Autogynephilia: On the “Shelf of Shame”

Years ago, I was in the “lesbian and gay nonfiction” section of a used bookstore, and I stumbled upon a book titled The Man Who Would Be Queen. Written by J. Michael Bailey, a psychology professor at Northwestern University, the title and the cover art of this book were intriguing – and a bit unsettling. I bought the book, and the word “autogynephilia” came into my life. And so we revisit our discussion of the DSM, which many of you may remember from a few weeks ago.

The DSM-IV includes a diagnosis called “Transvestic Fetishism,” which applies to heterosexual men who cross-dress for sexual gratification. In DSM-V, this will be changed to “Transvestic Disorder” (which, by the way, is categorized as a “paraphilia” – an aberrant sexual behavior), and it includes several notable changes. For one thing, the DSM-V version is no longer specific to heterosexual men – it’s now more of an equal-0pportunity diagnosis, applicable to people regardless of gender and sexual orientation. What’s more interesting to me than the fact that the diagnosis now casts a wider net, however, is that the DSM-V “Transvestic Disorder” diagnosis now also includes three potential specifiers:

  • with Fetishism (sexually aroused by fabrics, materials, or garments);
  • with Autogynephilia (sexually aroused by thought or image of self as female); and
  • with Autoandrophilia (sexually aroused by thought or image of self as male).

Most people are familiar with the concept of fetishism, although there’s considerable debate as to whether or not this is an abnormal behavior. But “autogynephilia” and “autoandrophilia” are unfamiliar terms to most people – although to many transpeople they are quite familiar, and quite disturbing. And the fact that they are soon to be included in the DSM sets off serious alarm bells for the trans community. For the purposes of our discussion, we’ll focus more on autogynephilia – largely because that concept has been more widely researched and debated.

Autogynephilia is a term popularized by Ray Blanchard, a Toronto researcher who has proposed the “two-type” model of male-to-female transsexualism. These two types are, according to Blanchard:

  1. the “homosexual transsexual,” who is effeminate, usually identifies as gay, transitions earlier rather than later and passes well; and identifies with the “I’m a woman born in a man’s body” narrative; and
  2. the “autogynephilic transsexual,” who tends to identify as a heterosexual male, is traditionally (and often excessively) masculine, and tends to transition later in life. The autogynephilic transsexual, according to Blanchard, isn’t motivated to transition because he was “born in the wrong body;” rather, he’s sexually aroused by the idea of having a vulva, and this motivates sex reassignment surgery.

Autogynephilia, not surprisingly, is a VERY controversial idea – there’s divisiveness about it in the academic world as well as in the trans community. About a third of the discussion in The Man Who Would Be Queen (which one trans activist included on her “Shelf of Shame”) is devoted to autogynephilia. There’s a decent amount of research behind it – much of which is documented in Bailey’s book – but most of the studies come from Blanchard and his colleagues. Not surprisingly, many transpeople are strongly opposed to this typology, arguing that the chosen terminology is offensive, and that the theory dehumanizes them and reduces their identity to a bizarre sexual fetish. The debate has gotten very, very ugly – if you want the full story, complete with lurid details, you can peruse Lynn Conway’s site at, and then take a look at Michael Bailey’s website at (My book Backdrop has a summary of this controversy as well.)

Is autogynephilia an idea concocted by ignorant, transphobic researchers? Is it a valid phenomenon that transpeople are afraid to talk about, because they don’t want to be seen as freaks? I think it’s entirely possible that autogynephilia is a true phenomenon – among some transpeople and, if you read Charles Moser’s research, in natal women as well. I also understand why transpeople are upset, and why they consider the theory and the terminology to be offensive and oppressive. I will, however, say this:

1.  If it’s not a widely accepted phenomenon, it probably shouldn’t go in the DSM.

That should probably go without saying, right?  But Ray Blanchard, along with several of his colleagues, sits on the DSM-V Working Group for Sexual and Gender Identity Disorders. Of course, numerous members of the trans community argue that the deck is stacked unfairly in this Working Group – and that’s an important point of consideration. Moreover, it’s important to note that naming the phenomenon isn’t necessarily problematic – in fact, some people who are autogynephilic may experience relief at knowing there’s a name for their desires. But including it in a diagnostic manual brings the “naming” process to an entirely different level.

Here’s my second thought:

2.  If autogynephilia does exist, it’s probably more closely related to sexual orientation than to gender dysphoria.

It’s common to see autogynephilia (and other “paraphilias”) referred to as “erotic target location errors.” To some researchers, homosexuality is considered to be an “erotic target location error.” Language is powerful – once you call something an “error,” the logical assumption is that it needs to be corrected. And if that’s the case, we’re looking at some form of reparative therapy – which LGBTQ activists have been fighting long and hard to eliminate.

