Blanchard's transsexualism typology

The American-Canadian sexologist Ray Blanchard proposed a psychological typology of gender dysphoria, transsexualism, and fetishistic transvestism in a series of academic papers through the 1980s and 1990s. Building on the work of earlier researchers, including his colleague Kurt Freund, Blanchard categorized trans women into two groups: homosexual transsexuals who are attracted exclusively to men and are feminine in both behavior and appearance; and autogynephilic transsexuals who experience sexual arousal at the idea of having a female body (autogynephilia). Blanchard and his supporters argue that the typology explains differences between the two groups in childhood gender nonconformity, sexual orientation, history of sexual fetishism, and age of transition.

Blanchard's typology has attracted significant controversy, especially following the 2003 publication of J. Michael Bailey's book The Man Who Would Be Queen, which presented the typology to a general audience. Scientific criticisms commonly made against Blanchard's research include that the typology is unfalsifiable because Blanchard and other supporters regularly dismiss or ignore data that challenges the theory, that it failed to properly control against cisgender women rather than against cisgender men in rating levels of autogynephilia, and that when such studies are performed they show that cisgender women have similar levels of autogynephilic responses to transgender women. The American Psychiatric Association includes with autogynephilia as a specifier to a diagnosis of transvestic disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (2013); this addition was objected to by the World Professional Association for Transgender Health (WPATH), who argued that there was a lack of scientific consensus on and empirical evidence for the concept of autogynephilia.

History

Background

Beginning in the 1950s, clinicians and researchers developed a variety of classifications of transsexualism. These were variously based on sexual orientation, age of onset, and fetishism.^[1] Prior to Blanchard, these classifications generally divided transgender women into two groups: "homosexual transsexuals" if sexually attracted to men and "heterosexual fetishistic transvestites" if sexually attracted to women.^[2] These labels carried a social stigma of mere sexual fetishism, and contradicted trans women's self-identification as "heterosexual" or "homosexual", respectively.^[2]

In 1982, Kurt Freund and colleagues argued there were two distinct types of trans women, each with distinct causes: one type associated with childhood femininity and androphilia (sexual attraction to men), and another associated with fetishism and gynephilia (sexual attraction to women).^{[1]: 533 [3]: 443} Freund stated that the sexual arousal in this latter type could be associated, not only with crossdressing, but also with other feminine-typical behaviors, such as applying make-up or shaving the legs.^[4]

Freund, four of his colleagues, and two other sexologists had previously published papers on "feminine gender identity in homosexual males" and "Male Transsexualism" in 1974.^[5][6] They occasionally also used the term homosexual transsexual to describe transgender men attracted to women.^[7] Blanchard credited Freund with being the first author to distinguish between erotic arousal due to dressing as a woman (transvestic fetishism) and erotic arousal due to fantasizing about being female (which Freund called cross-gender fetishism).^[3]: 443

Early research

Blanchard conducted a series of studies on people with gender dysphoria, analyzing the files of cases seen in the Gender Identity Clinic of the Clarke Institute of Psychiatry and comparing them on multiple characteristics.^{[8]: 10–15} These studies have been criticized as bad science for being unfalsifiable^[9] and for failing to sufficiently operationalize their definitions.^[10] They have also been criticized for lacking reproducibility, and for a lack of a control group of cisgender women.^[9][11] Supporters of the typology deny these allegations.^{[12][8]: 26}

Studying patients who had felt like women at all times for at least a year, Blanchard classified them according to whether they were attracted to men, women, both, or neither.^[3]: 444 He then compared these four groups regarding how many in each group reported a history of sexual arousal together with cross-dressing. 73% of the gynephilic, asexual, and bisexual groups said they did experience such feelings, but only 15% of the androphilic group did.^[8]: 10 He concluded that asexual, bisexual, and gynephilic transsexuals were motivated by erotic arousal to the thought or image of themself as a woman, and he coined the term autogynephilia to describe this.^[3]: 444

Blanchard and colleagues conducted a study in 1986 using phallometry (a measure of blood flow to the penis), demonstrating arousal in response to cross-dressing audio narratives among trans women. Although this study is often cited as evidence for autogynephilia, the authors did not attempt to measure subjects' ideas of themselves as women.^{[10]: 193 [13]} The authors concluded that gynephilic gender identity patients who denied experiencing arousal to cross-dressing were still measurably aroused by autogynephilic stimuli, and that autogynephilia among non-androphilic trans women was negatively associated with tendency to color their narrative to be more socially acceptable.^{[8]: 12–13} However, in addition to having methodological problems, the reported data did not support this conclusion, because the measured arousal to cross-dressing situations was minimal and consistent with subjects' self-reported arousal.^[13] This study has been cited by proponents to argue that gynephilic trans women who reported no autogynephilic interests were misrepresenting their erotic interests.^[13]

Popularization

Blanchard's research and conclusions came to wider attention with the publication of popular science books on transsexualism, including The Man Who Would Be Queen (2003) by sexologist J. Michael Bailey and Men Trapped in Men's Bodies (2013) by sexologist and trans woman Anne Lawrence, both of which based their portrayals of male-to-female transsexuals on Blanchard's taxonomy.^[14][15][16] The concept of autogynephilia in particular received little public interest until Bailey's 2003 book, though Blanchard and others had been publishing studies on the topic for nearly 20 years.^[15] Bailey's book was followed by peer-reviewed articles critiquing the methodology used by Blanchard.^[15] Both Bailey and Blanchard have since attracted intense criticism by some clinicians and by many transgender activists.^{[14][15][17][18]: 366}

Measures of orientation

Sexologists may measure sexual orientation using psychological personality tests, self reports, or techniques such as photoplethysmography. Blanchard argues that self-report is not always reliable.^[19][20] Morgan, Blanchard and Lawrence have speculated that many reportedly "non-homosexual" trans women systematically distorted their life stories because "non-homosexuals" were often screened out as candidates for surgery.^[21]

Blanchard and Freund used the Masculine Identity in Females (MGI) scale and the Modified Androphilia Scale.^[22] Lawrence writes that homosexual transsexuals averaged a Kinsey scale measurement of 5–6 or a 9.86 ± 2.37 on the Modified Androphilia Scale.^[20][23]

Neuroimaging studies and neurological differences

The concept that androphilia in trans women is related to homosexuality in cisgender men has been tested by MRI studies.^[24][25] Cantor interprets these studies as supporting Blanchard's transsexualism typology.^[25] These studies show neurological differences between trans women attracted to men and cis men attracted to women, as well as differences between androphilic and gynephilic trans women. The studies also showed differences between transsexual and nontranssexual people, leading to the conclusion that transsexuality is "a likely innate and immutable characteristic".^[25]

