New blog on crossdreaming and autogynephilia

There are not that many blogs covering crossdreaming and autogynephilia out there, but here is a new one you might like to visit:

Kelli TG is written by Kelli Roberts and she says that this blog will be "a bit different from others I have come across as it will contain no porn, no graphic conversations, and will be from a conservative Christian point of view..."

I will be interested to see how she handles the religious angle. Maybe I'll come back to that dimension later.

If you know of more relevant blogs that are not included on my crossdreamer resource page, please let me know!

The sissy and the dominatrix

I got the following comment on one of my posts from a dominatrix who calls herself Eva Bliss:

"I found your blog after I googled the word autogynephilac to find the correct spelling before I placed the word in my blog. I am one of the only dominatrices who to my knowledge has had a long term fascination in understanding how autogynephilia affects her crossdressing clients . I have also made a few comments about the phenomena in my most recent post. I would value your comments and insight Jack/Jackie. I will look forward to your response here there or anywhere."

This is a blog that boldly goes where even angels fear to thread, so here is my response:

Although there is no one to one relationship between crossdreaming (getting turned on by feminization fantasies, ref. autogynephilia) and the desire of sexual submission, there are clearly quite a few crossdreamers who fantasize about submitting to a strong willed woman.

The idea of sissyfication, men being forcefully turned into women and made to submit to sex, is a recurrent theme in transgender erotica.

Some researchers have argued that the fact that many autogynephiliacs harbor what they consider a masochistic kind of "paraphilia", proves that crossdreaming or autogynephilia is nothing but a perversion as well.

I doubt that this argument holds water. There are other explanations that make much more sense to me.

Imagine the following:

The crossdreamer has a strong "feminine" side. He may not thrive in the traditional aggressive and assertive male role. This role goes against his inner nature.

He strongly believes, however, that society expects him to be a tough, assertive, sport loving and beer drinking womanizer, and he does his best to fulfill that role. He overcompensates. Indeed, many crossdreamers appear in public life as successful alpha males having leading positions in companies and organisations.

Underneath that alpha male facade lives an "inner woman" who hates the whole game. The better he succeeds male wise, the more she suffers. This gives him a deep sense of insecurity.

He has no way of expressing his feminine side in his role as a citizen, husband, father or lover. This frustration leads to a build up of both emotional and sexual energies that seek another outlet, and that outlet is normally secret feminization fantasies and/or cross-dressing.

So why would he seek out a dominatrix? Well, this is another secret space where he can live out his fantasies without being caught by colleagues, friends and family.

In this setting he can put aside his mask of masculinity, and let go. In this space he does not have to perform, succeed or live up to the expectations of him being an alpha male. In this room he can forget himself, which gives him a huge emotional relief.

I do not think that this is about pain. But it is about humiliation. He feels, after all, a tremendous amount of guilt for having this feminine side, a guilt that is reinforced by the fact that he has to keep it secret from his friends and family.

In this role playing he is "punished" for his "sins" at the same time as he can give in to his longings. The punishment also gives emotional relief: In this fantasy he is forced into becoming a sissy. The game portrays him as a victim, not as a guilty perpetrator.

The fact that this is role playing is important. I do not think most crossdreamers actually believe that the two types of women this game presents are "real" in any sense of the word: the submissive slut versus the dominatrix. He would never treat his wife or girl-friend as a slave or a slaver. The crossdreamers who do transition, never live up this role in real life.

So this is an erotic fantasy and must be understood as a fantasy. Somehow his subconscious drives him to engage in this activity, because it satisfies a part of him that has been suppressed.

The role of the dominatrix may appear to be somewhat of a paradox. The stereotype of the sissy slut seems to indicate that the crossdreamers believe in a misogynistic view of women as weak and submissive. The dominatrix, however, represents the exact opposite: a woman in total control.

I do not think this is a paradox at all. Again: this is a fantasy, not real life, and in fantasies we simplify the complexity of life to get a grip on what is happening to us. In this fantasy the crossdreamer tries to leave room for one part of the complex human psyche that he believes is out of bounds for a "real man": the submissive, passive or reactive side.

This does not mean that he believes that all women are like this in real life, or that women ought to behave like this.

Secondly: The crossdreamer may have grown up with strong and dominant women near him (mothers, siters, aunts, grannies and nannies), women who have reinforced his fear of femininity in men. It is amazing to see how many women despise what they perceive as weakness in men. This especially applies to some of the strong willed women out there. The gender stereotypes are upheld by women, just as much as by men.

Thirdly: Crossdreamers are mostly gynephilic. They love women. They want to submit as a woman and they want to have sex with a woman. But the idea of having sex as a woman often entails the idea of being mounted and the desire for penetration. In this role playing the dominatrix takes the role of the dominant man. She may even let the client submit to anal sex, sealing his role as a submissive woman. But the dominatrix remains a feminine woman, and the crossdreamer desire her as such.

This also applies to transfans or transsensuals, i.e. men who seek out pre-op M2F transwomen for domination games. They desire a woman who can make them feel like a woman. Hence: the common idea that the crossdreamer is a closeted gay man is wrong, as he feels no attraction to the male body.

I must admit I have often wondered what would have happened if our cultures were more accepting towards men being emotional, nurturing, reactive, sensual and all the other traits we attribute to women.

