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Clinical observations and systematic studies of autogynephilia

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Abstract

The term autogynephilia denotes a male's paraphilic tendency to be sexually aroused by the thought or image of himself as a woman. This term subsumes transvestism as well as erotic ideas or situations in which women's garments per se play a small role or none at all. This review article presents clinical examples of the lesser known types of autogynephilia (i.e., those in which the element of cross-dressing is secondary or entirely absent), sketches earlier attempts to label and conceptualize these phenomena, summarizes recent quantitative studies exploring the relationships between autogynephilia and other psychosexual variables (e.g., heterosexual attraction), and speculates on the etiology of autogynephilia and its relationship to transsexualism. It is concluded that the concept of autogynephilia is needed to fill a gap in our current battery of concepts and categories for thinking about gender identity disorders.
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... Autogynephilia is the propensity in some natal males to be sexually aroused by the thought or fantasy of being a woman (Blanchard, 1989a). Because cross-dressing is an easily accessible means for natal males to enact their fantasy of being a woman, it is the most common expression of autogynephilia (Bailey, 2003;Blanchard, 1991;Brown et al., 2020;Hsu et al., 2015;Lawrence, 2013a). Indeed, many individuals with autogynephilia have experienced a period of erotic cross-dressing, usually in their adolescence. ...
... Indeed, many individuals with autogynephilia have experienced a period of erotic cross-dressing, usually in their adolescence. For a subset of these individuals, their crossdressing becomes less private and more public over time, and they may wear women's clothing for reasons that are not explicitly sexual but rather emotional (Blanchard, 1991;Blanchard et al., 1986;Docter, 1988;Illy, 2023;Lawrence, 2013a). Autogynephilic natal males who have progressed to public cross-dressing sometimes adopt a feminine identity while they are cross-dressed, and they usually report sexual attraction to women and that their sexual orientation is heterosexual (Buhrich & McConaghy, 1977a, 1977b, 1977c, 1979Docter & Fleming, 1992, 2001Docter & Prince, 1997;Hsu et al., 2017;Långström & Zucker, 2005;Lawrence, 2013a;Prince & Bentler, 1972;Zucker et al., 2012). ...
... Some autogynephilic natal males, rather than or in addition to cross-dressing, behave in a feminine manner or imagine themselves with female anatomic features like breasts or a vagina (Bailey, 2003;Blanchard, 1991;Hsu et al., 2015;Illy, 2023;Lawrence, 2013a). In one study, those who experienced sexual arousal specifically by the thought or fantasy of having a female body reported more gender dysphoria, which refers to persistent feelings of distress about being male or having a male body (Blanchard, 1993). ...
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Autogynephilia is a natal male’s propensity to be sexually aroused by the thought or fantasy of being a woman. Both male cross-dressers and transfeminine individuals (a broad range of individuals born male with a feminine gender identity; e.g., trans women) have been shown to be motivated or characterized by autogynephilia. Although there is a lack of research on whether other potentially related aspects of sexuality are comparable between them, the conceptual framework of autogynephilia offers several predictions that can be tested empirically. Following these predictions, the present study examined whether 10 diverse aspects of sexuality differed between 519 male cross-dressers and 288 transfeminine individuals recruited from online communities, as well as between both groups and 293 cisgender men and 301 cisgender women recruited as control groups. The overwhelming majority of male cross-dresser and transfeminine participants identified as heterosexual, bisexual, asexual, or pansexual. Compared with transfeminine participants, male cross-dressers reported more core and general autogynephilia, paraphilic interests, sociosexual orientation, sexual compulsivity, and problematic pornography use, but less bisexual attraction. Compared with cisgender men and women, male cross-dressers and transfeminine participants as a combined sample reported more bisexual attraction, sexual orientation ambiguity, core and general autogynephilia, paraphilic interests, analloeroticism, sexual compulsivity, and problematic pornography use, but less perceived desirability as a partner. Differences were larger comparing male cross-dressers and transfeminine participants with either control group than with each other. Results suggest that while autogynephilia is especially important to the sexuality of male cross-dressers, it also figures importantly in the sexuality of transfeminine individuals, even if it is expressed and organized differently.
