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Discovering the Concept of Autogynephilia

The theory that one form of MtF transsexualism is an outgrowth of autogynephilia—erotic arousal to the thought of being a female—was not widely known until recently. One of the topics informants most frequently discussed in their narratives was discovering the concept of autogynephilia for the first time. They often reported feeling amazement, relief, delight, and gratitude when they realized that the concept applied to them and could help them better understand themselves and their desires to be female. Many were reassured by the knowledge that other transsexuals shared similar feelings. Some said that the concept of autogynephilia helped them to feel more legitimately transsexual. In particular, it helped them to resolve the cognitive dissonance (“craziness”) that arose from believing that they were genuinely transsexual but having been told repeatedly that “real” transsexuals did not experience sexual arousal with cross-dressing or cross-gender fantasy. Not all informants described self-recognition as an autogynephilic transsexual to be a positive emotional experience, however: Some reported that it was associated with feelings of distress, sadness, or shame.

Encountering the concept of autogynephilia prompted several informants to reflect on their encounters with psychologists or psychiatrists who had informed them that they could not really be transsexual because of their autogynephilic feelings. Others described misrepresenting or concealing their autogynephilic feelings in past or ongoing interactions with psychotherapists. Informants also reflected on the extent to which they believed that autogynephilia was a motivating factor in their desire to be women or to seek or undergo sex reassignment; they expressed a range of opinions, from “definitely” to “not at all.”

Discovering an Accurate Description

Informants frequently stated that the concept of autogynephilia provided an authentic, true-to-life description of their feelings and experiences. Some were surprised to find their desires, fantasies, and behaviors portrayed with seemingly uncanny accuracy:

When I came across your paper on autogynephilia, I felt for the first time that I was reading about myself. (008)

After reading through the identifiers associated with autogynephilia, I realized that I related to each and every one. (009)

Your article on autogynephilia describes exactly how I have felt since age 6 or 7. (010)

When I read about autogynephilia, I saw myself so clearly that it hit me like a rock. (011)

Autogynephilia as a Revelation

For some informants, the concept of autogynephilia and the recognition of themselves as autogynephilic transsexuals had a revelatory quality: They felt that a profound personal mystery had been explained at last.

Thank you for your writings on autogynephilia. I thought I knew almost everything about transvestism and transsexuality, but I am speechless, as it described my entire journey much more accurately than the “woman trapped in a man’s body” explanation. For me, the idea of autogynephilia as a root or driving cause of transsexualism is a revelation. (012)

Autogynephilia has just been flat out revelatory to me. Over the last 5 years, I’ve been increasingly thinking that I’m transsexual but was always dismayed at not being able to find myself in the transsexual literature. I read your article and sat there smiling, laughing, and rereading and rereading it. (013)

Several informants used the word “epiphany” to describe what the concept of autogynephilia meant to them:

Discovering autogynephilia was an epiphany. The theory, the essays, and the personal accounts spoke directly to me. (014)

It is only since discovering Blanchard’s concept of autogynephilia that I’ve been able to finally make some sense of who and what I am. Since reading about autogynephilia, I’ve been able to accept the idea that my preoccupation with the female side of myself is rooted in sexual desire. It seems so obvious, but, as such personal epiphanies usually are, it was invisible until someone else pointed it out. (015)

Thank you for your articles on autogynephilia: I feel like I have had an epiphany, a revelation, an “ah-hah moment” of self-recognition. (016)

For a few, discovering the concept of autogynephilia was not only a revelatory experience but an intensely emotional one as well:

I have just finished reading about autogynephilia, and all I can say is, thank you from the bottom of my heart. I have tears in my eyes as I write this: At 54 years of age, I have found information that has liberated my thinking about myself. I had struggled for years to place myself in categories that did not seem right for me. Now I read about autogynephilia and all I can do is weep. It is like a homecoming. (017)

We will subsequently observe, however, that informants’ emotional reactions to learning about autogynephilia were not always so positive.

Facilitating Understanding and Clarity

Many informants reported that discovering an accurate description of their feelings and experiences facilitated greater self-understanding. Here are some representative comments:

The description of anatomic autogynephilia comes closer to my own personal experience than anything I have ever read on the subject of transsexuality and has helped me tremendously to understand my own transgendered feelings. (018)

I identify strongly with the anatomic type of autogynephilia. Your article has provided the first sensible discussion of how transgenderism applies to me. I am now motivated to review my life in a new context. (019)

I had not been able to explain the almost inexorable force that continues to drive me to want to have the body of a woman until I read about autogynephilia. Now I understand. (020)

In several narratives, the word “clarity” was used to describe individuals’ improved insight into themselves and their desires:

I had not heard of the word “autogynephilia” before. Everything rang utterly true for me. Never in all my research on this topic has any explanation nailed things down with such total obvious clarity for me. (021)

Autogynephilia is an amazing concept. When I found out about it, it was as if I finally saw this aspect of myself with complete clarity for the first time in my life. This is me! (022)

The information you published on autogynephilia has given me a sudden clarity into what I have experienced my whole life. I feel almost like a weight has been lifted off of me. (023)

One informant who had transitioned 3 years earlier observed that recognizing herself in the descriptions of autogynephilic transsexualism had helped her reach a more nuanced understanding of her status as a transsexual woman and come to terms with some personality traits that were not traditionally feminine:

I began my transition at age 26 and completed sex reassignment surgery 3 years ago. Reading about autogynephilia has helped me shed many of my pretensions, which has helped me to become more grounded and not as easily hurt when my femininity is questioned. Indeed, I have come to accept the dual nature of myself as a thinking male with a female emotional life. (024)

This excerpt illustrates how the theory of autogynephilic transsexualism cannot only promote personal understanding in a dramatic and revelatory way, but also in more subtle ways, by encouraging MtF transsexuals to reflect on the origins and meanings of their cross-gender identities.