I am amazed to see how male chauvinists, many radical feminists and the Pope seem to agree that there is one feminine essence that men do not take part in, in spite of the fact that all men and women clearly display different mixes of male and female traits. There are emotional and artistic men and there are assertive and politically powerful women, but we are led to believe that there exists a kind of blueprint for the perfect manly man that men should try to live up to.

That being said, I suspect that crossdreamers are as much caught up in their own prejudices as the culture surrounding them. In other words: they might find that their friends and girl friends may be more tolerant towards their feminine side than they imagine. When that happens, and they find other outlets for their feminine side, their desire for sissyfication and forced submission may subside.

Cosmo: The sex life of crossdreamers (autogynephiles)

It will probably take some time before Cosmopolitan writes a "how to" guide on how to cope with a crossdreamer (men who fantasize about having a woman's body, also known as autogynephiliacs). But if the woman's magazine ever does, maybe they would write something like this.

Cosmopolitan June 2025.

My husband is a crossdreamer! How to keep your relationship thriving.

Your boyfriend tells you he is a crossdreamer. He gets turned on by imagining himself being a woman. In bed he wants to take your role. He may even want to borrow your lingerie. So now what do you do?

Know that there are good news as well as bad news.

From Venus and Mars

The good news is that you have found a man that worships you more than most men can do. He admires your looks, your wits and your ways to such an extent that he would like to be like you. Given all the misogynists out there, that is not a bad bargain.

The "inner woman" of a crossdreamer may also make him more sensitive. What some of them lack in testosterone driven masculinity they make up for in their love for you, your family and kids.

Fear and self loathing

The bad news is that he may be slightly traumatized. There are male pop stars and Hollywood actors coming out as metrosexuals and male lesbians, but in small towns a man having feminisation fantasies will still be considered a freak.

This means that he may also think that you consider him a pervert, whatever you tell him. His self-esteem may be low. The fact that crossdreaming was considered a "paraphilia" by the American medical establishment up until 2023 has not helped.

In order to keep your love he might try to hide his dreams. If he is a crossdresser he may hide his feminine clothing out of your sight. This may make him distant and withdrawn. His inner woman becomes your rival instead of your partner. If you want to make this relationship to work, it is therefore important that you help him bring his secret life out in the open.

Do the woman thing: talk about it! The man in him probably hates the idea, but his "inner woman" may become your best ally.

Is he a transsexual?

Many women who love crossdreamers harbor another fear: Is he a transsexual? What if he wants to have an operation? Then what do you do?

Note that the crossdreamers can be put into at least three overlapping groups.

The crossmopolitan identifies as a man, and has a good relationship with his own male body. He thrives in the traditional assertive male role as well as the more feminine caring role. For him his feminization fantasies are sexual spice and a way of getting in touch with his feminine side. He will feel no desire to transition for real.

The transsexual feels a strong gender incongruence. He -- or she, rather -- may have spent a lot of energy to suppress her dreams of becoming a woman, but the fact is that if she does not transition she will probably never find peace with herself. She has reached the tipping point where the sum of various genetic and hormonal causes of crossdreaming equals woman. She is a woman!

There are some relationships that survive a male to female transition, but the process will cost you a lot of suffering. It is a sad fact, but most relationships and marriages of this kind fail. You being bisexual might help, though.

The twilighter gets his name from the twilight zone in between the male identifying crossdreamer and the transsexual. He is in the problematic position of being both male and female in close to equal proportions. In our cultural context there is no role for the twin-spirited, and he may find it extremely hard to make peace with himself and the people around him.

Some of the twilighters become love-shy and introvert geeks, preferring their secret fantasies to the love of a real woman. It is not that they do not want your love. The fact is that they desperately long for it, but they find no way of conceptualizing what kind of life you and his inner woman can share. And if they do, they may imagine themselves as male lesbians. And you are probably not looking for a lesbian, are you?

He may still be a very good catch, though. When he understands that you understand him, his gratitude and love will lead him to make a tremendous effort to make the relationship work. He is very likely to be a faithful and committed husband. The trick is to find room for his inner woman. There are ways of doing that.

Is he gay?

The first suspicion that comes to mind when a girl realizes that her boyfriend and husband has a strong inner woman, is that he is gay. There are a lot of gay men with strong feminine sides. Some of them may even harbor feminisation fantasies and get turned on by crossdressing. Drag queens explore their inner woman in this way. Some of them do get married, although not as many as before, now that male homosexuality has become accepted.

Still, most male to female crossdreamers are actually gynephilic. They want to have sex with girls. Really! Check his web browser history. If you find a lot of pictures of sexy hunks, he is most likely gay. But if he is more into Penthouse and Playboy he is straight or bi.

Note however, that some gynephilic crossdreamers may have erotic fantasies about being banged by men. That could mean he is bisexual. But if the men of his fantasies are faceless, they may also be an expression of his desire to be the bottom in the sexual act, not a real sexual desire for the male body per se. He would rather have a woman penetrate him than a man, which is why some crossdreamers also get into "shemale" porn.

8 ways of making a crossdreaming sex life work

1. Make sure he understands your needs and desires. Some crossexuals have never spoken to anyone about their desires and have become pretty self-obsessed. This is an interesting paradox: In spite of the fact that he has a strong inner woman, he may lack the skills needed to interpret the dreams of a woman. Make sure that he understand that your "inner woman" is as important as his. Most crossdreamers can take the active role when having sex -- he owes you much more than that!

2. All right, so he is willing to please you. What can you do to please him? Take the active role! He will love you to be on top! He may fantasizing about you being the one inside him and not the other way round, but who cares as long as you get turned on together?