According to a 2016 review, structural neuroimaging studies seem to support the idea that androphilic and gynephilic trans women have different brain phenotypes, though the authors state that more independent studies of gynephilic trans women are needed to confirm this.^[26] A 2021 review examining transgender neurology found similar differences in brain structure between cisgender homosexuals and heterosexuals.^[27]

Autogynephilia

Autogynephilia (derived from Greek for "love of oneself as a woman"^[13][a]) is a term coined by Blanchard^[14][28][15] for "a male's propensity to be sexually aroused by the thought of himself as a female",^[13][29] intending for the term to refer to "the full gamut of erotically arousing cross-gender behaviors and fantasies".^[13] Blanchard states that he intended the term to subsume transvestism, including for sexual ideas in which feminine clothing plays only a small or no role at all.^[30] Other terms for such cross-gender fantasies and behaviors include automonosexuality, eonism, and sexo-aesthetic inversion.^[28] Blanchard distinguishes between "the existence or nonexistence of autogynephilia", which he describes as settled, and theoretical statements advanced by him "at one time or another", including several major components of his typology.^[3] Blanchard writes that the accuracy of these theories needs further empirical research to resolve.^[3]: 445

Subtypes

Blanchard identified four types of autogynephilic sexual fantasy,^[28] but stated that co-occurrence of types was common.^{[31]: 72–73 [8]: 19–20}

• Transvestic autogynephilia: arousal to the act or fantasy of wearing typically feminine clothing
• Behavioral autogynephilia: arousal to the act or fantasy of doing something regarded as feminine
• Physiologic autogynephilia: arousal to fantasies of body functions specific to people regarded as female
• Anatomic autogynephilia: arousal to the fantasy of having a normative woman's body, or parts of one^{[31]: 72–73 [8]: 19–20}

Relationship to gender dysphoria

The exact proposed nature of the relationship between autogynephilia and gender dysphoria is unclear, and the desire to live as a woman often remains as strong or stronger after an initial sexual response to the idea has faded.^[32] Blanchard and Lawrence argue that this is because autogynephilia causes a female gender identity to develop, which becomes an emotional attachment and something aspirational in its own right.^{[8]: 20–21}

Many transgender people dispute that their gender identity is related to their sexuality,^[33] and have argued that the concept of autogynephilia unduly sexualizes trans women's gender identity.^{[34]: 1729 [35]} Some fear that the concept of autogynephilia will make it harder for gynephilic or "non-classical" MtF transsexuals to receive sex reassignment surgery.^[36] Lawrence writes that some transsexual women identify with autogynephilia, some of these feeling positively and some negatively as a result, with a range of opinions reflected as to whether or not this played a motivating role in their decision to transition.^[8]: 55

In the first peer-reviewed critique of autogynephilia research, Charles Allen Moser found no substantial difference between "autogynephilic" and "homosexual" transsexuals in terms of gender dysphoria, stating that the clinical significance of autogynephilia was unclear.^[10]: 193 According to Moser, the idea is not supported by the data, and that despite autogynephilia existing, it is not predictive of the behavior, history, and motivation of trans women. ^[13] In a re-evaluation of the data used by Blanchard and others as the basis for the typology, he states that autogynephilia is not always present in trans women attracted to women, or absent in trans women attracted to men, and that autogynephilia is not the primary motivation for gynephilic trans women to seek sex reassignment surgery.^[13]

In a 2011 study presenting an alternative to Blanchard's explanation, Larry Nuttbrock and colleagues reported that autogynephilia-like characteristics were strongly associated with a specific generational cohort as well as the ethnicity of the subjects; they hypothesized that autogynephilia may become a "fading phenomenon".^[15][37]

As a sexual orientation

Blanchard and Lawrence have classified autogynephilia as a sexual orientation.^[13][38] Blanchard attributed the notion of some cross-dressing men being sexually aroused by the image of themselves as female to Magnus Hirschfeld.^[39][29] (The concept of a taxonomy based on transsexual sexuality was refined by endocrinologist Harry Benjamin in the Benjamin Scale in 1966,^[40][41] who wrote that researchers of his day thought attraction to men while feeling oneself to be a woman was the factor that distinguished a transsexual from a transvestite (who "is a man [and] feels himself to be one").^[40]) Blanchard and Lawrence argue that just like more common sexual orientations such as heterosexuality and homosexuality, it is not only reflected by penile responses to erotic stimuli, but also includes the capacity for pair bond formation and romantic love.^{[31]: 73, 75 [8]: 20–21 [42]}

Later studies have found little empirical support for autogynephilia as a sexual identity classification,^[2] and sexual orientation is generally understood to be distinct from gender identity.^[43]: 94 Elke Stefanie Smith and colleagues describe Blanchard's approach as "highly controversial as it could erroneously suggest an erotic background" to transsexualism.^[44]: 262

Serano says the idea is generally disproven within the context of gender transition as trans women who are on feminizing hormone therapy, especially on anti-androgens, experience a severe drop and in some cases complete loss in libido. Despite this the vast majority of transgender women continue their transition.^[45]

Erotic target location errors

Further information: Erotic target location error

Blanchard conjectured that sexual interest patterns could have inwardly instead of outwardly directed forms, which he called erotic target location errors (ETLE). Autogynephilia would represent an inwardly directed form of gynephilia, with the attraction to women being redirected towards the self instead of others. These forms of erotic target location errors have also been observed with other base orientations, such as pedophilia, attraction to amputees, and attraction to plush animals. Anne Lawrence wrote that this phenomenon would help to explain an autogynephilia typology.^[8]: 26

Cisgender women

The concept of autogynephilia has been criticized for implicitly assuming that cisgender women do not experience sexual desire mediated by their own gender identity.^[2] Research on autogynephilia in cisgender women shows that cisgender women commonly^{[clarification needed]} endorse items on adapted versions of Blanchard's autogynephilia scales.^[46][47]

Moser created an Autogynephilia Scale for Women in 2009, based on items used to categorize MtF transsexuals as autogynephilic in other studies. A questionnaire that included the ASW was distributed to a sample of 51 professional cisgender women employed at an urban hospital; 29 completed questionnaires were returned for analysis. By the common definition of ever having erotic arousal to the thought or image of oneself as a woman, 93% of the respondents would be classified as autogynephilic. Using a more rigorous definition of "frequent" arousal to multiple items, 28% would be classified as autogynephilic.^[47]

Lawrence criticized Moser's methodology and conclusions and stated that genuine autogynephilia occurs very rarely, if ever, in cisgender women as their experiences are superficially similar but the erotic responses are ultimately markedly different.^[15][48] Moser responded that Lawrence had made multiple errors by comparing the wrong items.^[49] Lawrence argues that the scales used by both Veale et al. and Moser fail to differentiate between arousal from wearing provocative clothing or imagining that potential partners find one attractive, and arousal merely from the idea that one is a woman or has a woman's body.^[8]: 176

