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This is part 3 of a 3 part review. Part 1 Part 2

Autogynephilia and sexuality

The relationship between autogynephilia and other parts of the autogynephile's sexuality are varied. Lawrence spends a lot of time on this, but I don't find it particularly interesting or enlightening in most respects, so I'll just leave you with a few key points.

Since autogynephilia appears to be a misfiring version of heterosexuality, it unsurprisingly coexists with it; however, it also competes with it in various ways. In different people, the following are all possible:

  1. Normal heterosexuality is present most of the time, except during an autogynephilic "episode"; autogynephilic feelings are ended by orgasm.

  2. Normal heterosexuality and autogynephilia coexist, with soft rather than sharp boundaries, or some blending. Autogynephilic feelings may go away temporarily while falling in love with a woman.

  3. As (1), but autogynephilia is dominant and only temporarily goes away after orgasm.

  4. Normal heterosexual attraction to women exists, but orgasm is only possible while having an autogynephilic fantasy.

  5. Romantic attraction to women exists, but only autogynephilic fantasies/behaviors are sexually arousing.

  6. Complete absence of romantic or sexual attraction to anyone except a female version of oneself.

I wasn't able to get a good sense of how common each of these was except that the last was relatively rarer, and the first wouldn't be common among MtF transsexuals since they would be less likely to transistion.

Autogynephilic transsexuals' interpretations of autogynephilia

While a frankly shocking number of respondents (selection bias?) expressed that their autogynephilic sexual feelings were the dominant factor in their transition or desire for transition, most respondents, while acknowledging their autogynephilia, gave it an alternative interpretation or attributed to it a lower degree of significance.

Some of these alternative interpretations are present in the discourse, and seem to represent an attempt to rationalize the reality of autogynephilia in the context of the prevailing dogma of the transgender movement. Lawrence catalogues and argues against these briefly; since they are probably of interest I'll summarize them here.

  1. Autogynephilia is a symptom, not a cause, of transsexualism. This is the idea that gender dysphoria precedes autogynephilia, and that autogynephilia is a somehow a response to the female gender identity or to gender dysphoria, such as an escapist fantasy. This position is contradicted by the evidence that autogynephilia generally precedes the female gender identity, and doesn't explain why the fantasy of becoming female is so erotic.

  2. Autogynephilia can't be part of the reason for desire to be female because nonsexual desires preceded puberty. Lawrence appeals to the fact that sexual feelings can and often do start before puberty, including in many of the transsexuals cited in the book, as a counterargument, as well as to the unreliability of memory and testimony in such cases. I don't think this is a knock-down argument against the second part of the statement, but at any rate the first part just doesn't follow.

  3. Autogynephila is just the sexualization of childhood cross-gender wishes (for coincidental or idiosyncratic reasons). Lawrence's response here seems to be bewilderment, and I'm inclined to agree; these reasons seem like so many just-so stories, many of which are bizzare in their leaps of logic.

  4. Autogynephilia can't be the reason for transition, because it feels incidental / something else seems more important. But while the direct motivations might not be autogynephilia, this ignores the role that autogynephilia likely played in the development of the more immediate reasons.

  5. Autogynephilia is just part of normal female sexuality. This one shows up a lot, due to a couple of studies which seemed to find autogynephilia in natal women. I recall that Scott drew a similar conclusion from a question on one of his SSC reader surveys. The problem with those studies (and Scott's has a similar issue), according to Lawrence (p 176), is that they do not

adequately differentiate between being aroused by wearing sexually provocative clothing or by imagining that potential romantic partners might find one attractive (which some natal women apparently do experience) and being sexually aroused simply by the idea that one is a woman or has a woman’s body (which natal women arguably rarely or never experience).

  1. Transsexualism is due to a feminized brain in a male body. This is of course one of the "standard" theories, but makes no sense in the context of autogynephilic transsexuals who are within the normal-male distribution in everything except for wanting to be feminine.

Non-transsexual autogynephiles

Lawrence devotes a chapter to the testimonies of the of non-transsexual autogynephiles who responded to the survey. With a few exceptions (such as the people who just wanted to have breasts, but nothing else) they were very similar to those of the transsexuals, only somewhat less so. The primary distinguishing factor is that they had not made the decision to transition, for various reasons. This is further evidence for Lawrence's conclusion (which really ought to be the default one) that autogynephilic transsexualism, autogynephilia in heterosexual men, and fetishistic transvestism are all regions in the same general cluster ("part of a spectrum" as they say), differing by degree and specifics more than kind.

