetishistically. Indeed, a seminal case in Blanchard’s conceptualization was “Philip,” who did not cross-dress but fantasized sexually about being a nude woman by focusing on desired anatomical features (Blanchard 1991). Autogynephilia may be conceived as inner-directed heterosexuality. That is, autogynephilic males are like heterosexual men, except that their primary sexual attraction is to the image or idea of themselves as women.
Blanchard hypothesized that non-homosexual transsexuals are motivated by autogynephilia. That is, non-homosexual transsexuals experience erotic arousal at the idea of becoming a woman, and this arousal motivates them to become women. (We agree with Lawrence’s recent theoretical modification [2007a] hypothesizing that romantic attachment can play an important role in some cases. It is probable, however, that such attachment is usually preceded by substantial erotic arousal to the idea of being a woman. )
Not all autogynephilic males become transsexuals. Autogynephilic interests run a gamut from cross-dressing to engaging in stereotypic female activities (e. g. , knitting alongside other women) to possessing female breasts and genitalia. It is the latter interest that is most strongly associated with autogynephilic transsexualism (Blanchard 1993b). Other than the precise nature of their autogynephilic fantasy, there is no obvious difference between non-homosexual crossdressers who will become transsexuals and those who will not. They are all autogynephiles. Blanchard’s work also clarified the diversity of self-reported sexual orientations among non-homosexual transsexuals (Blanchard 1989a). Autogynephilia (inner-directed heterosexuality) appears to compete with outward-directed heterosexuality. Many autogynephilic transsexuals experience enough outward directed heterosexuality to label themselves as heterosexual pre- transition. Those whose autogynephilia is strong enough that they experience no other-directed sexual feelings identify as asexual. Finally, a common aspect of autogynephilia is the erotic fantasy of being admired, in the female persona, by another person.
Autogynephiles for whom this fantasy is sufficiently strong tend to identify as bisexual. However, this bisexuality is not characterized by equal or even similar kinds of attraction to male and female bodies. Blanchard (1989b) thus suggests that it be characterized as “pseudobisexuality. ” Autogynephilia appears to be a paraphilia. Paraphilias are unusual, intense, and persistent erotic interests. The concept of paraphilia is a controversial one, with some arguing that it is merely a word used to stigmatize sexual behavior that most people find undesirable (Moser 2001). Some paraphilias (e. g. , pedophilia and sadism) are harmful to other people, while others (e. g. , autogynephilia and fetishism) are not. Two non-obvious facts about paraphilias suggest that the label paraphilia may represent more than a mere value judgment. First, paraphilias are found nearly exclusively in males (APA 2000, p. 568). Second, at least some paraphilias tend to occur together. Autogynephilia, for example, appears to be correlated with other paraphilias, especially masochism (Lawrence 2006). Advertisements of dominatrixes frequently offer services to cross-dressers, and autogynephilic males are more likely than other males to become sexually aroused to stimuli depicting masochistic themes (Chivers and Blanchard 1996; Wilson and Gosselin 1980). Of men who die practicing the dangerous masochistic activity of autoerotic asphyxia, approximately 25% are cross-dressed, a much higher percentage than one would expect based on the number of non-homosexual crossdressers in the general population (Blanchard and Hucker 1991).
Homosexual Male-to-Female Transsexualism. Homosexual MtF transsexuals are much easier than autogynephilic transsexuals for most people to comprehend. Homosexual transsexuals are best understood as a subset of homosexual males who were very feminine from early childhood. In some ways, then, they do appear to fit the feminine essence narrative: they had male bodies as children, but behaviorally and psychologically they were different, in some respects, from typical boys and more similar to typical girls. Most males who begin life as extremely feminine boys, even those whose femininity includes the wish to become girls, do not become transsexual. In the contemporary United States, most become homosexual men (Bailey and Zucker 1995; Green 1987; Zuger 1984). Homosexual MtF transsexuals, in contrast, persist in their wish to become female (Bailey 2003; Blanchard 1990). The reasons for this atypical persistence are unclear. However, these individuals often have a difficult time socially, romantically, and sexually, and their transition appears to be largely motivated by a desire to improve their lives in these domains.