In a 2022 study, Bailey and Kevin J. Hsu dispute that "natal females" experience autogynephilia based on an application of Blanchard's original Core Autogynephilia Scale to four samples of "autogynephilic natal males", four samples of "non-autogynephilic natal males" and two samples of "natal females".^[50] Serano and Veale argue that Bailey and Hsu's results do not support their conclusion, because most "natal females" in their research reported at least some autogynephilic fantasies. Furthermore, Bailey and Hsu's "autogynephilic natal male" samples 1, 2, and 4 do not apply to trans people as the majority of the sample were cis crossdressers, not trans women. Sample 3, which was majority trans women, did not have high rates of autogynephilia compared to the other two samples. Serano and Veale also criticize Bailey and Hsu for leaving out two scales that played a central role in Blanchard's original conception of autogynephilia, saying that this implies a much narrower definition of autogynephilia which would have excluded many of Blanchard's original trans subjects.^[51]

Similar to Serano and Veale, Moser also criticizes Bailey and Hsu for mainly comparing the scores of cisgender women with cisgender male crossdressers instead of transgender women.^[52]

Transfeminist critique

Critics of the autogynephlia hypothesis include transfeminists such as Julia Serano and Talia Mae Bettcher.^[2] Serano describes the concept as flawed, unscientific, and needlessly stigmatizing.^[53] According to Serano, "Blanchard's controversial theory is built upon a number of incorrect and unfounded assumptions, and there are many methodological flaws in the data he offers to support it."^[54] She argues that flaws in Blanchard's original studies include: being conducted among overlapping populations primarily at the Clarke Institute in Toronto without nontranssexual controls; subtypes not being empirically derived but instead "begging the question that transsexuals fall into subtypes based on their sexual orientation"; and further research finding a non-deterministic correlation between cross-gender arousal and sexual orientation.^[9] She states that Blanchard did not discuss the idea that cross-gender arousal may be an effect, rather than a cause, of gender dysphoria, and that Blanchard assumed that correlation implied causation.^[9]

Serano also states that the wider idea of cross-gender arousal was affected by the prominence of sexual objectification of women, accounting for both a relative lack of cross-gender arousal in transsexual men and similar patterns of autogynephilic arousal in non-transsexual women.^[9] She criticised proponents of the typology, claiming that they dismiss non-autogynephilic, non-androphilic transsexuals as misreporting or lying while not questioning androphilic transsexuals, describing it as "tantamount to hand-picking which evidence counts and which does not based upon how well it conforms to the model",^[9] either making the typology unscientific due to its unfalsifiability, or invalid due to the nondeterministic correlation that later studies found.^[9] Serano says that the typology undermined lived experience of transsexual women, contributed to pathologisation and sexualisation of transsexual women, and the literature itself fed into the stereotype of transsexuals as "purposefully deceptive", which could be used to justify discrimination and violence against transsexuals.^[9] According to Serano, studies have usually found that some non-homosexual transsexuals report having no autogynephilia.^[9]

Bettcher, based on her own experience as a trans woman, has critiqued the notion of autogynephilia, and "target errors" generally, within a framework of "erotic structuralism," arguing that the notion conflates essential distinctions between "source of attraction" and "erotic content," and "(erotic) interest" and "(erotic) attraction," thus misinterpreting what she prefers to call, following Serano, "female embodiment eroticism." She maintains that not only is "an erotic interest in oneself as a gendered being," as she puts it, a non-pathological and indeed necessary component of regular sexual attraction to others, but within the framework of erotic structuralism, a "misdirected" attraction to oneself as postulated by Blanchard is outright nonsensical.^[55] Activist and law professor Florence Ashley writes that the autogynephilia concept has been "discredited", and that Bailey's and Blanchard's work "has long been criticised for perpetuating stereotypes and prejudices against trans women, notably suggesting that LGBQ trans women's primary motivation for transitioning is sexual arousal."^[56]

Terminology

The concept that trans people with different sexual orientations are etiologically different goes back to the 1920s,^{[57][58][40][59]} but the terms used have not always been agreed on.^[58][40]

Blanchard said that one of his two types of gender dysphoria/transsexualism manifests itself in individuals who are almost if not exclusively attracted to men, whom he referred to as homosexual transsexuals.^[60] Blanchard uses the term "homosexual" relative to the person's sex assigned at birth, not their current gender identity.^[13] This use of the term "homosexual" relative to the person's birth sex has been heavily criticized by other researchers.^{[61][58][62][63][64][40]} It has been described as archaic^[57] confusing,^[23][59][65] demeaning,^[66] pejorative,^[23] offensive,^[62][67] and heterosexist.^[58] Benjamin states that trans women can only be "homosexual" if anatomy alone is considered, and psyches are ignored; he states that after sex-reassignment surgery, calling a male-to-female transsexual "homosexual" is pedantic and against "reason and common sense".^[68] Many authorities, including some supporters, criticize Blanchard's choice of terminology as confusing or degrading because it emphasizes trans women's assigned sex, and disregards their sexual orientation identity.^[26] Leavitt and Berger write that the term is "both confusing and controversial" and that trans women "vehemently oppose the label and its pejorative baggage."^[23]

In 1987, this terminology was included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) as "transsexual, homosexual subtype".^[57][63] The later DSM-IV (1994) and DSM-IV-TR (2000) stated that a transsexual was to be described as "attracted to males, females, both or neither".^[63]

Blanchard defined the second type of transsexual as including those who are attracted almost if not exclusively to females (gynephilic), attracted to both males and females (bisexual), and attracted to neither males nor females (asexual); Blanchard referred to this latter set collectively as the non-homosexual transsexuals.^[69][70] Blanchard says that the "non-homosexual" transsexuals (but not the "homosexual" transsexuals) exhibit autogynephilia,^[60] which he defined as a paraphilic interest in having female anatomy.^[29][30]

Alternative terms

Professor of anatomy and reproductive biology Milton Diamond proposed the use of the terms androphilic (attracted to men) and gynephilic (attracted to women) as neutral descriptors for sexual orientation that do not make assumptions about the sex or gender identity of the person being described, alternatives to homosexual and heterosexual.^{[citation needed]} Frank Leavitt and Jack Berger state that the label homosexual transsexual seems to have little clinical merit, as its referents have "little in common with homosexuals, except a stated erotic interest in males"; they too suggest "more neutral descriptive terms such as androphilia".^[23][21] Sexological research has been done using these alternative terms by researchers such as Sandra L. Johnson.^[71] Both Blanchard and Leavitt used a psychological test called the "modified androphilia scale" to assess whether a transsexual was attracted to men or not.^[4][23] Sociologist Aaron Devor wrote, "If what we really mean to say is attracted to males, then say 'attracted to males' or androphilic ... I see absolutely no reason to continue with language that people find offensive when there is perfectly serviceable, in fact better, language that is not offensive."^[62]