Lawrence talks about clinical implications

At the end of the book we come to Lawrence's suggestions for what can and should be done in clinical care. Given that Lawrence is an advocate of Blanchard's theories and thus not in good graces with the trans activists, perhaps you can guess what they are...

I'll spare you the tedious scrolling. Yeah, it's a trick question. Here are a few things Lawrence proposes:

  • Transition (including SRS) is a good way to manage the gender dysphoria associated with autogynephilic transsexualism.

  • Cross-sex hormones are a good way of both giving men with less severe autogynephilia some of what they want (feminization) while also reducing their libido and thus (sometimes) the intensity of their autogynephilia.

  • Autogynephilia should be destigmatized, and presented according to Lawrence's theory that it is a sexual orientation and not just a paraphilia.

  • Puberty blockers in adolescence should be used more for autogynephilic boys, so that if they decide to transition they can have more feminine bodies and do so at an early enough age that they don't have baggage.

  • Autogynephilic adolescents should be given an environment supportive of things like cross-dressing, so that they can develop cross-gender identities more quickly and so be comfortable with (and eligible for) transition at an earlier age.

I'm afraid I disagree on all counts. (Well, I'm not exactly happy with the stigmatization part, but given the other items I suspect I don't envision the same sort of destigmatization that Lawrence does.) I guess the difference is that Lawrence is transsexual and thinks that it's a good thing, whereas I'm not and don't.

Also from this section, I can't resist quoting the following related, and rather incisive, bit about the attitudes of the trans activists and the associated medical industry (p 209):

Thirty or 40 years ago, mental health professionals who specialized in treating gender identity problems used to argue that paraphilic men—autogynephiles—who sought sex reassignment were not acceptable candidates because they were not genuinely transsexual. Nowadays, their successors seemingly want to argue that paraphilic men—autogynephiles—who seek sex reassignment have become acceptable candidates because they are not genuinely paraphilic!

My own final thoughts on autogynephilia

As I indicated early on, I think that autogynephilia is both real (personal experience is hard to deny on this one) and likely to be a key driver for a good fraction -- probably half in the eighties and a substantially higher proportion now -- of MtF transitions. Lawrence persuasively argues that autogynephilia is deeply tied up with the feelings (cross-gender wishes and identity, gender dysphoria, and so on) that lead to transition even when it is not the consciously-experienced primary motivation. But I disagree somewhat with the overall picture Lawrence paints.

Lawrence's model seems to be the following:

(Male heterosexual + ETLE) -> (autogynephilia) -> (cross-gender wishes and behaviors) -> (cross-gender identity and gender dysphoria)

where autogynephilia is understood in the "sexual orientation" sense that includes both overt lust but also some kind of romantic attraction to the feminized image of oneself and some sort of pair-bonding to that feminized self.

I'm skeptical about both "erotic target location error" and "autogynephilia as sexual orientation". The first honestly sounds quite a bit like "dormitive potency" (it's an unenlightening description, not an explanation) and the second seems like it doesn't quite cover the right territory. It seems to me that the model is stuck in a worldview where the explicitly sexual elements of things are the most basic and real, and everything else is just accretions around that.

My model is somewhat more complicated, but the gist is that the core thing is a whole complex of self-reinforcing desires all around the theme of "desire to be female/feminine", of which autogynephilia proper (the sexual arousal) is a very important part, but not necessarily more fundamental than the rest. Hence we see some people for whom the autogynephilia-proper seems to exist almost as an afterthought, or is even felt to be fundamentally undesirable (maybe because it spoils the "purity" of the rest of the fantasy), and others for whom it is almost the whole thing, as well as different times and places of emergence of various aspects of the desire, with sometimes the sexual preceding and sometimes succeeding cross-gender wishes. That is, the cross-gender wishes are at the same fundamental level as the sexual desire, and are mutually reinforcing with it, rather than being a simple consequence of it. I also disfavor ETLE as an description of what's gone wrong. I think that normal heterosexual desires-for femininity, including, of course, the purely sexual/lust part, "bleeding into" an abnormal desire-to-be female/feminine, is a more helpful way to think of it. But that may be mostly a difference in philosophical disposition.

Responding to Questions

I'm willing to answer questions in the comments. This includes questions about my own experience, if you think they'd be enlightening (I kept my experience out of the review itself since (a) I'm not transsexual, and (b) it seemed a bit too much like navel-gazing).