3. Talk dirty to his inner girl! That will shock him and delight her.

4. If he is a crossdresser, allow him to wear some lingerie. Borrow him some of yours if it fits. But if it makes you very uncomfortable, don't. Your needs are as important as his!

5. His inner woman may desire penetration. A finger up his anus may drive her wild. You will find that his ecstasy will turn you on as well. But demand proper hygiene!

6. If you are of the daring type, try out a strap-on. Pegging gives you full control and allows for his submission.

7. Most men, including many crossdreamers, do not fully get the bonding part of sex, i.e. that sex is just the natural culmination of friendship and love. Some crossdressers do, however. They would very much like to have a pajamas party for two with you doing girly things together -- like painting your toe nails and talk feelings. If you can live with him dressing up, that can work well. Again, tell him when you need him to be your man and not your girl friend!

8. Some crossdreamers would also like to make some body modifications. Shaving body hairs and electrolysis fit well into the crossdressing category. If you can live with his crossdressing, this should not be much of a burden. If he wants to take hormones, however, you need to have a looooong talk, and seek some counselling. Some wives can live with their man growing breasts. But he may also become non-functional as a man. Know also that if he wants to try out hormones there is a very good chance that he is a transwoman.

The ups and downs of a normal relationship

The relationships between a male crossdreamer and a woman are not that different from "regular" relationships. Or maybe there are no "regular" relationships. Given human diversity, they are all unique exercises in making love grow, and love requires patience, understanding, perseverance as well as a the kind of self-confidence and strong will that protects you from being exploited.

Crossdreamers may be traumatized from their struggle with their dreams and desires, especially if they have never felt acceptance for their secrets. That trauma may be healed by love, but it may also require professional help.

Go to My Husband is an Autogynephiliac for the story of Susanne and William, and their way of integrating crossdreaming into their love life.

If you have found ways of integrating crossdreaming (autogynephilia) in your love life, please share it in a comment!

Confessions of an Autogynephiliac

Thank you for all your suggestions for a new name for this blog!

"Confession of an Autogynephiliac" has now become "Crossdreamers". This name was suggested by tg_captioner and others.

If I am to untangle myself from all the negative connotations following the autogynephilia term, I need to make sure that the alternative term is clearly communicated.

I have also had emails arguing that the "crossdreamer" term is useful. It covers all men who have erotic fantasies of feminisation and having a woman's body.

I will follow up on Chris' proposal with posts on "the Anima". I think the Jungian concept is very useful for our purposes.

Several of you, including Isobelle, have argued that I should keep the "Confession" bit, as it makes the blog more intimate and personal.

Others, however, have pointed out that the word "confessions" indicate that I have a sin to confess, and since crossdreaming is a natural phenomenon that is giving the world the wrong message. That is a good point!

Radio show on Michael Bailey's book on transsexualism

In 2002 J. Michael Bailey published a book on transsexualism and autogynephilia called The Man Who Would Be Queen.

It is not really a scientific work, more of a popularization really. It was, and continues to be, very controversial.

I am not going to repeat my own arguments with the theory of Bailey's here, but point you to a 2007 radio show over at the San Francisco public KQED radio.

The guests are:

• Dr. Alice Dreger, associate professor of Clinical Medical Humanities and BioEthics at Northwestern University. She is the author of "The Controversy Surrounding The Man Who Would Be Queen: A Case History On the Politics of Science, Identity and Sex in the Internet Age".


• Dr. J. Michael Bailey himself , professor of Psychology at Northwestern University


• Joan Roughgarden, professor of Biological Science at Stanford University and author of "Evolution's Rainbow". She is the one having promoted the social selection paradigm in evolutionary biology. I have written about her and her work in my Sex, Gender, Nature series. She was the one who drew my attention to this radio show.


• Mara Keisling, executive director of the National Center for Transgender Equality

TS Roadmap has a transcript of the show.

Looking for a new name for the blog

Those of you who have read my posts on the DSM-V, will understand that I am getting to the point where the word "autogynephilia" has become too difficult to use in the title of the blog.

Up till now I have called it "Confessions of an Autogynephiliac".

As I have noted before I recognize that "autogynephiliacs" exist (i.e. men who get aroused by the idea of becoming women). This blog is, after all, for them.

The fact that Ray Blanchard made this term helped me gain a better understanding of myself, and I am grateful for that. Hopefully my use of the term has also helped others.

The problem is, however, that the term carry a lot of baggage I would like to leave behind.

• The "auto" of autogynephilia points to the "self" in "loving one self as a woman". I know for a fact that "AGPs" are capable of loving real women. I do so myself.
• I do not accept that autogynephiliacs are "paraphiliacs". The erotic fantasies are most likely the result of an underlying gender identity or a combination of biological and psychological factors. Blanchard has no explanation for his "target location error" theory, and it does not capture the complexity of the experience of being a "crossdreamer".
• I know for a fact that autogynephilia is not something that appears at puberty. It cannot therefore be reduced to a mere sexual phenomenon, or at least no more so than any other gender expression.
• It makes no sense to have a term that only applies to biological men, when we know that there are female to male crossdressers and "crossdreamers" as well. Blanchard's reluctance to include F2M transmen pretty much proves that he is caught up in gender stereotypes.
• The autogynephilia theory is reductionist to the point of becoming absurd. Sexuality and gender identity involves many more factors than a binary system of sexual orientation.

So I need a new name for my blog. Do you have any suggestions? It should preferably be a name that tells my visitors what the blog is about.

