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Book Review: Men Trapped in Men's Bodies (Part 1)

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.

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