This is part 2 of a 3 part review. Part 1 Part 3

How it all starts

Cross-gender fantasies in autogynephiles can start anywhere between early childhood and the onset of puberty; Lawrence reports that most of the respondents who specified an age of onset indicated a start between 4 and 6 years old, although this is likely due in part to selection bias (those with later age of onset are less likely to specify it, since the timing wouldn't seem as significant). Explicitly erotic feelings often started later, usually by puberty, though some reports also indicated an erotic aspect to the fantasies even in early childhood.

Expression of a fundamentally erotic fantasy prior to puberty sounds rather odd to modern Americans, but this is because our culture has a strong belief in childhood innocence -- a defense against bad actors like molesters, maybe, but not exactly accurate. Boys as young as toddlers get erections, and frequently displays of emotion associated with their eventual sexual orientation are present in early childhood.

At any rate, many respondents engaged in cross-dressing from an early age, and a good number of them reported erotic feelings from it then, though for others they did not start -- or were not remembered as such -- until later.

We maybe shouldn't read too much into occasional cross-dressing or cross-gender wishes at a young age, though. Lawrence points out that non-erotic cross-dressing or occasional wishes to be the opposite sex are fairly common, quoting studies that found these in several percent (varying by age) of preadolescent boys. Still, when these behaviors are erotic, that probably means something; several respondents mentioned masturbating to fantasies or while cross-dressing at as young as 6 (!) years old.

Lawrence notes that the existence of cross-gender fantasies and cross-dressing doesn't indicate consistent and persistent cross-gender wishes or a persistent cross-gender identity in childhood; indeed one narrative reports these from 4-6 years old, followed by a relative cessation in late childhood until it came back in full erotic force at puberty. This is a quite different pattern than the "classic" MtF presentation which includes consistent cross-gender wishes starting in early childhood.

What about cross-gender behaviors, such as playing with girl's toys, a choice of female friends, and so on? Here the data is more muddy. Partially this is because the normal range of male behavior is quite wide, many ordinary boys occasionally play with girl's toys, or prefer girls over boys as friends. Lawrence also cites a study which (p 82)

found that “preferring girls’ games and toys as a child” was one of the most frequent areas in which MtF transsexuals reported having lied to or misled their psychotherapists

So studies based on self-reported preferences should be taken with a grain of salt. The data seem equivocal; it's possible that autogynephilic MtF transsexuals are more likely than other boys to exhibit cross-gender behaviors as children, but it's also possible that the distribution is in reality much like the distribution for ordinary boys, and the prevalence of later in life reports to the contrary are mostly due to misremebering and misinterpretation of memories.

Many of Lawrence's respondents explicitly denied having female-typical interests in childhood; oddly, at least one of them still seemed to interpret his experience as evidence that he wasn't male enough; quoting Lawrence at length (p 83):

It is surprising that a boy who became cadet lieutenant-colonel at his military high school and was an avid water-skier and cross-country runner would conclude he was “not successfully masculine” simply because he was not proficient at baseball. Green (2008) observed that MtF transsexuals sometimes hold stereotyped views of masculinity and femininity and are apt to conclude that, if they deviate from the masculine stereotype in any way, they cannot really be men. Green gave the example of a gender dysphoric patient who concluded he was transsexual in part because he was not interested in cars and football. Although Green makes an important point, another explanation might be that autogynephilic men who are unremarkably masculine but experience a strong and seemingly inexplicable desire to be female might be eager to find evidence, however insubstantial, of psychological femininity or unmasculinity that would help them make sense of their cross-gender wishes.

Along similar lines, a number of other respondents described some instances of feminine interests and behaviors, but with no indication that these were common or persistent, about which Lawrence says (p 85):

In my clinical practice, I not uncommonly elicit histories like these from nonhomosexual gender dysphoric male patients. In many cases, the feminine behaviors in question turn out to be a few isolated and unrepresentative episodes (e.g., “For a time my closest playmate was a girl”—for 2 months one summer; “When I was 6, I used to play with dolls”—on three or four separate occasions). These isolated episodes of feminine behavior nevertheless feel quite meaningful to the men who experienced them. I almost never get the sense that these patients are trying to mislead me by portraying these childhood episodes as more representative than they genuinely are. Instead, I believe that these patients are desperately trying to make sense of their powerful cross-gender wishes and are grasping at straws in an effort to find evidence of childhood femininity that might help to explain their adult feelings.

I think that Lawrence is exactly correct here. Memories are, more than we would like, malleable things, and there is a lot of internal pressure to make sense of the powerful feelings involved. It probably takes an unusual level of commitment to the truth to not make mountains out of relative molehills in such cases.