Opening Eroticism to Discussion

A few informants observed that the concept of autogynephilia provided a descriptive term and an explanatory schema that addressed feelings and desires that were rarely discussed openly: the erotic feelings that provided the impetus, at least in part, for wanting sex reassignment:

As a transsexual who finds her own transsexualism to be the continuing culmination of many erotic fantasies, I want to thank you for eloquently expressing the importance for many of us of the “sexual” in transsexual. (025)

I was delighted to read about autogynephilia. It is very much the idea and fantasy of having a woman’s body and enjoying it that I find intensely arousing. It is a great relief to have this topic brought out into the open. (026)

I have yet to read an explanation that more closely and accurately describes the motivation I feel than the concept of autogynephilia. This is the first time anybody has ever said it is ok to have sexual feelings and motives. (027)

The concept of autogynephilia not only puts the erotic dimension of transsexualism on the table for discussion but also implies that individuals can participate in such a discussion with less worry about whether they are “genuinely” transsexual.

Finding a Theory That Feels Applicable

Several informants reported that the theory of autogynephilic transsexualism provided a better explanatory framework for making sense of their feelings and experiences than other theories of MtF transsexualism they had encountered. Other theories, they felt, either didn’t seem to apply to them or were missing some important element.

You’ve published the concept I’ve been searching for, which finally explains my feelings. I’ve read all the traditional theories, yet I’ve always felt I was different. I’ve been trying to decide what to do, feeling I didn’t match the standard descriptions, yet knowing I had to do something. With this cloud of confusion lifted, I can make clearer decisions. (028)

I think the ideas of autogynephilia match my feelings and understanding of my desires. I never really felt that the “politically correct” motivations matched my situation. (029)

Your articles on autogynephilia, especially concerning the physical aspect of feminizing one’s body, hit home for me. I have always sought a reason for my gender dysphoria but have not been satisfied with most of the theories. Your articles describe me to a T. (030)

I am convinced of the validity of the autogynephilic model of transsexualism. Unlike other theories I have read about, the autogynephilia model seems to exactly match up with my intuitive understanding of my own experience. (031)

Because MtF transsexuals are eager to make sense of their seemingly inexplicable feelings and desires, they are often intensely interested in scientific theories that attempt to explain the etiology or development of transsexualism. Finding a theory that is congruent with their personal experience is satisfying emotionally as well as intellectually.

Discovering Others Feel Similarly

Another major theme expressed by many informants was relief upon learning that they were not alone in experiencing autogynephilic arousal. The discovery that others shared similar feelings was frequently a source of comfort and hope:

I have struggled to find information that fits my story. Your articles for the first time have described my feelings. It feels good to realize that my feelings are felt by others. (032)

I definitely recognized myself in what I read about autogynephilia. Reading other ­people’s stories and learning that I am not alone is really a relief. (033)

Thanks for making me aware that I am not alone in my fantasies and feelings. I know there are plenty of transsexuals, but I really felt that many of my thoughts and fantasies were unique. (034)

I guess that I had simply never thought that someone else might feel the same way. It isn’t something that we talk about. Finding out that autogynephilia is not just something with me, uniquely, has made a difference in my status as a transsexual. (035)

Discovering that others shared the same feelings was not only emotionally gratifying but could also provide the impetus to seeking professional help:

The fact that I am not the only person who feels like a “man trapped in a man’s body” makes me hope that there is some way to mitigate my increasing distress. Thanks for writing the article. It made me feel less lonely and encouraged me to seek professional help. (036)

Your article on autogynephilia resonated so directly with my own experience that I was able to finally reconcile myself to my nature and move forward with treatment. I have accepted myself as transsexual and have begun counseling for hormone therapy as a result. (037)

Feeling Legitimately Transsexual

Another significant theme in the informants’ narratives was relief and gratitude that their histories of autogynephilic arousal did not disqualify them from being considered genuinely transsexual. The theory of autogynephilic transsexualism validated their experience of transsexualism as legitimate and helped to dispel their doubts and fears:

I have often had doubts about my own transsexuality and have felt like I was not a real transsexual. Now I have a better understanding of what I truly am. (038)

I feel like your essay on autogynephilia totally validates my desire to transition. I have been sexually aroused by fantasies of being a woman since puberty. I was seriously considering transition when I was 36 or 37, but I felt like I didn’t meet the requirement of feeling like a woman trapped in a man’s body. (039)

