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Theorizing Developmental History in Autogynephilic Transsexualism

If one accepts the theory that autogynephilic transsexuals are “men trapped in men’s bodies”—men who are unremarkably masculine except for the paraphilic sexual orientation that makes them want to turn their bodies into facsimiles of women’s bodies—one would predict that the developmental histories of these transsexuals should resemble those of other heterosexual men in most respects. Exceptions should be limited to traits or characteristics that are a result of their paraphilic sexual orientation. These predictions are consistent with observations by Whitam (1997), who offered this summary of the early developmental histories of transvestites and MtF transsexuals of the nonhomosexual type:

Often their only cross-gender behavior [during childhood] is cross-dressing, which may not appear until just before, during, or after puberty and is often done in secret. Many transvestites and transsexuals of the heterosexual type have childhood experiences indistinguishable from those of boys who later become nontransvestic heterosexual men. (p. 192)

Whitam’s observations are also largely consistent with the developmental histories provided by the study’s transsexual informants, albeit with a few exceptions.

The first indications of men’s eventual sexual orientations sometimes become evident in early childhood, as I will discuss in detail in chap. 10. For example, some pre-heterosexual boys develop crushes on girls or special friendships with them, or fantasize about eventual marriage with them (Bell, 1902; Hatfield, Schmitz, Cornelius, & Rapson, 1988); some pre-homosexual boys have comparable feelings or experiences involving boys. These early indications of eventual sexual orientations appear well before puberty. Many of the study’s transsexual informants similarly reported that the first indications of their eventual autogynephilic sexual orientations became evident in early childhood, taking the form of cross-gender wishes and fantasies or cross-dressing behavior. Unequivocal indications of men’s eventual sexual orientations, manifesting as genital arousal in response to stimuli involving preferred sexual objects, usually become evident at or during puberty. This is usually true of pre-heterosexual and pre-homosexual boys, and it was also true of the transsexual informants: In nearly all cases, they described having experienced unambiguous autogynephilic genital arousal in connection with cross-dressing or cross-gender fantasy during their early teenage years.

Most heterosexual men display typically masculine interests and behaviors during childhood and adolescence and choose male-typical occupations in adulthood (Lippa, 2002). Because autogynephilia is theorized to be a variant form of heterosexuality (Blanchard, 1992), one would predict that the same should be true of autogynephilic transsexuals: Their childhood interests and behaviors and adult occupational choices should theoretically be similar to those of other heterosexual men. With occasional exceptions, informants’ narratives were consistent with these predictions.

The familiar trope that describes pretransition MtF transsexuals as “women trapped in men’s bodies” is suggestive of a particular developmental history: It implies that MtF transsexuals will have developed psychological and behavioral characteristics that are typical of natal women, despite their incongruent male bodies. The theory of autogynephilic transsexualism implies a very different developmental history: It suggests that autogynephilic transsexuals usually will have developed psychological and behavioral characteristics that are typical of other heterosexual men; any exceptions will involve characteristics that derive from their autogynephilic sexual orientations (e.g., tendencies to cross-dress and engage in cross-gender fantasy). Consequently, one would predict that autogynephilic transsexuals would often reject the “woman trapped in a man’s body” description or at least be skeptical of it; some autogynephilic transsexuals might even endorse the countertrope I proposed and agree that they resemble “men trapped in men’s bodies” (Lawrence, 1998). For the most part, informants’ narratives were consistent with these predictions as well.

Men’s sexual orientations usually if not always remain stable throughout their lives, although strength of genital arousal and frequency of sexual behaviors often decline with advancing age. Because autogynephilia is conceptualized as a sexual orientation as well as a paraphilia, one would predict that autogynephilic transsexuals’ sexual orientations—manifesting as feelings of arousal from, attraction to, and love for the idea or reality of resembling women—would continue throughout their lives, including after sex reassignment. Once again, informants’ narratives were generally consistent with these predictions, although not in every case.

Age of Onset of Cross-Gender Fantasies, Behaviors, and Associated Arousal

Most informants who discussed the age of onset of their cross-gender fantasies and behaviors reported that these began in early childhood, usually between ages 4 and 6. This is somewhat earlier than most reports in the published literature. The nonhomosexual gender dysphoric men studied by Blanchard et al. (1987) reported the onset of cross-gender wishes at a mean age of 9.8 years and the onset of cross-dressing at a mean age of 9.6 years. In a study of 232 MtF transsexuals who had completed SRS (Lawrence, 2003), I observed that the mean age at which participants first felt the desire to be the other sex or to change sex was 8 years. In the current study, it is possible that informants who experienced an especially early age of onset of cross-gender wishes or behaviors might simply have been more likely to mention this fact than those who experienced a later and seemingly less remarkable age of onset.

In contrast, the ages at which informants first experienced explicitly erotic feelings in association with their cross-gender fantasies and behaviors varied widely. Some informants reported that their cross-gender wishes and behaviors were explicitly erotic from earliest childhood or were “exciting” or “thrilling,” implying possible erotic feelings. Others reported that associated erotic feelings developed only at puberty or, more rarely, well after puberty.

Early Childhood Onset of Cross-Dressing and Associated Arousal

More than a few boys cross-dress at least occasionally during early childhood. In a study of US children, Friedrich, Fisher, Broughton, Houston, and Shafran (1998) found that about 14% of 2-to-5-year-old boys and about 6% of 6-to-9-year-old boys had “dressed like the opposite sex” at least occasionally during the previous 6 months, according to reports by mothers or female caregivers. In an earlier study of US children, Friedrich, Grambsch, Broughton, Kuiper, and Beilke (1991) found similar but slightly lower figures: about 6% of 2-to-6-year-old boys and about 3% of 7-to-12-year-old boys were reported to have cross-dressed during the previous 6 months. Some boys who cross-dress during early childhood will become homosexual men, heterosexual transvestites, or MtF transsexuals in adulthood, but many or most probably will not.

Childhood cross-dressing by boys is sometimes, but certainly not always, associated with erotic arousal. The published literature contains two case reports of boys younger than age 3 who expressed the desire to wear girls’ or women’s clothing and who developed penile erections when allowed to do so (Stoller, 1985; Zucker & Blanchard, 1997); these reports suggest that autogynephilic sexual arousal can begin very early in life. In a study involving 36 transvestite participants, Doorn et al. (1994) found that 8 participants had begun cross-dressing before age 7, whereas only 5 or 6 (the article is unclear on this) denied that their cross-dressing was initially fetishistic, implying that at least 2 or 3 participants had experienced fetishistic arousal associated with cross-dressing earlier than age 7.

