The controversy surrounding "The man who would be queen": a case history of the politics of science, identity, and sex in the Internet age

How Autogynephilic Are Natal Females?

Blanchard proposed that autogynephilia is a natal male's paraphilic sexual arousal in response to the thought or fantasy of being a woman. Furthermore, based on evidence collected from natal males with gender dysphoria, Blanchard argued that autogynephilia is the fundamental motivation among nonhomosexual males (i.e., those not exclusively attracted to men) who pursue sex reassignment surgery or live as transgender women. These ideas have been challenged by several writers who have asserted, or offered evidence, that autogynephilia is common among women. However, their evidence was weakened by problematic measures and limited comparison groups. We compared four samples of autogynephilic natal males (N = 1549), four samples of non-autogynephilic natal males (N = 1339), and two samples of natal females (N = 500), using Blanchard's original measure: the Core Autogynephilia Scale. The autogynephilic samples had much higher mean scores compared with non-autogynephilic natal males and natal females, who were similar. Our findings refute the contention that autogynephilia is common among natal females.

Repressive Moralism: World Making and Petty Fascism in Transgender Politics

The past decade has seen a shift in the way that minorities exert their influence in society. Where in previous decades the emphasis was on winning the hearts and minds of the population at large, a recent strategy has been to ignore general public discourse and only to target specific influential bodies. In this paper we use the example of transgender issues to analyse the socio-psychological dimensions of this approach. We show how some groups promoting these issues eschew a wider social discourse and debate in the mass media, and how their strategy rests on a self-construction as victims of the hetero-normative society, with a concomitant appeal to moral rather than factual argumentation. This is combined with a programme of aggressive challenge to opponents through social media, and sometimes direct action, which effectively closes discussion on the topic. We conclude that these methods have much in common with the oppressive politics of fascist rule.

Queer Diagnoses Parallels and Contrasts in the History of Homosexuality, Gender Variance, and the Diagnostic and Statistical Manual (DSM) Review and Recommendations Prepared for the DSM-V Sexual and Gender Identity Disorders Work Group

(Copyright © 2009, American Psychiatric Association. Published with permission).

Fanon and the New Paraphilias: Towards a Trans of Color Critique of the DSM-V

This essay places psychiatrist and philosopher Frantz Fanon's anti-colonial, anti-racist message from Peau Noire, Masques Blancs/Black Skin, White Masks (1952; 1967; 2008) in conversation with the new diagnoses of "Gender Dysphoria" and "Transvestic Disorder" in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Specifically, the essay discusses sexologist Ray Blanchard's controversial theory of autogynephilia alongside Fanon's ambivalent rendering of transgender desire and interracial trans phenomenology in a crucial but frequently overlooked passage in Black Skin. Fanon's anti-colonial critique of psychiatry allows us to reconsider how Blanchard's theories on paraphilia engage with the foundational psychoanalytic concepts of identification and desire, as identified by the Freudian and Lacanian models and explored in the writings of Judith Butler, Catherine Millot, Charles Shepherdson, and others. By offering a fresh interpretation of the French text, this essay argues that a "trans of color critique" can benefit from Black Skin's unexpected insight into trans desire: Fanon's "man of color," who simultaneously undergoes a gender transition and a racial transformation, represents the literal embodiment of his critique of colonial racism. Given the role of the new paraphilias in the DSM-V, this essay concludes that a trans of color critique is well positioned to reinforce the anti-colonial message Fanon addressed to the psychiatric and psychoanalytical fields, which have tended to diagnose psychic injury while ignoring its causation, and which continue to neglect the fact that medical access is just as important as material support and security for minority subjects, in particular.

