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 MTF transsexuals

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

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

Given that a significant proportion of MTF (male to female)  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 trans women could therefore give us some insight into the etiology of crossdreaming (sometimes referred to as "autogynephilia", in reference to Ray Blanchard's transphobic theory).

General conclusions regarding the cause of gender identity

Jaimie F. Veale, David E. Clarke and Terri Lomax have 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.