As their label implies, homosexual MtF transsexuals are homosexual with respect to their birth sex. That is, they are attracted exclusively to men. Although some writers have objected to the use of the word homosexual to refer to individuals who have sex with men as women (e. g. , Gooren 2006),we retain the terminology because it emphasizes the fact that homosexual MtFs are a subset of, and developmentally related to, other homosexual males. Furthermore, it emphasizes the most efficient and practical way of distinguishing homosexual and autogynephilic transsexuals. Homosexual transsexuals are unambiguously, exclusively and intensely attracted to attractive men; autogynephilic transsexuals have some other pattern of sexual attraction. That is, an MtF transsexual who reports attraction to both men and women, or a history of sexual attraction to women, or considerable sexual experience with women, or attraction to neither men nor women—any clearly non-homosexual pattern—is almost certainly autogynephilic (Blanchard 1989a; Blanchard, Clemmensen, and Steiner 1987).
Evidence for the Feminine Essence Narrative and Brain-Sex Theory
The main theory competing with Blanchard’s theory of MtF classification is the theory that all MtF transsexuals have a (probably innate) female gender identity. By this theory, homosexual and non-homosexual transsexuals have different sexual orientations because sexual orientation and gender identity are distinct, perhaps even uncorrelated, phenomena. Both homosexual and non-homosexual transsexuals share the same psychological condition, female gender identity, which they experience in similar ways. Furthermore, both kinds of transsexuals, as well as natal women, have in common neural circuitry that differs from that of nontranssexual men, and that causes female gender identity.
Transsexual Narratives. The claim that MtF transsexuals are “women trapped in men’s bodies” is commonly made both by and about transsexuals. The evidentiary value of such claims depends on their plausibility and the lack of alternative, more plausible explanations. Non-homosexual MtF transsexuals are not especially feminine in their interests and behaviors compared with most women (Herman-Jeglínska, Grabowska, and Dulko 2002; Lippa 2001) or with homosexual MtF transsexuals (Bailey 2003; Blanchard 1988). Furthermore, they often acknowledge autogynephilia (Lawrence 2005), such as fetishistic cross-dressing (in contrast to most women and homosexual MtF transsexuals [APA 2000; Blanchard, Clemensen, and Steiner 1987]). Thus, the contention that women and all MtF transsexuals have feminine minds that motivate their feminine identification strikes us as implausible.
The Transsexual Brain Studies. In 1995, Zhou et al. described a sex difference in the size of a brain region, the central subdivision of the bed nucleus of the stria terminalis (BSTc), a collection of cells in the hypothalamus. This article included data from the brains of six MtF transsexuals, whose BSTc volumes were female-typical. A follow-up paper by Kruijver et al. (2000) added another MtF transsexual’s brain and confirmed the earlier finding using different measurement techniques.
These studies have been widely touted by transsexual activists as supporting the brain-sex theory of MtF transsexualism. Furthermore, a remarkable statement by the British group, the Gender Identity Research and Education Society (GIRES 2006), appeared to base its support of transsexual treatment and rights largely on the studies and their alleged implication that “transsexualism is a neuro-developmental condition of the brain. ” Several of the signatories of this statement are distinguished researchers. The transsexual brain studies have also received considerable scientific attention. As of February 1, 2007, the study by Zhou et al. (1995) has been cited by 117 scholarly articles, and that of Kruijver et al. (2000) has been cited by 43 scholarly articles. In contrast, Blanchard’s three most highly cited autogynephilia-related studies (Blanchard 1985, 1989b; Blanchard, Clemmensen, and Steiner 1987) have each earned 38 such citations.
In our view, the influence of the transsexual brain studies is disproportionate compared with their scientific value to understanding the etiology of MtF transsexualism. Their relevance as support for the feminine essence narrative, as opposed to Blanchard’s theory, is extremely weak—indeed, it is arguably absent. There are several important limitations that prevent the brain studies from being relevant in this regard (Lawrence 2007b). The most critical problem is that neither study includes the necessary hormonal controls to exclude the possibility that the feminization of the BSTc in MtFs was due to hormone treatment, especially estrogen therapy, received for transsexualism. Recent research shows that the volume of the hypothalamus is highly dependent on such hormonal treatment, with smaller volumes associated with estrogenic treatment (Hulshoff Pol et al. 2006). We concur with Lawrence (2007b) that this is the most likely explanation of the Zhou et al. (1995) and Kruijver et al. (2000) findings. Certainly those findings should be regarded cautiously until a study has ruled out the concern regarding hormonal treatment.
