Blanchard's transsexualism typology

Blanchard's transsexualism typology, also Blanchard autogynephilia theory (BAT) and Blanchard's taxonomy, is a psychological typology of male-to-female (MtF) transsexualism created by Ray Blanchard through the 1980s and 1990s, building on the work of his colleague, Kurt Freund. Blanchard divided trans women into two different groups: homosexual transsexuals, whom Blanchard says seek sex reassignment surgery to romantically and sexually attract (ideally heterosexual) men, and "autogynephilic transsexuals" who purportedly are sexually aroused at the idea of having a female body. The typology suggests distinctions between MtF transsexuals, but does not speculate on the causes of transsexualism. The distinction is a recurring theme in scholarly literature on transsexualism.^[1]

Supporters of the theory include Anne Lawrence, J. Michael Bailey, James Cantor, and others who say that there are significant differences between the two proposed groups, including sexuality, age of transition, ethnicity, IQ, fetishism, and quality of adjustment. Under the theory, homosexual transsexuals are predicted to begin transitioning earlier in life,^[2] generally before turning 30, which accounts for their supposedly better adjustment. They are also more likely to come from poorer, non-white or immigrant backgrounds,^[3] have lower IQs,^[4] as well as be by definition exclusively attracted to men. Autogynephilic transsexuals are more likely to be attracted to women, exclusively or not, or to be asexual.^[2] They are also said under the theory to display more fetishistic or otherwise paraphilic arousal.^[5]

Criticism of the research and theory has come from Charles Allen Moser, Julia Serano, Jaimie Veale, Larry Nuttbrock, John Bancroft, and others who say that the theory is poorly representative of trans women, and reduces gender identity to a matter of attraction. While Nuttbrock criticized it, he and his colleagues conducted research that fully supported the theory and replicated the most important findings of Blanchard's earlier work.

The theory has been the subject of protests in the transgender community, which peaked with the publication of Bailey's The Man Who Would Be Queen in 2003. Following the publication of Bailey's book, Blanchard distinguished between the value of the theory as a behavioral description, versus as an explanation of transsexualism and that only further scientific research could resolve the latter question.^[1] The World Professional Association for Transgender Health (WPATH) does not support the theory, citing a need for further research.^[6] WPATH also criticize the theory as being stigmatizing due to focusing on behavior instead of distress.^[7]

Background

The early history of the study of transsexualism is sparse; however, the concept of a categorization of transsexual people can be seen as early as 1923 with the work of Magnus Hirschfeld.^[8] In 1966, Harry Benjamin wrote that researchers of his day thought that attraction to men, while feeling that oneself is a woman, was the factor that distinguished a transvestite from a transsexual.^[9] In 1980 in the DSM-III, a new diagnosis was introduced, that of "302.5 Transsexualism" under "Other Psychosexual Disorders". This was an attempt to provide a diagnostic category for gender identity disorders.^[10] The diagnostic category, transsexualism, was for gender dysphoric individuals who demonstrated at least two years of continuous interest in transforming their physical and social gender status.^[11] The subtypes were asexual, homosexual (same "biological sex"), heterosexual (other "biological sex") and unspecified.^[10] This was removed in the DSM-IV, in which gender identity disorder replaced transsexualism. Previous taxonomies, or systems of categorization, used the terms classic transsexual or true transsexual, terms once used in differential diagnoses.^[9]

Sexologist Ray Blanchard coined the term autogynephilia in 1989 to describe MtF transsexuals who were sexually aroused by the idea of being women. He stated that while they lacked a specific term to describe the concept, there was evidence for the concept among clinicians of the early 20th century. Havelock Ellis used the terms eonism and sexo-aesthetic inversion to describe similar cross-gender feelings and behaviors.^[12]

Terminology

The clinical literature of Freund, Blanchard, and others has consistently divided male-to-female transsexuals into two distinct groups - "homosexual transsexuals," people who are sexually attracted to (ideally heterosexual) men and supposedly desire a normative female body to attract them, and "heterosexual fetishistic transvestites" in which the transsexual purportedly finds the idea of having a normative female body sexually arousing but desires a heterosexual female partner.^[1] Kurt Freund first distinguished between these two proposed types in a 1982 research article, theorizing that the "homosexual" transsexuals were qualitatively different from the so-called "heterosexual males" with gender dysphoria.^[13] Sexologist Ray Blanchard coined the term "autogynephilia" to describe this latter category of people.^[1] In a 2005 article on the concept of Ray Blanchard noted that Freund was probably the first author to distinguish between the erotic arousal due to dressing as a woman (transvestism) versus erotic arousal due to physically transforming into a more typically female form (autogynephilia).^[12]