Autogynephilia and the Typology of Male-to-Female Transsexualism

Abstract. Sexual scientists have recognized for over a century that biologic males who seek sex reassignment – male-to-female (MtF) transsexuals – are not a homogeneous clinical population but comprise two or more distinct subtypes with different symptoms and developmental trajectories. The most widely used typologies of MtF transsexualism have been based on sexual orientation and have distinguished between persons who are androphilic (exclusively sexually attracted to males) and those who are nonandrophilic (sexually attracted to females, both males and females, or neither gender). In 1989, psychologist Ray Blanchard proposed that most nonandrophilic MtF transsexuals display a paraphilic sexual orientation called autogynephilia, defined as the propensity to be sexually aroused by the thought or image of oneself as a woman. Studies conducted by Blanchard and colleagues provided empirical support for this proposal, leading to the hypothesis that almost all nonandrophilic MtF transsexuals are autogynephilic, whereas almost all androphilic MtF transsexuals are not. Blanchard’s ideas received increased attention in 2003 after they were discussed in a book by psychologist J. Michael Bailey. The concept of autogynephilia subsequently became intensely controversial among researchers, clinicians, and MtF transsexuals themselves, causing widespread repercussions. This article reviews the theory of autogynephilia, the evidence supporting it, the objections raised by its critics, and the implications of the resulting controversy for research and clinical care.

Sexual Arousal Patterns of Autogynephilic Male Cross-Dressers

Men's sexual arousal patterns have been an important window into the nature of their erotic interests. Autogynephilia is a natal male's paraphilic tendency to be sexually aroused by the thought or image of being a woman. Autogynephilic arousal per se is difficult to assess objectively, because it is inwardly focused. However, assessing sexual arousal patterns of autogynephilic males in response to external stimuli is also potentially useful. For example, there is substantial association between autogynephilia and gynandromorphophilia (GAMP), or sexual attraction to gynandromorphs (GAMs), colloquially "she-males." GAMP men's sexual arousal patterns in response to GAM, female, and male stimuli have recently been characterized. In the present study, we extended this understanding by comparing the sexual arousal patterns of autogynephilic male cross-dressers, GAMP men, heterosexual men, and homosexual men. Erotic stimuli included sexually explicit videos of men, women, and GAMs. Autogynephilic men were much more similar in their arousal patterns to heterosexual and GAMP men than to homosexual men. However, similar to GAMP men, autogynephilic men showed increased arousal by GAM stimuli relative to female stimuli compared with heterosexual men.

Gender Dysphoria in Adults

Gender dysphoria (GD), a term that denotes persistent discomfort with one's biologic sex or assigned gender, replaced the diagnosis of gender identity disorder in the Diagnostic and Statistical Manual of Mental Disorders in 2013. Subtypes of GD in adults, defined by sexual orientation and age of onset, have been described; these display different developmental trajectories and prognoses. Prevalence studies conclude that fewer than 1 in 10,000 adult natal males and 1 in 30,000 adult natal females experience GD, but such estimates vary widely. GD in adults is associated with an elevated prevalence of comorbid psychopathology, especially mood disorders, anxiety disorders, and suicidality. Causal mechanisms in GD are incompletely understood, but genetic, neurodevelopmental, and psychosocial factors probably all contribute. Treatment of GD in adults, although largely standardized, is likely to evolve in response to the increasing diversity of persons seeking treatment, demands for greater client autonomy, and improved understanding of the benefits and limitations of current treatment modalities.

Heteronormativity and Repronormativity in Sexological "Perversion Theory" and the DSM-5's "Paraphilic Disorder" Diagnoses

The move from "paraphilias" to "paraphilic disorders," where only the latter constitute mental disorders, has been hailed as a major change to the conception of non-normative sexualities in DSM-5. However, this is a claim that has been criticized by numerous activists and doctors working for removal of all diagnoses of so-called sexual disorders from the APA's manual. This article, written from a critical humanities, queer theory-inflected perspective, examines the historical and ideological grounds underlying the inclusion of the newly branded "paraphilic disorders" in DSM-5. It argues that the diagnosis does nothing to overturn the conservative and utilitarian view of sexuality as genitally oriented and for reproduction that has colored sexological and psychiatric history. It suggests that despite homosexuality no longer being classed as a disorder, an implicit heteronormativity continues to define psychiatric perceptions of sexuality. In sum, this article proposes that (1) the production of the field of psychiatric knowledge concerning "perversion"/"sexual deviation"/"paraphilia"/"paraphilic disorder" is more ideological than properly scientific; (2) the "normophilic" bias of the DSM is a bias in favor of heteronormativity and reproduction; and (3) some sexual practices are valued above others, regardless of claims that the presence of a paraphilic practice itself is no longer a criterion for a diagnosis of mental disorder.