The description of anatomic autogynephilia has hit the nail right on the head. I never knew that there was a term for what I have been experiencing all my life. I thought at first that I was transsexual; but I held off from transitioning because something just didn’t seem right about the definition of a transsexual and what I experience. (040)

Several narratives referred to the commonly held belief that anyone who experienced sexual arousal in connection with the fantasy of being a female was merely a transvestite or heterosexual cross-dresser, not a “real” transsexual:

I think that autogynephilia is why a lot of MtF transsexuals initially feel, as I did, that they are not really transsexual and must be transvestites. You shouldn’t enjoy these thoughts, and if you do, then you’re not really transsexual. It isn’t until you discover more about the subject that you understand that you can have these feelings and be transsexual. (041)

I have been involved with cross-dressing behavior since I was 5 or 6 years old and it has been sexually arousing for me. I had always been of the opinion that I was just a transvestite until recently. (042)

I did worry that I was not truly a transsexual due to the erotic nature of my fantasies, which are usually associated with transvestism. (043)

When I considered transition in the past, I quickly rejected the idea. I felt that my sexual gratification proved I wasn’t a “real” transsexual, rather just a cross-dresser. Your essay finally makes it clear that these two categories are not mutually exclusive. (044)

The last informant realized that one of the implications of the concept of autogynephilia is that “transsexual” and “cross-dresser” are not distinct and mutually exclusive conditions, but are merely points on a spectrum of symptomatology (see Lawrence, 2009b). Over time, greater awareness of the concept of autogynephilia may lead to a more sophisticated understanding of the relationship between these two closely related clinical entities.

No Longer Feeling Crazy

Before reading about the theory of autogynephilic transsexualism, several informants had felt “crazy”: They knew that, according to prevailing stereotypes about MtF transsexualism, experiencing erotic arousal in association with the idea of being female disqualified one from being genuinely transsexual. They knew that they had experienced such arousal, but they also knew that they were severely gender dysphoric. The inability to reconcile their feelings with the prevailing stereotypes was disconcerting and distressing.

I thought I was crazy, looking at myself as possibly transsexual but not fitting the general stereotypes. But as I read about behavioral autogynephilia, my eyes widened and I felt a sense of understanding to a question that has driven me insane for 8 years. (045)

Until I started reading the comments of others, I thought I was alone or crazy. I was having an incredible problem reconciling my desire to physically change my sex with most of the literature I had read on transsexualism. (018)

I have been so confused about my gender dysphoria. I went to a therapist and he kept trying to get me to believe transsexualism is solely about gender identity. Then I came across your essay about autogynephilia and it helps me confirm what is actually going on in my head and that I’m not crazy. (046)

Disconcerting Self-Recognition

Recognizing oneself to be an autogynephilic transsexual was not always a joyful, liberating experience for informants. On the contrary, it was a disconcerting realization for some. Several informants reported that acknowledging that they were autogynephilic transsexuals carried overtones of doubt, sadness, or shame. I consider the narrative excerpts describing these reactions to be especially important. Here are some representative comments:

I read most of your article on autogynephilia with my mouth open or my hand up to my face. It made me uncomfortable to read something that so closely described my cross-gender urges, which don’t seem to fit the transsexual norm. (047)

For most of my life, I have been sexually aroused both by wearing women’s clothing and the fantasy of being a woman. I am desperately seeking a way to cross over to femininity, but admitting the sexual arousal part of my gender dysphoria is difficult. (048)

The only time that I am at peace with myself and my desires is when I am progressing toward my goal of being a woman. My therapist is confident that I am on the right course, but I sometimes doubt myself because of my sexual fantasies. (049)

I very often need feminization fantasies to achieve orgasm. My partner has told me not to be ashamed of it. But there’s something about it that has made me feel so inauthentic. As if maybe, despite the incredible ease of my transition, I’m not for real after all—that I’m just a messed up guy. I’m still bothered by it, I have to be honest about that. (050)

One informant expressed distress and sadness that her self-focused pattern of autogynephilic erotic desire seemed to preclude genuine sexual intimacy with other persons:

When I read one of your articles on autogynephilia, it blew my mind. You described Blanchard’s thesis as an epiphany, and it was like that for me, too. However, it was also upsetting to realize that my sexual desire had always been centered on myself, rather than involving an intimate sharing with someone else. I felt really cheated out of something that seemingly was effortless for others. (051)

This informant’s statement is reminiscent of the one made in chap. 1 by Ms. Z, who described her obligatory reliance on autogynephilic imagery during partnered sex as “a profound, disabling defect in her ability to feel genuine sexual love for other people.” One of the most distressing aspects of intense autogynephilic eroticism is that it often precludes real intimacy with one’s sexual partners; several informant’s descriptions of this phenomenon will be presented in chap. 7. In my opinion, interference with interpersonal intimacy during sex constitutes one of the strongest bases for considering clinically significant autogynephilia to be a genuine mental disorder.

