July 4, 2022

The DSM-5 updates its gender/transgender vocabulary in a positive way, but "autogynephilia" remains

The American psychiatric manual, the DSM-5 (now called DSM-5-TR) has revised the chapter on gender dysphoria. The main changes reflects a more on target and respectful language for describing gender variance. 

  • The term “desired gender” is now “experienced gender.“
  • The term “cross-sex medical procedure” is now “gender-affirming medical procedure.”
  • The term “natal male”/“natal female” is now “individual assigned male/female at birth.”

It seems to me that the doctors writing this chapter are both willing and able to have a constructive dialog with trans people.

I am not saying that the gender dysphoria  text is perfect. Why on earth they continue to use the term “disorders of sex development” for intersex people, given the history of “gender identity disorder”, is beyond me. They did at least include the term “differences of sex development” as an alternative.

You can read the revised introduction to the DSM-5-TR gender dysphoria chapter here. 

Autogynephilia remains

What they have failed to do is to remove the “autogynephilia” diagnosis from the paraphilia chapter. 

The inclusion of this pseudo-scientific term is extremely unfortunate, and reflects the influence of Ray Blanchard on the DSM-5 process. The term is actively used by anti-trans activists to invalidate trans women. Indeed, Blanchard himself is actively helping TERFs and right wing extremist spread their transphobic gospel.

It is important to note that the inclusion of this term does not mean that the DSM-5 has adopted Ray Blanchard’s overall theory or view of trans women. Indeed, there is no description of Blanchard’s overall model of gender variance in the manual. 

The gender dysphoria chapter underlines that “autogynephilia” (in the sense of erotic cross-gender or crossdreaming erotic fantasies) may be an expression of gender dysphoria (which is not a mental illness in the DSM-5):

“A predisposing factor under consideration, especially in individuals with postpubertal-onset gender dysphoria (adolescence, adulthood), includes history of transvestism that may develop into autogynephilia (i.e., sexual arousal associated with the thought or image of oneself as a woman).”

The “autogynephilia” diagnosis (“sexually aroused by thoughts or images of self as a woman”) remains under the “Transvestic Disorder” heading, which is a part of the “Paraphilic Disorders” chapter. 

I understand that the DSM-5-TR editors may see erotic crossdreaming or “autogynephilia” as an expression of “transvestic disorder” in the same way as it can be an expression of “gender dysphoria”. In this way “autogynephilia” is not considered a mental illness in and for itself. 

But this is, frankly, meaningless sophistry resulting from too many compromises. The whole “transvestic disorder” chapter should have been removed from the manual, in the same way WHO removed “fetishistic transvestism” from its international ICD-11 health manual.

Members of the relevant ICD-11 working group put it this way back in 2012:

The ICD-11 Working Group on the Classification of Sexual Disorders and Sexual Health believes it is now appropriate to abandon a psychopathological model of transgender people based on 1940s conceptualizations of sexual deviance and to move towards a model that is (1) more reflective of current scientific evidence and best practices; (2) more responsive to the needs, experience, and human rights of this vulnerable population; and (3) more supportive of the provision of accessible and high-quality healthcare services.

The gender dysphoria chapter uses the term "autogynephilia" as a neutral descriptive term of erotic crossdreaming. But it is not a neural term, and the editors of the DSM-5-TR should have understood that, especially now that the term is actively used as a weapon against transgender women.

See also: 


  1. they could simply have called it cross gender arousal but by using the term AGP you are implicitly giving the Blanchard pseudoscience weight and saying that the origin of a trans identity is steeped in sexual deviance. Doing the right thing could have been as simple as pointing to a symptom rather than to a proposed unproven origin. Hence the DSM has failed in my opinion showing that many either didn't read Blanchard properly or very much believe in his work.

  2. I agree. It is as simple as that. I am afraid that some (but not all) of esteemed doctors are so used to work behind paywalls for periodicals, manuals and conferences, that they do not understand that the terms they use have an effect in society. They somehow think they stand outside society. They do not.

  3. Hello, my comment it's off topic. My best friend wanted go through transition from woman to man. He really wanted to get on that side and was extremely happy after surgery. I will never forget his smile in hospital after removing breast :) Unfortunately he is not happy at all now. He doesn't want to talk about it anymore but I want to help him. He says he loves men. So it should be simple. He just like a "trans gay". But he also told me he thought he will have different personality. Like he is still "crazy" as women are. He also had to stop taking hormones because he didn't feel well. It seems like he just didn't like himself not his gender or sex. I'm interested in G.C. Jung's archetypes long time and get idea I could find the answer there. So I'm reading about this subject deeply first time so I'm a bit confused about all "options" but maybe there is the solution. It's also interesting he always looked like a boy, his behaviour like body language was like man. His father was policeman and my opinion is he could behaved him more like a boy (into boy's role which wasn't natural for him). All toys were for boys. He think his mother would help him in this time but she died around his 15. He said she knew he is different. Please could you help me or show the direction? Where was the mistake? Why is he still struggling? I'm not English speaker so if you could use my mail lenka.zimmerova@yahoo.co.uk . Thank you. And thank you for this web which opens my eyes :)

    1. I think part of the problem might be that we are so flooded with messaging as we grow up our instincts become polluted by it. This isn't just conventional binary messaging but also popular trans belief. Defining yourself outside of that is very difficult and sometimes our decisions might be ill advised because they don't come from who we really are. Physical transition is an option but not for everyone and something that dramatic requires much reflection hope your friend is doing well :)


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