Sex, Gender, Transsexualism and Trauma – Part 3 : Transsexualism


[Previous Section]

3. Transsexualism 

Sexuality is complex. It appears to be particularly complex in the case of men. Sexologists have a term ‘paraphilia’ which means ‘an unusual sexual interest’ or, as sexologist Ray Blanchard put it, “a paraphilia is a sexual orientation we don’t like.”

Paraphilia are thought to be far more common in men. If correct, this weirdness (or ‘diversity’) may be an innate feature of male sexuality.  On the other hand, there is a lack of research on paraphilias in women, in part because most studies are done on people convicted of sex crimes, who are overwhelmingly male.

Paraphilia also tend to cluster, meaning basically that if a person (a man, let’s assume) has one paraphilia, it’s more likely he’ll have others as well. Many paraphilias are harmless to society. But some can cause big problems, not least for the person with the paraphilia.

There’s a phenomenon called ‘transsexualism’ which has existed for a very long time. This is where a person of one sex wishes to become, or believes they are, a person of the other sex. It’s not a new phenomenon, but it’s still quite poorly understood. It’s not identical with transgenderism, but it’s close; most transsexuals do have gender dysphoria, and often seek to alleviate it by modifying their bodies to resemble those of the other sex. 

The focus of this discussion will be on transsexualism in men. Many of the theories presented would require modification before they could be applied to women.

Transsexualism is (or at least, is thought to be) far more common in men than in women. So the question arises, could it be some kind of paraphilia?

Sexologists were thinking about this before Blanchard came along:

In essence, Blanchard had the idea of dividing male-to-female (MtF) transsexuals into two types. One type he called Homosexual Transexuals (HSTS). This type is *exclusively* sexually attracted to men; ie. they could be considered homosexual.

The other type have ‘a history of sexual arousal by cross-dressing or cross-gender fantasy.’ This type are called autogynephiles, or AGPs. This type are sexually aroused primarily by the idea of themselves as women. There are far more AGPs than HSTS transwomen – about 70% are AGP.

Blanchard initially identified four types of autogynephilia, which often co-occur:

  • Transvestic: arousal to the act or fantasy of wearing typically feminine clothing.
  • Behavioral: arousal to the act or fantasy of doing something regarded as feminine.
  • Physiologic: arousal to fantasies about female body functions.
  • Anatomic: arousal to the fantasy of having a woman’s body, or parts of one.

A fifth category was added later:

  • Interpersonal: arousal to the act or fantasy of being recognised or treated as a woman by others.

Blanchard also pointed out that an autogynephile does not typically become sexually aroused every time he (for example) wears feminine clothes — it is more that there is the potential for sexual arousal. Also, that AGP works something like a sexual orientation, including the capacity for both pair-bonding and romantic love.

It should be noted that the concept of autogynephilia does not imply that autogynephilic males are always sexually aroused by the thought of themselves as women, or by dressing in women’s clothes, or by contemplating themselves cross-dressed in the mirror – any more than a man in love always obtains an erection at the sight of his sweetheart, or pair-bonded geese copulate continuously.

But how can one form a pair-bond, or fall in love with oneself? Isn’t this just narcissism? Not exactly.


It appears that AGP may involve the creation of a female pseudopersonality. This is something like a childhood ‘imaginary friend’ that persists into adulthood; this pseudopersonality then becomes the object of the autogynephile’s romantic and sexual desire — their ‘erotic target’. This pseudopersonality is the autogynephile’s ‘perfect woman’ — an imaginary female version of himself. 

Here’s some background on the psychological concept of a pseudopersonality, which often develops in cult-members. If it is true that many AGPs have developed a kind of pseudopersonality, perhaps they would be unusually susceptible to cult indoctrination? We don’t know.

Awareness of the AGP pseudopersonality varies between individuals; many will not consider this ‘perfect woman’ to be a pseudopersonality at all — they may instead regard her as their ‘true self’; the woman they should have been all along. For others, it makes more sense to think of her as an artefact of the imagination — a ‘second self’. Sometimes it’s better to think of the ‘male self’ as a pseudopersonality; a mask which hides the individual’s natural femininity from a hostile masculine world. 

Rod Fleming (a man with a great interest in MtF transsexuals owing to his self-described sexual preference for ‘ladyboys’) believes that the AGP pseudopersonality can exist outside of the individual’s sexual fantasies, and may compete with the male (‘host’) self for overall control:

Here, Fleming speculates about a possible connection between AGPs and what he calls ‘narcissistic homosexuals’; in short, he suggests that ‘narcissistic homosexuals’ are attracted to the image of themselves, not as women, but as men:

It’s hard to know how seriously to take Fleming’s ideas, but I find them thought-provoking.