Several informants used the word “pervert” to describe themselves, based on their recognition that their sexual arousal pattern was paraphilic:

Your article on autogynephilia explains the way I feel and what I have thought about myself all my life. I have always been honest about why I want to transition, but I feel like some kind of pervert when I tell any shrink. (052)

You hit the nail right on the head with the theory of autogynephilia. This is truly about my sexual orientation. It is quite a kick in the butt to realize that you are a pervert or a deviant, but I’m also smart enough to know that I can’t rationalize my sexual desires away. (034)

Reading your essay on autogynephilia, I made sense of my transsexual feelings for the first time in my life. I cannot begin to express the misery of the self-loathing resulting from the fact that the object of my sexual desire is an abstract concept. For a very long time I regarded myself as a total pervert. (053)

Although I consider the word “pervert” to be unnecessarily pejorative, I admire the insight and honesty of these informants: Autogynephilia is indeed a paraphilia—a condition formerly known as a perversion. Therein lies one likely reason why Blanchard’s theory of autogynephilic transsexualism has not gained much traction among MtF transsexuals: It requires unusual honesty and courage to embrace a theory that tells you that you have a paraphilia. Some psychotherapists may have been reluctant to accept Blanchard’s ideas for a similar reason. It requires a high degree of professional integrity to embrace a theory that tells you that some of your clients—clients whom you genuinely want to help and support—suffer from a paraphilia.

I would argue that, from a psychotherapeutic perspective, validation of a client’s experience of psychopathology (and addressing associated issues of shame and stigma) is ultimately a more powerful and effective intervention than attempting to “depathologize” a condition that is genuinely pathological. The following two narrative excerpts support the value of this approach:

Your description of paraphilic autogynephilia in transsexuals is right on the mark, so far as my life has been concerned. I am glad and greatly relieved that the paraphilic condition of autogynephilia has been recognized. (054)

I have always been sexually aroused at the thought of my feminization. Many transsexuals who are brave enough to look at themselves objectively will admit to some level of autogynephilia. The problem is that our society has put such shame on sexual perversion that many people feel they have to put on a big front and avoid the issue. (055)

I will discuss feelings of shame about autogynephilic transsexualism in detail in chap. 12.

Anxieties About Consequences

In contrast to the more positive views expressed in many of the earlier narratives, two informants expressed concerns about possible negative consequences for themselves or for MtF transsexuals generally if it became widely recognized that one form of MtF transsexualism was the outgrowth of a paraphilia.

My wife was initially accepting of my cross-dressing desires as a fetish, but became very opposed when it became clear to her that it wasn’t just a sexual turn-on. She feels this will harm our children, so she is trying to limit me to supervised visitation only. I am a little concerned about the effect of me being viewed as having a paraphilia, as opposed to being purely “a woman in a man’s body,” on the court case. (056)

I think we need to be very careful with study of this subject. If you are not transgender, this stuff will blow your mind, although if you are transgender, it makes sense. That’s why the concept of autogynephilia is dangerous. I think we need to move toward an understanding of gender dysphoria on a deeper level than sexual gratification, which is where autogynephilia puts it. And it is not about that. Sure, it’s part of it, but a small part. People are starting to see us transsexuals as something other than freaks, so please don’t screw that up. (057)

The latter informant’s belief that the concept of autogynephilia implies that gender dysphoria is exclusively about sexual gratification is not accurate, as I explained in chap. 2. Unfortunately, misconceptions of this kind concerning autogynephilia are not uncommon among MtF transsexuals and the psychotherapists who provide care to them.

Invalidation by Psychotherapists

More than a few informants reported receiving invalidating statements from their psychologists and psychiatrists, who sometimes suggested that an informant’s history of autogynephilic arousal meant that she was not genuinely transsexual:

I have had autogynephilic sexual fantasies for as long as I have had sexual fantasies—of having a woman’s body and responding the way a woman would. This part of my life has always been intensely sexual. For decades, professionals told me that I could not really be a transsexual, because I was oriented toward women. Reporting my fantasies got an equally negative response. (058)

My thoughts of being female almost always were accompanied by erotic feelings. I was bitter for years because of the rejection I met in the psychiatric community when I acknowledged that many of my thoughts had a sexual element involved. “Well, you’re just a transvestite, then,” was the dismissive message I received. That’s ridiculous and naive. (059)

The evaluation at the John’s Hopkins gender clinic was interesting. They asked questions about my fantasies, about arousal during cross-dressing, and lots that seemed to be related to latent homosexuality. Their conclusion was that I wasn’t transsexual because I wasn’t homosexual and was aroused by cross-dressing. (056)

By the time I was 22, I was sure I was a good candidate for MtF sex reassignment surgery. Unfortunately, I had a psychologist at that time who did not see me as a “true transsexual” because of my autogynephilia. The autogynephilia really did have me thinking that I was merely a hopeless paraphiliac and not a realistic candidate for sex reassignment surgery. (060)

With respect to the last informant’s comment: One of the implications of the theory of autogynephilic transsexualism is that paraphilic individuals can sometimes be very appropriate candidates for SRS.