An interlude about self-descriptions

Lawrence takes some space to discuss how the respondents processed the standard "woman trapped in a man's body" framing in light of their autogynephilia. Some asserted that that expression fit them, others adopted the "man trapped in a man's body" variation (Lawrence published a shorter piece with the same title as the book, and some of the respondents had read it); still others tried other variations or denied that the (original) expression fit them without providing an alternative.

I didn't find all this particularly interesting, except for the following quote from one respondent (p 88):

The best phrase to describe my belief about myself is that “I desire (or need) to be a woman with all my heart, in every way,” as opposed to feeling “I have always been a woman.”

Keep that one in your back pocket. I suspect it's the key to this whole mess.

Autogynephilia over a lifetime

The vast majority of autogynephilic MtF transsexual/transgender people (Lawrence here uses both terms, to include those who don't have an intent to fullly transition, I think) express that their autogynephilia has continued during their entire adult life. This is not great news to people who might expect that they will "just grow out of it" (though I will note that the fraction of people who don't report lifetime persistence is nonzero). Lawrence adduces this as evidence for the autogynephilia-as-sexual-orientation hypotheses, though I'm not sure it's really evidence for that over it being "just" a paraphilia.

Perhaps surprisingly, a large fraction of MtF transsexuals who had undergone SRS also reported continuing autogynephilia, and some of them reported that feminization fantasies (about becoming female) were necessary for them to acheive orgasm. Others said that contemplating their own body was now sexually arousing. Some respondents also reported a lessening or cessation of autogynephilic fantasy after transition, but people also frequently reported a lessening of their sex drive in general, so it's kind of hard to tell what's going on.

Four Types of Autogynephilia

Following Blanchard, Lawrence divides the actions and fantasies typical to autogynephilia into four types:

  1. Transvestic autogynephilia: Erotic cross-dressing, basically. Lawrence's contention is that "transvestic fetishism" in the old sense is in most cases a subtype or expression of autogynephilia.

  2. Anatomic autogynephilia: Fantasies/actions having to do with having female anatomic features. Typical examples include: breasts, genitalia, body structure, facial structure, soft skin, etc.

  3. Physiologic autogynephilia: Fantasies/actions having to do with female physiological functions. Examples include pregnancy and breastfeeding, but also more unusual fantasies like menstruation.

  4. Behavioral autogynephilia: Fantasies/actions having to do with engaging in (stereotypically) feminine behaviors. This can cover pretty much anything, and in some of the accounts of this you can see some pretty sexist underlying assumptions, honestly. One particularly important type of behavioral autogynephilia is the "act or fantasy of engaging in sexual activity with a man as a woman", which Lawrence thinks is particularly significant for interpreting data and in a clinical setting.

These are not mutually exclusive (e.g. cross-dressing could also be behavioral, or as an aid to anatomic fantasy, etc) and they frequently co-occur (all are present to an extent in most of the transsexual survey respondents). It's important to also note that autogynephilic behavior can consist of pure fantasies, actions, or both.

Lawrence goes on to give details of each of these types; we'll hit just a few of the highlights.

Transvestic Autogynephilia

Lawrence says that transvestic autogynephilia is the most prevalent type, and that "almost all autogynephilic males probably experience it". The first part is probably true if Lawrence is correct that almost all fetishistic cross-dressing is just a species of autogynephilia. I'm not so sure about the second part.

Transvestic autogynephilia can center around almost any type(s) of feminine clothing. There's the stereotypical one, of course: clothes that men find sexually attractive when worn by women: lingerie or high-heels, for instance. There's women's clothes that are associated with key parts of femal anatomy, such as panties (the number of respondents that talked about wearing panties is crazy) and bras. But this can also include ordinary and unremarkable women's clothing.

The reasons that these men cross-dress can vary a bit also. We can group into roughly five categories (these are mine, from reading the examples; Lawrence doesn't explicitly categorize like this):

  1. Because it's arousing, with no reference as to why.

  2. Because it helps to imagine oneself as a woman, and that is arousing.

  3. Because it is exciting, pleasurable, or "comfortable" as such, but with no conscious experience of sexual arousal (Lawrence thinks that this is usually due to low-grade sexual arousal that the cross-dresser is unaware of).

  4. Because it facilitates female-typical behavior.

  5. As (2), but not necessarily experienced as arousing.

There's some clear overlap between these, and between cross-dressing and other manifestations of autogynephilia as well.

Anatomic Autogynephila

According to Blanchard and Lawrence, although transvestic autogynephilia is more common, anatomic autogynephilia is (perhaps understandably) the one most associated with gender dysphoria and the desire for SRS.