DSM-V: What others say

I just wanted to draw your attention to a few other blog posts covering autogynephilia and the DSM-V manual (see my previous post).

Cheryl over at Cheryl's Mewsings makes a point similar to mine regarding the fact that crossdressing men are considered perverts, while crossdressing women are not:

"Let’s backtrack a little to talk about Transvestic Fetishism. This is what we used to call Transvestism, and is used to be an 'illness' only if it caused distress. Under the draft of DSM-V it is now an illness regardless of whether the patient is distressed or not. It is also gender-specific. Only men can be diagnosed with it. So if a woman wears clothes that the psychiatrist deems appropriate to a man that’s fine, but if a man wears clothes that the psychiatrist deems appropriate for a woman then he’s automatically diagnosed as crazy, even if he exhibits no other symptoms."

The DSM-V does give transsexual autogynephiliacs the chance of having sex reassignment surgery, but the price is high. Cheryl puts it this way:

"I should note that Blanchard & Zucker are prepared to allow people that they diagnose with Autogynephilia to go forward for surgery. However, that is at the price of having been labeled a narcissistic sex pervert, and with no option for being declared 'cured' as there is with Gender Incongruity."

Over at Wrestling Emily Dickinson Adam Fish follows up on Chery's musings, discussing the "reality" of autogynephilia. He points out, correctly as I see it, that psychological disorders are not the same as illness caused by viruses and bacteria. Mental disorders are "nebulous collections of symptoms":

"But the labels we apply to these collections of symptoms are always subject to change, as are the symptoms which fall under a certain label. For example, schizophrenia as we know it has developed over a curious course of diagnostic evolution from its original classification as 'dementia praecox' to the clinical definition we know today. Currently, moves are afoot to eliminate Asperger's Syndrome as a separate condition and merge it with the other Autism Spectrum Disorders, on the grounds that it fits in better on that spectrum than as a separate entity. All this is as it should be: research modifies our understanding of a condition, which in turn modifies the way we categorise it, which in turn leads to improvements in the ways we treat or help people deal with these conditions. "

Exactly! Good science is always changing, challenging its own preconceptions. This requires humility in the face of complex phenomena like crossdressing and autogynephilia. As far as I am concerned Blanchard and his friends have the right to do the research they do and make the claims they do. But they and everybody else should keep in mind the following:

Blanchard and his friends have not presented the objective truth of anything. They have no real proof for their statements. That does not mean that theirs is bad science. It isn't. It just means that we have to read it for what it is: Another argument in a never ending scientific discussion.

Blanchard and his friends (as well as all scientists) are not disinterested observers of the world. They carry their own baggage and their own prejudices, and in this case it seems that what their mama told them ("Real men don't dress up in skirts, but women can wear trousers!") forces them to interpret their observations in one way only.

These ideas about what is normal and abnormal sex has been reinforced by their scientific training. Traditional evolutionary biology can only interpret hetero sex normal, as that is the only sex that can lead to offspring. This is why Blanchard & Co spends so much time on trying to explain homosexuality and why they cannot accept that heterosexual men would like to be women.

Fish again:

"I mentioned in my previous piece that, for a long time, homosexuality was considered a psychiatric 'disorder' because it was regarded as 'abnormal.' Thankfully, these days it is accepted that this isn't the case. But psychiatry persists in categorising some sexualities as normal and others as not so. The device used for this purpose is the idea of 'paraphilia' or, in layman's terms, sexual fetishism. "

But something doesn't have to be causing anyone harm to be considered a paraphilia. Fish argues gender incongruence becomes a disorder because it conflicts with the social expectations a society places on someone because of their birth gender, and failing to meet those expectations causes feelings of trauma and guilt:

"Most sexual fetishes only become disorders when the treatment of people who happen to enjoy such fetishes leads to their experiencing feelings of marginalisation and low self-worth. "

The purpose of medicine is to heal those who are hurting, without harming them further, Fish says.

"So, to return to Autogynephilia, here we have a definition of something which could easily be classed as Gender Incongruence, but isn't because some cis male psychologists have decided that the only real gender incongruence is heterosexual in nature. If you're a [male to female] trans woman and you want to fuck men, Roberta's your auntie. But if you're male assigned at birth, feel gender incongruence, but want to get it on with other ladies...that's not real Gender Incongruence. That's just a paraphilia. That's just sexual deviancy (don't worry if you're a [female to male] trans man who wants to fuck other fellas, though. Ray Blanchard doesn't consider gay trans men in his definition of Autogynephilia. Perhaps, like Queen Victoria on lesbians, he doesn't think they really exist)."

Fish's advice to the DSM is simple: Focus on gender incongruence and drop autogynephilia.

See also comments by

• Kelly Winters
• Aethelread
• Pam's House Blend
• For a second opinion, see Alice Dreger's post over at the Bioethics Forum

DSM-V: What about autogynephilia?

Some of you have asked me what I think about the proposal for DSM-V, the the fifth edition of the US Diagnostic and Statistical Manual of Mental Disorders (DSM-5) , which is to be published in 2013.

What this manual says about transsexuals and trangendered people matter a lot, both as regards the common understanding of such phenomena and to what extent Americans can get insurance companies to pay for treatments.

The good news is that there is a new gender incongruence category that leaves room for both classical transsexuals as well as other transgendered people. The bad new is that the category for transvestic fetishism remains.