In the current study, several transsexual informants reported that they had experienced penile erections or definite erotic arousal or had engaged in masturbation in association with cross-dressing or cross-gender fantasies beginning in early childhood, typically between ages 4 and 6. Some informants distinctly remembered having had erections in association with cross-dressing:

I have experienced sexual arousal from both imagining that I am a woman and looking at myself wearing feminine clothing since 4 years old. Long before my testes started to function at age 14, I could always get an erection by just putting on the panties, bras or petticoats of my sisters. (094)

I can relate to the autogynephilic model to a great degree. I dressed often, up until about the start of elementary school, when my interactions with other children caused me to suppress this behavior. My mother never complained about my dressing up; in fact, she was quite encouraging. I remember at an early age getting erections while wearing my mother’s silken nightgowns. I started dressing again in earnest about the time male puberty started, around age 12. (095)

Other informants reported that cross-gender fantasies alone were enough to induce penile erections in early childhood:

I can remember vividly at the age of 6 getting a hard-on while wearing my mother’s clothing. I did this whenever I got a chance, which was hardly ever. Because I hardly ever got a chance to dress up, I discovered that merely fantasizing about wearing my mother’s clothing also gave me a hard-on. (096)

From the age of 4, I had thoughts of wanting to know what it felt like to be a girl. I would make a wish, hoping that I would turn into a girl. I would develop an erection when I thought about becoming a girl; when I developed an erection, I thought some magical being was granting me my wish and I was going to become a girl. The erections were pleasurable, even after I knew that I wasn’t going to become a girl. This lasted until I was 8 or 10. It went away until I was 11 or 12, then it all came back very strongly. (097)

Another informant reported penile erections in early childhood from daydreaming about being the maid of an attractive next-door neighbor and wearing her clothes:

At about the age of 6 years, I became besotted by a lovely lady living next door. She must have been about 30, with a body to die for. In my dreams, both day and night, I was her maid and assistant, who was required to help her dress and provide assistance in her bathing and personal hygiene. I seem to remember getting a form of erection; however, my biggest wish was simply to grow up like her and be able to wear such lovely clothes. (098)

Yet another informant recalled masturbating in early childhood to the image of having female rather than male genitalia:

When I was 6 or 7, I used to masturbate with a piece of clothing—it did not need to be gendered clothing, I just did not want to touch my penis—and fantasize about not having a penis, but having a vagina. I was not sure how that all would work, but I was sure that this was what I wanted and should have. (099)

Still another informant reported having experienced orgasms starting at age 6 and strongly implied that these occurred in association with cross-dressing or cross-gender fantasy:

I have highly developed skill at using my mind to facilitate orgasm, and what stimulates me the most is to be a female. From my earliest recollections at age 3 or 4 years, I have been able to do this. I got great pleasure wearing my sister’s skirts, and I was extremely paranoid about being discovered. I can remember orgasm from the age of 6. (100)

Some informants did not describe penile erections or masturbation but ­nevertheless reported definite erotic excitement or arousal associated with cross-dressing or cross-gender fantasies in early childhood:

I have vivid memories starting from about age 6 or 7 of wanting to be a girl and of sexual desires which accompanied it. I also remember feeling ashamed of those feelings, though I do not remember any particular incident which instilled such feelings. Fantasies of intentionally becoming a girl began around age 10. (101)

I have had the autogynephilic sex drive since I was a small boy; I have memories of it that go back to around age 6. (102)

Your discussion of autogynephilia seems to fit me to a tee. I was dressed as a girl at age 4 or 5 and found it arousing then. Whenever I was presented with the chance to be alone and wear my mother’s or sister’s clothes, I did so. (103)

These narratives demonstrate that for some autogynephilic MtF transsexuals, cross-dressing and cross-gender fantasies in early childhood are erotically charged phenomena.

Early Childhood Onset of Cross-Dressing and Possible Erotic Feelings

Several informants reported that cross-dressing or cross-gender fantasies during early childhood were thrilling, exciting, or associated with sensations similar to the explicitly erotic sensations of adulthood. These feelings, too, are plausibly erotic.

As a very young child, age 4, I already had the urge to have my ears pierced and alter my sex. My mother let me try her collection of clip-on earrings, which excited me beyond belief. The exploitation of these feelings for eroticism occurred much later, of course, but I don’t think that proves that autogynephilia was not manifest in my early childhood. For example, I remember being thrilled by stories of boys allowed to wear dresses and long hair. (081)

The concept of autogynephilia describes to a tee what I have been feeling all my life. Since age 4, I remember being excited by the thoughts of becoming and being a woman. After puberty, the only sexual fantasies that would bring me to orgasm involved me being a female. (104)

I have always wanted to be a female. As long as I can recall, I have always had this desire. When I was around 5 years old, I remember sneaking into my mother’s closet and wearing her hose and girdles. I found this so exciting. (105)

I have always found crossdressing extremely erotic and very sexually satisfying. It all started at the age 15, when I discovered my mom’s panties. That was when I had my first sexual experience. However, I remember feeling different from other boys in kindergarten. I would compare myself and my frail body to girls my age. This sent a shivering and tingling sensation throughout my entire body. These thoughts were with me at a very young age. (080)

My first understanding that I desired to be a woman and its following excitement came when I was around 5 years old. This occurred watching a Doris Day movie and at first involved the wonderful clothes she wore. The idea of the clothing continued to both fascinate me and cause an excitement that I did not know what to do with at that age. My first cross-dressing incident was directly an attempt to emulate Ms. Day. By the age of 8, I cross-dressed “regularly”—meaning every chance I could find. I would find reasons to stay at home when my mom went visiting friends. By about age twelve, the early-on “excitement” began to be associated with the beginnings of sexual arousal the clothing seemed to cause. (106)

I can distinctly remember being excited as young as 6 or 7 at the prospect of becoming a girl and living a girl’s life. While too young to be really sexually stimulated by these thoughts, they certainly stirred an erotic side of me that has remained strong to this day. (107)

I apologize for my limited knowledge of written English (I am Spanish). When I was 4 or 5 years old, I was playing with a girl friend of mine who was the same age. We were in her house, because our parents were friends. I don’t remember the reason, but her mother put me in the clothes of that girl that evening. I experienced some kind of happiness that I still remember. It was a physiological pleasure, and though I was just a child and couldn’t understand the nature of what I was feeling, it was something similar to the sexual pleasure I have experienced when I became an adult. It wasn’t the clothes I was wearing, I think it was that I felt I was like that girl friend of mine. (108)

The final narrative excerpt is a particularly instructive one. The informant was not able to truly understand what he experienced at the age of 4 or 5, but the episode was obviously memorable. He remembered feeling a “physiological pleasure”—a bodily pleasure, at least by implication, and one similar to the bodily pleasures of adult sexuality. He also remembered that this physiological pleasure came from feeling he was like a girl—not from, say, some tactile or esthetic quality of the clothing itself. These two highlighted features comprise the irreducible core of the autogynephilic experience: pleasurable erotic arousal associated with the idea of being female.