The two big ones here are having breasts and having female (external) genitalia. Testimony after testimony reports a strong desire for breasts and female genitals, and often intense sexual arousal at fantasizing about having them. Of course, having female genitals mean not having male genitals, so many respondents report sexual excitement at the idea (or fact!) of the removal of their male genitalia, and frequently become uncomfortable with the continued existence of their penis and/or testes. We can see how the positive desire to have a female body leads to the negative body-associated dysphoria popularly associated with transsexualism.

There's also some weird cases. Some men expressed a strong desire for a female body, even to the point of seeking SRS, but no desire to be female in any other way. Others (Lawrence did not count these as transsexuals) went as far as to use feminizing hormones to develop breasts, but had no interest in having female genitalia. (You might call them boob men.)

Physiologic Autogynephilia

Some people have pregnancy or lactation fetishes. Some autogynephiles have pregnancy or lactation fetishes about themselves. This manifestation of autogynephilia is probably the least common, but it is present. It seems pregnancy and breastfeeding were the most common fantasies, here, but menstruation fantasies were also present. Some people reported also taking actions to act out or pretend to enact their fantasies, such as stuffing a pillow to pretend (to themselves) to be pregnant, or urinating on sanitary pads.

While the specifics seem weird, the origin seems (to me) to be clear: these people are obsessed with having female experiences, and what experiences are more quintessentially female than ones associated with reproduction?

("But wait," I hear you saying. "Isn't there another important experience associated with reproduction?" We'll get to that.)

Behavioral Autogynephilia

This manifestation of autogynephilia has to do with engaging in "feminine behaviors", as understood by the autogynephile, of course. Sometimes these are explicitly erotic, other times, they are part of the general program of fantasizing about being a woman.

Examples include: having a feminine voice, using a feminine name, tossing one's hair, being "one of the girls", being in a women's locker room or restroom without sexual overtones (yes, multiple people reported sexual arousal at the thought of not having sexual arousal), having to sit/squat to urinate, acting sexy, taking birth control pills, getting manicures, and so on.

There's a lot of crossover with the other categories, especially transvestism (wearing women's clothes, especially in public, is a behavior).

Of particular public interest here is the bathroom/locker room thing. It's safe to say that there probably are some trans people who are getting horny about using the women's bathroom or locker room, but the reason they do it is not to ogle or engage in predatory behavior, but because it makes them feel like a woman (and that makes them horny). You can decide for yourself whether that makes it better or not. (To respond to the inevitable, yes, there are also predators that are using the trans-bathroom-thing as cover. I have no idea how much overlap they have with trans people.)

And then there is the ultimate female behavior, which also touches on female anatomy and physiology.

Sex with men

Here we have the autogynephilic sexual fantasy as it touches on fantasizing about sex. Sexual behavioral autogynephilia is pretty common, and one common form of it involves the fantasy of (as a woman, this is important) having sex with men. From one perspective this is very odd -- autogynephilia is, presumably, due to a malfunctioning heterosexual male sexuality, and heterosexual men are not exactly well known for fantasizing about having sex with men.

Nevertheless, it is explicable, and its explanation has some pretty important implications. The explanation is this: what autogynephiles have is a desire to be female, and what is more quintessentially female than enacting the female role in reproduction? Add this to the fact that the desire is sexual, and it is unsurprising that "being a woman having sex with a man" is a potent fantasy. It hits all the high points: female anatomy, female physiology (reproduction), female behavior, and, of course, sex.

The only problem is that (with possibly a few exceptions) they aren't actually attracted to men.

Lawrence spends a lot of time describing how the autogynephilic transsexuals surveyed dealt with this, and drawing out the implications. Some of this analysis goes back to Blanchard (who is cited here). I'll give the quick summary.

Many of these fantasies (and actions, when autogynephilic MtF transsexuals do have sex with men) involve an explicit desire to be validated as being "real women", being desirable, and other ways in which it proves femininity and enables other aspects of female experience.

Most of these fantasies seem to involve a "faceless" (that word was literally present in many testimonies) man, not a particular individual, or any particular imagined male attributes. This allows the fantasizer to enact "having sex with a man as a woman" without having to deal with the the fact that they are not actually attracted to men. Many people reported that they found the idea of sex with a man to be exciting, but only when they were also fantasizing about being a woman or otherwise inhabiting a female role; they found the idea repulsive otherwise.

Many of the autogynephilic MtF transsexuals report that their sexuality changed, from exclusively attracted to women to bisexual or even exclusively androphilic as part of or after their transition. All I have to say about that is that if they are right about some of the reasons they gave, society gave up on gay conversion therapy too soon.