Blanchard's observations at the Clarke Institute began by categorizing male-to-female transsexuals into four groups based off their supposed sexual orientations: "homosexual," "heterosexual," bisexual, and analloerotics (i.e. trans women attracted to men, women, both, or neither, respectively.)^[14][15] Blanchard then conducted a series of studies on people assigned male at birth with gender dysphoria, including male-to-female transsexual people, and concluded that there existed only two distinct types.^[14][15][16] Blanchard said that one type of gender dysphoria/transsexualism manifests itself in individuals who are exclusively attracted to men (Homosexual transsexuals averaged a Kinsey Scale measurement of 5-6 and six is the maximum, or a 9.86±2.37 on the Modified Androphilia Scale.^[17][18]), whom he referred to as homosexual transsexuals, adopting Freund's terminology^[16] The other type he defined as including those who are attracted to females (gynephilic), attracted to both males and females (bisexual), and attracted to neither males nor females (analloerotic or asexual); Blanchard referred to this latter set collectively as the non-homosexual transsexuals.^[19][20] Blanchard says that the "non-homosexual" transsexuals (but not the "homosexual" transsexuals) exhibit autogynephilia,^[16] which he defined as a paraphilic interest in having female anatomy.^{[15][21][22][23]}

Autogynephilia and autoandrophilia

Autogynephilia (/ˌɔːtoʊˌɡaɪnəˈfɪliə/; from Greek αὐτό- ("self"), γυνή ("woman") and φιλία ("love") — "love of oneself as a woman") is a term coined in 1989 by Ray Blanchard, to refer to "a man's paraphilic tendency to be sexually aroused by the thought or image of himself as a woman."^[15] Alternative terms proposed for this notion include automonosexuality, eonism, and sexo-aesthetic inversion.^[24] The DSM-IV-TR includes an essentially equivalent definition, and recognizes autogynephilia as a common occurrence in the transvestic fetishism disorder, but does not classify autogynephilia as a disorder by itself.^[25] The paraphilias working group on DSM 5 included autogynephilia and autoandrophilia as subtypes of transvestic disorder, a proposal that was opposed by the World Professional Association for Transgender Health (WPATH), stating the lack of empirical evidence for the theory.^[6][7][26]

Autogynephilia is most notable for its use in Blanchard's taxonomy to explain the presence of gender dysphoria in "non-homosexual" (gynephilic) male-to-female transsexuals, in contrast to the gender dysphoria observed in "homosexual" (androphilic) transsexuals. Autogynephilia has also been suggested to pertain to romantic love as well as to sexual arousal patterns.^[27]

Blanchard provides case examples to illustrate the autogynephilic sexual fantasies that people reported:^[12]

Philip was a 38-year-old professional man referred to the author's clinic for assessment....Philip began masturbating at puberty, which occurred at age 12 or 13. The earliest sexual fantasy he could recall was that of having a woman's body. When he masturbated, he would imagine that he was a nude woman lying alone in her bed. His mental imagery would focus on his breasts, his vagina, the softness of his skin, and so on—all the characteristic features of the female physique. This remained his favorite sexual fantasy throughout his life.

According to Blanchard, "An autogynephile does not necessarily become sexually aroused every time he pictures himself as female or engages in feminine behavior, any more than a heterosexual man automatically gets an erection whenever he sees an attractive woman. Thus, the concept of autogynephilia—like that of heterosexuality, homosexuality, or pedophilia—refers to a potential for sexual excitation"^[21] [emphasis in original].

