Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Original Articles and Reviews

Autogynephilia and the Typology of Male-to-Female Transsexualism

Concepts and Controversies

Published Online:March 23, 2017https://doi.org/10.1027/1016-9040/a000276

Abstract

Abstract. Sexual scientists have recognized for over a century that biologic males who seek sex reassignment – male-to-female (MtF) transsexuals – are not a homogeneous clinical population but comprise two or more distinct subtypes with different symptoms and developmental trajectories. The most widely used typologies of MtF transsexualism have been based on sexual orientation and have distinguished between persons who are androphilic (exclusively sexually attracted to males) and those who are nonandrophilic (sexually attracted to females, both males and females, or neither gender). In 1989, psychologist Ray Blanchard proposed that most nonandrophilic MtF transsexuals display a paraphilic sexual orientation called autogynephilia, defined as the propensity to be sexually aroused by the thought or image of oneself as a woman. Studies conducted by Blanchard and colleagues provided empirical support for this proposal, leading to the hypothesis that almost all nonandrophilic MtF transsexuals are autogynephilic, whereas almost all androphilic MtF transsexuals are not. Blanchard’s ideas received increased attention in 2003 after they were discussed in a book by psychologist J. Michael Bailey. The concept of autogynephilia subsequently became intensely controversial among researchers, clinicians, and MtF transsexuals themselves, causing widespread repercussions. This article reviews the theory of autogynephilia, the evidence supporting it, the objections raised by its critics, and the implications of the resulting controversy for research and clinical care.

References

  • á Campo, J., Nijman, H., Merckelbach, H. & Evers, C. (2003). Psychiatric comorbidity of gender identity disorders: A survey among Dutch psychiatrists. The American Journal of Psychiatry, 160, 1332–1336. doi: 10.1176/appi.ajp.160.7.1332 First citation in articleCrossref, Google Scholar

  • Abel, G. G. & Osborn, C. (1992). The paraphilias. The extent and nature of sexually deviant and criminal behavior. The Psychiatric Clinics of North America, 15, 675–687. First citation in articleCrossref, Google Scholar

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author. First citation in articleGoogle Scholar

  • American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., revision). Washington, DC: Author. First citation in articleGoogle Scholar

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. First citation in articleGoogle Scholar

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revised). Washington, DC: Author. First citation in articleGoogle Scholar

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. First citation in articleCrossref, Google Scholar

  • Bailey, J. M. (2003). The man who would be queen: The science of gender-bending and transsexualism. Washington, DC: Joseph Henry Press. First citation in articleGoogle Scholar

  • Bancroft, J. (2008). Lust or identity? [Commentary]. Archives of Sexual Behavior, 37, 426–428. doi: 10.1007/s10508-008-9317-1 First citation in articleCrossref, Google Scholar

  • Benjamin, H. (1966). The transsexual phenomenon. New York, NY: Julian Press. First citation in articleGoogle Scholar

  • Becker, I., Nieder, T. O., Cerwenka, S., Briken, P., Kreukels, B. P., Cohen-Kettenis, P. T., … Richter-Appelt, H. (2016). Body image in young gender dysphoric adults: A European multi-center study. Archives of Sexual Behavior, 45, 559–574. doi: 10.1007/s10508-015-0527-z First citation in articleCrossref, Google Scholar

  • Bettcher, T. M. (2014). When selves have sex: What the phenomenology of trans sexuality can teach us about sexual orientation. Journal of Homosexuality, 61, 605–620. doi: 10.1080/00918369.2014.865472 First citation in articleCrossref, Google Scholar

  • Blanchard, R. (1985). Typology of male-to-female transsexualism. Archives of Sexual Behavior, 14, 247–261. First citation in articleCrossref, Google Scholar

  • Blanchard, R. (1988). Nonhomosexual gender dysphoria. Journal of Sex Research, 24, 188–193. First citation in articleCrossref, Google Scholar

  • Blanchard, R. (1989a). The classification and labeling of nonhomosexual gender dysphorias. Archives of Sexual Behavior, 18, 315–334. First citation in articleCrossref, Google Scholar