Other traits

According to the typology, autogynephilic transsexuals are attracted to femininity while homosexual transsexuals are attracted to masculinity. However, a number of other differences between the types have been reported. Cantor states that "homosexual transsexuals" usually begin to seek sex reassignment surgery (SRS) in their mid-twenties, while "autogynephilic transsexuals" usually seek clinical treatment in their mid-thirties or even later.^[32] Blanchard also states that homosexual transsexuals were younger when applying for sex reassignment, report a stronger cross-gender identity in childhood, have a more convincing cross-gender appearance, and function psychologically better than "non-homosexual" transsexuals.^[60] A lower percentage of those described as homosexual transsexuals report being (or having been) married, or report sexual arousal while cross-dressing.^[72] Bentler reported that 23% of homosexual transsexuals report a history of sexual arousal to cross-dressing, while Freund reported 31%.^{[73][23][74][75]} In 1990, using the alternative term "androphilic transsexual", Johnson wrote that there was a correlation between social adjustment to the new gender role and androphilia.^[71]

Anne Lawrence, a proponent of the concept,^[16][76] argues that homosexual transsexuals pursue sex reassignment surgery out of a desire for greater social and romantic success.^[13] Lawrence has proposed that autogynephilic transsexuals are more excited about sexual reassignment surgery than homosexual transsexuals. She states that homosexual transsexuals are typically ambivalent or indifferent about SRS, while autogynephilic transsexuals want to have surgery as quickly as possible, are happy to be rid of their penis, and proud of their new genitals.^[42] Lawrence states that autogynephilia tends to appear along with other paraphilias.^[31]: 79 J. Michael Bailey argued that both "homosexual transsexuals" and "autogynephilic transsexuals" were driven to transition mainly for sexual gratification, as opposed to gender-identity reasons.^[14]

Birth order

Blanchard and Zucker state that birth order has some influence over sexual orientation in male-assigned people in general, and androphilic trans women in specific.^[77][78][79] This phenomenon is called the "fraternal birth order effect".^[78] In 2000, Richard Green reported that androphilic trans women tended have a later-than-expected^{[clarification needed]} birth order, and more older brothers than other subgroups of trans women. Each older brother increased the odds that a trans woman was androphilic by 40%.^[79]

Transgender men

Blanchard's typology is mainly concerned with transgender women.^[16] Richard Ekins and Dave King state that female-to-male transsexuals (trans men) are absent from the typology,^[16] while Blanchard, Cantor, and Katherine Sutton distinguish between gynephilic and androphilic trans men. They state that gynephilic trans men are the counterparts of androphilic trans women, that they experience strong childhood gender nonconformity, and that they generally begin to seek sex reassignment in their mid-twenties. They describe androphilic trans men as a rare but distinct group who say they want to become gay men, and, according to Blanchard, are often specifically attracted to gay men. Cantor and Sutton state that while this may seem analogous to autogynephilia, no distinct paraphilia for this has been identified.^{[32]: 603–604 [80]}

Gynephilic transgender men

In 2000, Meredith L. Chivers and Bailey wrote, "Transsexualism in genetic females has previously been thought to occur predominantly in homosexual (gynephilic) women." According to them, Blanchard reported in 1987 that only 1 in 72 trans men he saw at his clinic were primarily attracted to men. They observed that these individuals were so uncommon that some researchers thought that androphilic trans men did not exist, or misdiagnosed them as homosexual transsexuals, attracted to women. They wrote that relatively few studies had examined childhood gender variance in trans men.^[7]

In a 2005 study by Smith and van Goozen, their findings in regards to trans men were different from their findings for trans women.^[72] Smith and van Goozen's study included 52 female-to-male transsexuals, who were categorized as either homosexual or non-homosexual. Smith concluded that female-to-male transsexuals, regardless of sexual orientation, reported more GID symptoms in childhood, and a stronger sense of gender dysphoria. Smith wrote that she found some differences between homosexual and non-homosexual female-to-male transsexuals. Smith says that homosexual female-to-males reported more gender dysphoria than any group in her study.^[72]

Inclusion in the Diagnostic and Statistical Manual of Mental Disorders

In the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) (1980), the diagnosis of "302.5 Transsexualism" was introduced under "Other Psychosexual Disorders". This was an attempt to provide a diagnostic category for gender identity disorders.^[81] The diagnostic category, transsexualism, was for gender dysphoric individuals who demonstrated at least two years of continuous interest in transforming their physical and social gender status.^[82] The subtypes were asexual, homosexual (same "biological sex"), heterosexual (other "biological sex") and unspecified.^[81] This was removed in the DSM-IV, in which gender identity disorder replaced transsexualism. Previous taxonomies, or systems of categorization, used the terms classic transsexual or true transsexual, terms once used in differential diagnoses.^[83]

The DSM-IV-TR included autogynephilia as an "associated feature" of gender identity disorder^[11] and as a common occurrence in the transvestic fetishism disorder, but does not classify autogynephilia as a disorder by itself.^[84]

The paraphilias working group on the DSM-5, chaired by Ray Blanchard, included both with autogynephilia and with autoandrophilia as specifiers to transvestic disorder in an October 2010 draft of the DSM-5. This proposal was opposed by the World Professional Association for Transgender Health (WPATH), citing a lack of empirical evidence for these specific subtypes.^{[85][86][10]: 201} WPATH argued that there was no scientific consensus on the concept, and that there was a lack of longitudinal studies on the development of transvestic fetishism.^[85] With autoandrophilia was removed from the final draft of the manual. Blanchard later said he had initially included it to avoid criticism: "I proposed it simply in order not to be accused of sexism [...] I don't think the phenomenon even exists."^[87] When published in 2013, the DSM-5 included With autogynephilia (sexual arousal by thoughts, images of self as a female) as a specifier to 302.3 Transvestic disorder (intense sexual arousal from cross-dressing fantasies, urges or behaviors); the other specifier is With fetishism (sexual arousal to fabrics, materials or garments).^[88]

Societal impact

Litigation

Further information: O'Donnabhain v. Commissioner

In the 2010 U.S. Tax Court case O'Donnabhain v. Commissioner, the Internal Revenue Service cited Blanchard's typology as justification for denying a transgender woman's tax deductions for medical costs relating to treatment of her gender identity disorder, claiming the procedures were not medically necessary.^[89] The court found in favor of the plaintiff, Rhiannon O'Donnabhain, ruling that she should be allowed to deduct the costs of her treatment, including sex reassignment surgery and hormone therapy.^[90] In its decision, the court declared the IRS's position "at best a superficial characterization of the circumstances" that was "thoroughly rebutted by the medical evidence".^[91][92]