Measures of clinical health among female-to-male transgender persons as a function of sexual orientation

The present study examined the sexual orientation classification system that was used in the DSM-IV-TR for categorizing those who met the Gender Identity Disorder diagnostic criteria in order to determine the extent to which female-to-male transgender persons (FTMs) differ on psychological variables as a function of sexual orientation. Participants were 605 self-identified FTMs from 19 different countries (83 % U.S.) who completed an internet survey assessing their sexual orientation, sexual identity, symptoms of depression and anxiety, stress (Depression Anxiety Stress Scales), social support (Multidimensional Scale of Perceived Social Support), and health related quality of life (SF-36v2 Health Survey). Over half the sample (52 %) reported sexual attractions to both men and women. The most common sexual identity label reported was "queer." Forty percent of FTMs who had begun to transition reported a shift in sexual orientation; this shift was associated with testosterone use. Overall, FTMs ranged from normal to above average on all psychological measures. FTMs did not significantly differ by sexual attraction on any mental health variables, except for anxiety. FTMs attracted to both men and women reported more symptoms of anxiety than those attracted to men only. Results from the present study did not support a sexual orientation classification system in FTMs with regard to psychological well-being.

Darkness’s descent on the American Anthropological Association. A cautionary tale

In September 2000, the self-styled “anthropological journalist” Patrick Tierney began to make public his work claiming that the Yanomamö people of South America had been actively—indeed brutally—harmed by the sociobiological anthropologist Napoleon Chagnon and the geneticist-physician James Neel. Following a florid summary of Tierney’s claims by the anthropologists Terence Turner and Leslie Sponsel, the American Anthropological Association (AAA) saw fit to take Tierney’s claims seriously by conducting a major investigation into the matter. This paper focuses on the AAA’s problematic actions in this case but also provides previously unpublished information on Tierney’s falsehoods. The work presented is based on a year of research by a historian of medicine and science. The author intends the work to function as a cautionary tale to scholarly associations, which have the challenging duty of protecting scholarship and scholars from baseless and sensationalistic charges in the era of the Internet and twenty-four-hour news cycles.

A further assessment of Blanchard's typology of homosexual versus non-homosexual or autogynephilic gender dysphoria

In a series of important but now highly controversial articles, Blanchard examined associations of sexual orientation and transvestic fetishism among male-to-female (MTF) transgender persons in Toronto, Canada. Transvestic fetishism was rare among the homosexuals but prevalent among the non-homosexuals. Subtypes of non-homosexual MTFs (heterosexual, bisexual, and asexual) were consistently high with regard to transvestic fetishism. Non-linear associations of a continuous measurement of sexual attraction to women (gynephilia) and transvestic fetishism were interpreted in terms of an etiological hypothesis in which transvestic fetishism interferes with the early development of heterosexuality. Blanchard concluded that homosexual versus non-homosexual sexual orientation is a dominant and etiologically significant axis for evaluating and understanding this population. We further assessed these findings among 571 MTFs from the New York City metropolitan area. Using the Life Chart Interview, multiple measurements of transvestic fetishism were obtained and classified as lifetime, lifecourse persistent, adolescent limited, and adult onset. Large (but not deterministic) differences in lifetime, lifecourse persistent, and adolescent limited transvestic fetishism were found between the homosexuals and non-homosexuals. Contrary to Blanchard, differences in transvestic fetishism were observed across subtypes of the non-homosexuals, and linear (not curvilinear) associations were found along a continuous measurement of gynephilia and transvestic fetishism. Age and ethnicity, in addition to sexual orientation, were found to be statistically significant predictors of transvestic fetishism. The clinical, etiological, and sociopolitical implications of these findings are discussed.