Automonosexualism / Analloeroticism

Some AGPs are completely analloerotic — meaning they have no sexual interest in other people. These AGPs are sexually interested only in themselves; a kind of analloeroticism called automonosexualism:

Analloerotic gender dysphorics represent those cases in which the autogynephilic disorder nullifies or overshadows any erotic attraction to women; those cases, in Hirschfeld’s metaphor, in which “the woman within” completely supplants her fleshly rivals. The difference between the asexual and the automonosexual varieties may lie in the concreteness of the individual’s preferred expression of femininity. An individual for whom sexual arousal was closely associated with dressing in women’s garments would – if there were no other erotic interests – be diagnosed as automonosexual. Not all persons of this general type are stimulated by external objects, however. A colleague of the writer’s, for example, had a patient who was sexually aroused by contemplating his shaved legs in the mirror [..] It is possible to imagine a continuum of “fetish objects” of ever-decreasing tangibility, culminating perhaps in the simple thought of being a woman or some talismanic idea associated with that. On this view, asexual gender dysphorics are simply those analloerotics whose erotically valued symbol of femininity is a “fetish idea” rather than a tangible fetish object. The autogynephilic fantasy of intercourse with a male is a prime example of such an idea; and, in fact, Person and Ovesey’s asexual transsexuals were described as masturbating “with a vague heterosexual fantasy in which the patient saw himself as a woman. The fantasies were impersonal, and the partner was usually a stylized man rather than a real person.”

Erotic Target Location Errors (ETLEs)

Blanchard attributes autogynephilia to an ‘Erotic Target Location Error’ (ETLE).  

Rod Fleming discusses the concept here:

The idea is that there can be not only sexual arousal towards various kinds of people or things, but also towards *being* that kind of person or thing. Some people experience both kinds of arousal at the same time. So ‘plushophilia’ would be a sexual arousal towards plush animals, and ‘autoplushophilia’ would be arousal towards the idea of being a plush animal. Thus — perhaps — one could think of AGP transwomen, furries, and others as different manifestations of the same basic phenomenon.

(Perhaps you could look at sadism and masochism in the same way — sadism would be arousal to people suffering pain or degradation, and masochism would be arousal at the idea of being such a person. The two often occur together under the label ‘sadomasochism’.)

AGP then, would be due to an ETLE that can occur within heterosexual men — autogynephiles are sexually aroused by women, as well as by the idea of being a woman. 

Many AGPs also have gynandromorphilia (GAMP), which is arousal to ‘gynandromorphs’ (essentially, pre-op MtF transsexuals); presumably, autogynandromorphilia would be arousal to the idea of being a pre-op MtF transsexual — which might be difficult to distinguish from AGP.

According to Blanchard, in both HSTS and AGP transsexuals the desire to transition — to ‘become a woman’ — is motivated by the individual’s sexuality, though in very different ways.

More recently Blanchard has endorsed the idea there could be additional forms of gender dysphoria; these are outlined in this article:

Supporters of Blanchard

Anne Lawrence

Anne Lawrence, a self-confessed AGP transwoman, is a supporter of Blanchard’s work. I’ve read a lot of her own work, and found it both thoughtful and compassionate towards AGPs.

Anne Lawrence here writes, of Blanchard, 

[His] research revealed that gender dysphoric males who were primarily attracted to men (androphilic) usually reported having been quite feminine as children (Blanchard, 1988).

Please note the use of the word ‘feminine’ — this is clearly referring to gender, not sex.

I’ve seen it suggested that ‘femininity’ is behaviour which tends to attract males — at least, heterosexual ones. That suggests some aspects of gender may relate to sexual orientation. That appears to make sense; after all, gay men are often criticised for being feminine. Lesbians, meanwhile are often accused of being masculine.

Many gay men are masculine of course, and there are plenty of feminine lesbians. But still, there appears to be a correlation.

Back to Anne Lawrence (same paper):

Blanchard’s other category […] included those attracted primarily to women (gynephilic); those attracted to both women and men (bisexual); and those with little attraction to other persons of either sex [… he] found that the males in this combined group reported less childhood femininity than those in the androphilic group; some might not have been especially masculine as children, but few if any had been extremely feminine. Those in the combined group presented for initial evaluation later in life, at an average age of 34 years (Blanchard et al., 1987). About 75% of them admitted to a history of sexual arousal with cross-dressing (Blanchard, 1985). Most significantly for Blanchard’s theory, they were far more likely than persons in the androphilic group to be sexually aroused by autogynephilic fantasies, that is, by fantasies of simply being female (Blanchard, 1989b).