Early Childhood Onset of Cross-Dressing, Pubertal Onset of Erotic Feelings

Other informants reported that they first cross-dressed or engaged in cross-gender fantasies in early childhood but did not develop explicitly erotic feelings associated with these activities until puberty. This is the classic pattern described in much of the published literature (e.g., Whitam, 1997).

I first became aware of my feelings at age 4, my earliest recollection. At that age, I loved getting in my mother’s closet and playing in her high heels. At age 5, I remember fantasizing I was a beautiful American Indian princess. At age 6, I remember secretly identifying with lead female characters in movies and cartoons. Ages 7–12 are filled with fantasies of me being a male hero: a cowboy, a patriot, a Roman soldier, and so on. By age 10 or so, stories of Christine Jorgensen were in the news. It fascinated me and I wished I could be her. I wished I was Natalie Wood; I wished I was Brenda Starr. At age 12, I picked up a copy of one of my dad’s adult papers, containing pictures of cute, partially clothed girls. On the cover was a photo of French actress Noelle Noblecourt, age 19, wearing a frock that was split at the sides so you could see her thighs. I stole the paper and kept it; I started wishing I was her. One night, I was rubbing myself on my mattress, fantasizing being a girl on an all-girl island where everyone wears outfits like Noelle’s. I imagined myself as Noelle, my first femme identity. As I rubbed myself, something happened: It was my first ejaculation. Soon I was ejaculating several times a night, wishing I was a girl. (109)

My first cross-dressing experience was at age 5. When I was a child, prior to 11 years old, I had occasional interest in having things girls had—long hair at first. Later, as I became more aware of other differences between boys and girls, I wanted the additional things I knew girls had. At age 11, I began cross-dressing regularly—the experience of seeing and imagining myself as a girl and later as a woman was nearly always erotic for me. (110)

At 6 years old, I wanted to be a girl. I loved to go through the Sears catalogue and wish I could wear all the pretty clothes the little girls were wearing. Every night when I went to bed, I’d dream about how the world stopped and I could go into stores and pick out all the pretty clothes and wear them. I wore my mother’s clothes whenever I could without being caught. As a teenager, I would wear women’s panties and masturbate into them. (111)

I wanted to be a girl since age 5 or 6. I dressed in my sister’s clothes and somehow got away with it. As I reached puberty, my frustration at not being able to do anything about the physical changes was overwhelming. Although my desires clearly did not begin as sexual, sex certainly became the focus. (112)

The first of the four narrative excerpts above is notable for its report of the development of male hero fantasies between ages 7 and 12 that temporarily pushed aside the informant’s earlier cross-gender fantasies. This example illustrates that the ­existence of occasional or even frequent cross-gender fantasies during childhood does not necessarily imply the existence of a strong and persistent cross-gender identity during childhood.

Other Patterns of Onset of Cross-Gender Behavior and Erotic Feelings

One informant recalled the onset of cross-gender fantasies in later childhood, with associated erotic feelings developing just before or at puberty:

The idea of “becoming a woman”—that is, being changed physically—was indeed a source of sexual stimulation for me. I remember this starting in my pre-teen years. Before that, I remember longing to be a girl, but without any distinctly sexual feelings; this I can recall to about age 9. (113)

Two others recalled the onset of cross-gender fantasies or cross-dressing in childhood, but no associated erotic feelings until well into adulthood:

When I cross-dressed, as a child and growing up, not once did I feel sexual arousal—that is, until I married and began having intercourse with the woman who is now my ex-wife. When I dressed, a sense of “rightness” overtook me, a feeling of much more completeness than existed while dressed in my male role. (114)

I am almost 100% sure that my desire to be a woman is more established than autogynephilia, which I also recognize in myself. The former has been rather stable since the age of 6, whereas I don’t recall any remotely autogynephilic fantasies before the age of 20. (084)

In interpreting histories like these, it is useful to recall that inaccurate denial of autogynephilic sexual arousal by persons who are known or presumed to be autogynephilic is a well-documented phenomenon (Blanchard et al., 1986; Zucker et al., 2012).

The statement by the last informant that her desire to be a woman had been “rather stable since the age of 6” deserves comment. It seems quite possible that her desire to be a woman had continued in some form, perhaps continuously but more probably intermittently, until she submitted her narrative at age 32. Elsewhere in her narrative, she stated that she had then been living as a woman for 4 years, so she probably had a strong and persistent cross-gender (female) identity at that time. I would conjecture (but obviously cannot know) that she probably did not have a strong and persistent cross-gender identity at age 6; for example, I doubt that she had yet taken a female name. If my conjecture is correct, her claim that her desire to be a woman had been “stable” over the intervening 26 years would constitute a significant exaggeration.

One should not read too much into cross-gender wishes in early childhood. It is not uncommon for young boys to occasionally express the wish to be the opposite sex, but most boys who do so do not develop strong, persistent cross-gender identities in adulthood. Friedrich et al. (1991) observed that about 7% of 2-to-6-year-old boys and about 2% of 7-to-12-year-old boys had “talked about wanting to be the opposite sex” at least occasionally during the previous 6 months, according to their mothers or female caregivers. Friedrich et al. (1998) subsequently found that about 6% of 2-to-5-year-old boys and about 4% of 6-to-9-year-old boys had expressed the wish to be the opposite sex occasionally or more often during the previous 6 months. Goldman and Goldman (1982) observed that 8% of 5-year-old boys and 13% of 7-year-old boys from their North American sample would choose to be a girl rather than a boy. Studies of boys in the Netherlands and Belgium have revealed slightly higher figures: Friedrich, Sandfort, Oostveen and Cohen-Kettenis (2000) observed that, in two different groups of Dutch children, about 10% of 2-to-6-year-old boys and about 15% of 4-to-6-year-old boys had at least occasionally talked about wanting to be the opposite sex during the previous 6 months, according to reports by their mothers. In a study of Dutch and Belgian children, Sandfort and Cohen-Kettenis (2000) found that about 10% of 0-to-11-year-old boys (about three-quarters of whom were between 2 and 6 years old) had expressed the wish to be the opposite sex at least occasionally in the past 6 months. Many heterosexual cross-dressing men who have no desire to be women also retrospectively report cross-gender wishes during childhood: Buhrich and Beaumont (1981) found that 8% of American cross-dressers and 26% of Australian cross-dressers who reported no desire to be women had “often” wished to have been born a girl between ages 6 and 12 years.