Anti-LGBT groups

According to the Southern Poverty Law Center (SPLC), autogynephilia has been promoted by anti-LGBT hate groups.^[93][94][95] These include the Family Research Council (FRC), United Families International (UFI), and the American College of Pediatricians (ACPeds).^[93][94][95] Both Blanchard and Bailey have written articles for 4thWaveNow, which the SPLC describes as an anti-trans website.^[93]

Serano writes that "trans-exclusionary radical feminists", self-described as "gender-critical" feminists, have embraced the idea of autogynephilia beginning in the 2000s.^[53] One early proponent of autogynephilia was radical feminist Sheila Jeffreys.^[53] The concept has been used to imply that trans women are sexually deviant men.^[53][96] The concept of autogynephilia became popular on gender-critical websites such as 4thWaveNow, Mumsnet, and the Reddit community /r/GenderCritical.^[53]

See also

• Classification of transsexual and transgender people
• Autoeroticism
• Partialism
• Transgender sexuality
• List of transgender-related topics

Notes

1. Greek autos 'self'; gyne 'woman'; philia 'love'^[28]

References

1. Lawrence, Anne A. (April 2010). "Sexual orientation versus age of onset as bases for typologies (subtypes) for gender identity disorder in adolescents and adults". Archives of Sexual Behavior. 39 (2): 514–545. doi:10.1007/s10508-009-9594-3. ISSN 1573-2800. PMID 20140487. S2CID 23271088.
2. Pfeffer, Carla A. (2016). "Transgender Sexualities". In Goldberg, Abbie E. (ed.). The SAGE Encyclopedia of LGBTQ Studies, Volume 3. Thousand Oaks, CA: SAGE Publications. pp. 1249–1250. doi:10.4135/9781483371283.n439. ISBN 978-1-4833-7129-0. The term autogynephilia was first used in 1989 by Ray Blanchard, a sexologist, to describe a purported class of transgender women. Classifications of transgender women prior to this time tended to divide this group into those who were sexually and romantically interested in men as 'homosexual transsexuals,' and those who were sexually and romantically interested in women were classified as 'heterosexual fetishistic transvestites.'
3. Blanchard R (August 2005). "Early history of the concept of autogynephilia". Archives of Sexual Behavior. 34 (4): 439–446. CiteSeerX 10.1.1.667.7255. doi:10.1007/s10508-005-4343-8. PMID 16010466. S2CID 15986011.
4. Blanchard R (June 1985). "Typology of male-to-female transsexualism". Archives of Sexual Behavior. 14 (3): 247–261. doi:10.1007/bf01542107. PMID 4004548. S2CID 23907992.
5. Freund K, Nagler E, Langevin R, Zajac A, Steiner B (1974). Measuring feminine gender identity in homosexual males. Archives of Sexual Behavior, Volume 3, Number 3 / May, 1974, pp. 249–260.)
6. Person ES, Ovesey L (1974), "The Psychodynamics of Male Transsexualism". In Friedman RC, Richart RM, and Vande Wiele LR (eds.) Sex Differences in Behavior, pp. 315-331. John Wiley & Sons, ISBN 978-0-471-28053-8
7. Chivers, ML; Bailey, JM (2000). "Sexual orientation of female-to-male transsexuals: A comparison of homosexual and non-homosexual types" (PDF). Archives of Sexual Behavior. 29 (3): 259–278. doi:10.1023/A:1001915530479. PMID 10992981. S2CID 10707797.
8. Lawrence, Anne (2013). Men Trapped in Men's Bodies: Narratives of Autogynephilic Transsexualism. Springer Science+Business Media. ISBN 978-1-4614-5181-5.
9. Serano, J. M. (2010). "The Case Against Autogynephilia" (PDF). International Journal of Transgenderism. 12 (3): 176–187. doi:10.1080/15532739.2010.514223. S2CID 16456219. There are few concepts within the fields of transgender studies and human sexuality that are more controversial than autogynephilia.
10. Bevan, Thomas E. (2015). The Psychobiology of Transsexualism and Transgenderism: A New View Based on Scientific Evidence. Santa Barbara, CA: Praeger. ISBN 978-1-4408-3126-3.
11. Winters, Kelley (2005). "Gender Dissonance: Diagnostic Reform of Gender Identity Disorder for Adults". Journal of Psychology & Human Sexuality. 17 (3–4): 76. doi:10.1300/J056v17n03_04. S2CID 147607818. Simultaneously published in: Karasic, Dan; Drescher, Jack, eds. (2005). Sexual and Gender Diagnoses of the Diagnostic and Statistical Manual (DSM): A Reevaluation. The Haworth Press. ISBN 0-7890-3213-9.
12. Lawrence, Anne A. (2010). "Sexual orientation versus age of onset as bases for typologies (subtypes) for gender identity disorder in adolescents and adults". Archives of Sexual Behavior. 39 (2): 514–545. doi:10.1007/s10508-009-9594-3. ISSN 1573-2800. PMID 20140487. S2CID 23271088.
13. Moser C (July 2010). "Blanchard's Autogynephilia Theory: a critique". Journal of Homosexuality (6 ed.). 57 (6): 790–809. doi:10.1080/00918369.2010.486241. PMID 20582803. S2CID 8765340.
14. Bancroft, John (2009). "Transgender, gender nonconformity and transvestism". Human Sexuality and its Problems (3rd ed.). Elsevier. pp. 290–291. ISBN 978-0-443-05161-6. Controversy over [Blanchard's] division into two types peaked with Bailey's publication of his book The Man who would be Queen: the Science of Gender Bending and Transsexualism (2003), which caused anger and outrage in the transgender community and disapproval among some clinicians working in this field.
15. Sánchez, Francisco J.; Vilain, Eric (2013). "Transgender Identities: Research and Controversies". In Patterson, Charlotte J.; D'Augelli, Anthony R. (eds.). Handbook of Psychology and Sexual Orientation. Oxford University Press. pp. 47–48. doi:10.1093/acprof:oso/9780199765218.003.0004. ISBN 978-0-1997-6521-8.
16. Ekins, Richard; King, Dave (2006). The Transgender Phenomenon. London: SAGE Publications. pp. 86–87. ISBN 0-7619-7163-7.