Lawrence suggests that a better question than the standard of asking whether someone is sexually attracted to men or to women is to ask who the first person they fell in love with is, or whether they habitually fall in love with men (respectively boys for adolescents) or women (resp. girls). Lawrence observed that only one of the respondents here claimed to fall in love with men, despite many claims of orientation change or sexual fantasies involving men, and speculates that a real androphilic sexual orientation among autogynephilic MtF transsexuals is extremely rare.

This lends some credence to the explanation that Blanchard gave of the puzzle that many autogynephiles report, across a number of studies, that they are either bisexual or exclusively androphilic. Some of this might be lying, but more likely it is reporting of autogynephilic sexual fantasy of being a woman having sex with a man as sexual attraction to men. They are both about sex, and there's some powerful internal pressure to adopt the narrative that says "it's because you're a (normal) woman".

A funny tidbit is the stories some of these people tell to explain their (pre-transition) attraction to, and sexual behaviors with, women (marriages with children are not uncommon). Lawrence quotes several who attributed it to "internalized homophobia". Suuuure.

In the final part of this review, we'll look at how autogynephilia interacts with other parts of sexuality, and what all this means: to the autogynephilic transsexuals themselves, to non-transsexual autogynephiles, and to everyone else.


This is part 1 of a 3 part review. Part 2 Part 3

What is this?

This is a review of Men Trapped in Men's Bodies: Narratives of Autogynephilic Transsexualism by Dr. Anne Lawrence (2013).

The subject is enmeshed in a bunch of culture war, but since this is a book review outside the CW thread, I will try to keep culture war heat out of it. Please do the same in the comments.

What is the book about?

This book is about autogynephilia. If you don't know what that is, I'll explain below; you can also read @drmanhattan16's description in this review of a book on the history of transgenderism. The book engages with various studies in the literature, but is primarily a synthesis of testimonials from MtF transsexuals with autogynephilia, aiming to describe and understand the phenomenon and its role in gender dysphoria and transsexualism.

Who is the author of this book? Who are you?

The author of the book is Dr. Anne Lawrence, a now-retired psychologist, sexologist, and (per Wikipedia) former anaesthesiologist. Lawrence also happens to be an autogynephilic MtF transsexual.

I am a thirtysomething man who suffered from autogynephilia for much of his life, beginning in adolescence (arguably earlier, depending on what you count). You might quibble about the past tense, according to the same theory that a former drunkard is still an alcoholic no matter how long he's been sober. At any rate I do not consider myself trans and live a normal life without any of the behaviors typically associated with autogynephilia.

The point is that both the author and reviewer of this book have personal experience of the thing under study, albeit from quite different perspectives.

Why do you keep using the word "transsexual"?

To avoid wading into culture war issues or getting into the weeds of definitions, I'm going to use the terminology and definitions that are used in the book -- with one exception. Lawrence uses "homosexual" in the context of MtF transsexuals who are exclusively sexually attracted to men. Regardless of your culture war position, this is in today's context very confusing, so I'm going to call these individuals exclusively androphilic.

Should I read the book?

I am going to recommend that you not read the full book, unless one of the following applies:

  1. You are a doctor, psychologist, or therapist who might see patients for gender- or sex-related issues.

  2. You personally suffer from autogynephilia, and want to try to understand your condition better. I give this particular suggestion with some trepidation; you might find some of the content of the book to be something of an infohazard.

  3. You think someone you care for (spouse, child, etc.) may suffer from autogynephilia.

This is not because the book is a bad book. It's just that reading about other people's paraphilias is really not a healthy thing to do and you will probably find it unpleasant and gross.

Introduction: Blanchard's typology and autogynephilia

In the 1980s, psychologist Ray Blanchard discovered that a lot of patients seeking MtF transition did not fit the standard picture of especially feminine men who had since early childhood considered themselves to "really be" female and were sexually attracted to men, but were instead basically the opposite on all counts except for their extreme desire to transition. What would drive them to this? He discovered that many of them exhibited sexual arousal at fantasies of themselves as women: what he came to term autogynephilia.

Blanchard described two types of MtF transsexuals:

  1. The first group fit the standard picture. Feminine from an early age, they "behaved like girls, identified with girls, and frequently proclaimed themselves to be girls". They hade female-typical interests, hobbies, and occupations, usually cross-dressed openly since childhood, and were exclusively sexually attracted to men.