Wishing at times to be a girl, however, is not the same as having a strong and persistent cross-gender (female) identity. Strong, persistent cross-gender identities usually develop many years or decades after the onset of erotic cross-dressing in nonhomosexual men and are preceded by episodes of complete cross-dressing, public self-presentation as a woman, and adopting a feminine name (Docter, 1988). The last of these is “the most explicit statement that a cross-gender identity has emerged” (Docter, 1988, p. 209). Based on his studies of nonhomosexual MtF transsexuals and other nonhomosexual cross-dressing men, Docter observed that:

Among our subjects, 79% did not appear in public cross dressed prior to age 20; at that time, most of the subjects had already had several years of experience with cross dressing. The average number of years of practice with cross dressing prior to owning a full feminine outfit was 15. The average number of years of practice with cross dressing prior to adoption of a feminine name was 21. Again, we have factual evidence indicative of the considerable time required for the development of the cross-gender identity. (p. 209)

Boys who are destined to be nonhomosexual or autogynephilic MtF transsexuals often experience episodic, unsustained cross-gender wishes and fantasies in early childhood but rarely, if ever, develop strong, persistent cross-gender identities that can act as the driving force for a decision to seek or undergo sex reassignment until they reach young adulthood. In contrast, boys who are destined to be homosexual MtF transsexuals usually experience sustained cross-gender wishes and fantasies in early childhood and often meet full diagnostic criteria for GID in childhood; their adult transsexualism is often merely a continuation of their childhood GID (Cohen-Kettenis & Pfäfflin, 2003). Childhood cross-gender wishes and fantasies in boys who are destined to be autogynephilic MtF transsexuals are important primarily because they constitute one of the earliest indications of an autogynephilic sexual orientation; I will discuss this concept in detail in chap. 10.

Gender Expression in Childhood and Adulthood

Many boys without known gender identity issues sometimes play with traditional girl’s toys during early childhood, and some express a preference for girls rather than boys as friends or playmates or occasionally take female roles in fantasy play. Friedrich et al. (1991) observed that about 63% of 2-to-6-year-old boys and about 31% of 7-to-12-year-old boys had played with girl’s toys at least occasionally during the previous 6 months, according to their mothers or female caregivers. Friedrich et al. (1998) similarly found that about 57% of 2-to-5-year-old boys and about 55% of 6-to-9-year-old boys had played with girl’s toys occasionally or more often during the previous 6 months. Sandfort and Cohen-Kettenis (2000) reported that about 60% of 0-to-11-year-old boys (most between ages 2 and 6 years) in the Netherlands and Belgium had played with girl’s toys at least occasionally during the past 6 months. Goldman and Goldman (1982) observed that 23% of 5-year-old boys and 32% of 7-year-old boys from a North American sample would choose a girl rather than a boy as a friend. Several studies (Friedrich et al., 1991, 1998; Sandfort & Cohen-Kettenis, 2000) have demonstrated that between 17% and 20% of boys at least occasionally “pretend to be the opposite sex while playing” during early childhood.

There is disagreement in the scientific literature about whether the childhood behaviors and interests of autogynephilic transsexuals are usually male typical—which would include the possibility of at least occasional play with girl’s toys or choice of female friends or female roles in fantasy play, as described above—or whether the behaviors and interests of autogynephilic transsexuals are sometimes or often female typical. Observations by some researchers (e.g., Blanchard, 1990; Whitam, 1987, 1997) support the former point of view, but observations by other investigators support the latter. For example, Buhrich and McConaghy (1977a) found that most members of a sample of 12 MtF transsexuals with a history of fetishistic cross-dressing reported that, during childhood, they avoided rough-and-tumble play, preferred girls’ company and games, and had been called “sissy” at school.

Observations by Doorn et al. (1994) provide the strongest support for the idea that many late-onset MtF transsexuals (LOTs; most of whom are nonhomosexual and putatively autogynephilic) and even some transvestites (TVs) display female-typical preferences in childhood. Note that all of Doorn et al.’s data concerning childhood cross-gender behaviors involved informants’ preferences, not actual behaviors (i.e., “preference for female toys,” rather than “usually played with female toys”). Doorn et al. found that roughly one-quarter to one-third of LOTs reported that they preferred female-typical toys and games and female playmates during childhood and that roughly 15% of TVs reported that they preferred female playmates (p. 191); these figures were substantially higher than those reported by male control subjects. Additional percentages of LOTs and TVs reported combinations of female-typical and male-typical preferences in childhood. Doorn et al. argued that the higher than expected prevalence of self-reported female-typical preferences during childhood in these groups required a reevaluation of Docter’s (1988) theory about the late-life development of cross-gender identities in LOTs and TVs:

The major finding is that LOTs and, to a lesser degree, TVs show much more feminine behavior in their early years than expected. Doctor’s [sic] theory is therefore only applicable to a small proportion of the LOTs and to most, but clearly not all TVs. Many of the LOTs and an important proportion of the TVs show signs of clearly developing feminine gender identity aspects in early childhood. (p. 196)

Once again, I would note that Doorn et al.’s informants reported more female-typical preferences than expected—not necessarily more female-typical behaviors.

A crucial issue in interpreting the Doorn et al. (1994) data is whether the retrospective reports by late-onset MtF transsexuals and transvestites concerning female-typical preferences in childhood are accurate or not. One should bear in mind that Walworth (1997) found that “preferring girls’ games and toys as a child” (p. 359) was one of the most frequent areas in which MtF transsexuals reported having lied to or misled their psychotherapists. Moreover, Blanchard, Clemmensen, et al. (1985) observed a significant positive correlation between socially desirable response style and self-reports of female-typical interests and behaviors during childhood in a group of heterosexual male gender patients. Finally, as previously noted in chap. 3, many experienced clinicians (e.g., Bancroft, 1972; Fisk, 1974; Lukianowicz, 1959; Sørensen & Hertoft, 1980) have observed that MtF transsexuals often distort their histories to make them conform more closely to accepted stereotypes about MtF transsexualism. Consequently, I believe that both the data and the conclusions reported by Doorn et al. should be interpreted with a high degree of skepticism. One possible explanation of the data is that many of the LOT and TV participants who reported female-typical preferences in childhood might have displayed behaviors that were far more male typical than their recalled preferences would imply.