  • Blanchard, R. (1989b). The concept of autogynephilia and the typology of male gender dysphoria. The Journal of Nervous and Mental Disease, 177, 616–623. First citation in articleCrossref, Google Scholar

  • Blanchard, R. (1991). Clinical observations and systematic studies of autogynephilia. Journal of Sex & Marital Therapy, 17, 235–251. First citation in articleCrossref, Google Scholar

  • Blanchard, R. (1993). Partial versus complete autogynephilia and gender dysphoria. Journal of Sex & Marital Therapy, 19, 301–307. First citation in articleCrossref, Google Scholar

  • Blanchard, R. (2005). Early history of the concept of autogynephilia. Archives of Sexual Behavior, 34, 439–446. doi: 10.1007/s10508-005-4343-8 First citation in articleCrossref, Google Scholar

  • Blanchard, R. & Clemmensen, L. H. (1988). A test of the DSM-III-R’s implicit assumption that fetishistic arousal and gender dysphoria are mutually exclusive. Journal of Sex Research, 25, 426–432. First citation in articleCrossref, Google Scholar

  • Blanchard, R., Clemmensen, L. H. & Steiner, B. W. (1985). Social desirability response set and systematic distortion in the self-report of adult male gender patients. Archives of Sexual Behavior, 14, 505–516. First citation in articleCrossref, Google Scholar

  • Blanchard, R., Clemmensen, L. H. & Steiner, B. W. (1987). Heterosexual and homosexual gender dysphoria. Archives of Sexual Behavior, 16, 139–152. First citation in articleCrossref, Google Scholar

  • Blanchard, R., Dickey, R. & Jones, C. L. (1995). Comparison of height and weight in homosexual vs. nonhomosexual male gender dysphorics. Archives of Sexual Behavior, 24, 543–554. First citation in articleCrossref, Google Scholar

  • Blanchard, R., Racansky, I. G. & Steiner, B. W. (1986). Phallometric detection of fetishistic arousal in heterosexual male cross-dressers. Journal of Sex Research, 22, 452–462. First citation in articleCrossref, Google Scholar

  • Blanchard, R., Steiner, B. W. & Clemmensen, L. H. (1985). Gender dysphoria, gender reorientation, and the clinical management of transsexualism. Journal of Consulting and Clinical Psychology, 53, 295–304. First citation in articleCrossref, Google Scholar

  • Bolin, A. (1988). In search of Eve: Transsexual rites of passage. New York, NY: Bergin & Garvey. First citation in articleGoogle Scholar

  • Brown, G. R. & Jones, K. T. (2016). Mental health and medical health disparities in 5135 transgender veterans receiving healthcare in the Veterans Health Administration: A case-control study. LGBT Health, 3, 122–131. doi: 10.1089/lgbt.2015.0058 First citation in articleCrossref, Google Scholar

  • Cerwenka, S., Nieder, T. O., Briken, P., Cohen-Kettenis, P. T., De Cuypere, G., Haraldsen, I. R. H., … Richter-Appelt, H. (2014). Intimate partnerships and sexual health in gender-dysphoric individuals before the start of medical treatment. International Journal of Sexual Health, 26, 52–65. doi: 10.1080/19317611.2013.829153 First citation in articleCrossref, Google Scholar

  • Cohen-Kettenis, P. T. & Pfäfflin, F. (2010). The DSM diagnostic criteria for gender identity disorder in adolescents and adults. Archives of Sexual Behavior, 39, 499–513. doi: 10.1007/s10508-009-9562-y First citation in articleCrossref, Google Scholar

  • Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., De Cuypere, G., Feldman, J., … Zucker, K. (2011). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13, 165–232. doi: 10.1080/15532739.2011.700873 First citation in articleCrossref, Google Scholar

  • Diamond, L. M. (2003). What does sexual orientation orient? A biobehavioral model distinguishing romantic love and sexual desire. Psychological Review, 110, 173–192. doi: 10.1037/0033-295X.110.1.173 First citation in articleCrossref, Google Scholar

  • Docter, R. F. (1988). Transvestites and transsexuals: Toward a theory of cross-gender behavior. New York, NY: Plenum Press. First citation in articleCrossref, Google Scholar