Reluctance to Discuss Autogynephilia with Therapists

Reluctance to disclose autogynephilic feelings to psychotherapists was a common theme in the narratives, especially when dealing with therapists who were in a position to grant or deny approval for hormone therapy or SRS. Several informants concluded that being honest about their feelings was simply too risky:

I haven’t broached the subject with my therapist. I think that a lot of women are apprehensive about telling someone that they get excited in this fashion, because that is what is associated with transvestites, and it would potentially hurt their transition goals. (041)

The definition of autogynephilia describes me perfectly. My life-long desire to have feminine urinary function and female genitalia was definitely a major reason for my sex reassignment surgery. However, I never explained this to my therapist, fearing he would not support my planned surgery. (061)

When I first came across the concept of autogynephilia, I identified strongly with some of the personal accounts by autogynephilic transsexuals. I have never discussed or admitted my sexual feelings to the psychiatrists at Charing Cross for fear of being labeled a fetishist and losing access to treatment and sex reassignment surgery. (062)

I am in my second year of transition. More often than not, I have had to indulge in forced feminization fantasy to enable me to orgasm. I feel that forced feminization fantasies are probably normal for most transsexuals, regardless of what they say. Let’s face it, though: Tell that to a psychiatrist gatekeeper and see how far you get. I think most of us know what we want and just play the game to get there. (063)

I am a 42-year-old male, currently living full-time as a woman and approved for SRS. While I do not believe that sexual fantasy is my primary motivating force towards seeking sex reassignment surgery, it is certainly one of the factors. But it is a factor I cannot even mention to my therapist, for fear of having sex reassignment surgery denied me. Although I want to trust my therapist, she is a gatekeeper and could easily put an end to my sex reassignment surgery with a phone call. Obviously, this attitude greatly skews any data collected on this ­subject. (064)

I am seeing a psychiatrist about my gender dysphoria. To see some of my autogynephilic feelings described makes them less scary to me, but I’m still leery about sharing them with my psychiatrist. In my opinion, we all must keep some of these feelings private and keep the smokescreen of pure and simple gender dysphoria at the forefront. I think that most therapists would interpret some of these feelings as fetish-driven and try to protect us from ourselves by placing barriers in the way of gender reassignment. (057)

Other autogynephilic transsexuals similarly concluded that the safest approach to take with psychotherapists was to present themselves as “textbook cases” of MtF transsexualism, not only refusing to disclose their history of sexual arousal with cross-dressing or cross-gender fantasy but lying about this if necessary. Their attitude is consistent with data from Walworth’s (1997) survey of 52 MtF transsexuals, who reported that sexual arousal with cross-dressing was the single most common topic about which they had lied to or misled their psychotherapists.

One comment on why transsexuals may be so unwilling to talk to therapists on this issue: I didn’t bring it up because I wanted sex reassignment surgery. I figured out early on that I had to present what they wanted to see, not what I really was. I had no belief at all that I could get approval without lying, so I lied. (065)

Before I began transition, I read your writing about autogynephilia. I felt that the concept applied to me somewhat, although I did not want to tell anyone that, because I was determined to have a flawless, “by-the-book” case of transsexualism so that I could pursue sex reassignment surgery. (066)

I’m considering finding a therapist so that I can begin moving toward transition. Sadly, it seems apparent that, if I’m honest with my therapist about my autogynephilic feelings, she will consider me inappropriate for sex reassignment surgery. So, I’m left with having to find a therapist and parrot the lines they want to hear in order to get my letter. (067)

Explanations like these might partly explain why many psychotherapists who specialize in gender issues report that they rarely encounter clients for whom autogynephilia is a significant issue.

Counternarratives: Acceptance by Psychotherapists

In contrast to the experiences described above, some informants disclosed their autogynephilic feelings to their psychotherapists and did not encounter invalidating reactions:

I showed your article to my psychiatrist on my first visit and said that it was closer to my own feelings than anything else I had read. He had not heard of the term autogynephilia, although he probably has seen other cases. He is nonjudgmental and this action does not seem likely to have any adverse effect on my diagnosis. I certainly feel much better about this than creating a package of lies to meet my expectations of what I think “they” want to hear. (068)

I received my surgery about 2 years ago. When I was in the throes of making my ­decision, some of the issues in your article about autogynephilia concerned me a great deal. I was lucky that I had a very understanding therapist and I was able to openly discuss those feelings. (069)

I have just gotten my letter of approval for genital surgery from my therapist. I identified as autogynephilic from the get-go, and my therapist was willing to work with me anyhow. (070)

Perhaps such accepting reactions from psychotherapists will become more prevalent as the concept of autogynephilia becomes more widely known and its explanatory value becomes more generally appreciated.

Invalidating Reactions from Peers

Some informants reported that other MtF transsexuals had told them that a history of autogynephilic arousal disqualified them from being genuinely transsexual. Others feared that disclosing their autogynephilic feelings to other transsexuals might elicit such responses.