There is good reason to believe that the males in the combined group might have underreported their sexual arousal to cross-dressing. Blanchard, Clemmensen, and Steiner (1985) demonstrated that in nonandrophilic gender dysphoric males, denial of sexual arousal to cross-dressing was significantly correlated with the tendency to describe oneself in a socially approved way, as measured by the Crowne-Marlowe Social Desirability Scale.

Hardly surprising; if society disapproves of your sexuality, and you care what society thinks, you don’t talk about it.

So that’s Blanchard’s two types of MtF transsexuals. They’re very different:

HSTS can be thought of as super-feminine gay men. Femininity is natural to them; masculinity is alien. They know they are not women, but they wish to live as women. They are attracted to heterosexual men.

AGPs are heterosexual men with an attraction to the idea of themselves as women, plus, often, a ‘standard’ attraction to real flesh-and-blood women. They tend to be less ‘naturally feminine’ than HSTS. 

AGPs don’t want to live as women. They want to *be* women; they find the idea sexy. The problem for AGPs is obvious: they’re not women, and they can’t be women; they can only fantasise about it, and this pisses them off.

Sexologist James Cantor summarizes the differences in this article:

On this view, HSTS and AGPs are as different as a whale and a basking shark. Superficially, they look similar, but under the skin, they are completely different animals.

Still, it is important to note that the idea that HSTS are ‘genuine transsexuals’ while AGPs are imposters is absolute nonsense. A homosexual man is no more a woman than a heterosexual man, and ‘transition’ is no more (or less) natural for one than the other. Though the causes may be different, both ‘types’ suffer from gender dysphoria; the medical purpose of ‘transition’ is simply to alleviate their distress.

Michael Bailey / The Man Who Would Be Queen

Anne Lawrence wrote another paper; ‘Shame and Narcissistic Rage in Autogynephilic Transsexualism’:

In this paper, she discusses factors possibly underlying the campaign against Michael Bailey following publication of his book The Man Who Would Be Queen (TMWWBQ; Bailey, 2003),

Bailey’s book was intended for a mainstream audience, and drew heavily on Blanchard’s work. The possibility it might bring the concept of autogynephilia to public awareness outraged some MtF transsexuals, many of whom do not accept Blanchard’s ideas, and find them insulting. 

Anne Lawrence writes:

The attacks [included…] attempts to turn Bailey’s colleagues against him; attacks directed against Bailey’s children; and efforts to discredit or silence nearly anyone who openly supported him. Dreger’s article suggests that many of Bailey’s opponents intended not only to discredit Bailey’s book, but also to destroy its author. The duration, intensity, and sheer savagery of the campaign waged by many of Bailey’s MtF transsexual opponents is astonishing[…]

One could imagine that Kohut (1972) was describing the campaign conducted by some of Bailey’s MtF transsexual opponents when he wrote the following:

“[There is a] need for revenge, for righting a wrong, for undoing a hurt by whatever means, and a deeply anchored, unrelenting compulsion in pursuit of all these aims…. There is utter disregard for reasonable limitations and a boundless wish to redress an injury and to obtain revenge…. […] Aggressions employed in the pursuit of maturely experienced causes are not limitless…. The narcissistically injured [person], on the other hand, cannot rest until he has blotted out [the]…offender who dared to oppose him, [or] to disagree with him.” (pp. 380, 382, 385)

These excerpts are taken from Kohut’s description of narcissistic rage, a concept that I believe is central to understanding many of the attacks against Bailey and their implications.

I propose that nonhomosexual (i.e., presumably autogynephilic) MtF transsexuals are probably at increased risk for the development of narcissistic disorders […] as a consequence of the inevitable difficulties they face in having their cross-gender feelings and identities affirmed by others, both before and after gender transition. As a result, many autogynephilic transsexuals are likely to be particularly vulnerable to feelings of shame and may be predisposed to exhibit narcissistic rage in response to perceived insult or injury. It is not hard to understand why Bailey’s book was experienced by at least some nonhomosexual MtF transsexuals as inflicting narcissistic injury and why this led some of them to express apparent narcissistic rage. 

