December 11, 2012

"Is there a cure for autogynephilia?"

A cure for autogynephilia.
(Photos.com)
My site statistics cannot tell me who my readers are, but the numbers do tell me what search terms they used when finding the site. The most popular search phrase is variations of "Is there a cure for autogynephilia?" (or "Is there a treatment for autoandrophilia?" as might be).

I will,  to the best of my ability, try to answer that question in this blog post.

An important disclaimer

Before I do, however, there are a few points that have to be made:

1. "Autogynephilia" is a term made by the researcher Ray Blanchard meaning "the love of one self as a woman". The idea is that autogynephiles are men sexually attracted to the image of themselves as women (as opposed to "normal" men who are attracted to real women "out there").

This explanation is definitely wrong. Male to female "autogynephiles" do fall in love with real women "out there" all the time, and are often very loyal partners and husbands. Nor can crossdreaming be reduced to a sexual condition only.

I have coined the term "crossdreaming" as a neutral alternative. It simply refers to men and women who get aroused by imagining themselves as the opposite sex. As I understand it crossdreamers is a subcategory of the umbrella term transgender (referring to all people who diverge from the normative gender roles allotted  to their original biological sex).

2. There is in fact no scientific consensus on what causes crossdreaming. I belong to those that believe that it has a biological core that is expressed through culturally determined symbols, but you should not take my word for it. All crossdreamers have to determine for themselves what makes sense to them.

3. I am not a certified doctor, psychologist or sexologist. I probably know more about crossdreaming than most professionals, but you should always seek professional guidance before you do something drastic. If you find a therapist with and open and emphatic heart, that may compensate for their lack of crossdreamer competences.

Is there a cure for crossdreaming?

The short answer to this question is no. Sorry about that.

I have been in touch with a large number of crossdreamers and crossdressers, and I have read most of the literature. I have so far not found one reliable story about a crossdreamer who has been cured of this condition.

But do not despair yet. There are ways of coping.

In the following I will discuss what strategies seem to work and what clearly does not work. I am not going to burden you with a lot of academic references in this post. If you want to explore the literature, explore this blog. Many posts contain extensive discussions of research in the area.


Conditioning

One of the most popular ways of handling crossdreaming is through conditioning. All the way up to the 1980's it was not uncommon for doctors trained in so-called behavior therapy  or aversion therapy to give a crossdresser -- or "transvestite" as they used to be called -- electroshock while he was dressed up as a woman. Some also gave them nausea inducing drugs to eliminate what was considered an undesired behavior. This treatment was also given to children.

This type of treatment is the same  as the so-called conversion therapy or "reparative therapy" given to homosexuals.

The basic idea is that transgender conditions as well as homosexuality are personality traits or obsessions acquired through some kind of conditioning, childhood trauma or bad influences.

In other words: The premise is that these conditions are not inborn --- they are unnatural perversions and can be cured by "reprogramming" the mind of the crossdreamer. This is done by forcing  him (or her) to associate sexual arousal from crossdreaming with pain.

This form of therapy is now generally considered very  harmful and inhumane by health professionals in most civilized countries. It is condemned by, for instance, the American Psychiatric Association and the American Psychological Association.

There is also broad agreement among professionals that these therapies do not work, not on homosexuals and not on transgender people.

In fact, they will  make patients suffer more. The ideology that underpins these therapies consider both homosexuals and transgender people mentally ill deviants.They therefore reinforce homophobic and transphobic attitudes found in our cultures, and instill even more guilt and shame in the crossdreamers.

Self-conditioning

The fact that these therapies do not work is a clear indication that these conditions are not caused by  conditioning, and that there is more to them than psychological trauma.

This doesn't stop crossdreamers from trying to condition themselves, though. Again and again crossdreamers try to discipline themselves by burning their alternative wardrobe, by punishing themselves for reading transgender stories and for just thinking about being the opposite sex.

Many male to female crossdreamers try to purge their mind of transgender thoughts by taking part in "manly" activities, including joining the military. Parents and family members also do their best to "toughen them up", while female to male crossdreamers  are force fed Barbie dolls and pink dresses.

Others crossdreamers try to ignore the problem, hoping that it will disappear by itself. This is not a stupid assumption. After all, there are other psychological problems that will go away by themselves as a person's life situation changes. Getting a new job may cure depression.

Some crossdreamers hope that a normal married life will extinguish the crossdreamer longings. For a while this may even seem to work, as busy days taking care of children and life in general keep the thoughts at bay. In the end, however, the feelings will reappear, and if the crossdreamer continue to suppress this side of him- or herself, they will only get stronger.

In other words: These types of "self-conditioning" do not work either, for the same reasons "reparative therapies" do not work.