Evidence from Sex-Reassigned Children. In principle, the feminine essence narrative and brain sex theory could be instantiated by selecting a normal girl, medically masculinizing her body, and rearing her as a boy from an early age. If anyone could be a female trapped in a male body, or have a female brain in a male body, it would be a female such as this. What we know about such cases suggests that they are similar to homosexual, and different from non-homosexual, MtF transsexuals. There have been a few rare cases of females born with virilized genitalia due to prenatal maternal use of a progestin, in which the attempt was made to rear them as boys. The second author of this article is one such case, and she has known two others personally. All three cases were quite similar in presentation to homosexual MtF transsexuals: noticeably feminine presentation and interests, early expression of dissatisfaction with the male role, and sexual interest in males. None of these cases had signs of autogynephilia, such as fetishistic cross-dressing. Finally, their decisions to transition were made on the basis of optimizing sexual and social functioning, rather than because of a deep conviction that they were women trapped in men’s bodies.
Blanchard’s Theory Versus the Feminine Essence Narrative
We believe that Blanchard’s theory of MtF transsexualism is far better supported, and far more likely to be true, than the feminine essence narrative and the associated brain-sex theory. It is based on far more data, with respect to the number of both studies and subjects; no published scientific data in the peer-reviewed literature contradict it; and other investigators in other countries have obtained similar findings (Smith et al. 2005). It also provides a plausible explanation for phenomena that are problematic for the feminine essence narrative (e. g. , fetishistic cross-dressing and lack of early femininity among non-homosexual transsexuals). Why, then, has Blanchard’s theory remained underappreciated, compared with the standard, feminine essence narrative? In the remainder of this section, we try to explain this. First, however, we wish to emphasize some important respects in which the two approaches to MtF transsexualism do not differ. Perhaps most importantly, both proponents of the feminine essence narrative and of Blanchard’s theory support the treatment of transsexuals by sex reassignment surgery. Indeed, Blanchard (2000) has been a consistent advocate of such treatment for both homosexual and autogynephilic transsexuals, as has one of the authors of this article (Bailey 2003).
In addition, proponents of both theories see the histories people tell of their lives as an important source of understanding. In a recent paper on autogynephilia, Blanchard (2005) quotes extensively from self-reports of people with autogynephilia, primarily from collections compiled by Lawrence (Lawrence 1999a, 1999b). We ourselves have learned much about diversity among MtF transsexuals from our own interactions with members of each type. We believe, however, that in this domain, as in others, people’s own narratives do not always correspond to the true reasons for their choices and behaviors. Finally, proponents of both theories recognize that MtF transsexuals are a diverse population who differ among themselves in many ways due to life circumstances and personal characteristics. Nonetheless,we maintain that those who promote the feminine essence narrative fail to acknowledge one important source of that diversity, the distinction between homosexual and autogynephilic MtF transsexuals.
Denial of Autogynephilia. Few non-homosexual transsexuals publicly identify as autogynephilic, and most neither admit a history of sexual arousal to the idea of being a woman, nor accept that such arousal was a motivating factor for their transsexualism. Indeed, although most public transsexual activists appear by their histories and presentations to be non-homosexual MtF transsexuals, they have generally been hostile toward the idea that non-homosexual transsexualism is associated with, and motivated by, autogynephilia. Prominent MtF transsexuals and transgenders who have expressed outrage at the theory include Becky Allison (1998), Christine Burns (2004), Lynn Conway (2006), Andrea James (2006), Deirdre McCloskey (2003), Nancy Nangeroni (Grubb 2004), and Joan Roughgarden (2003). The most visible exception has been Anne Lawrence, a physician, researcher, and psychotherapist, who both identifies as autogynephilic and has done most of the recently published research on autogynephilia. Willow Arune (2004) is another exception.
There are a number of reasons why autogynephilic individuals may prefer the feminine essence narrative as an account of their condition, even if autogynephilia is in fact the driving force. These include the concern (pre-transition) that clinicians will deem them unacceptable for sex reassignment if their transsexualism is erotically motivated, or that people will consider them sexually deviant (Bailey 2003; Lawrence 2004). Because autogynephilia produces a strong desire to imagine oneself as a woman, the feminine essence narrative is intrinsically appealing to autogynephilic individuals, even if it is implausible. In contrast, an explanation based on autogynephilia may be experienced as a narcissistic injury.
