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Focus on Sexuality Research
Series Editor: Marta Meana
For further volumes:
http://www.springer.com/series/10132
Anne A. Lawrence
Men Trapped in Men’s
Bodies
Narratives of Autogynephilic Transsexualism
Foreword by Ray Blanchard
Anne A. Lawrence
University of Lethbridge
Lethbridge , Alberta , Canada
ISBN 978-1-4614-5181-5 ISBN 978-1-4614-5182-2 (eBook)
DOI 10.1007/978-1-4614-5182-2
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2012948681
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v
Foreword
One day, around 1987 or 1988, I spent the afternoon in a reference room of the Robarts
Library of the University of Toronto. I was trying to fi nd a word—or failing that, to
invent one—to denote a phenomenon I had gradually apprehended during clinical
interviews with many biologically male patients interested in sex reassignment surgery.
That phenomenon was the tendency of certain males to become erotically aroused by
the thought or image of themselves as females. The word I fi nally invented, after fruit-
less searching through various kinds of dictionaries, was autogynephilia . I could
scarcely have imagined, on that long-ago day in that quiet room, that I would be writing
the Foreword to a complete book on the subject 25 years later.
My early writings on autogynephilia were published in specialty journals with
limited circulations. They were intended for a small readership of clinicians who
specialized in the assessment and management of gender dysphoric patients. The
general availability of the Internet in the home and workplace was still several years
away, and access to print journals for people unconnected to major universities was
dif fi cult. I therefore had no expectation that the readership of my autogynephilia
papers would ever extend beyond the small group I had originally envisioned.
One person who did manage to fi nd and read them was the author of the present
volume, Dr. Anne A. Lawrence. She was open to my ideas, which—although actually
rooted in eight decades of prior clinical thinking—were bitterly opposed as heretical
innovations by the increasingly politicized transgender community and the clinicians
who served it. My ideas included the notions that gender identity and sexuality are not
separate and unrelated phenomena but rather two sides of the same coin; that there are
two major, etiologically and phenomenologically different types of male-to-female
transsexualism; and that neither of these types is sui generis —rather, one is related to
ordinary homosexuality and the other is related to autogynephilia. The contemporary
dogma in the transgender and allied health communities was that male-to-female
transsexualism is caused by a feminine gender identity—a proposition that is obvi-
ously and utterly circular without some auxiliary hypothesis such as neuroanatomic
intersexuality. On this orthodox view, gender identity is about one’s sex but not about
sexuality, and to connect it with an erotic preference like homosexuality or autogyne-
philia is conceptually (and politically) incorrect. Dr. Lawrence did not merely accept
vi Foreword
my ideas; she pushed them towards their logical conclusion and, in a 1998 essay
published on her Web site, startled even me with the audacious title of her essay, “Men
Trapped in Men’s Bodies: An Introduction to the Concept of Autogynephilia.” And so
it was that the word autogynephilia began its slow escape from the library.
Challenging the emotionally invested beliefs of any group often has its price, and
Dr. Lawrence began receiving hate mail shortly after her views became known.
Worse consequences than hate mail awaited J. Michael Bailey, who published a
book dealing in large part with autogynephilia in 2003. This book, The Man Who
Would Be Queen , so enraged some male-to-female transsexuals that a small group
of them made a coordinated and sustained effort to get Dr. Bailey fi red from his
university faculty and ruined professionally. The events of this extraordinary cam-
paign have been documented in a long and meticulously documented essay by med-
ical historian and bioethicist Alice Domurat Dreger.
In light of this history, it is remarkable that Dr. Lawrence has written a book that
describes autogynephilic transsexuals in a way that differs in important regards
from the way many in this group wish to see themselves or wish to be seen by oth-
ers. Her motives for completing this project are twofold. First, she is convinced that
psychologists, psychiatrists, and other helping professionals can provide better care
to autogynephilic gender dysphoric men if they understand the nature and
signi fi cance of autogynephilia. Second, she believes that there exist many isolated
and confused autogynephiles who would be comforted and reassured by the knowl-
edge that there are others in the world like them and that, in the long term, autogy-
nephilic transsexuals would lead mentally healthier lives if they had a
self-understanding based on objective reality.
The book with which Dr. Lawrence’s volume is most readily compared is Magnus
Hirschfeld’s 1910 classic work, Die Transvestiten . Both books include multiple
autobiographies written by persons who might nowadays be grouped under the
umbrella term “transgendered,” both also include direct clinical observations of
transgendered persons by the authors, and both contain substantial sections of theo-
retical interpretation and conjecture. If I were forced to recommend to someone that
he or she read only one of these two books, I would—despite my deep admiration
for the great Magnus Hirschfeld—recommend Dr. Lawrence’s volume. Men
Trapped in Men’s Bodies is more focused, organized, and clear. It is simply a more
ef fi cient and accessible introduction, for modern readers, to the phenomenon of
autogynephilic transsexualism. It does not, and does not attempt to, provide an
account of homosexual transsexualism in natal males or females—a topic that
would properly require a volume of its own.