A wide view of gender identity

The description of gender identity disorders has become more tolerant of gender variation. In fact, the proposal no longer talks about a gender identity disorder, but gender incongruence.

The argument is that this is a descriptive term that better reflects the core of the problem: an incongruence between, on the one hand, what identity one experiences and/or expresses and, on the other hand, how one is expected to live based on one’s assigned gender. The term is considered less stigmatizing than gender identity disorder.

This is what it says:

Gender Incongruence (in Adolescents or Adults)

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by 2^* or more of the following indicators:

1. a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics)

2. a strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)

3. a strong desire for the primary and/or secondary sex characteristics of the other gender

4. a strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)

5. a strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)

6. a strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

The transsexual dimension

The revision has been taken as a confirmation of the binary view of sex and gender, meaning that this definition fits "classical transsexuals" (women trapped in men's bodies) only.It does fit the lives of M2f classical transwomen well. Their experience of being born with a body of the wrong sex is accepted, and it seems to me these formulations will help them gain respect as women. That is a good thing.

The transgender dimension

According to the "Rationale", the text also allows for a "transgender" interpretation, opening up for a wide variety of gender identities. Paragraph 5 clearly points to "alternative gender" as well as "the other gender."

This is what the comment says:

"Furthermore, in the DSM-IV, [the present edition] gender identity and gender role were described as a dichotomy (either male or female) rather than a multi-category concept or spectrum (Bockting, 2008; Bornstein, 1994; Ekins & King, 2006; Lev, 2007; Røn, 2002). The current formulation makes more explicit that a conceptualization of GI acknowledging the wide variation of conditions will make it less likely that only one type of treatment is connected to the diagnosis. Taking the above regarding the avoidance of male-female dichotomies into account, in the new formulation, the focus is on the discrepancy between experienced/expressed gender (which can be either male, female, in-between or otherwise) and assigned gender (in most societies male or female) rather than cross-gender identification and same-gender aversion (Cohen-Kettenis & Pfäfflin, 2009)."

There is nothing in the definition of gender incongruence that says that transwomen who have experienced AGP erotic arousal or who have been crossdressing should not be included. But there is a catch.

Transvestic disorder

The manual does keep the additonal transvestic fetishist category, although under a new name. The category is now called "Transvestic Disorder".

This is what the proposal says about crossdressing and autogynephilia:

Transvestic Disorder

A. Over a period of at least six months, in a male, recurrent and intense sexual fantasies, sexual urges, or sexual behaviors involving cross‑dressing.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

With Fetishism (Sexually Aroused by Fabrics, Materials, or Garments)

With Autogynephilia (Sexually Aroused by Thought or Image of Self as Female)

So crossdressing is no longer a fetish. But don't keep your hopes up. Crossdressers and autogynephiliacs are still perverts.

Committee-member Blanchard argues that the old term (Transvestic Fetishism) stresses erotic interest in the material properties of a woman's clothing. This is too narrow, he believes, as it fails to include the "erotic arousal at the thought or image of one self as a woman" (autogynephilia).

Blanchard believes, as I have noted before, that crossdressing is just one of several subcategories under the top category "autogynephilia". The rest of the text continue to focus on crossdressing, however, and here transvestism is the top category. This leads me to believe that this text is some kind of compromise between Blanchard and other members of the gender identity disorder work group. That is, someone in the committee has insisted that they should stick to "transvestite" as the umbrella term.

Non-crossdressing autogynephiliacs are left out

If autogynephilia is a subcategory under crossdressing, there is no room for autogynephiliacs who do not crossdress. This implicitly means that they do not have a disorder. The crossdressers who want to transition will find themselves marooned in the paraphilia category, however. That means that they have a disorder.

This is, of course, pure nonsense.

All crossdressing is a disorder

As i noted in my previous post on the DSM Blanchard is using his own unscientific prejudices as regards what's normal and what's not as a basis for medical classifications, in effect labeling a lot of people as perverts in the process.

He repeats his extremely narrow definition of normal sex in the accompanying paper (available online).

"Such a name change [Transvestic Disorder] is consistent with my general proposal to distinguish between paraphilias and paraphilic disorders. On this view, a paraphilia is any powerful and persistent sexual interest other than sexual interest in copulatory or precopulatory behavior with phenotypically normal, consenting adult human partners (Cantor, Blanchard, & Barbaree, 2009). "

If you took this definition seriously only heterosexual sex between men and women using a penis and a vagina would pass the muster. And even if Blanchard does accept that homosexuals should not be considered paraphiliacs, the logic underpinning his arguments points in another direction. Note that the definition above has two categories. The A category is a paraphilia. The B category is a paraphilic disorder. The difference is that B - the paraphilic disorder -- causes impairment or distress.

Fine! That would mean that we could leave out the A (the healthy crossdressers), right? And if crossdressing is not a disorder, it should not be included under the headline "transvestic disorder". Moreover, if it is not a disorder, it does not belong in a manual for mental disorders in the first place -- no more than enthusiastic stamp collecting or aggressive mountain climbing.

So you could take out the A category and leave in the B.

The use of language

That is what you would expect. But it does not matter what crossdressers may think, because Blanchard has made up his mind. Read the next paragraph carefully and note the words I have underlined:

"The immediate consequence of re-naming the diagnosis is that the patient does not have to be subjectively distressed or objectively impaired by his transvestism to be identified as a transvestite; he simply has to manifest the syndrome of repeated dressing in women’s apparel with sexual excitement (Criterion A). An ego-syntonic [i.e. in self-denial], well-adjusted transvestite could be classified as a transvestite for research or descriptive purposes without being diagnosed with a disorder.