  2. The second group were basically mostly-normal men, except for their intense desire to be women and their autogynephilia, and some behaviors associated with the autogynephilia.

He proposed that this typology was essentially complete, and that the autogynephilia in the second group was their ultimate (though perhaps not conscious) motivating factor for transition.

Now, this complete binary classification was probably not justified by his original data. A small fraction (15%) of the people who reported being exclusively androphilic also reported symptoms of autogynephilia; a larger fraction (27%) of the non-exclusively-androphilic group did not. Further studies seemed to support a strong, but not complete association.

As for autogynephilia being not merely a symptom, but the cause, of the autogynephilic transsexuals' desire to transition, Blanchard proposed that autogynephilia was a paraphilia, resulting from an "Erotic Target Location Error" (ETLE). Essentially, these people had a normal heterosexual male orientation, but something went wrong (as it does) and these men located the sexually desired feminine object in themselves, instead of (or in addition to) in others. This erotic desire led to all the other wishes, feelings, and behaviors associated with transsexuality.

Needless to say, this theory wasn't, and isn't, popular. Nobody likes to hear that their core desires and a major part of their identity might be due to a paraphilia -- even aside from the stigma of having a paraphilia. And nobody likes to be associated with, well, perverts -- at best it's bad optics for the movement. Plus, a lot of the noisiest proponents of the theory definitely take the line that "this proves trans people are just gross perverts". In addition, the theory was rather sweeping (exactly these two types), and the data seemed not to fully support the clean bifurcation, at least not without assuming that people were lying or very mistaken about their self-reports; similarly, these self-reports usually denied the putative etiology of their condition. So the theory had additional unpleasant implications about the reliability of the transsexuals' testimony. Whether or not it was true, the theory was going to provoke a lot of backlash.

Is Blanchard's typology true?

Well, the book really isn't about arguing whether Blanchard's typology is true, but about describing the nature of autogynephilia, so...

Oh, screw it. It's true. At least to a first approximation. Maybe there are some exceptions to the two-type categorization, but if so they are rare. Maybe the simple etiological description for how autogynephilia is the full cause of transgender ideation and gender dysphoria in the autogynephiles is wrong, but it's more right than the other major hypotheses on offer.

About the fact that some of the non-exclusively-androphilic transsexuals reported no sexual arousal around, say, cross-dressing? Well, it turns out that psychologists have a way of figuring out if a male is aroused by something. Yeah. You check if they get hard ("penile tumescence"). It turns out that most of them were, in fact, aroused by imagining cross-dressing. Blanchard and Lawrence think this is not preverication, but because the these people are honestly not fully aware of it.

For the other error type -- (reportedly) exclusively-androphilic MtF transsexuals who reported autogynephilia -- Lawrence has another explanation, which we'll get to later. (Besides the obvious "they lied about being exclusively-androphilic," for which there is some evidence in that some people have admitted to doing just that to get past gatekeeping.)

Finally, the etiological part. So what if all of these MtF transsexuals have autogynephilia -- couldn't this be irrelevant? Maybe it's a result rather than a cause of their feminine identity, maybe it's something of an epiphenomenon, or maybe it's just normal female sexuality? Autogynephilic transsexuals have proposed all these things. But we'll see (Lawrence has a chapter on this later on) that these are mostly not good explanations.

Why should I care about a tiny number of people?

Because it's not a tiny number of people. It's hard to draw conclusions about prevalence, but Lawrence estimates about 3% or more for any form or amount of autogynephilia, and that severe and persistent autogynephilia affects "probably fewer than 1% of men and perhaps fewer than 0.1%" (I interpret that as a vague confidence interval).

Lawrence also estimates that about one-half to two-thirds of transsexuals are autogynephilic. But this is based on data from the 1980s through 2000s. With the explosion of transgender identification since then, and the apparent collapse of the old gatekeeping regime which disproportionately excluded them, I expect the group of MtF autogynephilic transsexuals -- both as a fraction of the population and as a fraction of the people undergoing medical treatment (hormones and/or SRS) -- to be much larger now.

So it's all really "just a fetish"?

Sort of, but not really. There's more to the autogynephilia thing than just getting off. Lawrence thinks of it as more of a sexual orientation, complete with impacts on romantic love, pair bonding, and so on, than purely a paraphilia. I don't think that's the best lens, but it's apparent that what's going on is a whole complex of things, of which the paraphilia proper is a (larger or smaller) part. If you want a pithy-but-accurate statement, you could do worse than Lawrence's formulation: people with autogynephilia are "men who love women and want to become what they love".