Transsexuals who have successfully accomplished the MtF transition sometimes see themselves as mentors to younger people attempting or considering this path. They may feel that public acceptance of the feminine essence narrative will facilitate the transition for these younger individuals. For example, parents may be more accepting of a child whom they think of as a female unfortunately born with a male’s body than of one whom they think of as a male erotically aroused by the idea of being female. Finally, as Lawrence (2007a) notes, postoperative transsexuals whose desire and attachment to being women persists as their sex drive diminishes with age may come to doubt that this desire has anything to do with eroticism. She also explains how this pattern is explicable via autogynephilia.
Attempts to Intimidate Proponents of Blanchard’s Theory. Beyond denying the role of autogynephilia in MtF transsexualism, some transsexual activists have mounted attacks on those who publicly disagree with them. In 2003, the first author published a book, The Man Who Would Be Queen, about male femininity, including MtF transsexualism. The section on transsexualism included summaries of Blanchard’s theory illustrated by transsexual women of both types whom he had met, and who agreed to let their stories be included. Upon publication, there was a firestorm of controversy among some MtF transsexuals.
Most notably, the transsexual activists Lynn Conway (2006) and Andrea James (2006) led an internet “investigation” into the publication of the book. Conway (2004) likened the book to “Nazi propaganda” and said that it was “transsexual women’s worst nightmare. ” As a result of Conway’s and James’s efforts, a number of very public academic, personal, and professional accusations were made against the first author. None of these accusations was true (Bailey 2005). (For an historical investigation into the controversy surrounding The Man Who Would Be Queen, including a description of the substance and the merits of the accusations, see Dreger 2007. ) The attacks on The Man Who Would Be Queen were precisely an attempt to punish the author for writing approvingly about Blanchard’s ideas, and to intimidate others from doing so.
The second author was also attacked by some of the same transsexuals after she helped create the Website transkids. us. This website was created by a group of homosexual transsexuals, or “transkids,” their nonclinical name for themselves, to educate the clinical and research communities in the wake of the controversy regarding The Man Who Would Be Queen. The writings on the site both endorsed Blanchard’s distinction between homosexual and autogynephilic MtF transsexuals and criticized the standard feminine essence narrative as being both false and harmful to homosexual MtF transsexuals. Subsequently, Andrea James (2007) conducted highly personal attacks on individual transkids (including the second author), urging that these transkids be exposed and asserting that they were “fakes” because they would not reveal their identities publicly.
How Denial of Autogynephilia Can Be Harmful
We believe that advocacy for the standard feminine essence narrative, and against Blanchard’s theory, is primarily conducted by, or at least on behalf of, non-homosexual transsexuals who incorrectly deny their autogynephilia. We have outlined why some autogynephilic transsexuals might want to deny that they are autogynephilic, and why they might strongly prefer the standard (but false) feminine essence narrative. Those who advocate on behalf of autogynephilic transsexuals in denial include many gender clinicians; their motives may include their unwillingness to disbelieve or displease their patients and their greater comfort with the idea of facilitating sex reassignment for reasons related to gender than to eroticism (Lawrence 1998). Some clinicians may also think that belief in the feminine essence narrative may be beneficial for their patients’ psychological health and social interactions, even if it does not correspond to the true etiology of their desire for sex reassignment. Nevertheless, there are both scientific and human costs to colluding with autogynephilies in denial by propping up the feminine essence narrative as an explanation for all MtF transsexualism.
Impeding Scientific Progress. Obviously, the extreme, highly personal attacks on those who agree with Blanchard’s theory of transsexualism are likely to deter people from researching, agreeing with, or publicizing the theory. That is, indeed, the intended function of the attacks. Most theories can benefit by scientific criticism, but the attacks on The Man Who Would Be Queen and its author by transgender activists were not scientific criticism. We have argued that Blanchard’s “two types” theory has greater explanatory value than the feminine essence narrative and the associated brain-sex theory. Whether or not we are right, deciding between the two views via political pressure cannot be the right way to advance science. The scientific costs of this pressure include embracing a less plausible theory and failure to advance the better theory. For example, it is possible that some transsexuals’ resistance to the current theory is due to its incompleteness, which prevents it from explaining their inner experiences to their satisfaction (Lawrence 2007a). Progress toward a more complete theory is impeded by the kinds of pressure we have described, but it would be facilitated by thoughtful criticism.