Blanchard classified four subtypes of autogynephilic sexual fantasies, but noted that "All four types of autogynephilia tend to occur in combination with other types rather than alone."^[21][28]

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

There also exist male assigned at birth people who report being sexually aroused by the image or idea of having some but not all normative female anatomy, such as having breasts but retaining their penis and testicles; Blanchard referred to this phenomenon as partial autogynephilia.^[29][30]

To test the possibility that natal females can also experience autogynephilia, Moser (2009) created an Autogynephilia Scale for Women based on items used to categorize MtF transsexuals as autogynephilic in other studies. A questionnaire that included the ASW was distributed to a sample of 51 professional women employed at an urban hospital; 29 completed questionnaires were returned for analysis. By the common definition of ever having erotic arousal to the thought or image of oneself as a woman, 93% of the respondents would be classified as autogynephilic. Using a more rigorous definition of "frequent" arousal to multiple items, 28% would be classified as autogynephilic.^[31] However, in a response to the paper, Lawrence (2009) criticized Moser's methodology and conclusions, and asserted that genuine autogynephilia occurs very rarely, if ever, in natal women.^[32]

DSM-5

In DSM-5, published in 2013, With autogynephilia (sexual arousal by thoughts, images of self as a female) is a specifier to 302.3 Transvestic disorder (intense sexual arousal from cross-dressing fantasies, urges or behaviors); the other specifier is With fetishism (sexual arousal to fabrics, materials or garments).^[33]

Autoandrophilia and autoandrophobia

The analogous term autoandrophilia refers to a person assigned female at birth who is sexually aroused by the thought or image of being a man.^[34] It was classified as a type of transvestic fetishism in a proposed revision to the DSM-5^[35] but not included in the final version. Less work has been done on autoandrophilia,^[36] and in an interview with Vice, Blanchard stated "I proposed it simply in order not to be accused of sexism, because there are all these women who want to say women can rape too, women can be pedophiles too, women can be exhibitionists too. It’s a perverse expression of feminism, and so, I thought, let me jump the gun on this. I don’t think the phenomenon even exists."^[37]

Autoandrophobia (from Greek αὐτό- ("self"), ἀνήρ ("man") and φόβος ("fear") — "fear of oneself as a man") is a related but different term to autogynephilia which was coined by Moser (2010). Some MtF transsexuals in whom estrogen has been contraindicated (e.g., due to deep vein thrombosis) have found that antiandrogens alone were sufficient to relieve their gender dysphoria. This suggests that MtF transsexuals are motivated to transition not merely by an interest in possessing feminine characteristics but also by a desire to block masculine characteristics. According to Moser, "the desire to block other sexual interests is not characteristic of individuals with a paraphilia."^[38]

Criticism

Criticism of the theory of "homosexual transsexuals" is generally focused in two categories: the use of the terms "homosexual" and "non-homosexual" to refer to MtF transsexuals by their assigned sex^[39][40] and the data underlying the theory itself.^{[31][38][41][42]} Harry Benjamin, in his seminal work The Transsexual Phenomenon, opined that the question "is a transsexual homosexual?" had both "yes" and "no" answers depending on whether sexual anatomy or gender identity was prioritised, and in cases of post-operative male-to-female transsexuals, describing them as "homosexual men" was against "common sense and reason".^[40] The terminology has also been described as confusing and controversial among transsexuals seeking sexual reassignment,^[18] archaic,^[43] and demeaning.^[44] In 2008 sexologist John Bancroft expressed regret for having used this terminology, which was standard when he used it, to refer to transsexual women, and that he now tries to use words more sensitively.^[45]

Charles Allen Moser, a physician, criticized Blanchard's theory, stating that it uses an overly-broad definition of autogynephilia, is not sufficiently relevant to MtF transsexual patients, fails to account for all information on sexual and romantic interests of homosexual and transsexual people, relies too heavily on phallometry, and lacks supporting data.^[38] Jaimie Veale, a psychologist, published a modified version of the typology in 2010 which proposes that variances in gender identity are driven by biological and childhood socialization factors but personality and environment determine whether psychological defense mechanisms are employed to repress these variances. In the presence of defense mechanisms, the typology predicts crossdressing or "atypical transsexuality," while their absence results in drag artists or "classic transsexuality."^[46]