The crossdresser does not have to be subjectively distressed to be included, because Blanchard believes he has a disorder regardless of what the crossdresser may say. After all, a man who wants to dress up as a woman cannot possible be in his right mind. Getting turned on by imagining himself as a woman having sex as a woman is not a "sexual interest in copulatory or precopulatory behavior with phenotypically normal, consenting adult human partners".

(Or at least, it is not according to him. Most crossdressers actually dream of having normal sex as a woman with normal partners, but who cares about what they say?)

Misogyny

Note that this is the only disorder in the whole manual that is limited to men. A woman who gets aroused by dressing up as a man is not a paraphiliac. Why not? Well, neither the draft nor the Blanchard paper say.

We know that F2M crossdressers and autoandrophiliacs exist. There can only be one explanation: For a man to want to dream about having the body of a woman is considered a disease; for a woman to desire the body of a man is not. What on earth are these people thinking? This is the year 2010, not the misogynistic 19th century!

A convenient excuse

Still, Blanchard clearly sees the problem of classifying healthy people as perverts, so he comes up with an excuse. The "well-adjusted transvestite could be classified as a transvestite for research or descriptive purposes without being diagnosed with a disorder."

So in order to help Blanchard with his autogynephilia research, the American health system is to label a large number of men as mentally ill, even if they are not. And just to make sure that ever doctor in America understand that they are "well-adjusted", the condition is put under the headline "transvestic disorder".

This makes me sick! I know of autogynephiliacs who plan to chemically castrate themselves to get rid of their feelings. Why? Because they are labeled as perverts. Over at Laura's Playground you will find the most tragic tales of transgendered people breaking down under the burden of shame, pain and despair. All caused because their self respect has been obliterated by some people's obsessive need to categorize people as deviants. And yes, there are suicides.

In spite of this Blanchard wants to keep the transvestite disorder category in the manual, so that he can do research.

Smooth operator

In a text that otherwise is both liberal and enlightened, this bigotry makes it through because it is hidden behind a deceivingly smooth phrasing.

Note, for instance, that the word “heterosexual” has been removed "because some transvestites interact sexually with other males, especially when cross-dressed, and may subjectively perceive themselves as bisexual."

OK, so Blanchard and his friends are willing to accept that M2F crossdressers and autogynephiliacs may be attracted to men? Oh no! The phrase "subjectively percieve themselves" means "they may say so, but we don't believe them". Blanchard believes all autogynephilic crossdressers are gynephilic, and that there are no bisexuals.

Where did the gender dysphoria go?

The old DSM-IV specification was the following:

With Gender Dysphoria: if the person has persistent discomfort with gender role or identity

The reason this has been removed is not that Blanchard and his colleagues are not recognizing that crossdressers cannot experience gender dysphoria (or "gender incongruence" as it is called now). They do, but Blanchard argues that you can use the Gender Incongruence category as well if this is the case.

This is actually a good thing. It doesn't matter how much you pull these sentences apart, the manual recognizes that crossdressers can be suffering from "gender incongruence". This also means that autogynephilic fantasies can not in themselves hinder anyone from getting sex reassignment surgery.

But without this specification, the practitioners and specialists do not get the help they need to do this reclassification. The fact that crossdressers can be recognized under the gender incongruence cateogory is hidden. And given that "gender incongruence" is not a disorder, while crossdressing is, this will cause a lot of confusion.

Do we need a "transvestic disorder" category?

I do not accept that crossdressing or autogynephilic fantasies are "paraphilias". I am still open for the possibility that it has a psychological as opposed to a biological origin, although all evidence points in the direction of it having a biological basis. But I do not accept that it is a paraphilia in the way it is defined by Blanchard.

Sexuality is not there for normal procreation only. Sexuality is not that is limited to "copulatory or precopulatory behavior with phenotypically normal, consenting adult human partners". Sexuality is a force that binds us together. Sexuality gives us a room for exploration of our inner identity and of our relationship with others. Sex is creativity. Sex is bonding. And it helps us express love, joy, ecstasy and grief.

For most autogynephiliacs, sexual fantasies are the only way their inner woman can find an expression. And the reason this is the only way, is because there is no room for such feelings in our society. This manual reinforces these prejudices and makes it even harder for these people to find themselves and a life of meaning. This manual negates their identity and makes a mockery of their lives.

I am not saying that there are no mental diseases among autogynephiliacs. There are probably more psychological suffering in this group than in the general population, because of the stigma. There are depressions, obsessions and addictive behavior. But you do not need the "transvestic disorder" category to help them. You can just use the relevant categories for depressions, obsessions and addictive behavior -- as you do for carpenters, hairdressers and lovers of good books.

The transvestic disorder category has to go!

What brain science says about M2F transsexuals

Is there a biological basis for the gender identity of transsexuals and autogynephiliacs? It turns out there might be.

Even if there has been no proper research done on the causes of autogynephilia, there are many scientific papers on the etiology (cause) of transsexualism.

Given that a significant proportion of M2F transwomen are gynephilic, it is reasonable to believe that some of them have or have had erotic fantasies about becoming women as well. The research on transwomen could therefore give us some insight intothe etiology of autogynephilia.