Related to this idea is my final concern:

3.  If we’re going to include a diagnosis in the DSM, we need to consider what ramifications its inclusion will have.

And what might some of those ramifications be?

  • Including autogynephilia in the DSM legitimizes it – even if it hasn’t been fully vetted by the research community. The DSM is a very powerful document that carries an incredible amount of weight, and every change needs to be considered with that in mind.
  • Including autogynephilia creates one more thing that transpeople – one of the most oppressed groups in the LGBTQ community – can potentially be diagnosed with, marginalizing them even further.
  • People diagnosed with autogynephilia might be prescribed some form of reparative therapy to “correct” their “erotic target location error.”
  • If autogynephilia is included in the DSM, it will likely become part of the decision tree that gender clinics use to determine whether an individual is a candidate for sex reassignment surgery. I can imagine a flow chart with a series of if-then statements:

“If ‘Gender Dysphoria,’ then ‘Yes.”

“If ‘Transvestic Disorder with Autogynephilia,’ then ‘No.'” 

A decision tree based on a tenuous concept, at best. No wonder the trans community is so enraged about this DSM revision.


August 26, 2012 · 8:00 AM

6 responses to “Autogynephilia: On the “Shelf of Shame”

  1. Diana

    Autogynephilia is pseudo-science. The research used a convenience sample of transsexual women at a transgender conference and the author based her research on that instead of a random of women. It is like if you did a survey of prisoner in a jail on smoking and found that 75% of them smoke and drawing a conclusion that smoking cases criminal behavior.

    In addition, the survey was never validated or in other words the questions asked were never proven to show that by answering the questions in a certain way is an indication of autogynephilia.

    A doctor gave the same questionnaire to a convenience sample of female professional employees of an urban hospital and found female autogynephilia was present in 93% of the respondents using the same criteria that was used in the transgender study. (Moser, Charles(2009) ‘Autogynephilia in Women’, Journal of Homosexuality, 56: 5, 539 — 547)

    • The Moser article you cited, Diana, is the one I was referring to in my post, so thank you for including the full citation. I met personally with Dr. Moser last week to interview him for my next book, and he had a LOT to say about the autogynephilia controversy – and he’s written several articles on the issue. Unfortunately, I don’t think his work gets taken very seriously by the small group of researchers who study this.

      I’m not ready to say that autogynephilia isn’t a true phenomenon – however, there’s clearly not enough well-designed studies on it to justify its inclusion in the DSM. Moreover, I see some disturbing circular reasoning going on – in several instances, researchers have made the assumption that transwomen who fit the autogynephilia “profile” but deny autogynephilia are either, well, in denial, or they’re just plain lying. This is a clear violation of the principle of falsifiability, which is a cornerstone of the scientific method. Assuming that a hypothesis is true and ignoring contradictory evidence is massively problematic.

      Thanks for your commetn!

  2. Gregory Smith

    Why do MTF trans people continue to try to deny this theory? It’s what led me to the operating table and I can assure you it made me no more a woman than the man on the moon. For late transitioners such as myself; it is and was the driving factor. Why continue to lie to yourself?


    • I can’t speak for the MTF community, because I’m not a part of it. If you read my post, you’ll see that I certainly don’t deny the possibility that autogynephilia exists. However, I will reinforce Points #1, 2, and 3 from my post. Debating the existence of autogynephilia exists is one thing. Including it as a DSM criterion when it hasn’t been vetted by more than a handful of researchers is a big problem. And that’s not just true for autogynephilia – there are many, many diagnoses and criteria in the DSM that haven’t been vetted well through the research process, and that’s why so many psychiatrists and psychologists (including the chair of the DSM-IV working group) have voiced such serious concerns about this new edition.

  3. Vicki

    Hmmm. See, I don’t necessarily equate being autoandrophilic/autogynephilic with being transexual, as many seem to. I would consider myself a cis lesbian that loves being a woman and has absolutely no intentions of changing sex. But the idea of physically being male, especially in the context of sex with a woman, is THE most sexually stimulating thought I can have. I would agree that it is more in line with a fetish, although I don’t think most fetishes should be in the DSM.

    • You should read some of Charles Moser’s stuff – he’s a doctor in San Francisco who specializes in sexual medicine. He’s written many articles about why fetishes (among other things) shouldn’t be in the DSM. He also wrote an article a few years ago about autogynephilia in cis women, and found that it occurs just as frequently among them as it does in trans women. I bet autoandrophilia is pretty common too, and quite possibly in both sexes as well as among transpeople. It’s scary that once we start exploring the range of sexual possibilities, there’s the danger that those possibilities will become pathology.

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