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:
Normal heterosexuality is present most of the time, except during an autogynephilic "episode"; autogynephilic feelings are ended by orgasm.
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.
As (1), but autogynephilia is dominant and only temporarily goes away after orgasm.
Normal heterosexual attraction to women exists, but orgasm is only possible while having an autogynephilic fantasy.
Romantic attraction to women exists, but only autogynephilic fantasies/behaviors are sexually arousing.
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.
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.
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.
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.
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.
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).
- 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.
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).