General conclusions regarding the cause of gender identity

Jaimie F. Veale, David E. Clarke and Terri Lomax has made a review of recent research in the paper "Biological and psychosocial correlates of adult gender-variant identities: A review" (Personality and Individual Differences Volume 48, Issue 4, March 2010, Pages 357-366).

These are their conclusions:

"There is evidence that biological factors, especially prenatal androgen exposure, play a significant role in the etiology of gender-variant identities. While there is also evidence for other biological correlates, this does not necessarily imply more than one biological factor plays a role – it is likely that they are related and share a common precursor. For instance, it is entirely plausible that there is a causal pathway from genes causing atypical prenatal hormone levels causing neuroanatomical differences and an adult gender-variant identity.

"We know from studies of individuals with intersex and related conditions that it is not uncommon for an individual to have a male-typical prenatal environment (including androgen levels), to be assigned a female sex at birth, and develop a female gender identity. Therefore, psychosocial factors also have a role to play in the etiology of gender-variant identities.

"There is evidence that a poor or absent parental relationship, childhood abuse, and parental encouragement of gender-variance are more common amongst gender-variant populations. It is unclear whether these are a cause or effect of gender-variance. It is likely that any psychosocial variables that play a causative role in the development of gender-variant identities are complex and work in interaction with biological variables."

In short: psychological and social factors may influence the development of gender identity, but there is most likely a biological basis.

(Sidenote: Note that these researchers are not using the word gender in the sociological meaning -- i.e as a social construct. In this context the word gender is used for the physical basis for behavioral differences between men and women.)

Brain research

There are several research teams who have found differences between the brains of M2F transwomen and the ones of men. This research shows that in some brain areas the brains of M2F transsexual women are more similar to the ones of women. According to the relevant researchers this is not caused by possible hormone treatments.

It should be noted, though, that you cannot rule out some kind of biofeedback, in the sense that the very act of wanting to become a woman may change the brain itself. The plasticity of the brain is significant, and it will change according to how we use it. Still, I must say that idea of us feminizing our brains through sheer willpower is a long stretch.

I should also add that there is a lot the scientists do not know about the brain, and the very fact that there is a correlation between the size of a certain brain area in women and M2F transwomen does not prove that that very area determines gender identification. But it is likely that they do.

A recent study made by Alicia Garcia-Falgueras and Dick F. Swaab, "A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity", (Brain, a Journal of Neurology, published online on November 2, 2008 Brain, doi:10.1093/brain/awn276) concludes that there is such a correlation.

BSTc

The researchers had previously found that "the bed nucleus of the stria terminalis (BSTc)" is female in size and neuron number in male-to-female transsexual people. The BSTc has the size of a rice grain.

The BSTc is found in the thalamus of the brain, and is often referred to by transsexual activists who argue that their female gender identity is inborn. For these activists the sexual orientation of the transsexual women is irrelevant.

This BSTc research was heavily criticised by among others Anne Lawrence, the famous autogynephilic transwoman and Blanchard supporter.

Lawrence points out that individuals who oppose Blanchard's formulation tend to favor the brain-sex theory, which postulates that there is a neuroanatomical basis for female gender identity in MtF transsexuals that is independent of sexual orientation. The brain-sex theory is a "unitary" theory of transsexualism. It therefore appears to contradict what she calls the"widely accepted theory" of Blanchard.

[Image: The thalamus. Photo from Wikipedia]

She writes:

"According to Blanchard's typology, homosexual MtF transsexuals, who are exclusively sexually attracted to men, seek sex reassignment primarily because their appearance and behavior are markedly gender-atypical. Nonhomosexual MtF transsexuals, who may be sexually attracted to women, to women and men, or to persons of neither sex, are not markedly gender-atypical in their appearance or behavior; they are believed to seek sex reassignment primarily because they are sexually attracted to the idea of becoming women, a paraphilic sexual interest that Blanchard (1989a) called autogynephilia. "

When trying to explain why the BSTc findings do not undermine Blanchard's theory, Lawrence presents three possible explanations:

• "First, but probably least likely: The Zhou/Kruijver findings might reflect the chance selection of a sample of MtF transsexual brains with unrepresentative BSTc volumes and neuron numbers.

• Second, and somewhat more likely: Because all six MtF transsexuals in the Zhou/Kruijver studies were probably nonhomosexual, their atypical BSTc volumes and neuron numbers might be markers for nonhomosexual MtF transsexualism specifically, but not for MtF transsexualism generally.

• Third, and most likely: The Zhou/Kruijver findings might reflect the effects of feminizing or masculinizing hormone therapy, which all six MtF transsexuals and the one FtM transsexual received."

The report she is referring to is Kruijver, F. P., Zhou, J. N., Pool, C. W., Hofman, M. A., Gooren, L. J., & Swaab, D. F. (2000). "Male-to-female transsexuals have female neuron numbers in a limbic nucleus." Journal of Clinical Endocrinology and Metabolism, 85, 2034-2041. This is the research Garcia-Falgueras and Swaab are referring to as well.

In other words: Lawrence believes that all of the M2F transwomen included are autogynephiliacs. That leaves her with a big problem. The research seems to indicate that as regards this brain area, these AGP transwomen are more like natural born women. That seems to imply that they have some kind of inborn femininity.

But autogynephiliacs do not have an innate femininity according to Blanchard, so this is a finding Lawrence cannot accept. Lawrence therefore concludes that the fact that their brains look feminine must be an effect of hormone therapy:

"The simplest and most plausible explanation of the Zhou/Kruijver findings is that they are attributable, completely or predominantly, to the effects of cross-sex hormone therapy administered during adulthood. There is no longer any reason to postulate anything more complicated."