Psychotherapy

In the early 20th century researchers like Magnus Hirschfeld developed a very open minded and tolerant view of crossdreamers, recommending acceptance and respect. Sigmund Freud's theories should in principle lead to the same kind of tolerance, given that his basic premise was that all men and women are bisexual fetishists.

Instead psychoanalysis became increasingly oppressive. It became, in fact, one of the major tools for cultural discipline, in the US in particular, but also in other parts of the world.

Some of the most extreme psychoanalyst used the same conditioning techniques as the behaviorists. Others went for a slightly more humane talking cure where the patient was to find and accept the childhood trauma that presumably led to their "unnatural" desire to be the other sex.

Even now you will find a lot of psychotherapists who claim they can cure transgender people.

I have found absolutely no proof of such a cure being possible. This means that the same applies here as for behavioral therapy: The "cure"  becomes part of the problem.

That does not mean that psychotherapy cannot be of use to transgender people. Far from it! It might actually be essential in a journey towards self-discovery and self-understanding. Moreover, the very act of finding an emphatic soul that is willing to listen to your problems and help you carry your pain may make an intolerable situation tolerable.

And if you do believe, like I do (and many -- if not most -- modern psychotherapists do as well) that being transgender is a natural inborn phenomenon, talk therapy may bring the reconciliation and self-respect  transgender people need.

Pharmaceuticals

Most scientists within the biological disciplines  now believe that crossdreaming has a biological component that could be caused by pre-natal hormonal influences. As far as I know, however, none of them believe that it is possible to rewire the brain by the use of hormones.

The most popular theory right now is that the wiring is developed in the womb, and that you cannot change the basic sex identity or the sexual orientation at a later stage.

Pumping a male to female crossdreamer full of testosterone will make him sick and aggressive,  but it will not make him more manly.

There are, however, doctors who try to alleviate the pressure of crossdreaming fantasies by giving crossdreamers antiandrogens (AKA "anti-T", a medicine that blocks the reception of androgens in the body).

Androgens like testosterone are hormones that -- among a lot of other things -- leads to development of male sexual characteristics in men. Women have them too, although in smaller quantities.

Given that many crossdreamers find no normal outlet for their dream of having sex as a woman, they can develop what is called obsessive compulsive disorders. The antiandrogens are supposed to diminish the sexual urge that fuels this obsession.

From what I hear in male to female crossdreamer circles, this might work for some, but it does not remove the crossdreamer fantasies completely. In other words: This therapy does not constitute a cure, and the negative effects are many, including possible impotence.

Other therapists believe giving a male to female crossdreamer antiandrogens may lead to a hormonal balance that is more in harmony with his feminized brain. The hormones therefore have a calming effect on the crossdreamer, and many male to female crossdreamers do report that taking antiandrogens give them a sense of peace. Others, though, report that antiandrogens make them depressed and even suicidal.

A more radical step for male to female crossdreamers is to take estrogen and so-called female sex hormones. Both men and women produce estrogen naturally, but men has much less of it than women.

Some doctors give estrogen to male bodied persons who do not plan to transition, as it may give them a sense of emotional calm. Again the effect is that a possible obsessive part of erotic crossdreaming becomes less prominent, even if the general dream of becoming a woman does not disappear.

Indeed, the male to crossdreamer may feel that taking estrogen represents an affirmation of an inborn femininity, and the fact that someone -- i.e. the doctor -- accepts this femininity is helpful in itself. It is therefore  hard to know to what extent the hormones really change the psyche of the crossdreamer or whether we are facing some kind of placebo-effect.

The side effects may be dramatic. The hormones may change the body of the crossdreamer and make it more feminine. Male to female crossdreamers may enjoy growing breasts, but their female partners may find it disconcerting. Some of these changes will be irreversible.

My impression is that many (but not all) of the MTF crossdreamers who accept -- or ask for -- estrogen pills are truly transsexual.

My knowledge of female to male crossdreamers ("girfags" and "transfags") is more rudimentary, but I know that some of them may experiment with testosterone to realign their psyche with their inner self. To what extent doctors help them with this if they are not going to transition is unclear to me.

I would strongly urge any crossdreamer who contemplate taking hormones to contact a doctor.The negative health effects may be severe if you do this the wrong way. Given the emotional roller coaster effect such hormones may have, crossdreamers would also benefit greatly from having a therapist to consult while using them.

I would love to have some input from crossdreamers who have tried hormones regarding their effects. Please add a comment to this post!

Creative crossdreaming

Uli Meyer came up with the term "creative transvestism" in her study of female to male crossdreamers or girlfags. I have adopted the term as "creative crossdreaming".

Regardless of whether you consider  crossdreaming a biological or psychological phenomenon, it is clear that it nearly always lead to some kind of psychological repression. Crossdreaming is considered a taboo in most communities, and the social stigma attached to it is significant..

