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 www.tsroadmap.com, and then take a look at Michael Bailey’s website at http://faculty.wcas.northwestern.edu/JMichael-Bailey/controversy.htm. (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.