In the current study, most informants who described their gender expression in childhood or adulthood denied effeminacy or female-typical interests or behaviors. There were some clear exceptions, however.

Male-Typical Interests and Behaviors in Childhood and Adulthood

Several informants reported that their childhood interests and behaviors had been male typical and that they had never been effeminate. Here are some representative accounts:

As a child, riding my bike and playing with robots and guns and blowing up toy cars was more interesting to me than playing with dolls and dress-ups. Clothes and fashion never really interested me. (004)

I was never effeminate. I wasn’t into dolls or girl’s play, and I enjoyed sport and was okay, if not good, at it. I liked music and drawing and collecting and gemstones and many non-gender-specific things, too. (115)

I was never effeminate, although I often wished I was in order to “validate” my desire to be a woman. As a young male, I was an athlete, served in the military, and became a husband and father. (110)

Other informants reported that, although most of their interests and behaviors were male typical, they felt different from other boys in certain ways, especially in their lack of interest in or aptitude for team sports:

Growing up, I never fit in well with other boys and was not into sports or many other boyish things. But at the same time, I also preferred male toys like cars, guns, trains, etc. I was not confused about my gender. (023)

I was not successfully masculine. In a village culture that defined boyhood around baseball, I was hopeless at hitting, throwing, and catching. But I did try to be a boy, constructing my alternative masculinity around the outdoors in the woods surrounding the village, water-skiing, cross-country running, and becoming cadet lieutenant-colonel at the military high school I attended. (116)

It is surprising that a boy who became cadet lieutenant-colonel at his military high school and was an avid water-skier and cross-country runner would conclude he was “not successfully masculine” simply because he was not proficient at baseball. Green (2008) observed that MtF transsexuals sometimes hold stereotyped views of masculinity and femininity and are apt to conclude that, if they deviate from the masculine stereotype in any way, they cannot really be men. Green gave the example of a gender dysphoric patient who concluded he was transsexual in part because he was not interested in cars and football. Although Green makes an important point, another explanation might be that autogynephilic men who are unremarkably masculine but experience a strong and seemingly inexplicable desire to be female might be eager to find evidence, however insubstantial, of psychological femininity or unmasculinity that would help them make sense of their cross-gender wishes.

Other informants’ narratives discussed only their adult interests and behaviors, which they usually described as male typical:

I have an advanced degree in chemistry and have led a successful life as a male. I grew up as a normal male and I played a wide range of sports in both high school and college. I still enjoy outdoor activities and lead a rather active life. (075)

I am a 49-year-old who has been on and off hormones many times. I am the classic male: Naval Academy, US Marine Corps, weightlifter, etc. (117)

I am a 47-year-old male, athletic and muscularly built. I played college sports. I am an avid outdoorsman and love to hunt and fish. (105)

One informant observed that she, like other MtF transsexuals of her acquaintance, had made typically masculine occupational choices:

I might have had thoughts of being a girl at a very young age, but that didn’t keep me from being a very good athlete and later a Navy pilot. I personally know 3 fighter pilots other than myself who are postoperative transsexuals. My roommate is a 64-year-old postop who was once a semi-pro baseball player and has a doctorate in chemistry. (118)

Male- and Female-Typical Interests and Behaviors in Childhood

A few informants reported a combination of male- and female-typical interests and behaviors during childhood:

I had friends of both sexes. I would have been a tomboy if I was a girl. My sister was my best friend, and we played with dolls and girlish fantasy games, but I also played cowboys and softball and ran around the badlands with my boy friends. (119)

In my early childhood and when I first went to school, I preferred the company of girls and played “girly” games regularly with neighbors and my female cousins. I liked dolls and although I never had anything much more than a teddy myself, I used to play with them, especially in bed. After a couple of years of primary school, I was sent to an all-boys school. I learned to act the part eventually, never showing my feminine side at school or in the company of boys. It became difficult for me to play with girls in this environment and I concentrated my creative side on model railways and airplanes alone. I hated sports and did my best to avoid rough playground games. Instead I concentrated on softer activities such as swimming, chess, and painting. (120)

Although these histories do mention a few feminine interests and behaviors, they seem otherwise ordinary in most respects and similar to what many men without gender dysphoria might report.

Female-Typical Interests and Behaviors in Childhood

A few informants described primarily female-typical interests and behaviors in childhood, although their narratives did not state whether these persisted into adolescence or adulthood:

I do not conform to the portrayal of standard characteristics of autogynephiles, as I was feminine as a child. (121)

I didn’t fit in with boys. I loathed sports and fighting or war-related role playing. I was quite drawn to trying on my mother’s and sister’s things, including clothes, makeup, perfume, and jewelry. My favorite toys were all my sisters’—the dolls and the easy bake oven. (122)

Throughout my childhood, I always engaged in behaviors and activities which have been considered feminine. All of my friends were female up until about the age of ten, when pressure from peer groups caused me to branch out. (095)

At a very young age, I would play pretend games and hide and go seek with neighborhood girls my age. I also had a couple of dolls as a young child. (080)

I always preferred dolls and frilly things to the toys my parents wanted to buy me. When I was really small, 4–6 years old, I would love to go to my grandparents’ house and I would play with the dolls she had. She also had a small sewing machine that I would try to use. (089)

Another informant described some female-typical interests and behaviors in passing, without saying whether or not they were representative of her ordinary day-to-day childhood experiences:

I look back on my past, when I was five and wearing perfume, or making pretty necklaces out of colored beads, or arranging flowers, or when I was 7 and volunteering to play “Mother Goose” in the school play. (123)

In my clinical practice, I not uncommonly elicit histories like these from nonhomosexual gender dysphoric male patients. In many cases, the feminine behaviors in question turn out to be a few isolated and unrepresentative episodes (e.g., “For a time my closest playmate was a girl”—for 2 months one summer; “When I was 6, I used to play with dolls”—on three or four separate occasions). These isolated episodes of feminine behavior nevertheless feel quite meaningful to the men who experienced them. I almost never get the sense that these patients are trying to mislead me by portraying these childhood episodes as more representative than they genuinely are. Instead, I believe that these patients are desperately trying to make sense of their powerful cross-gender wishes and are grasping at straws in an effort to find evidence of childhood femininity that might help to explain their adult feelings.