... Indeed, autogynephilia is the motivation for paraphilic transvestism. Some autogynephilic males fantasize about having female bodies, and a subset of these undergo sex reassignment surgery (Blanchard, 1991;Lawrence, 2004). Most autogynephilic males are also sexually attracted to women, and thus their internalized and external erotic targets match. ...
... Our results suggest that these items comprise especially important indicators of paraphilia. One hesitation about this generalization is that our paraphilic samples included two recruited for autogynephilia, and transvestism is very highly correlated with autogynephilia (Blanchard, 1991;Hsu et al., 2015;Lawrence, 2013). Perhaps this exaggerated the importance of transvestism, or the success of our measures employing the relevant item. ...
... Autogynephilia is a natal male's sexual arousal by the fantasy of being, or the act of imitating, a woman (Blanchard, 1989). Transvestism is a common expression of autogynephilia (Blanchard, 1991;Hsu et al., 2015;Lawrence, 2013). Two results so far suggest that autogynephilia may be important in understanding PISC. ...
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Is the category paraphilia a natural kind? That is, do different paraphilias share anything scientifically interesting or are they classified together because they are unusual and sometimes problematic? We investigated this question systematically in 11 samples of paraphilic males (N = 4,617) and 11 samples of control males (N = 1,494). Primary data consisted of responses to the 11-item Paraphilic Interests Scale. Contrary to our initial hypothesis, the scale mean was similar for paraphilic and control samples. Using logistic regression and the same items, we derived three highly correlated measures that robustly discriminated paraphilic and control samples (ds ranging from 0.86 to 0.92). These successful measures capitalized on the unanticipated fact that some items (especially those assessing transvestism and masochistic humiliation) were positively associated with membership in paraphilic samples, while others (especially those assessing voyeurism) were negatively associated with such membership. Subsequent analyses focused on one of the measures, the Paraphilic Interests Scale Contrast (PISC). Consistent with prior findings distinguishing paraphilias and homosexual orientation, PISC was not elevated among homosexual males compared with heterosexual males among the control groups. Within four paraphilic samples, PISC was positively associated with additional paraphilic phenomena. Results provide tentative support for both the proposition that paraphilia is a natural kind and the usefulness of PISC as a measure of paraphilia.
... Individuals who are recognised as having BID experience a deep sense of discomfort that is caused by the mismatch between their physical body and their perceived body sensations (First, 2005;First & Fisher, 2012), although the aetiology of BID is not yet entirely clear. Such discomfort can lead the individual to develop intense desires to remove the affected body part, either with medical assistance or through self-amputation attempts that employ various means (Bensler & Paauw, 2003;Berger et al., 2005;Blanchard, 1999;Brenner, 1999;Dyer, 2000;First, 2005;Parson, Brown & Sirota, 1981;Riddle, 1998;Sorene et al., 2006;Steward & Lowrey, 1980;Tvcar, Dernovsek & Zvan, 1999). So far, no therapies have been developed specifically to treat BID. ...
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The bioethical principle of autonomy is of paramount importance within medical practice. The extent to which a patient’s autonomy overlaps or conflicts with the physician’s duty of beneficence and non-maleficence, however, is not so clear cut, especially for those cases in which the patient’s request for medical intervention goes against the physician’s advice, either because of personal belief or because there is uncertainty regarding the therapeutic approach. Body integrity dysphoria (BID) is a condition that has been included recently in the International Classification of Diseases, 11th edition (ICD-11). It may lead an affected individual to develop an intense desire to remove a specific body part in order to restore congruity between their body and their mind. Thus, its occurrence creates challenging moral and ethical dilemmas for the medical world (Loriga, 2023). The aim of this study was to investigate how Czech physicians understood, assessed and supported patient autonomy regarding requests for invasive body modifications. The objective was to produce a blueprint regarding how much a patient could influence the medical treatment they could gain within the Czech medical system and to develop a comparison with the ethical challenges of BID. A five-section survey was designed and submitted to Czech physicians on topics relevant to the BID debate. On the surface, the results showed an apparent predisposition toward collaboration between doctors and patients. However, further investigation showed that this supposed collaboration crumbled as the physiological risk-reward ratio moved further toward risk, which caused physicians progressively to rely less on the patient’s opinion and psychological needs. Moreover, a strongly authoritarian approach was evident, which became overwhelming in cases of amputation requests and removed, a priori, any collaboration. The results indicate that the Czech medical system does not accept or comprehend fully patients’ psychological needs, and therefore the BID phenomenon is a long way from being understood, which requires a fundamental paradigm shift.