Sex, romance, and research subjects: an ethical exploration

Professional standards in medicine and psychology treat concurrent sexual relationships with patients as violations of fiduciary trust, and they sometimes rule out sexual relationships even after a clinical relationship is over. These standards also rule out sex with research subjects who are also patients, but what about nonclinical relationships where there are not always parallels to the standards of clinical medicine? One way to treat sex in nonclinical research relationships is to treat it as sex is treated elsewhere among adults, as a matter of individual choice and responsibility. Alternately, one could ask oversight bodies to draw lines between research that can safely accommodate sexual relationships and research that cannot. One could even ask researchers to avoid all concurrent sexual relationships with their research participants, as happens in clinical medicine. Each of these options has drawbacks that undermine its value as a definitive solution. The deficiencies of these options highlight the need for a professional code of conduct for nonclinical researchers.

Queer diagnoses: parallels and contrasts in the history of homosexuality, gender variance, and the diagnostic and statistical manual

The American Psychiatric Association (APA) is in the process of revising its Diagnostic and Statistical Manual (DSM), with the DSM-V having an anticipated publication date of 2012. As part of that ongoing process, in May 2008, APA announced its appointment of the Work Group on Sexual and Gender Identity Disorders (WGSGID). The announcement generated a flurry of concerned and anxious responses in the lesbian, gay, bisexual, and transgender (LGBT) community, mostly focused on the status of the diagnostic categories of Gender Identity Disorder (GID) (for both children and adolescents and adults). Activists argued, as in the case of homosexuality in the 1970s, that it is wrong to label expressions of gender variance as symptoms of a mental disorder and that perpetuating DSM-IV-TR's GID diagnoses in the DSM-V would further stigmatize and cause harm to transgender individuals. Other advocates in the trans community expressed concern that deleting GID would lead to denying medical and surgical care for transgender adults. This review explores how criticisms of the existing GID diagnoses parallel and contrast with earlier historical events that led APA to remove homosexuality from the DSM in 1973. It begins with a brief introduction to binary formulations that lead not only to linkages of sexual orientation and gender identity, but also to scientific and clinical etiological theories that implicitly moralize about matters of sexuality and gender. Next is a review of the history of how homosexuality came to be removed from the DSM-II in 1973 and how, not long thereafter, the GID diagnoses found their way into DSM-III in 1980. Similarities and differences in the relationships of homosexuality and gender identity to psychiatric and medical thinking are elucidated. Following a discussion of these issues, the author recommends changes in the DSM-V and some internal and public actions that the American Psychiatric Association should take.

The embodied self: thinking psychoanalytically in a time of 'science'

In order to be relevant in our 'scientific' times, it is necessary that we psychoanalysts situate our ideas in thoughtful and respectful relationship to neighbouring disciplines such as genetics, cultural studies, and neuro-anatomy. In this paper I suggest that, although psychoanalysis still continues to have valuable contributions to make to the understanding of human sexual experience and behaviour, in order to make these contributions relevant we must tune in with openness to the challenges posed by the unfolding discoveries in the other disciplines that grapple with the arena of human sexuality. I will suggest ways in which research on sexual desire and gender identity may be assimilated into psychoanalytic thinking and give some examples of its use in analytic practice.

Sexuality of male-to-female transsexuals

Blanchard's (J Nerv Ment Dis 177:616-623, 1989) theory of autogynephilia suggests that male-to-female transsexuals can be categorized into different types based on their sexuality. Little previous research has compared the sexuality of male-to-female transsexuals to biological females. The present study examined 15 aspects of sexuality among a non-clinical sample of 234 transsexuals and 127 biological females, using either an online or a paper questionnaire. The results showed that, overall, transsexuals tended to place more importance on partner's physical attractiveness and reported higher scores on Blanchard's Core Autogynephilia Scale than biological females. In addition, transsexuals classified as autogynephilic scored significantly higher on Attraction to Feminine Males, Core Autogynephilia, Autogynephilic Interpersonal Fantasy, Fetishism, Preference for Younger Partners, Interest in Uncommitted Sex, Importance of Partner Physical Attractiveness, and Attraction to Transgender Fiction than other transsexuals and biological females. In accordance with Blanchard's theory, autogynephilia measures were positively correlated to Sexual Attraction to Females among transsexuals. In contrast to Blanchard's theory, however, those transsexuals classified as autogynephilic scored higher on average on Sexual Attraction to Males than those classified as non-autogynephilic, and no transsexuals classified as autogynephilic reported asexuality.