I transitioned in my early 20s. The fact that I was sexually excited by being a woman made other transgender people label me a cross-dresser or a fetishist and not a true ­transsexual. (071)

When I was still preoperative, I would sometimes tell some of my transsexual friends that I really wanted to have sex as a woman and that it was one of the primary motivating factors, not so much in my transition, but in the desire to have sex reassignment surgery. I quickly learned that an admission like that was not really a good idea: I usually got an earful about how I couldn’t be transsexual. (072)

I’ve never honestly discussed my feelings within the transsexual community, because I know that admitting to autogynephilia would lead to being ostracized. (062)

It is easy to find examples of such invalidating assessments on many of the Internet sites maintained by high-profile MtF transsexual activists. These individuals often state or imply that autogynephilic transsexuals are not genuinely or legitimately transsexual. Ironically, the transsexual activists who maintain these Internet sites often have demographic profiles that are strongly suggestive of autogynephilic transsexualism, although the activists usually deny or minimize any history of autogynephilic arousal. As I noted in chap. 1, counterfactual denial of autogynephilic arousal by genuinely autogynephilic persons is a well-documented, well-understood phenomenon (Blanchard et al., 1986; Zucker et al., 2012).

Reluctance to Alienate or Upset Others

Some informants stated that they were reluctant to disclose their autogynephilic feelings to professional or nonprofessional persons, either out of shame or a wish to avoid controversy:

I fit the autogynephile description. In my own mind, I don’t feel the need to hide behind a gender-based excuse or explanation for my desire to have a woman’s body. But I’ve felt the need to express it to others cloaked in the terms of “gender reassignment,” simply because my paraphilia seemed indefensible. How could I admit to being intensely sexually interested in an altered version of my own body? I don’t want to alienate others by admitting what society has asked me to be ashamed of: the fact that nothing turns me on more than the idea of inhabiting a woman’s body. (073)

I hope I can find a good way to explain why I am doing this without having to reveal just how perverted this is. How ironic: When I live as a woman, I will have to live a lie. (034)

I don’t talk about autogynephilia much with other transgender persons, since it upsets them. They feel that it invalidates them or something. (070)

Your descriptions of autogynephilia are very consistent with my experiences. I have had the opportunity to discuss these topics with others in my local transgender support group. As you might imagine, it was not always a popular topic. (074)

If the concept of autogynephilia were to become more widely known and appreciated, autogynephilic transsexuals might eventually be able to discuss their feelings with fewer concerns about negative social consequences.

Considering Autogynephilia as a Motive

Several narratives contained reflections on the implicit theory of motivation that is associated with the concept of autogynephilia. Not surprisingly, informants expressed differing opinions about whether autogynephilia was a motive for their cross-gender expression or for seeking sex reassignment.

Autogynephilia as a Principal Motive

Several informants reported that the desire to actualize their autogynephilic feelings was the principal driving force or motivation for their cross-gender expression or for their decision to seek sex reassignment:

I kept denying that there was a sexual component to my transgendered feelings until I read your paper concerning autogynephilia. I now realize that the driving force for my transgender behavior is the sexual feelings in becoming a woman. For the first time, I understand the motivating factors. (075)

The autogynephilic hypothesis makes plenty of sense to me, as it is self-sexual desire that has driven my fantasies and my desire to change my body. (076)

I have always had highly charged erotic feelings associated with the development of female sex characteristics. It seems to me it’s been the root cause of a greater commitment to transsexuality and it’s what drives me from one step to the next. (077)

I transitioned in my early 20s. I started hormones at 21 and was full-time at 22. The idea of being a woman sexually excited me. I was literally driven to go for facial feminization surgery and to get SRS by this urge. (071)

My sexuality and pleasure comes from the thought of myself as a woman. In my case, being a woman is all I ever wished for. My most intense feelings are bound up in this idea. It has been the driving force of my life. (078)

I am a 55-year-old MtF, nearly 4 years post-op. The concept of autogynephilia helped provide an understanding of my behavior. Sex is a powerful force for some of us and certainly me. I just wanted to add to the ever increasing body of evidence that many of us are indeed motivated to undergo sex reassignment surgery by our autogynephilia. (079)

An informant who had not yet transitioned likewise felt that her autogynephilic eroticism would eventually lead her to sex reassignment:

I have always found cross-dressing extremely erotic. I still find women’s clothing and the thought of becoming a woman sexually exciting. I feel like the erotic feelings are eventually going to drive me to start hormone therapy, electrolysis, and eventually surgical reassignment. (080)

Another observed that the impetus to actualize her autogynephilic sexual desires was comparable to the impetus to actualize her other sexual desires, such as engaging in sexual activity with preferred partners or undergoing erotic piercing:

My fantasies of feminization of my body are intertwined with piercing fantasies and practice, both genital and other (facial, nipples, navel), and with heterosexual desire and fantasies. As such, they are a very strong force in my pursuing SRS, like piercing fantasies are for pursuing being pierced and sexual desire is for pursuing heterosexual sex. (081)

Yet another informant observed that sexuality was such an important aspect of life that it seemed wrong to forego the opportunity to actualize her autogynephilic desires:

Your views about autogynephilia made a lot of sense to me. To be a woman, to be taken, to have orgasms as a woman—I have a compulsion to experience those feelings. It seems wrong to live as a conventional man, imagining sexually being a woman, and just leave it at that. You can minimize it all, say, oh, well, it is just sex, and sex is just one aspect of life among many. Yes, but sex is like the tip of the pyramid of life. (082)