Male-Typical Versus Female-Typical Occupational Choices in Adulthood

Nonhomosexual MtF transsexuals rarely choose occupations that are typically preferred by women; their career choices are usually unremarkably masculine. As Whitam (1987) observed, “Heterosexual transvestites and trans-sexuals [sic] tend to have traditionally masculine occupations such as engineer, mechanic, salesman, or produce manager” (p. 198). The limited data provided by the transsexual informants was generally consistent with this observation.

Only 24 (9.6%) of the 249 transsexual informants reported their occupation. Although these 24 informants cannot be assumed to constitute a representative sample, it is notable that most of them reported occupations preferred by men more than by women. The reported occupations, with the number of informants reporting each, were:

  • 4 physicians (1 psychiatrist, 1 surgeon, 2 unspecified)

  • 4 military service members (1 Marine, 1 Navy pilot, 1 unspecified Navy, 1 unspecified)

  • 3 computer professionals (2 software developers, 1 programmer)

  • 3 engineers (1 electrical, 1 mechanical, 1 unspecified)

  • 2 business managers

  • 2 firefighters

  • 1 airline pilot

  • 1 attorney

  • 1 experimental psychologist

  • 1 truck driver

  • 1 factory worker

  • 1 medical technologist

Lippa (2002) provided gender preference data for 50 different occupations, including 8 of the 12 listed above. Fourteen of the 24 informants reported occupations that men prefer significantly more than women according to Lippa’s data (military service member, computer professional, engineer, business manager, airline pilot, and attorney). Four of the 24 reported an occupation that men and women prefer about equally (physician). Only 1 reported an occupation that women prefer significantly more than men (psychologist). The remaining 5 informants reported an occupation not listed by Lippa, but 3 of these—the 2 firefighters and 1 truck driver—chose occupations that Govier and Feldman (1999) described as male typical. Eight of the 24 informants—the engineers, military service members, and pilot—reported occupations that were among the five most strongly preferred by men over women, according to Lippa’s data.

Why do so many autogynephilic transsexuals decide to pursue male-typical occupations? Brown (1988) proposed that some MtF transsexuals go through a “hypermasculine phase of transsexual development” (p. 527), during which they choose stereotypically masculine or hypermasculine occupations (e.g., military service) in a last-ditch attempt to suppress or eliminate their feminine personality traits. This could account, at least in part, for the male-typical occupations that many nonhomosexual MtF transsexuals choose. Some MtF transsexuals would probably be inclined to offer this socially acceptable explanation to their therapists—and some therapists would probably uncritically accept it. But a more parsimonious and more plausible explanation—albeit a less socially acceptable one—is that nonhomosexual MtF transsexuals choose male-typical occupations primarily because they genuinely prefer them. For example, I have heard too many MtF transsexuals describe with relish their enjoyment of firing automatic weapons, blowing things up during demolition training, practicing hand-to-hand combat skills, and flying jet fighters in real or simulated combat to believe that they chose military service primarily to suppress their intrinsic femininity. In my experience, the occupational choices of nonhomosexual MtF transsexuals are at least as male typical as those of nontranssexual men. The occupations of the last 10 nonhomosexual MtF clients I have seen in my practice included 3 information technology professionals, 2 aircraft assembly technicians, 1 physicist, 1 security guard, 1 shipyard worker, 1 loss-recovery specialist, and 1 manufacturer’s representative in hardware sales.

Applicability of the “Woman Trapped in a Man’s Body” Trope

As noted earlier, the description of pretransition MtF transsexuals as “women trapped in men’s bodies” connotes a particular developmental history: It implies that MtF transsexuals will have developed the same psychological and behavioral characteristics that are typical of natal women. For rhetorical purposes, I have sometimes described autogynephilic transsexuals as “men trapped in men’s bodies” (Lawrence, 1998), which connotes a different developmental history: It implies that autogynephilic transsexuals will have developed psychological and behavioral characteristics that are typical of other heterosexual men, except in those areas that reflect their autogynephilic sexual orientations. Many informants spontaneously commented on the applicability of either the original trope or my counter-trope.

Five informants invoked the original trope or something close to it. Three of them provided little or no explanation or qualification:

I always felt like a girl trapped in a man’s body. (124)

I wanted to feel a vagina between my legs as I masturbated instead of a penis. I view this as a supremely normal thought for a girl trapped in the body of a male. (125)

I have not always felt like a woman trapped in a man’s body: It is only now starting to feel close to that. (126)

Two other informants who also invoked the original trope offered longer, more complicated explanations of their feelings. I will present excerpts from their narratives in chap. 10.

Four informants thought that my revised version of the trope described them accurately; here are two of their comments:

I now realize that I am a “man trapped inside a man’s body.” (014)

For me, there’s a strong sexual compulsion to look female. I am a man trapped in a man’s body. (127)

Nine other informants rejected the original description without proposing an alternative. Here are a few representative examples of their comments:

I have never felt like a woman trapped in a male body. (128)

I have never regarded myself as a “woman trapped in a man’s body.” (129)

I don’t really feel like a woman trapped in a man’s body. (108)

Two others who rejected the original trope distinguished between the belief that one is a woman and the desire to be a woman; the latter was what they experienced.

I never felt like I was “a woman trapped in a man’s body” but instead just wished I were a girl. (130)

The best phrase to describe my belief about myself is that “I desire (or need) to be a woman with all my heart, in every way,” as opposed to feeling “I have always been a woman.” (042)

The distinction that the last two informants made is important but is one that autogynephilic transsexuals too often fail to make.