... If such an increased sexual desire were mirrored in stronger VS activation, this would provide an alternative perspective on our findings to autogynephilia: The comparably weaker VS activation in TW after undergoing GHT matches the gradient in sexual desire indicated by Laube et al. (2020). In turn, the weaker VS activation as well as diminished sexual desire are in line with the argumentation of Blanchard (1991) that the effects of estrogen treatment and surgical castration reduce the sex drive in TW. Another possible explanation for the VS activation shift in TW strongest for female-female stimuli would be the group's generally higher activation levels being reduced after GHT and this coinciding with the strongest difference in activation between CM and CW for female-female stimuli. ...
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Self-reported sexual orientation of transgender individuals occasionally changes over transition. Using functional magnetic resonance imaging, we tested the hypothesis that neural and behavioral patterns of sexual arousal in transgender individuals would shift from the assigned to the experienced gender (e.g., trans women’s responses becoming more dissimilar to those of cis men and more similar to those of cis women). To this aim, trans women (N = 12) and trans men (N = 20) as well as cisgender women (N = 24) and cisgender men (N = 14) rated visual stimuli showing male–female, female–female or male–male intercourse for sexual arousal before and after four months of gender-affirming hormone therapy. A Bayesian framework allowed us to incorporate previous behavioral findings. The hypothesized changes could indeed be observed in the behavioral responses with the strongest results for trans men and female–female scenes. Activation of the ventral striatum supported our hypothesis only for female–female scenes in trans women. The respective application or depletion of androgens in trans men and trans women might partly explain this observation. The prominent role of female–female stimuli might be based on the differential responses they elicit in cis women and men or, in theory, the controversial concept of autogynephilia. We show that correlates of sexual arousal in transgender individuals might change in the direction of the experienced gender. Future investigations should elucidate the mechanistic role of sex hormones and the cause of the differential neural and behavioral findings. The study was registered at ClinicalTrials.gov (NCT02715232), March 22, 2016.
... Benjamin conceptually separated homosexuality from both transsexualism and eroticised transvestism. The latter was to be later conceptualised as one aspect of variegated transgender phenomena, 'autogynephilia' (Blanchard, 1991). ...
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The roots of the recent controversy about how mental health professionals should respond to gender non-conforming children are traced. To make historical sense, this paper distinguishes between epistemological (discursive) and ontological (non-discursive) aspects and describes their features, since 1970. This helps to clarify some of the confusions at the centre of the still heated debate about sexuality and gender identity today. In the concluding discussion, the philosophical resource of critical realism is used to interpret the historical narrative provided. It cautions against the anachronistic tendency to amalgamate the short-lived, and now defunct, experiment of aversion therapy for homosexuality with more recent defences of exploratory psychotherapy. The latter have challenged a different form of experimentation: the bio-medicalisation of gender non-conforming children.
... The hypothesis sparked controversy and has since garnered severe criticism from transgender activists for misrepresenting an already disenfranchised minority, apart from conflating gender with sexuality -some of these impressions were recorded in later academic research (Veale et al., 2012). Moser (2010) criticised Autogynephilia theory for its misrepresentation of the transgender community and cited the lack of concrete evidence in case studies and clinical observations, which are too limited to be generalisable -as in Blanchard (1991Blanchard ( , 2005 -while also crucially criticising the idea that Autogynephilia is always absent in Mtf transgender people who are attracted to men and always present in MtF transgender people who are not exclusively attracted to men. There are a few proponents of Autogynephilia theory within academia. ...