  • Dreger, A. (2008). The controversy surrounding The Man Who Would Be Queen: A case history of the politics of science, identity, and sex in the Internet age. Archives of Sexual Behavior, 37, 366–421. doi: 10.1007/s10508-007-9301-1 First citation in articleCrossref, Google Scholar

  • Freund, K., Steiner, B. W. & Chan, S. (1982). Two types of cross-gender identity. Archives of Sexual Behavior, 11, 47–63. First citation in articleCrossref, Google Scholar

  • Gosselin, C. & Wilson, G. (1980). Sexual variations: Fetishism, sadomasochism, transvestism. New York, NY: Simon and Schuster. First citation in articleGoogle Scholar

  • Guillamon, A., Junque, C. & Gómez-Gil, E. (2016). A review of the status of brain structure research in transsexualism. Archives of Sexual Behavior, 45, 1615–1648. doi: 10.1007/s10508-016-0768-5 First citation in articleCrossref, Google Scholar

  • Hsu, K. J., Rosenthal, A. M. & Bailey, J. M. (2015). The psychometric structure of items assessing autogynephilia. Archives of Sexual Behavior, 44, 1301–1312. doi: 10.1007/s10508-014-0397-9 First citation in articleCrossref, Google Scholar

  • Hwahng, S. J. & Nuttbrock, L. (2007). Sex workers, fem queens, and cross-dressers: Differential marginalizations and HIV vulnerabilities among three ethnocultural male-to-female transgender communities in New York City. Sex Research & Social Policy, 4, 36–59. First citation in articleCrossref, Google Scholar

  • Kreukels, B. P., Haraldsen, I. R., De Cuypere, G., Richter-Appelt, H., Gijs, L. & Cohen-Kettenis, P. T. (2012). A European network for the investigation of gender incongruence: The ENIGI initiative. European Psychiatry, 27, 445–450. doi: 10.1016/j.eurpsy.2010.04.009 First citation in articleCrossref, Google Scholar

  • Lawrence, A. A. (2004). Autogynephilia: A paraphilic model of gender identity disorder. Journal of Gay & Lesbian Psychotherapy, 8(1/2), 69–87. doi: 10.1300/J236v08n01_06 First citation in articleCrossref, Google Scholar

  • Lawrence, A. A. (2005). Sexuality before and after male-to-female sex reassignment surgery. Archives of Sexual Behavior, 34, 147–166. doi: 10.1007/s10508-005-1793-y First citation in articleCrossref, Google Scholar

  • Lawrence, A. A. (2007). Becoming what we love: Autogynephilic transsexualism conceptualized as an expression of romantic love. Perspectives in Biology and Medicine, 50, 506–520. First citation in articleCrossref, Google Scholar

  • Lawrence, A. A. (2009). Transgenderism in nonhomosexual males as a paraphilic phenomenon: Implications for case conceptualization and treatment. Sexual and Relationship Therapy, 24, 188–206. doi: 10.1080/14681990902937340 First citation in articleCrossref, Google Scholar

  • Lawrence, A. A. (2010a). Sexual orientation versus age of onset as bases for typologies (subtypes) of gender identity disorder in adolescents and adults. Archives of Sexual Behavior, 39, 514–545. doi: 10.1007/s10508-009-9594-3 First citation in articleCrossref, Google Scholar

  • Lawrence, A. A. (2010b). Something resembling autogynephilia in women: Comment on Moser (2009) [Letter to the Editor]. Journal of Homosexuality, 57, 1–4. doi: 10.1080/00918360903445749 First citation in articleCrossref, Google Scholar

  • Lawrence, A. A. (2011). Autogynephilia: An underappreciated paraphilia. Advances in Psychosomatic Medicine, 31, 135–148. First citation in articleCrossref, Google Scholar

  • Lawrence, A. A. (2013). Men trapped in men’s bodies: Narratives of autogynephilic transsexualism. New York, NY: Springer. First citation in articleCrossref, Google Scholar

  • Lawrence, A. A. (2014). Veale’s (2014) critique of Blanchard’s typology was invalid [Commentary]. Archives of Sexual Behavior, 43, 1679–1683. doi: 10.1007/s10508-014-0383-2 First citation in articleCrossref, Google Scholar