17. Lawrence, Anne A. (2017). "Autogynephilia and the Typology of Male-to-Female Transsexualism". European Psychologist. 22 (1): 39–54. doi:10.1027/1016-9040/a000276. ISSN 1016-9040. Autogynephilia became a controversial topic after it was discussed in a contentious book by psychologist Bailey (2003). Autogynephilia and the ideas associated with it, including transsexual typologies based on sexual orientation, have subsequently been criticized by some clinicians and researchers and by many transsexual activists.
18. Dreger, Alice D. (June 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 (3): 366–421. doi:10.1007/s10508-007-9301-1. PMC 3170124. PMID 18431641.
19. Blanchard, Ray; Leonard H. Clemmensen; Betty W. Steiner (December 1985). "Social desirability response set and systematic distortion in the self-report of adult male gender patients". Archives of Sexual Behavior. Netherlands: Springer. 14 (6): 505–516. doi:10.1007/BF01541751. PMID 4084050. S2CID 24970286. 1573-2800.
20. Lawrence, Anne; Latty, Elizabeth M; Chivers, ML; Bailey, JM (April 2005). "Measurement of sexual arousal in postoperative male-to-female transsexuals using vaginal photoplethysmography". Archives of Sexual Behavior. 34 (2): 135–145. doi:10.1007/s10508-005-1792-z. PMID 15803248. S2CID 8356885. 1573-2800.
21. Morgan AJ Jr (1978), "Psychotherapy for transsexual candidates screened out of surgery". Archives of Sexual Behavior. 7: 273-282.|
22. Blanchard, Ray; Kurt Freund (1990). Carole A. Beere (ed.). Gender Roles. Greenwood Publishing Group. p. 35. ISBN 978-0-313-26278-4. Retrieved April 21, 2009.
23. Leavitt F, Berger JC (October 1990). "Clinical patterns among male transsexual candidates with erotic interest in males". Archives of Sexual Behavior. 19 (5): 491–505. doi:10.1007/BF02442350. PMID 2260914. S2CID 21588827.
24. Simon, Lajos; Lajos R. Kozák; Viktória Simon mail; Pál Czobor; Zsolt Unoka; Ádám Szabó; Gábor Csukly (December 31, 2013). "Regional Grey Matter Structure Differences between Transsexuals and Healthy Controls—A Voxel Based Morphometry Study". PLOS ONE. 8 (12): e83947. Bibcode:2013PLoSO...883947S. doi:10.1371/journal.pone.0083947. PMC 3877116. PMID 24391851.
25. Cantor, James M (July 8, 2011). "New MRI Studies Support the Blanchard Typology of Male-to-Female Transsexualism". Archives of Sexual Behavior. 40 (5): 863–864. doi:10.1007/s10508-011-9805-6. PMC 3180619. PMID 21739338.
26. Guillamon A, Junque C, Gómez-Gil E (October 2016). "A Review of the Status of Brain Structure Research in Transsexualism". Archives of Sexual Behavior. 45 (7): 1615–1648. doi:10.1007/s10508-016-0768-5. PMC 4987404. PMID 27255307. Untreated MtFs and FtMs who have an early onset of their gender dysphoria and are sexually oriented to persons of their natal sex show a distinctive brain morphology, reflecting a brain phenotype....the available data seems to support two existing hypotheses: (1) a brain-restricted intersexuality in homosexual MtFs and FtMs and (2) Blanchard's insight on the existence of two brain phenotypes that differentiate "homosexual" and "nonhomosexual" MtFs.
27. Frigerio, Alberto; Ballerini, Lucia; Valdes-Hernandez, Maria (2021). "Structural, Functional, and Metabolic Brain Differences as a Function of Gender Identity or Sexual Orientation: A Systematic Review of the Human Neuroimaging Literature". Archives of Sexual Behavior. 50 (8): 3329–3352. doi:10.1007/s10508-021-02005-9. hdl:20.500.11820/7258d49f-d222-4094-a40f-dc564d163ea7. PMC 8604863. PMID 33956296. S2CID 233870640.
28. Milner, Joel S.; Dopke, Cynthia A.; Crouch, Julie L. (2008). "Paraphilia Not Otherwise Specified: Psychopathology and Theory". In Laws, D. Richard; O'Donohue, William T. (eds.). Sexual Deviance: Theory, Assessment, and Treatment. Guilford Press. p. 408. ISBN 978-1-59385-605-2.
29. Blanchard R (October 1989). "The concept of autogynephilia and the typology of male gender dysphoria". The Journal of Nervous and Mental Disease. 177 (10): 616–623. doi:10.1097/00005053-198910000-00004. PMID 2794988.
30. Blanchard, R (1991). "Clinical observations and systematic studies of autogynephilia". Journal of Sex and Marital Therapy. 17 (4): 235–251. doi:10.1080/00926239108404348. PMID 1815090.
31. Lawrence, Anne A. (August 26, 2004). (PDF). Journal of Gay & Lesbian Psychotherapy. 8 (1–2): 69–87. CiteSeerX 10.1.1.656.9256. doi:10.1080/19359705.2004.9962367. ISSN 0891-7140. Archived from the original (PDF) on September 23, 2015. Retrieved November 24, 2019.
32. Cantor, James M.; Sutton, Katherine S. (2014). "Paraphilia, Gender Dysphoria, and Hypersexuality". In Blaney, Paul H.; Krueger, Robert F.; Millon, Theodore (eds.). Oxford Textbook of Psychopathology. Oxford University Press. pp. 593, 602–604. ISBN 978-0-19-981177-9.
33. Tosh, Jemma (2016). Psychology and Gender Dysphoria: Feminist and Transgender Perspectives. Routledge. pp. 114–115. ISBN 978-1-13-801392-6. Much like feminists who challenged psychology for its poor representation of women, so too have trans individuals and allies examined and criticized the profession for failing to understand their experiences [...] The autogynephilia theory in particular has been framed as 'incorrect, offensive, and potentially politically damaging to a marginalized group' [...] Most state that transition is related to their gender identity not their sexuality
34. Sojka, Carey Jean (2017). "Transmisogyny". In Nadal, Kevin L. (ed.). The SAGE Encyclopedia of Psychology and Gender, Volume 4. Thousand Oaks, Calif.: SAGE Publications. pp. 1727 ff. doi:10.4135/9781483384269.n588. ISBN 978-1-4833-8427-6.
35. Lev, Arlene Istar (September 2013). "Gender Dysphoria: Two Steps Forward, One Step Back" (PDF). Clinical Social Work Journal. 41 (3): 288–296. doi:10.1007/s10615-013-0447-0. S2CID 144556484.
36. LeVay, Simon; Valente, Sharon M. (2003). Human sexuality. Sunderland, Mass.: Sinauer Associates. p. 166. ISBN 978-0-8789-3454-6.
37. Nuttbrock, Larry; et al. (2011). "A Further Assessment of Blanchard's Typology of Homosexual Versus Non-Homosexual or Autogynephilic Gender Dysphoria". Archives of Sexual Behavior. 40 (2): 247–257. doi:10.1007/s10508-009-9579-2. PMC 2894986. PMID 20039113.