Perhaps unfortunately, reading this book (or this review) may create the impression that it is pretty much just a paraphilia, because the sexual element is the focus of the book. And the sexual element is pretty important to the phenomenon! It's just not the whole story.

Getting Narratives

So what do transsexuals with autogynephilia have to say about themselves?

Lawrence obtained a few hundred extensive, anonymous narratives, and classified them. From the book (p 41):

I considered informants to be transsexual if they (a) identified themselves as such or described the severe gender dysphoria (discomfort with anatomic sex or gender role) or pronounced cross-gender identity (desire to be female, live as a woman, or undergo SRS) that are typical of MtF transsexualism; (b) stated that they were using hormones to feminize their bodies (with one exception noted below), were living full-time in female role, or had been approved for SRS (implying both of the former), or (c) stated that they had completed SRS.

After elimination of irrelevant and fabricated stories and deduplication, Lawrence had narratives from 249 transsexuals and 52 non- (or not-clearly-) transsexuals. All of them reported autogynephilia (that was in the call for submissions); many of them, however, rejected the accompanying theory or denied that their autogynephilia was as significant as Blanchard's theory implies.

Unreliable Narrators

Lawrence is well aware that individual narratives are unreliable, especially when there is no way to cross-check their stories. One major source of this unreliability is bias towards a socially-preferred or consistent narrative; as Lawrence says (p 44):

Several clinicians who have worked extensively with MtF transsexuals have reported that their clients tend to consciously or unconsciously distort their histories to conform to the picture of “classic” MtF transsexualism. A classic MtF transsexual is one “who has felt and acted feminine from earliest childhood, has never been sexually aroused by women’s apparel, and is romantically inclined toward males”

Lawrence also provides some choice quotes from earlier papers to this effect; from one in 1959:

A wishful falsification of memory takes place, the patients begin to recall and misinterpret various insignificant incidents in their childhood, till they finally firmly believe that "ever since I can remember, I always wanted to be a woman.”

from one in 1972:

[One patient] when first seen reported his transexual feelings to be of recent origin; 9 months later he was reporting them as starting much earlier in his life.

and from another in 1974:

the patient quite subtly alters, shades, rationalizes, denies, represses, forgets, etc., in a compelling rush to embrace the diagnosis of transsexualism.

Lawrence makes it clear that this is the general pattern of bias one should expect, and that narratives that do not fit the pattern of "classic transsexualism" should be seen as "reluctant testimony", something of a declaration against interest, and are more likely to be accurate.

In this, as in other places in this book, I find that I agree with Lawrence's conclusions while being vaguely uncomfortable with what seems to be bad epistemic practice. Every datum that goes against Lawrence's narrative is explained away, and every datum that confirms it is accepted without much question. I'd prefer to see comments along the lines of "this seems like evidence against the theory, but I think the evidence for is just better on balance" or "this would support the theory, but I am nonetheless skeptical of it". This isn't supposed to be a pop-science book, you can just admit it when the evidence is not totally one-sided!

I'm in this picture and I (don't) like it

Lawrence reports that the respondents often had very strong reactions to encountering the concept of autogynephilia. Some respondents described it as relevatory, or said that it offered increased insight into their experience. Others expressed gratitude for being able to talk about the erotic aspect of their experience. Some expressed relief at finding a concept that described them, when they had felt uncomfortable with not matching the standard descriptions, or crazy for being transsexual while not matching those descriptions. Many expressed a sense of finally not feeling alone in their experience.

Not all reactions were positive. A number of people expressed discovering the concept to be true of them as difficult; it had uncomfortable implications. And there were the people who talked about others' reactions: being shamed for their feelings, often by other trans people, hiding information from gatekeepers in order to pursue SRS, and so on.

Respondents also had varying perspectives about their autogynephilia's role in their transition, ranging from full affirmation of the centrality of sex to their decision, to placing it as one among several motives, to denial of its importance, to introspective descriptions of how their initial sexual feelings had grown to something more broad over time.

Some of them hated their autogynephilic sexual arousal, despite being aware of it. It spoils the fantasy, since there's hardly a clearer symbol of maleness than an erection.

I'm not sure why Lawrence places the chapter on these reactions before the analysis of the respondents' experiences of autogynephilia itself. Its presence here highlights one of the frustrating things about this book, though probably it was inevitable: everything seems to be all tangled up together, developments and etiology and motivations and fantasies and actions and reactions, and it's hard to know how to form a structured analysis or narrative.

In the next part we'll look at the development of autogynephilia and at what kinds of things autogynephiles are doing and fantasizing about.