The tolerance of homosexuals is increasing. Transsexuals are more accepted than ever before, at least in "industrialized" countries. Unfortunately non-transsexual transgender people  fall between the cracks. This especially applies to male to female crossdressers and crossdreamers. While our societies may sometimes forgive a woman who behaves like a man, the opposite remains unacceptable in most circles (including many gay communities).

Crossdreamers must therefore find other ways of expressing their "inner man" or "inner woman"  to let off steam and in order to explore their own psyche and identity. Many do this through creative crossdreaming.

Uli Meyer tells the story of female to male crossdreamers writing slash and yaoi comics and stories, where they can explore the possibility of being a gay man. Male to female crossdreamers may write and read so-called "TG fiction", short stories and novels about men being transformed into women. There is also a thriving captioning culture, where crossdreamers create "TG caps" consisting of photos accompanied by short texts.

These stories, captions and comics may be erotic or non-erotic, but they all help the crossdreamer stay sane. This is in many ways another variation of the corollary that emotional suffering may lead to artistic creativity. It certainly does in transgender circles.

Crossdressing

I know that most of the people finding this post via Google are looking for a way to stop crossdressing. The fact is, however, that crossdressing is one of the most efficient way of coping with crossdreaming, and to stay mentally healthy.

Through crossdressing both male and female bodied crossdreamers get a release from an oppressive society that does not normally allow for such  violations of gender roles. Through crossdressing crossdreamers may explore the dream of being of the opposite sex (or -- as a transsexual will tell you -- his or her real sex).

The problem with crossdressing as well as creative crossdreaming is that these activities may become compulsive and obsessive. This is why some therapists recommend controlled crossdressing.

These therapists argue that the transgender condition is real and normal. Acceptance  removes much of the guilt and shame associated with crossdressing. But for some crossdreamers this tolerance comes too late, and the person has already established behavioral patterns that can diminish his or her life quality severely and which can cause him or her to neglect the needs of loved ones. Establishing a kind of well defined, fixed, and accepted space for crossdressing may therefore be of help.

Crossliving

I have been in touch with many crossdreamers who live out their dreams without transitioning. They go beyond crossdreaming and crossdressing. Alice Novic is one such male to female crossdreamer. She dresses up as her female sex and explore her sexuality with men.

If you have the body and the looks to get away with it, this may work. I also know of female to male crossdreamers who put on their strap-on and dominate their male lover, in the same way a lesbian may enjoy the company of a female "femme" lover.

Crossdreamers with a non-transgender partners may also include crossdreaming in their sexual games.  It is amazing what you can do as soon as you get the idea that crossdreaming is something sinful out of your mind. Through compromises, love and understanding a lot of couples make this work.

Transitioning

But if you define having dreams about being the opposite sex a problem, moral failure or a sexual perversion, there is actually only one way of "curing" it, and that is transitioning. It seems that for most post-op transsexuals the crossdreaming disappear or  is transformed into the "normal" sexual desires of a regular heterosexual or homosexual men or women..

That will come as no surprise to those of us who believe that crossdreaming is caused by some kind of misalignment between the brain and the body. The sexual arousal that follows from crossdreamer fantasies is just an expression of a desire that it is hard to express in a "normal" relationship. As soon as you can express this sexuality  as your target sex, the very idea of becoming the other sex stops being erotic.

Or, at least, this applies to most post-op transsexuals. There are those to continue to enjoy creative crossdreaming, and as regards fetishes, these are as common among crossdreamers and transsexuals as among non-transgender house wives reading "Fifty Shades of Grey".

This does not mean that hormone therapy and sex realignment surgery is the solution for all crossdreamers. I believe -- in fact -- that it is only the solution for a few. There are at least two reasons for this:

The first is that the transgender condition is not a simple binary where all transgender people are women or men trapped in the wrong body.

For some this metaphor makes sense. These are the gender dysphoric, i.e. the ones that are completely alienated from their own birth bodies and who suffer daily from the discrepancy between their inner and outer selves.

But many crossdreamers do not suffer from gender dysphoria. Some of them identify fully with their birth sex and crossdream only for the thrill of it. Others belong in the twilight zone between the sexes and find it impossible to identify fully with one sex or the other. For these people transitioning makes little sense.

It is not given that all gender dysphoric crossdreamers can or should transition either. There may be health reasons, professional reasons, family reasons for not going down that road. No one can truly know the life situation of another human being, so who are we to judge? I am gender dysphoric myself and I am not going to transition.

But for some transitioning is the only way of staying sane or staying alive. They need all the support we can give them.

Click here for essential blog posts on crossdreaming, autogynephilia and autoandrophilia

The American Medical Network has an extensive article on the treatment of transvestism

Discuss crossdreamer and transgender issues!