38. Blanchard R (1993). "Partial versus complete autogynephilia and gender dysphoria". Journal of Sex & Marital Therapy. 19 (4): 301–307. doi:10.1080/00926239308404373. PMID 8308916.
39. Hirschfeld, M. (1948). Sexual anomalies. New York: Emerson.
40. Benjamin H (1966). The Transsexual Phenomenon. The Julian Press ASIN: B0007HXA76 August 21, 2006, at the Wayback Machine
41. . shop.weka.de. Archived from the original on January 9, 2009.
42. Lawrence AA (October 24, 2007). (PDF). Perspectives in Biology and Medicine. Elsevier. 50 (4): 506–520. doi:10.1353/pbm.2007.0050. PMID 17951885. S2CID 31767722. Archived from the original (PDF) on February 5, 2015. Retrieved May 26, 2011.
43. Galupo, M. Paz; et al. (2016). "'The labels don't work very well': Transgender individuals' conceptualizations of sexual orientation and sexual identity". International Journal of Transgenderism. 17 (2): 93–104. doi:10.1080/15532739.2016.1189373. ISSN 1553-2739. S2CID 148318373.
44. Smith, Elke Stefanie; et al. (2015). "The transsexual brain – A review of findings on the neural basis of transsexualism". Neuroscience & Biobehavioral Reviews. 59: 251–266. doi:10.1016/j.neubiorev.2015.09.008. ISSN 1873-7528. PMID 26429593. S2CID 23913935.
45. Serano, Julia (July 3, 2020). "Autogynephilia: A scientific review, feminist analysis, and alternative 'embodiment fantasies' model". The Sociological Review. 68 (4): 763–778. doi:10.1177/0038026120934690. S2CID 221097198.
46. Veale JF, Clarke DE, Lomax TC (August 2008). "Sexuality of male-to-female transsexuals". Archives of Sexual Behavior. 37 (4): 586–597. doi:10.1007/s10508-007-9306-9. PMID 18299976. S2CID 207089236.
47. Moser C (2009). "Autogynephilia in women". Journal of Homosexuality. 56 (5): 539–547. doi:10.1080/00918360903005212. PMID 19591032. S2CID 14368724.
48. Lawrence AA (2010). "Something resembling autogynephilia in women: comment on Moser (2009)". Journal of Homosexuality. 57 (1): 1–4. doi:10.1080/00918360903445749. PMID 20069491. S2CID 205469176.
49. Moser C (2010). "A rejoinder to Lawrence (2010): it helps if you compare the correct items". Journal of Homosexuality. 57 (6): 693–696. doi:10.1080/00918369.2010.485859. PMID 20582797. S2CID 31285118.
50. Bailey, J. Michael; Hsu, Kevin J. (2022). "How Autogynephilic Are Natal Females?". Archives of Sexual Behavior. 51 (7): 3311–3318. doi:10.1007/s10508-022-02359-8. PMID 35759067. S2CID 250071413.
51. Serano, Julia M.; Veale, Jaimie F. (September 6, 2022). "Autogynephilia Is a Flawed Framework for Understanding Female Embodiment Fantasies: A Response to Bailey and Hsu (2022)" (PDF). Archives of Sexual Behavior. 52 (2): 473–477. doi:10.1007/s10508-022-02414-4. PMID 36066682. S2CID 252088801 – via Juliaserano.com.
52. Moser, Charles (September 9, 2022). "A Response to Bailey and Hsu (2022): It Helps If You Stop Confusing Gender Dysphoria and Transvestism". Archives of Sexual Behavior. 52 (2): 469–471. doi:10.1007/s10508-022-02418-0. PMID 36085213. S2CID 252181797 – via ResearchGate.
53. Serano, Julia (2020). "Autogynephilia: A scientific review, feminist analysis, and alternative 'embodiment fantasies' model". The Sociological Review. 68 (4): 763–778. doi:10.1177/0038026120934690. ISSN 0038-0261. S2CID 221097198 – via ResearchGate.
54. Serano, Julia (2007). Whipping girl: a transsexual woman on sexism and the scapegoating of femininity. Seal Press. p. 178. ISBN 978-1-58005-154-5. While Blanchard's controversial theory is built upon a number of incorrect and unfounded assumptions, and there are many methodological flaws in the data he offers to support it, it has garnered some acceptance in the psychiatric literature...
55. Bettcher TM (2014). "When selves have sex: what the phenomenology of trans sexuality can teach about sexual orientation". Journal of Homosexuality. 61 (5): 605–620. doi:10.1080/00918369.2014.865472. PMID 24295078. S2CID 24098739.
56. Ashley, Florence (August 10, 2020). "A critical commentary on 'rapid-onset gender dysphoria'" (PDF). The Sociological Review. 68 (4): 779–799. doi:10.1177/0038026120934693. S2CID 221097476.
57. Wahng, SJ (2004). "Transmasculinity and Asian American Gendering". In Aldama AJ (ed.). Violence and the Body: Race, Gender, and the State. Indiana University Press. pp. 292, 307n8. ISBN 0-253-34171-X.
58. Bagemihl, B (1997). "Surrogate phonology and transsexual faggotry: A linguistic analogy for uncoupling sexual orientation from gender identity". In Livia A; Hall K (eds.). Queerly Phrased: Language, Gender, and Sexuality. Oxford University Press. p. 380. ISBN 0-19-510471-4.
59. Diamond M, Karlen A (1980). Sexual Decisions. Little, Brown, ISBN 978-0-316-18388-8
60. Blanchard R, Clemmensen LH, Steiner BW (April 1987). "Heterosexual and homosexual gender dysphoria". Archives of Sexual Behavior. 16 (2): 139–152. doi:10.1007/BF01542067. PMID 3592961. S2CID 43199925.
61. Bancroft J (June 2008). "Lust or identity?". Archives of Sexual Behavior. Springer. 37 (3): 426–428, discussion 505–510. doi:10.1007/s10508-008-9317-1. PMID 18431640. S2CID 33178427.
62. Lane R (June 2008). "Truth, lies, and trans science". Archives of Sexual Behavior. 37 (3): 453–456, discussion 505–510. doi:10.1007/s10508-008-9336-y. PMID 18431622. S2CID 45198200.
63. Shefer T, Boonzaier F (2006). The Gender of Psychology (Illustrated ed.). Juta and Company Limited. pp. 273–274, 282. ISBN 978-1-919713-92-2.
64. Diamond M (2006). Biased-Interaction theory of psychosexual development: "how does one know if one is male or female?" Sex Roles
65. Diamond, M (2002a). "Sex and gender are different: Sexual identity and gender identity are different". Clinical Child Psychology and Psychiatry. 7 (3): 320–334. doi:10.1177/1359104502007003002. S2CID 144721800.