Note that the original researchers argued that they had taken the possible effects of hormone treatments into consideration.

Round Two

But this was not the end of the story. The Swaab & Co team had heard the complaints. And now they had decided be even more careful when checking for variables like gender orientation, hormone treatments, non-transsexual control groups etc.

INAH 3 and 4

In the new study the Swaab & Co team investigated the so-called "hypothalamic uncinate nucleus", which is composed of two subnuclei, namely interstitial nucleus of the anterior hypothalamus (INAH) 3 and 4.

Don't worry too much about all these medical terms. The point is that they have found another area of the brain, close to the BSTc, that also varies in size between men and women.

The researchers used post-mortem brain material from 42 subjects: 14 control males, 11 control females, 11 male-to-female transsexual people, 1 female-to-male transsexual subject and 5 non-transsexual subjects who were castrated because of prostate cancer.

They say that the most pronounced differences were found in the INAH3 subnucleus.

"Its volume in thionin sections was 1.9 times larger in control males than in females and contained 2.3 times as many cells . We showed for the first time that INAH3 volume and number of neurons of male-to-female transsexual people is similar to that of control females. The female-to-male transsexual subject had an INAH3 volume and number of neurons within the male control range, even though the treatment with testosterone had been stopped three years before death. "

In other words: The data seem to indicate that the INAH3 volume and neuron number in transsexual male-to-female people is in the female range, while the values of the female-to-male subject is in the male range.

They researchers propose that the sex reversal of the INAH3 in transsexual people is at least partly a marker of an early "atypical sexual differentiation of the brain" and that the changes in INAH3 and the BSTc may belong to a complex network that may structurally and functionally be related to gender identity.

The fact that they refer to both volume and the number of neurons is important, as the neurones are more densely packed in female brains. This is the only reason female brains are smaller than male brains. The overall number of nerve cells are similar, which means that it the number of neurons in a region become equally important if you are to track down differences between men and women.

The researchers argue that differences in adult testosterone levels can only partly explain the observed differences in the INAH3 subdivision of transsexual people while estrogen levels do not seem to have an influence.

And yes, they have looked at gender orientation. That is: they are aware of the fact that some believe that M2F gynephilic transsexuals may be fetishists or paraphiliacs and for that reason cannot have an innate femininity. Still, they have found no difference between man-loving and woman-loving M2F transwomen:

"In male-to-female subjects the number of neurons in the INAH3 does not seem to be related to sexual orientation, nor to the onset time of transsexuality, but rather to atypical early female-biased gender."

In other words: all the M2F transsexuals seem to suffer from a misalignment between their brain sex and their body sex.

The researchers believe that these are the brain structures are responsible for gender identity formation:

"The differences observed between the INAH3 structure, its innervation in relation to sexual orientation and gender identity and its putative connection to the BSTc suggest that these two nuclei, together with the SDN-POA (= intermediate nucleus, = INAH1 and 2) and the SCN (Swaab et al.,1985) are part of a complex network involved in various aspects of sexual behaviour."

No proof, but clear indication

Again: This is not the final proof for the brain sex theory. This kind of brain research is in its infancy, and new research may go in another direction. Still, it seems to me that current neurological research is accepting that gender identity formation is based in the brain and that it has a genetic or pre-natal (before birth) hormonal explanation.

Moreover, the researchers seem to believe that this gender identity is not linked to sexual orientation. In other words: whether the M2F transwomen love women or men makes no difference.

We do not know whether any of the transwomen included in this research were or had been autogynephiliacs. But if Lawrence and Blanchard are correct when they say that all non-androgynephilic transsexuals are autogynephiliacs, they must have been. I must admit that I am not so sure of that, but given the large number of autogynephiliacs that do transition it is likely that at least some of them were.

The variants of autogynephilia

If the brain sex researchers are correct, and gender identity formation is anchored in these brain areas, the next question would be: To what extent are other, non-transsexual, autogynephiliacs similar to women brain wise?

Could it be that the autogynephiliacs and crossdressers who do not feel the urge to transition have INAH3 and BSTc structures that are in between men and women in size? Or is the great variation we find among autogynephiliacs caused by psychosocial factors?

Another possibility may be that different brain areas determine different aspects of the gender identity and sexual orientation. Joan Roughgarden has argued that this kind of research does not confirm the gender binary (Evolution's Rainbow, p. 240).

She points to the fact that the three "sexually dimorphic neural clusters" (i.e. BSTc, SDN-POA and VIP-SCN) vary independently of one another. A person can have a "female" BSTc and a "male" SDN-POA etc. This leads to a large number of possible combinations. The large number of permutations may explain the confusing array of gender identities we find around us.

Swaab & Co add another dimension to this. They speculate that the INAH3 volume may have a relationship with sexual orientation while the number or neurons is related to gender identity. One of the gynephilic M2F transwomen examined had not had a hormone treatment. This person's INAH3 was in the male range volume wise (an indication of gynephilia), but she had a female number of neurons (an indication of a female gender identity).

The researches should probably include some non-op crossdressers in their next study.

In any case: this research can be interpreted as a neurological underpinning of Natalie's innate femininity theory. In other words: gynephilic -- and through them also autogynephilic -- transwomen seem to have a biological basis for their gender dysphoria.

For a second opinion, see Cloudy's post over at On the Science of Changing Sex: The Incredible Shrinking Brain.