Yet another informant poignantly expressed her doubts about the accuracy of the original description in her answer to a rhetorical question:

I really want to be a woman with breasts and a vagina. I guess I’ll have to accept everything else that goes with it. Is this the same as feeling like I am a “woman trapped in a man’s body”? Possibly not. (068)

Nine other informants provided their own variations on the original trope; some of the more instructive ones are presented below. Two informants described themselves as lesbians trapped in men’s bodies:

I feel like I am a lesbian trapped in a man’s body, since I have intense sexual desires for women and also want to be a woman myself. (131)

I knew I was a lesbian trapped in a male body by the time I was 13. (132)

Presumably the implication here was that the informants felt like typical women except that they were attracted to females. Other informants provided their own unique descriptive variations:

Frankly, most of us are not far from being men trapped in men’s bodies. I would tweak that a bit and suggest maybe tomboys trapped in men’s bodies. (025)

I do not feel as if I am a woman trapped in a man’s body. Rather, I have always felt more of a hermaphrodite. I am neither solely male nor female, but both. (022)

Still other informants stated or implied that the “wrong body” metaphor was indeed applicable to them, even if the original trope was not:

I have had the persistent feeling that I am trapped in the wrong body, that the gentleness of my mind and spirit and my creative nature could never be free in this male body. (095)

I’ve very rarely felt like a “woman trapped in a man’s body,” but I do feel like I should be a woman, and there is an erotic component to that feeling. (067)

I want to become what I have so deeply wished to be: a human in a female body. (081)

Two informants admitted that they considered it prudent to at least appear to personify the original trope, whether or not it was genuinely accurate:

I am conducting myself like the standard vanilla “woman trapped in a man’s body,” and the prospect of my carrying out a successful transition, including changing gender in my present job, seems to be good. (047)

My “girl next door” image is simply a ploy for minimizing the impact of my intended transition and for winning support by appearing to be a genuine case of a “girl in a man’s body.” (053)

I consider the informants’ overall degree of skepticism about the original trope to be an encouraging sign. In my opinion, there is an off-putting hubris about autogynephilic transsexuals who describe themselves as women in men’s bodies. We have not been raised as women, we have never experienced female physiology or embodiment, and we have benefitted from male privilege throughout our entire lives; to assert that we are, in effect, women like any other natal women seems to me to represent both lack of insight and remarkable insensitivity. Before undergoing sex reassignment, we autogynephilic transsexuals are not women: We are only men who want to become women. If we live as women and attempt to conduct ourselves recognizably as women, I believe we earn the right to call ourselves women, but we should nevertheless be quick to acknowledge that our womanhood is atypical. In short, it behooves us to display and feel a little humility. We autogynephilic transsexuals generally choose other women as partners (if we find partners at all) and often live our posttransition lives, by choice or necessity, primarily in the company of other women. If we claim to be other than what we truly are, we risk alienating the women upon whom we are likely to depend for friendship, support, love—and ongoing education in how to better emulate them.

Autogynephilia Over the Life Course and After SRS

Men’s sexual orientations tend to be stable over the course of their lives. If autogyne-philia is a sexual orientation, then one would predict that its manifestations—sexual arousal from, attraction to, and love for the idea or reality of resembling a female—would continue over the life course for most or all autogynephilic transsexuals, including after SRS.

Many transsexual and transgender persons who acknowledge a history of autogynephilic arousal report that their autogynephilic feelings have continued throughout their lives; others, however, state that their autogynephilic feelings have waned or disappeared. Nuttbrock, Bockting, Mason, et al. (2011) examined one form of autogynephilia, transvestic fetishism (TF), in a large group of MtF transgender participants. Among 58 nominally heterosexual participants who acknowledged a history of TF, 49 (84%) reported that their TF was “lifecourse persistent”; among 65 nominally bisexual participants who acknowledged TF, however, only 43 (66%) reported lifecourse persistent TF. Most participants in both groups appeared to have been in their 40s or 50s when surveyed. In a survey of 232 MtF transsexuals who had completed SRS and were mostly nonhomosexual, I observed that 84% of participants reported having experienced one or more episodes of autogynephilic arousal before SRS but only 44% reported having done so after SRS (Lawrence, 2005). In interpreting these figures, it is important to remember that autogynephilic arousal is probably greatly underreported, for the reasons explained in chap. 1.

In the current study, many informants stated that they had continued to experience autogynephilic arousal throughout their lives, including after SRS. There were exceptions, but they were uncommon.

Continuation of Autogynephilic Arousal over the Life Course

Many informants unequivocally stated that their experience of autogynephilic arousal had been a lifelong phenomenon.

I am in my 60s. I have suffered with autogynephilia since I first became aware of my feelings at age 4. Cross-dressing still arouses me. (109)

I am a 52-year-old heterosexual male. From about age 12 or 13, the idea of being able to wear women’s clothes and present and live as a woman was an amazing sexual turn-on, and it remains so to this day. (133)

I’ve been experiencing autogynephilia since the first time that I tried on my mother’s nightgowns and wigs. I’m now a pre-op transsexual taking hormones, and nothing has changed. As a man, I had to fantasize that I was a woman to get excited sexually. Now, as a female, I get aroused at times by the thought of just being female. (134)

At age 50, the erotic aspects of my condition have subsided somewhat. I am still aroused by the thought of having a female body, but the requirement to ­masturbate has all but disappeared. (005)

I am in my 60s. Imagining myself a woman has always been sensually pleasurable, whether accompanied by climax or not. I would like to say the arousal and pleasure are now gone or irrelevant, but I would be lying. There is still deep pleasure that is sexual and compelling. There is an imagination of myself as the object of my own desire. (135)

Continuation of Autogynephilic Arousal After Sex Reassignment

In my original solicitation, I specifically invited potential informants to comment on whether autogynephilic arousal had continued after SRS. Several informants addressed this issue, and most who did stated that autogynephilic erotic arousal had indeed continued following SRS:

Wearing women’s clothing and feminizing my body has always been sexually exciting for me, even after SRS. It was and still is sexually exciting for me to have female body functions. (061)

I am 7 months postoperative. I was extremely autogynephilic. My fantasies were of my feminization, which still continue, despite not having testosterone. (136)

I am 6 months postop now, and at 46 years old, still get sexually aroused when I think of the entire transformation that I just completed. (132)

I am a 41-year-old postoperative transsexual. I received my surgery about 2 years ago. I admit that I have many sexual fantasies about being female and having a female body, a lifelong dream for me. I am not ashamed that I am sexually turned on by being female now. (069)

I am a 31-year-old MtF post-op. After starting hormone therapy and living in female role for a while, the fantasies continued like they always had, only now there was more satisfaction from having them. (072)

I am 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. Even now, I embrace my autogynephilic fantasies as part of my sexuality, which is alive and very well. (079)

Others, however, reported that feelings of autogynephilic erotic arousal had become less frequent or intense after SRS, although they still occurred periodically.