Julia Serano, a male-to-female transgender biochemist and trans activist, wrote that there were flaws in Blanchard's original papers, including that they were conducted among overlapping populations primarily at the Clarke Institute in Toronto without nontranssexual controls, that the subtypes were not empirically derived but instead were "begging the question that transsexuals fall into subtypes based on their sexual orientation," and that further research had found a non-deterministic correlation between cross-gender arousal and sexual orientation.^[47] She said that Blanchard did not discuss the idea that cross-gender arousal may be an effect, rather than a cause, of gender dysphoria, and that Blanchard assumed that correlation implied causation.^[47] Serano also stated that the wider idea of cross-gender arousal was affected by the prominence of sexual objectification of women, accounting for both a relative lack of cross-gender arousal in transsexual men and similar patterns of autogynephilic arousal in non-transsexual women.^[47] Serano criticised proponents of the theory, claiming that they dismiss non-autogynephilic, non-androphilic transsexuals as misreporting or lying while not questioning androphilic transsexuals, describing it as "tantamount to hand-picking which evidence counts and which does not based upon how well it conforms to the model",^[47] either making the theory unscientific due to its unfalsifiability, or invalid due to the nondeterministic correlation that later studies found.^[47] Further criticisms alleged that the theory undermined lived experience of transsexual women, contributed to pathologisation and sexualisation of transsexual women, and the literature itself fed into the stereotype of transsexuals as "purposefully deceptive", which could be used to justify discrimination and violence against transsexuals.^[47]

Philosopher T. M. Bettcher, also drawing from her own experience as a trans woman, has critiqued the notion of "autogynephilia", and "target errors" generally, within a framework of "erotic structuralism", arguing that the notion conflates essential distinctions between "source of attraction" and "erotic content", and "(erotic) interest" and "(erotic) attraction", thus misinterpreting what she prefers to call, following Serano, "female embodiment eroticism". She maintains that not only is "an erotic interest in oneself as a gendered being", as she puts it, a non-pathological and indeed necessary component of regular sexual attraction to others, but within the framework of erotic structuralism, a "misdirected" attraction to oneself as postulated by Blanchard is outright nonsensical.^[48]

Transsexual community reaction

The concept received attention when Anne Lawrence described it on her website in the late 1990s.^[49] When Bailey published The Man Who Would Be Queen in 2003, which based its portrayal of male-to-female transsexual people on Blanchard's taxonomy, an enormous controversy resulted.^[50] Transsexual activist and engineer Lynn Conway investigated the publication of Bailey's book by the United States National Academy of Sciences and along with other activists accused Bailey of misconduct. Northwestern University investigated Bailey, but did not reveal the findings of that investigation and did not comment on whether or not Bailey had been punished.^[51] According to a summary of the controversy written by Northwestern University bioethicist and historian Alice Dreger, the accusations were unfounded and comprised an attempt by some trans activists to silence Bailey for expressing views that contrasted with the public image they wanted. The accusations themselves did not hold up to scrutiny, according to Dreger's analysis. For example, two of the four transsexual women who accused Bailey of misusing their stories in the book were not actually mentioned in the book at all.^[50]

According to Leavitt and Berger, "transsexuals, as a group, vehemently oppose the homosexual transsexual label and its pejorative baggage."^[18] Trans man Aaron Devor wrote, "If what we really mean to say is attracted to males, then say 'attracted to males' or androphilic... I see absolutely no reason to continue with language that people find offensive when there is perfectly serviceable, in fact better, language that is not offensive."^[52] Still other transsexual people are opposed to any and all models of diagnosis which allow medical professionals to prevent anyone from changing their sex, and seek their removal from the DSM.^[53]

Alice Dreger studied the reactions of trans activists and other controversies.^[54] She argued that although the science appears correct that eroticism is behind the typology of transgenderism, activists in the trans community preferred the simpler narrative of literally being one sex trapped in the body of the other. Dreger says, "Autogynephilia is perhaps best understood as a love that would really rather we didn’t speak its name",^[54] in reference to the famous expression the love that dare not speak its name formerly used to refer to homosexuality or pederasty.

Jaimie Veale, Dave Clark and Terri Lomax studied trans women's impressions of and opinions on Blanchard's typology.^[55] They found that over half had negative views. Common criticisms included that the typology was too narrow and restrictive, it did not apply to their experiences, or that the typology was driven by questionable motives.

See also

• Classification of transsexual people
• Autoeroticism
• Partialism
• Transsexual sexuality
• List of transgender-related topics

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