  • Lawrence, A. A. & Bailey, J. M. (2009). Transsexual groups in Veale et al. (2008) are “autogynephilic” and “even more autogynephilic” [Letter to the editor]. Archives of Sexual Behavior, 38, 173–175. doi: 10.1007/s10508-008-9431-0 First citation in articleCrossref, Google Scholar

  • Lukianowicz, N. (1959). Survey of various aspects of transvestism in the light of our present knowledge. The Journal of Nervous and Mental Disease, 128, 36–64. First citation in articleCrossref, Google Scholar

  • Mathy, R. M. (2008). Cowboys, sheepherders, and The Man Who Would Be Queen: “I know” vs. first-order lived experience [Commentary]. Archives of Sexual Behavior, 37, 462–465. doi: 10.1007/s10508-008-9335-z First citation in articleCrossref, Google Scholar

  • Money, J. & Gaskin, R. J. (1970–1971). Sex reassignment. International Journal of Psychiatry, 9, 249–269. First citation in articleGoogle Scholar

  • Moser, C. (2009). Autogynephilia in women. Journal of Homosexuality, 56, 539–547. doi: 10.1080/00918360903005212 First citation in articleCrossref, Google Scholar

  • Moser, C. (2010a). A rejoinder to Lawrence (2010): It helps if you compare the correct items [Letter to the editor]. Journal of Homosexuality, 57, 693–696. doi: 10.1080/00918369.2010.485859 First citation in articleCrossref, Google Scholar

  • Moser, C. (2010b). Blanchard’s autogynephilia theory: A critique. Journal of Homosexuality, 57, 790–809. doi: 10.1080/00918369.2010.486241 First citation in articleCrossref, Google Scholar

  • Nichols, M. (2014). Men trapped in men’s bodies: Narratives of autogynephilic transsexualism, by Anne Lawrence [Book review]. Journal of Sex & Marital Therapy, 40, 71–73. doi: 10.1080/0092623X.2013.854559 First citation in articleCrossref, Google Scholar

  • Nieder, T. O., Herff, M., Cerwenka, S., Preuss, W. F., Cohen-Kettenis, P. T., De Cuypere, G., … Richter-Appelt, H. (2011). Age of onset and sexual orientation in transsexual males and females. The Journal of Sexual Medicine, 8, 783–791. doi: 10.1111/j.1743-6109.2010.02142.x First citation in articleCrossref, Google Scholar

  • Nuttbrock, L., Bockting, W., Mason, M., Hwahng, S., Rosenblum, A., Macri, M. & Becker, J. (2011). A further assessment of Blanchard’s typology of homosexual versus non-homosexual or autogynephilic gender dysphoria. Archives of Sexual Behavior, 40, 247–257. doi: 10.1007/s10508-009-9579-2 First citation in articleCrossref, Google Scholar

  • Ovesey, L. & Person, E. (1976). Transvestism: A disorder of the sense of self. International Journal of Psychoanalytic Psychotherapy, 5, 219–236. First citation in articleGoogle Scholar

  • Rönspies, J., Schmidt, A. F., Melnikova, A., Krumova, R., Zolfagari, A. & Banse, R. (2015). Indirect measurement of sexual orientation: Comparison of the implicit relational assessment procedure, viewing time, and choice reaction time tasks. Archives of Sexual Behavior, 44, 1483–1492. doi: 10.1007/s10508-014-0473-1 First citation in articleCrossref, Google Scholar

  • Savic, I. & Arver, S. (2011). Sex dimorphism of the brain in male-to-female transsexuals. Cerebral Cortex, 21, 2525–2533. doi: 10.1093/cercor/bhr032 First citation in articleCrossref, Google Scholar

  • Serano, J. M. (2009, June). Psychology, sexualization and trans-invalidations . Paper presented at the 8th Annual Philadelphia Trans-Health Conference, Philadelphia, PA. Retrieved from http://www.juliaserano.com/av/Serano-TransInvalidations.pdf First citation in articleGoogle Scholar

  • Serano, J. M. (2010). The case against autogynephilia. International Journal of Transgenderism, 12, 176–187. doi: 10.1080/15532739.2010.514223 First citation in articleCrossref, Google Scholar