Harm to Homosexual Transsexuals. Clinicians who work with transgender patients and who believe in the feminine essence narrative of MtF transsexualism sometimes take a similar approach to both homosexual and non-homosexual MtF transsexuals. For example, the second author knows transkids whose therapists have offered them, and their families, readings by and about non-homosexual transsexuals (e. g. , She’s Not There, by Jennifer Boylan  and Conundrum by Jan Morris ). The narratives in these readings did not even approximate the transkids’ lives, and the therapists’ assumptions that they did had a highly negative effect on the transkids’ attitudes toward therapy. Inevitably, they dropped out early.
Homosexual and non-homosexual MtF transsexuals have different life issues and goals, and the persistence of the belief that they are similar prevents development of clinical interventions likely to benefit the homosexual subtype. Velasquez (2004) has argued that there is a lack of meaningful therapy for young homosexual transsexuals like herself, and that this is because transkids are not recognized as a subtype distinct from non-homosexual transsexuals. The denial of autogynephilia helps make this possible.
Harm to Autogynephilic Male-to-Female Transsexuals. There are also substantial human costs to autogynephilic transsexuals due to insistence on the false, feminine essence narrative. We consider two groups whom we believe are harmed by embracing the false narrative at the expense of Blanchard’s categorical theory: autogynephiles not in denial, and autogynephiles in denial.
Although few non-homosexual MtF transsexuals publicly identify as autogynephilic, many more do so privately. Of the e-mail correspondence the first author received regarding The Man Who Would Be Queen, about a third was from individuals who understood themselves to be autogynephilic. Some of these individuals said that reading about Blanchard’s theory in the book had been revelatory and that they understood themselves for the first time, and all of them were happy that autogynephilia was being discussed openly. Even before the controversy concerning the book, transsexuals sympathetic to Blanchard’s ideas have found themselves unwelcome in transsexual forums (e. g. , online forums discussing transgender issues). Typically, any endorsement of Blanchard’s theory, or admission of significant autogynephilic motivation, is met with hostility. This hostility appears to emanate primarily from individuals who fit the profile of autogynephiles in denial. The extreme stigmatization of the (true) idea of autogynephilia harms autogynephiles not in denial in obvious ways. It makes it much less likely that they can find resources that help them understand themselves, forces them into the closet, invalidates their self-concepts, and heightens feelings of shame.
Although autogynephiles in denial prefer the standard feminine essence narrative, this does not necessarily mean that wide acceptance of that narrative is in their best interests. In general, it seems likely that the best clinical and personal decisions are made on the basis of accurate conceptualizations. For example, we have noticed that some transsexuals we would classify as autogynephilic have chosen to pursue sex reassignment surgery after being diagnosed as “transsexual” rather than “transvestite,” a diagnostic moment they often recount with a sense of relief. Currently, in the psychiatric nomenclature, the official name for transsexualism is gender identity disorder, highlighting the centrality of gender identity, consistent with the feminine essence narrative (American Psychiatric Association 2000). However, the differential diagnosis between transsexualism (gender identity disorder) and transvestism (“transvestic fetishism” in the DSM) is not clearly meaningful. Both non-homosexual transsexuals and transvestites are motivated by autogynephilia; many (perhaps most) non-homosexual transsexuals were transvestites prior to transitioning; and most importantly, the main difference between the two conditions is that transsexuals, but not transvestites, decide to take steps to achieve women’s bodies. As we have noted, the precise nature of one’s autogynephilic fantasies is a key factor in this decision. It seems detrimental to us that what should be an explicit cost-benefit decision, with important consequences to the lives of autogynephilic patients and their families, might be unduly influenced by a differential diagnosis of questionable validity.
It is unfortunate that the public face of MtF transsexualism is so different from reality. The controversy concerning The Man Who Would Be Queen has raised awareness of Blanchard’s ideas within the transgender community, but it has not yet encouraged open-mindedness to those ideas. Those who value scientific truth and the well-being of transsexuals are advised to do better.
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