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:
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).
Jump in the discussion.
No email address required.
What exactly is the distinction between a paraphilia and a sexual orientation? The most thoughtful answer I can find with a quick search suggests that the latter is biological and the former psychological? But that already strikes me as a fairly fuzzy and non-absolute distinction. Most of the rest of what I found can be boiled down to "paraphilia = gross/sexual orientation = perfectly legitimate, no judgement dammit" without ever actually explaining why that would be.
I do think that thinking of these things as a cluster of associated impulses is probably the best way to describe it. I don't really think you can separate sex from emotion from social roles from (insert X addenda here). One thing Lawrence and Blanchard don't touch on but may be worth bringing up. From my personal observations, frequently the fantasy of being a woman is associated with a fantasy of the loss of agency, and by extension, responsibility. You mentioned a military academy cadet and star athlete who apparently didn't measure up to his own standards for masculinity. I suspect there may be a lot of folks in this space with similar profiles. There's an element of stress relief to the fantasy. The wall street dude who spends all day amongst ultra-competitive alpha males making split-second decisions on which millions of dollars ride. The soldier who has to make split-second decisions on which the lives of his team-members ride. Anyone who lashes themselves into the breach of war or politics or business or science, through some combination of ambition and responsibility. To someone like that, the fantasy of being a stereotypical princess - of being passive, helpless even, loved for what you are rather than anything you do, of being at the whim of people and forces more powerful than yourself - that can be a powerful intoxicant. Nothing to base this on other than my own personal experiences and too much time spent in the seedy parts of the internet, but I think its worth considering.
I agree that the line is blurry. I think that Lawrence thinks of a sexual orientation as having emotional/romantic aspects, whereas a paraphilia would just have the facially-sexual ones; so sexual orientation is about love+lust, but paraphilia is just lust. In practice I think this is more a matter of respectability.
This is an interesting point about loss of agency. One thing I didn't touch on in this review but that came up in the book is that apparently a decent chunk of the sexual feminization fantasies of autogynephiles are forced feminization fantasies. That wasn't the case for me, and I just figured that it was an intersection with the (common) BDSM paraphilia, but you may be onto something about the attractiveness of passivity for someone who is always (expected to be) responsible. Or maybe it's more of a thing where lack of agency is seen as feminine, and therefore desired? (I don't think the common theory -- usually offered to explain rape fantasies -- that lack of agency gives the fantasizer an excuse to not be morally or socially culpable for their actions is at all plausible here.)
Lawrence's book has a "terminology and definitions" section, which spells out specifically her definition of sexual orientation as "Sexual orientation refers to the category of persons to whom an individual is sexually attracted (or with whom he or she tends to fall in love)", while using paraphilia by the more DSM-conventional "psychosexual disorders characterized by recurrent, intense sexual urges, fantasies, or behaviors that involve unusual objects, activities, or situations and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning", and specifically calls out that these aren't exclusive distinctions.
She uses zoophilia as an extreme example of something that is at least sometimes a matter of sexual attraction targeting, and also a disorder characterized by significant distress or impairment, but you could as easily talk about people strongly attracted to trans people (aka 'chasers') or harder BDSM submissives or people who like redheads too much. And it's pretty easy to come up with matters that fall in one category or the other.
Lawrence pretty clearly believes that autogynes fit into both categories: that "Explaining autogynephilic transsexualism as a paraphilic phenomenon is factually correct" but also that "Autogynephilia, we should explain, is another variety of sexual orientation: It is an unusual variant form of heterosexuality. Like other sexual orientations, it is something we autogynephilic transsexuals did not choose and something we cannot change. It certainly determines what we lust after, but it also determines what we love and want to unite with."
Respectability is definitely a large part of why she's trying to emphasize the orientation aspects (literally "associations with illegal paraphilias will probably be unavoidable"), but Lawrence thinks that this has some useful predictive and therapeutic power. Her model holds that transsexualism-as-paraphilia is considers things in a purely medicalizing way, which patients sometimes like because it removes the responsibility of choice from them ("The clinician will, in effect, make the decision for them."), but doesn't really present the full spectrum of that choice nor does it seem dependent on people having a good acceptance (and sometimes even admission) of their own desires and preferences, which.
((I'm somewhat skeptical that's true for all trans women and very skeptical that it's true for all autogynephiles, but it's probably not wrong for some, and especially for those most likely to end up seeking help with autogynephilia.))
May I ask why not? 'Doing something feminine is at least worthy of severe social sanction, if not outright humiliation' is a pretty common message for guys, especially American Red Tribe-adjacent guys raised before the late-00s or so. I didn't internalize it much, but I can provide no shortage of (cis) gay examples where 'oh no not that briar patch' is far more overt than the sub/dom aspect.
You are absolutely right and I should have referred to that first. My bad.
Because many of these people are doing things (cross-dressing, usually) which are already seen as shameful, with no pretense of being forced to; plus, doing feminine things is only socially shameful for men, but the desire in question is to be/become a woman. But I've gotten some firsthand pushback on this so probably I was typical-minding here.
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