  • Smith, Y. L. S., van Goozen, S. H. M., Kuiper, A. J. & Cohen-Kettenis, P. T. (2005). Transsexual subtypes: Clinical and theoretical significance. Psychiatry Research, 137, 151–160. doi: 10.1016/j.psychres.2005.01.008 First citation in articleCrossref, Google Scholar

  • Stoller, R. J. (1968). Sex and gender: On the development of masculinity and femininity. New York, NY: Science House. First citation in articleGoogle Scholar

  • van de Grift, T. C., Cohen-Kettenis, P. T., Steensma, T. D., De Cuypere, G., Richter-Appelt, H., Haraldsen, I. R., … Kreukels, B. P. (2016). Body satisfaction and physical appearance in gender dysphoria. Archives of Sexual Behavior, 45, 575–585. doi: 10.1007/s10508-015-0614-1 First citation in articleCrossref, Google Scholar

  • Veale, J. F. (2014). Evidence against a typology: A taxometric analysis of the sexuality of male-to-female transsexuals. Archives of Sexual Behavior, 43, 1177–1186. doi: 10.1007/s10508-014-0275-5 First citation in articleCrossref, Google Scholar

  • Veale, J. F. (2015). Comments on ethical reporting and interpretations of findings in Hsu, Rosenthal, and Bailey’s (2014) “The psychometric structure of items assessing autogynephilia” [Letter to the editor]. Archives of Sexual Behavior, 44, 1743–1746. doi: 10.1007/s10508-015-0552-y First citation in articleCrossref, Google Scholar

  • Veale, J. F., Clarke, D. E. & Lomax, T. C. (2008). Sexuality of male-to-female transsexuals. Archives of Sexual Behavior, 37, 586–597. doi: 10.1007/s10508-007-9306-9 First citation in articleCrossref, Google Scholar

  • Veale, J. F., Clarke, D. E. & Lomax, T. C. (2011). Male-to-female transsexuals’ impressions of Blanchard’s autogynephilia theory. International Journal of Transgenderism, 13, 131–139. doi: 10.1080/15532739.2011.669659 First citation in articleCrossref, Google Scholar

  • Walworth, J. R. (1997). Sex-reassignment surgery in male-to-female transsexuals: Client satisfaction in relation to selection criteria. In B. BulloughV. L. BulloughJ. EliasEds., Gender blending (pp. 352–369). Amherst, NY: Prometheus Books. First citation in articleGoogle Scholar

  • Whitam, F. L. (1987). A cross-cultural perspective on homosexuality, transvestism, and transsexualism. In G. D. WilsonEd., Variant sexuality: Research and theory (pp. 176–201). Baltimore, MD: Johns Hopkins University Press. First citation in articleGoogle Scholar

  • Winters, K. (2008). Autogynephilia: The infallible derogatory hypothesis, part 2. Retrieved from http://gidreform.wordpress.com/2008/11/19/autogynephilia-the-infallible-derogatory-hypothesis-part-2/ First citation in articleGoogle Scholar

  • World Health Organization. (1992). International statistical classification of diseases and related health problems (10th rev., Vol. 1). Geneva, Switzerland: Author. First citation in articleGoogle Scholar

  • Zucker, K. J., Bradley, S., Owen-Anderson, A., Kibblewhite, S. J., Wood, H., Singh, D. & Choi, K. (2012). Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism. Journal of Sex & Marital Therapy, 38, 151–189. doi: 10.1080/0092623X.2011.611219 First citation in articleCrossref, Google Scholar

  • Zucker, K. J., Cohen-Kettenis, P. T., Drescher, J., Meyer-Bahlburg, H. F., Pfäfflin, F. & Womack, W. M. (2013). Memo outlining evidence for change for Gender Identity Disorder in the DSM-5. Archives of Sexual Behavior, 42, 901–914. doi: 10.1007/s10508-013-0139-4 First citation in articleCrossref, Google Scholar

  • Zucker, K. J., Lawrence, A. A. & Kreukels, B. P. C. (2016). Gender dysphoria in adults. Annual Review of Clinical Psychology, 12, 217–247. doi: 10.1146/annurev-clinpsy-021815-093034 First citation in articleCrossref, Google Scholar