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Autogynephilic Persuasive Pornography (AGPP) is a type of pornography that is characterised by its unique autogynephilic and persuasive traits. Autogynephilia refers to the sexual pleasure one derives by imagining themselves as women. Known in the subculture as Sissy Hypno, this type of pornography is an altered mishmash of conventional licensed studio/mainstream pornography found on the internet, designed to interact with/persuade the user (by text or audio) and aid in the process of erotic self-feminisation. AGPP is consumed by a wide range of individuals and for a wide variety of reasons. Yet, there is little to no empirical research aimed at describing this novel form of media, the motivations of its consumers and the effects of its consumption. Therefore, this research study qualitatively explores the experiences of 16 participants (N = 16, age > 19), who consumed AGPP at the time of the study, by phenomenologically interpreting self-reported behaviour and self-described inclinations regarding AGPP use. The participants were recruited from Reddit, and the participant sample is an ethnically diverse sample consisting of men and transwomen. The key findings were categorised into the following superordinate themes: (1) Influence of AGPP on personality and individual lifestyle (2) Exploring femininity and submissive sexual behaviour and (3) Influence of AGPP on gender and sexuality. The analysis of these themes (and their subordinate themes) allows for the conceptualisation of AGPP and an analysis of its reported effects, contributes to the limited evidence of cisgender men strongly relating to Autogynephilia or erotic self-feminisation, alongside Autogynephilia being a frequent motivation for consuming AGPP. Some of the positive and negative effects of consuming AGPP (primarily focusing on gender identity, sexual attitudes and sexuality) were also identified through self-report, thereby, necessitating the need for widening the scientific exploration of Autogynephilia amongst AGPP consumers (not limited to gender categories) and the clinical implications of consuming AGPP (e.g., compulsive AGPP consumption).
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This chapter breaks down the instinctual rejection of amputation requests displayed by surgeons during the fieldwork phase. The physician demonstrates an evident scepticism on the legitimacy of such demands, which presupposes assumptions of potential patients’ inner coercion due to the amputation desire or even hidden intent from the patient’s side to deceive the physician. A central issue is whether pursuing amputation through official medical channels reflects genuine medical needs or stems from other motivations. Through interviews and fieldwork, the chapter reveals that many physicians see BID patients as potentially seeking amputation for personal satisfaction rather than true medical relief, which raises ethical concerns. However, another perspective is also considered: some BID patients might lack knowledge about alternative treatments due to limited access to information or social stigma. This dual view—where blame could stem from either questionable intentions or simple unawareness—adds complexity to the moral discussion. The chapter closes with a thought-provoking suggestion: in situations where options are limited, self-amputation might be the commendable moral choice for the BID individual.
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Chapter
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A series of 30 persistent exhibitionists is presented, with evidence suggesting that sexual violence was exceptional among them, while a comparatively high proportion had a history of paedophiliac or hebephiliac activities. There were three cases of incest. Other sexual deviations reported by these subjects are considered, and their relationship to genital exploratory behaviour in childhood is discussed. Exposing, peeping, touching and paedophiliac activities appear to develop on the basis of an innately determined behavioural complex which first appears in childhood. The overlap between these activities even in the established exhibitionists of the present series indicates the difficulties inherent in thinking of exhibitionism as some kind of clinical entity or syndrome. Current disagreement over the relationship between sexual aggressiveness, child molesting and exhibitionism may be the outcome of considering exhibitionists as though they were a homogeneous group of offenders. It is concluded that future studies could profitably focus on some of the differences between exhibitionists; the present study suggesting, for instance, that persistent exhibitionists have a low incidence of sexual offences involving force, and might usefully be compared with incidental exhibitionists in this respect; while an investigation into the effect of choice of witness might clarify the relationship between exhibitionism and incestuous or paedophiliac behaviour.