In a lengthy meditation on her motive for wanting to transition, an informant proposed that, in her case, autogynephilia led to the creation of a powerful cross-gender identity (“will to be a woman”) that she felt she had to express in order to live a truly vital life:

No matter how much effort I put into the project of developing a female personality, the final product will not be equal to my male personality in terms of integration and authenticity. At best, it will have elements of phoniness, insecurity, and awkwardness. Why exchange something good for something poor? The answer is that a female personality will afford a superior link to my subconscious and therefore will be better in certain very important areas. I prefer to explain this in terms of autogynephilia. Just as a forest fire can develop into something that is categorically different—namely, a fire storm, which generates its own weather patterns—so can autogynephilia develop into something that is categorically different than a mere sex drive: It can give rise to a subconscious will to be a woman. Once this subconscious will to be a woman has been born, life can only truly be vital when one is consciously projecting oneself toward being a woman. How important are the relatively rare moments when life is truly vital? To me they are extremely important. I would trade a good deal in the area of the practical to be able to have states of conscious will that were “supercharged” with energy from the subconscious. (083)

Although I might quibble with the term “subconscious,” I feel that this informant makes several excellent points. First, we autogynephilic transsexuals often observe that autogynephilia seems to exert its motive force indirectly, by giving rise to our strongly held, highly valued cross-gender identities. Second, our lives often do feel as though they lack vitality and purpose if we fail to express our cross-gender identities. Finally, we often pay a heavy price for expressing our cross-gender identities, because we are not naturally feminine and because the female personas we create sometimes appear unusual or inauthentic—to ourselves as well as to others. I will discuss these issues in more detail in chap. 12.

Autogynephilia as a Possible or Partial Motive

Other informants acknowledged that autogynephilia was probably or definitely part of their motive for seeking sex reassignment. Many of them suggested, however, that other factors—especially female gender identity—played a significant part as well. Regrettably, the latter informants rarely addressed the question of whether their female gender identities might have been direct outgrowths of their autogynephilic feelings or whether their cross-gender identities had developed independently of autogynephilia.

I think the increasing pervasiveness of those autogynephilic sexual fantasies have contributed to my decision to transition. I could, within the acceptable range of male behavior, wear feminine clothes, have sex with men, knit during school lessons, work in a kindergarten and so on. I have done all this, and it has given me some relief as to my struggles with my male gender identity. At a certain point, I realized that I had done everything possible to accept my male gender, and it still didn’t work. I have thought a lot about the reason for this, and after having read your article it becomes more clear that the fact that I see myself as a woman in my sexual fantasies may have a say here. (084)

I am a 39-year-old heterosexual anatomic autogynephilic transsexual. I am now seriously considering SRS. I have declined in the past, simply because I have known that my motives were sexual. My motives now are less connected with my sexual desire and more to do with an ever-deepening desire to be female generally. (053)

While I do not believe that sexual fantasy is my primary motivating force towards seeking sex reassignment surgery, it is certainly one of the factors. (064)

I am 49 years old and have been approved for hormone therapy by a gender therapist. We have talked about my belief that elements of autogynephilia are part of the reason that I want to pursue such a course. While the thought of being female has and continues to be somewhat arousing to me, there was no time in life that I didn’t want to be the opposite sex. Based on my experience, I think one can be a blend of autogynephilic and so-called “legitimate” tendencies. (085)

I guess in some ways sexual desire did play a part in my decision to transition, but certainly it was not the entire reason. I did it because I have felt this way for as long as I can recall. (086)

I am a 41-year-old postoperative transsexual. I don’t think it is as simple as saying that wanting a sex change is purely driven by sexual fantasies or not. I think that it is a factor that is woven into a complex set of emotions and feelings that drive one to undergo such a dramatic change in life. I admit that I have had many sexual fantasies about being female and having a female body, a life long dream for me. I am not ashamed that I am sexually turned on by being female now, nor do I think that it was a wrong motivation for transitioning. (069)

Other informants conceded that autogynephilia might constitute a principal or partial motive for seeking sex reassignment but were unable to say so definitely:

I did not transition until age 36. I’ve never understood what might have been the spur for the gender dysphoria, but perhaps in my case the autogynephilia acted as positive reinforcement. After all, if I feel the best ever (and sexy) when fantasizing as a female, that would be a powerful incentive to promote and enlarge that fantasy. (087)

I have been exploring transsexualism actively for maybe 6 months. Cross-dressing in the closet has been my outlet for 25 years. The thought of being a woman transports me. I don’t seek only to be a woman in appearance, I want the full experience. Is it arousing? Sure. Is it the reason? I don’t think so, but it is hard for me to differentiate. (088)

Desire to Engage in Sex as a Woman as a Principal Motive

The desire to engage in sex as a woman was emphasized as a principal motivation for seeking sex reassignment in a few narratives. This desire is plausibly a manifestation of behavioral autogynephilia, although some informants offered other explanations for it.