Several years after SRS, I still have erotic feelings about being female, although they are not nearly so compelling as in the old days. But sometimes I’ll look in the mirror as I head out to work and feel a flush of excitement over who I have become. (059)

I underwent SRS 22 years ago. Preoperatively, I had some sexual arousal when wearing women’s clothes; postoperatively, I have felt arousal in the vulva when wearing lingerie. Preoperatively, when I was fantasizing myself to be a woman with a vagina, I was strongly sexually aroused and got an orgasm. Most of the preoperative feelings of arousal stopped gradually after SRS. The urges diminished in intensity but are still present. (137)

There have been times when I was totally turned on by the whole experience of becoming a woman, but mainly it has been more a sense of happiness and peace, as I can now relax and be myself. But I have had moments where I have had a total orgasmic rush because of the transformation in myself and my body. In self-pleasuring, I do think about what I have done at times and that does sexually excite me, I must admit. (086)

I first fantasized about being a girl at an early age. In my teens, I behaved like a typical transvestite, cross-dressing and masturbating in private. I also had the usual forced feminization fantasies, so typical of transvestites, and now I realize, transsexuals, too. Now, a year postop at age 41, I feel great about it all. Yet, I am far from a typical woman. Sexually, I still get aroused by forced feminization fantasies and being the woman among men. (115)

I will say more about forced feminization fantasies, which were mentioned by the last informant, in chap. 9.

Some informants reported that arousal to the thought or image of being female continued to occur in the context of masturbation later in life and that autogynephilic fantasies were sometimes necessary for orgasm after SRS:

During puberty, I began to fantasize about physically being a girl, and the thought of this aroused me. I went full-time at age 41 and had SRS at age 43. Even though I only rarely masturbate now, I typically do so while looking at myself in the mirror. I get off on my appearance. (096)

I’m 3 years postoperative. Many of my sexual fantasies as a kid were feminization fantasies. I’m still wired the same way. I very often need those fantasies to achieve orgasm. (050)

One informant observed that during and after sex reassignment, engaging in and observing the results of self-feminization resulted in a feeling of “warmth” that was hard to distinguish from the feeling of sexual arousal:

I am 46 years old, 23 years postoperative. The occasion of my first estrogen injection was a real high. I was jubilant and warm all over. I don’t think that it was entirely hormonal. The first week after surgery was almost manic in its happiness. Standing naked in front of a mirror was all that was necessary to renew the warmth that I felt. I have been sexually aroused since surgery and would readily admit that the sensation is indistinguishable from the above mentioned warmth. (138)

The observation that autogynephilic arousal sometimes, perhaps often, persists after SRS is of theoretical interest for at least two reasons. First, this observation supports—or is at least consistent with—the theory that autogynephilia is (or resembles) a sexual orientation. Second, this observation calls into question an alternative explanation of autogynephilia that has been proposed by some critics of Blanchard’s theory. This explanation asserts that autogynephilia is merely an epiphenomenon that emerges when males who have female gender identities and incongruent male bodies fantasize about having female bodies in order to have satisfying sexual experiences. Serano (2010) summarized this explanation:

It makes sense that pretransition transsexuals (whose gender identity is discordant with their physical sex) might imagine themselves inhabiting the “right” body in their sexual fantasies and during their sexual experiences with other people. Indeed, critics of autogynephilia theory have argued that such sex embodiment fantasies appear to be an obvious coping mechanism for pretransition transsexuals. (p. 184)

This alternative explanation implies, however, that autogynephilic arousal should disappear after hormone therapy and SRS have largely corrected the incongruence between embodiment and gender identity that MtF transsexuals experience. The observation that autogynephilic arousal sometimes, perhaps often, persists after SRS suggests that Serano’s explanation has limited, if any, ability to account for autogynephilic transsexualism.

Cessation of Autogynephilic Arousal After SRS

One informant reported that, after completion of SRS, she no longer experienced autogynephilic arousal. She submitted her narrative only 1 month after SRS, however.

I am 47 years old, post-operative by 1 month, and clearly identify with the feelings you describe. I was aware that something like autogynephilia could be driving me and I made sure that I could function in a female body before committing to my surgery. I never have these kind of thoughts now. (139)

To put her report in perspective, consider this narrative from an informant who described revisiting her earlier autogynephilic fantasies after undergoing SRS one year earlier:

About a year after SRS, I realized that I’d lost touch with my sexuality and I wanted to reclaim it. I revisited old thoughts and fantasies and ultimately found that some of those fires still burned. To make it happen, I had to “turn up the heat,” so to speak, and add intensity and violence to them. I still like to play with some of the old fantasies, but they are much more gentle and loving now. (059)

In my professional practice, I have sometimes been consulted by autogynephilic transsexuals who have been unsuccessful in achieving orgasm after SRS. Among other things, I often advise these clients to experiment with using the same autogynephilic fantasies they found exciting prior to SRS. In many cases, resurrecting their earlier autogynephilic fantasies facilitates high levels of erotic arousal and eventually enables clients to achieve orgasm. In my first review article on autogynephilia (Lawrence, 1998), I recounted the case of a MtF transsexual friend of mine—now a prominent transsexual activist and opponent of the theory of autogynephilia—who had for a time been unable to achieve orgasm following SRS but eventually had succeeded with the help of fantasies of forced feminization.

Concluding Comments on Developmental History

The narrative excerpts presented in this chapter demonstrate that, among autogynephilic transsexuals, autogynephilic erotic arousal not uncommonly begins in early childhood, usually is evident by the time of adolescence, and often continues throughout life, including after SRS. The excerpts also demonstrate that significant numbers of autogynephilic transsexuals report that they were not effeminate in childhood or adulthood but were instead unremarkably masculine in their interests and behaviors, even though they intensely desired to make their bodies resemble women’s bodies and live and be recognized as women.

Are (or were) nearly all autogynephilic transsexuals unremarkably masculine men whose gender dysphoria was simply an outgrowth of their paraphilic desire to turn their bodies into facsimiles of women’s bodies? I believe that the narratives presented in this chapter support that interpretation, but they obviously cannot settle the issue. The value of these narratives does not lie in their ability to prove or ­disprove any theoretical proposition, but in their capacity to inform the decisions that severely gender dysphoric autogynephilic men face.

The narratives in this chapter are important because they demonstrate that some autogynephilic transsexuals truly are, by their own account, “men trapped in men’s bodies”: unremarkably masculine men who experience the paraphilic wish to have women’s bodies—and who sometimes overcome the skepticism of the psychiatric establishment and many of their peers to successfully complete sex reassignment and lead happier lives thereafter (Lawrence, 2003). This information is likely to be of significant value to severely gender dysphoric autogynephilic men who are considering sex reassignment but feel deterred by the realization that they lack intrinsic femininity. These men may or may not eventually decide that sex reassignment is the best option available to them, but they will be in a better position to seriously consider this option if they realize that they are neither unique nor unusual—except, perhaps, in being unusually honest.