66. Leiblum SR, Rosen RC (2000). Principles and Practice of Sex Therapy, Third Edition. ISBN 1-57230-574-6,Guilford Press of New York, c2000.
67. James A (2006), "A defining moment in our history: Examining disease models of gender identity". Gender Medicine. 3:56 ISSN 1550-8579
68. Benjamin, Harry (1966). . The Transsexual Phenomenon. Archived from the original on January 6, 2009. Retrieved December 10, 2008.
69. Blanchard R (August 1989). "The classification and labeling of nonhomosexual gender dysphorias". Archives of Sexual Behavior. 18 (4): 315–334. doi:10.1007/BF01541951. PMID 2673136. S2CID 43151898.
70. Blanchard R (January 1988). "Nonhomosexual gender dysphoria". Journal of Sex Research. 24 (1): 188–193. doi:10.1080/00224498809551410. PMID 22375647.
71. Johnson SL, Hunt DD (1990), "The relationship of male transsexual typology to psychosocial adjustment". Archives of Sexual Behavior, Volume 19, Number 4 / August 1990, 349-360.
72. Smith, Yolanda L.S.; Stephanie Van Goozen; Aj Kupier; Peggy T. Cohen-Kettenis (December 15, 2005). (PDF). Psychiatry Research. Elsevier. 137 (3): 151–160. doi:10.1016/j.psychres.2005.01.008. PMID 16298429. S2CID 207445960. Archived from the original (PDF) on February 27, 2008. Retrieved June 26, 2007.
73. Freund, K; Steiner, BW; Chan, S (1982). "Two types of cross-gender identity". Archives of Sexual Behavior. 11 (1): 49–63. doi:10.1007/bf01541365. PMID 7073469. S2CID 42131695.
74. Bentler, P M (1976). "A typology of transsexualism: Gender identity theory and data". Archives of Sexual Behavior. 5 (6): 567–584. doi:10.1007/bf01541220. PMID 1008701. S2CID 22830472.
75. Blanchard, R (1985). "Typology of male-to-female transsexualism". Archives of Sexual Behavior. 14 (3): 247–261. doi:10.1007/bf01542107. PMID 4004548. S2CID 23907992.
76. Davy, Zowie (June 9, 2015). "The DSM-5 and the Politics of Diagnosing Transpeople". Archives of Sexual Behavior. 44 (5): 1165–1176. doi:10.1007/s10508-015-0573-6. PMID 26054486. S2CID 9627776.
77. Blanchard, Ray; Zucker, Kenneth J.; Cohen-Kettenis, PT; Gooren, LJ; Bailey, JM (October 1996). "Birth order and sibling sex ratio in two samples of Dutch gender-dysphoric homosexual males". Archives of Sexual Behavior. 25 (5): 495–514. doi:10.1007/BF02437544. PMID 8899142. S2CID 41147086.
78. Zucker, Kenneth J; Blanchard, Ray (October 2007). "Birth order and sibling sex ratio in homosexual transsexual South Korean men: Effects of the male-preference stopping rule". Psychiatry and Clinical Neurosciences. 61 (5): 529–533. doi:10.1111/j.1440-1819.2007.01703.x. PMID 17875032. S2CID 22175314.
79. Green, Richard (July 2000). "Birth order and ratio of brothers to sisters in transsexuals". Psychological Medicine. 30 (4): 789–795. doi:10.1017/S0033291799001932. PMID 11037086. S2CID 42713566.
80. Blanchard, Ray. "Gender Identity Disorders in Adult Women" (PDF). Clinical Management of Gender Identity Disorders in Children and Adults. American Psychiatric Press. pp. 77–91.
81. Lothstein, Leslie Martin (1983). Female-to-male Transsexualism: Historical, Clinical, and Theoretical Issues. Boston, MA: Routledge & Kegan Paul. p. 60. ISBN 0-7100-9476-0.
82. Meyer, Walter; Walter O. Bockting; Peggy Cohen-Kettenis; et al. (February 2001). (PDF). 6th. Harry Benjamin International Gender Dysphoria Association. Archived from the original (PDF) on June 10, 2007. Retrieved April 22, 2009.
83. Benjamin H (1966). "The Transsexual Phenomenon" (PDF). Transactions of the New York Academy of Sciences. The Julian Press. 29 (4): 428–430. doi:10.1111/j.2164-0947.1967.tb02273.x. PMID 5233741.
84. Diagnostical and Statistical Manual of Mental Disorders: DSM-IV-TR: 4th Edition Text Revision. American Psychiatric Association. January 2000. p. 574. ISBN 978-0-89042-025-6.
85. Gijs L, Carroll RA (2011). "Should Transvestic Fetishism Be Classified in DSM 5? Recommendations from the WPATH Consensus Process for Revision of the Diagnosis of Transvestic Fetishism". International Journal of Transgenderism. 12 (4): 189–197. doi:10.1080/15532739.2010.550766.
86. Knudson G, De Cuypere G, Bockting W (2011). "Second Response of the World Professional Association for Transgender Health to the Proposed Revision of the Diagnosis of Transvestic Disorder for DSM5". International Journal of Transgenderism. 13: 9–12. doi:10.1080/15532739.2011.606195. S2CID 143808776.
87. Drabek, Matt L. (2014). Classify and Label: The Unintended Marginalization of Social Groups. Lanham, MD: Lexington Books. p. 93. ISBN 978-0-7391-7976-5.
88. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 685–705. ISBN 978-0-89042-555-8.
89. Pratt, Katherine (2016). "The Tax Definition of 'Medical Care:' A Critique of the Startling IRS Arguments in O'Donnabhain V. Commissioner". Michigan Journal of Gender & Law. 23 (2): 313–389. doi:10.36641/mjgl.23.2.tax. ISSN 1095-8835. S2CID 151576703.
90. Lavoie, Denise (February 3, 2010). . Montgomery Advertiser. Montgomery, Ala. Associated Press. Archived from the original on February 5, 2010.
91. Lavoie, Denise (February 3, 2010). "Case backs need for sex-change surgery". Boston Globe. Associated Press. Retrieved April 27, 2023.
92. O'Donnabhain v. Commissioner, 134 T.C. 34 (T.C. 2010)).
93. "Roundup of anti-LGBT activities 10/3/2018". Hatewatch. Southern Poverty Law Center. October 3, 2018. Retrieved October 17, 2022.
94. "Anti-LGBT Hate Group Releases Anti-Trans Position Statement". Hatewatch. Southern Poverty Law Center. April 7, 2016. Retrieved October 21, 2022.
95. "10 things you need to know about Tony Perkins and the Family Research Council". Hatewatch. Southern Poverty Law Center. May 15, 2018. Retrieved October 21, 2022.
96. Compton, Julie (November 22, 2019). "'Frightening' online transphobia has real-life consequences, advocates say". NBC News. Retrieved October 17, 2022.

External links

  The dictionary definition of autogynephilia at Wiktionary