I am a 35-year-old who has undergone therapy for gender dysphoria over the past 2 years. My erotic thoughts have always been fueled by my thinking of myself as female, and having sex as a woman was a great motivator in my pursuit of SRS. (066)

I’m not sure whether my feelings are really completely autogynephilic. I believe I would have transitioned anyway, because there were a whole variety of nonsexual experiences that I wanted to have. But at the same time, the thought of having sex as a woman was strong—very strong—and I’m not sure I would have gone through sex reassignment surgery without it. (072)

Sexual feelings have been very important in my decision to transition. For a long time, I’ve had sexual fantasies about men, but physically I couldn’t have a relationship, because in my mind I’ve always had an image of myself as female, and having a male body kept me from being able to experience the type of sex I wanted. (089)

I read a statement about some autogynephilic transsexuals “becoming the women they love.” I’m becoming what I’m attracted to, and at the same time, I’m hoping to attract a woman who is like me and likes that aspect of me. There is a sexual motivation for my pursuit of SRS, but it is not for personal gratification, it is to feel whole and complete, able to function with a woman the way I want to. (090)

Autogynephilia Not a Motive

Other informants who acknowledged a history of autogynephilic eroticism denied (or doubted) that autogynephilic feelings played any significant part in motivating them to seek or undergo sex reassignment:

I have experienced sexual arousal from all the things on your list and conform with all else I’ve read about autogynephilia. I always was attracted to women. These desires were NOT the reason for transitioning; the understanding of my really being transsexual was. (091)

My thoughts of being female almost always were accompanied by erotic feelings. But I don’t believe it would be accurate to say that I transitioned because of erotic feelings, for I might well have done so anyway. (059)

One informant observed that her autogynephilic fantasies disappeared after she began hormone therapy; she concluded from this that autogynephilia had not been a significant motive for her transition.

I must admit that I have had sexual fantasies of forced feminization and having a feminine body. After I started hormone therapy, though, feeling sexual desire in this manner became nonexistent. Even before hormones, wearing women’s clothing had lost any appeal to sexual desire for me. I don’t think sexual desire played any large role in my decision to transition. (092)

Another informant believed that the process of sex reassignment was too arduous to undertake simply for the sake of living out her sexual fantasies. She conceded, however, that actualizing her fantasies would be an “unexpected benefit” of transition:

Regarding autogynephilic sexual fantasies, I experienced many of these things much more intensely when I was younger, but the feelings are still there to a certain degree. Now, being out and accepted as just one of the girls is more of a goal for me. I feel out of place in my male body and aware that the male walls I had constructed around myself were nothing other than protection from my true self. Sure there are sexual desires within me, but I can experience sexual pleasure without transitioning and can act out many of my fantasies without transitioning. So why would I want to put myself and everyone around me through the costs and hell of transition? To finally find peace with myself. Living out some of these fantasies in a female body would be an unexpected benefit of transitioning, not a motivating factor. (093)

Narratives such as this are not unusual and are worth considering carefully. Blanchard’s theory proposes that the cross-gender identity of an autogynephilic transsexual is a manifestation of her autogynephilic sexual orientation: Her “desire to be a female” is an outgrowth of her autogynephilic sexual desire to be a female. From this perspective, an autogynephilic transsexual’s wish to express her “true self” (feminine gender identity) in order to “finally find peace” can be understood as driven or motivated, at least initially, by autogynephilia. Therefore, to claim that autogynephilia is not a motivating factor in such a case is merely to say that autogynephilia exerts its motive force indirectly, through the intermediary of the transsexual’s gradually developing cross-gender identity. After one’s journey toward finding peace has gone on for years or decades, it is seemingly easy to forget the autogynephilic sexual desires that originally gave impetus to that journey.

Must Revelatory Knowledge Remain Private Knowledge?

In the narrative excerpts presented in this chapter, informants often reported that discovering the concept of autogynephilia was a revelatory experience. Many felt that the concept and the associated theory of autogynephilic transsexualism accurately described their feelings, facilitated greater self-understanding, and reassured them that they were genuinely transsexual. But this revelatory information did not always cause informants to rejoice: Sometimes it was an occasion for sadness or distress. None of the informants felt that autogynephilia was anything to be proud of, and some clearly considered it shameful.

Moreover, many informants felt that they could not safely disclose their autogynephilic feelings to anyone. Disclosure to psychotherapists was risky, because therapists might withhold access to treatment if they believed an autogynephilic client could not be genuinely transsexual. Disclosure to other transgender persons was risky, too, because autogynephilia was controversial and disclosure might elicit invalidating responses. For many informants, then, the concept of autogynephilia was revelatory knowledge, but it seemed prudent to treat their personal experience of autogynephilia as private knowledge.

Given these realities, it will probably be challenging for the concept of autogynephilic transsexualism to become widely known and generally accepted. Transsexuals who experience autogynephilia and could testify to its applicability and explanatory value are often reluctant to talk about their experiences, deterred by shame and the very real practical consequences of disclosure. Because such individual testimonials are rare, autogynephilic transsexualism can too easily be dismissed as “just a theory”—and one that describes only a tiny minority of MtF transsexuals. This, in turn, makes autogynephilic transsexualism feel even more unusual and shameful to those who experience it and makes the possible consequences of disclosure potentially more serious. The resulting vicious cycle of ignorance, secrecy, shame, and fear of disclosure will probably be difficult to break. In chap. 12, I will offer some suggestions about how the process might begin.