The controversy is described in detail here by Alice Dreger:

An alternative perspective by Charles Moser, more sympathetic to those enraged by Bailey’s book, can be found here:

A timeline of events relating to the controversy, compiled by Lynn Conway, one of the protagonists, is available here:

More from Anne Lawrence:

Becoming What We Love:

Men Trapped In Men’s Bodies:

So, according to Blanchard, transwomen come in two types: a minority (HSTS) with no sexual interest in women; and a majority (AGPs) who are suffering (the right word in many cases) from a paraphilia which severely fucks with their heads. AGPs may have other paraphilias too; sadomasochistic ones are common — we’ll come back to this point.

Critics of Blanchard

Blanchard’s typology is still highly controversial. As noted earlier, many transwomen find it both inaccurate and deeply offensive. They complain that Blanchard’s work characterises them as ‘perverted men’, whereas they see themselves simply as women. This concern is well-founded; in the name of science, sexologists may refrain from making moral judgements, but the general public does not.

Serano’s Views on Sex and Gender

Julia Serano, a transwoman, is a major critic of Blanchard’s work.

Here, Julia Serano attempts to debunk the idea that there are two, and only two sexes, relying on a conflation of primary sex characteristics (which determine what sex an individual is) and secondary sexual characteristics (which are typical of individuals of a particular sex).

She then goes on to use the terms ‘gender identity’, ‘social gender’ and ‘gender’ interchangeably, which further muddies the waters. According to Serano, gender is:

an amalgamation of bodies, identities and life experiences… subconscious urges, sensations and behaviors, some of which develop organically, and others which are shaped by language and culture.

The purpose of this wibble is to support Serano’s claim that transwomen are women — though she cannot tell us what, exactly, a woman is; the word is not to be found in her glossary. (The glossary itself is an intriguing read, offering insight into Serano’s mindset. See, for example, her entry about the word ‘paraphilia’

Serano’s Views on Blanchard

Here, Serano tackles Blanchard’s work on autogynephilia, summarises the evidence against it, and concludes that it has been discredited:

 She points out that Blanchard has had to invent several new ‘types’ of gender dysphoria to account for the problems in his original theory, and goes to on give her opinion on why the theory is still promulgated. 


But if we are to abandon Blanchard’s theory, what should we replace it with? Serano prefers what she calls the ‘Intrinsic Inclinations’ model of gender to explain transsexualism:

According to Serano:

[S]ubconscious sex, gender expression, and sexual orientation represent separate gender inclinations that are determined largely independent of one another. 

[…T]hese gender inclinations are, to some extent, intrinsic to our persons… and generally remain intact despite societal influences and conscious attempts by individuals to purge, repress, or ignore them. 

[…E]ach of these inclinations roughly correlates with physical set, resulting in a bimodal distribution pattern (i.e., two overlapping bell curves) similar to that seen for other gender differences, such as height.

This is broadly similar to John Money’s ideas about gender. The major difference in this model from the radfem view of gender seems to be the addition of ‘subconscious sex’ — which sounds very much like the concept of ‘gender identity’. How a person could be subconsciously female, though physically male, is unclear. Nor is it clear how ‘subconscious sex’ could be detected, nor why it should take precedence over physical sex when determining the sex of an individual. 

Overall, I find Serano’s theory less convincing than Blanchard’s — perhaps they’re both wrong?

Charles Moser

Charles Allen Moser, a sexologist with an interest in BDSM and transsexualism, criticised Blanchard’s views on transsexualism in this paper:

First, Moser complains about Blanchard’s insensitive use of language, pointing out that what Blanchard called homosexual transsexuals do not consider themselves homosexual, as they view themselves as women, attracted to men. Meanwhile, non-homosexual transsexuals often call themselves lesbians, as they view themselves as women attracted to women. He notes that the characterisation of female-attracted MtF transsexuals as simply paraphilic men is unnecessarily stigmatising, and likely to cause offence. 

He also points out limitations in the tests used to categorise these individuals, and points to Blanchard’s own data, which shows that AGP is not exclusive to female-attracted MtF transsexuals, as the theory suggests.

He argues that AGP should not be classified as a paraphilia, and that it could be a characteristic of many MtF transsexuals, without being the main motivation for them to seek sex-reassignment surgery. He says there may be multiple possible causes of transsexualism, and points out that Blanchard accepts there can be multiple causes of a paraphilia.

Moser also calls into question the idea that non-homosexual subjects who did not report AGP-typical experiences were falsifying their responses. 

Moser wrote about his own views on transsexualism here:


Many MtF transsexuals who would fit the category of autogynephiles have also argued against Blanchard’s work; for example, this piece contains a mashup of Serano’s and Moser’s objections, among others:

This page, written by someone called Zagria, is also highly critical of Blanchard’s ideas:

In the next section we’ll look at some lesser-known alternatives to Blanchard’s views.

[Next Section]