Some days of one’s work life one remembers with a shudder of horror, others
with pleasurable memories of satisfaction at a job fi nally completed. Today, as I sign
the Foreword to this excellent book by my friend and colleague Anne Lawrence, is
like the long-ago day when I shut the last of the dictionaries and decided simply to
invent the word I needed— autogynephilia .
Ray Blanchard
Department of Psychiatry
University of Toronto
vii
Acknowledgments
This book could not have been written without the help and support of several
colleagues and friends, whose assistance I gratefully acknowledge and to whom I
offer my sincere thanks. Marta Meana, editor of the Springer Focus on Sexuality
Research series, encouraged me to submit the proposal for this book, advocated for
its acceptance by the publisher, and helped me fi nd and trust my authorial voice in
creating the manuscript. Her comments and suggestions on my chapter drafts and
her overall support for the project were invaluable.
Three other colleagues, J. Michael Bailey, Robinn J. Cruz, and Paul L. Vasey,
were also kind enough to read portions of the manuscript, share their observations,
and propose various improvements. Their analyses, whether congratulatory or skep-
tical, helped me to proceed with a healthy mixture of caution and enthusiasm.
Although he provided no direct input to the book, Kenneth J. Zucker helped cre-
ate the conditions that made it possible. He edited and published my earliest aca-
demic articles in Archives of Sexual Behavior , helped me to believe that I had
something valuable to say, and taught me how to say it with greater clarity, preci-
sion, and economy.
More than anyone else, Ray Blanchard is responsible for this book’s existence.
He introduced the concept of autogynephilia and conducted the seminal research
from which all further investigations of the topic would proceed. He graciously read
and reread my early chapter drafts, gently pointing out areas where changes were
needed and praising my more successful efforts. After nearly two decades of read-
ing Dr. Blanchard’s elegant prose in his numerous academic publications, I have
inevitably absorbed some elements of his style and made them my own; if any parts
of my writing ever verge on eloquence, I largely have him to thank.
Anne A. Lawrence
ix
Contents
1 Men Trapped in Men’s Bodies .............................................................. 1
Two Types of Male-to-Female Transsexuals ........................................... 1
Trapped in the Wrong Body ..................................................................... 2
An Autogynephilic Transsexual’s Case History ...................................... 4
The Concept of Autogynephilia ............................................................... 6
Definitions and Terminology ................................................................... 7
Early Development of the Concept of Autogynephilia ............................ 10
Accounting for Departures from Theorized Associations
with Sexual Orientation ........................................................................... 11
Additional Correlates of Sexual Orientation
in MtF Transsexualism ............................................................................. 14
Introducing the Term Autogynephilia ...................................................... 15
Blanchard’s Proposed Transsexual Typology: Brief Comments .............. 16
Exploring the Implications of Autogynephilia ......................................... 17
2 Theory and Case Histories .................................................................... 19
Further Research Studies of Autogynephilia in Transsexuals .................. 19
Different Types of Autogynephilia........................................................... 19
Etiological Conjectures ............................................................................ 20
Autogynephilia Competes with Heterosexual Attraction ........................ 22
Anatomic Autogynephilia Predicts Gender Dysphoria ............................ 22
Analogs of Autogynephilia in Men Attracted to Children,
Amputees, and Animals ........................................................................... 24
Empirical Studies of Autogynephilia Published After 1993 .................... 26
Reviews, Popular Accounts, and Critiques of Autogynephilia ................ 29
Case Histories of Autogynephilic Transsexualism Are Rare ................... 30
Missing Discourses and Forbidden Narratives ........................................ 32
xContents
3 Narratives by Autogynephilic Transsexuals ........................................ 37
Rationale for the Narrative Project .......................................................... 37
Collecting the Narratives ......................................................................... 38
Editing and Analysis ................................................................................ 40
Validity Issues .......................................................................................... 44
Previous Publication of Selected Narratives ............................................ 46
Illustrative Examples of Narratives ......................................................... 46
Major Themes in the Narratives............................................................... 53
4 Confronting Autogynephilia ................................................................. 55
Discovering the Concept of Autogynephilia ............................................ 55
Discovering an Accurate Description ...................................................... 56
Autogynephilia as a Revelation ............................................................... 56
Facilitating Understanding and Clarity .................................................... 57
Opening Eroticism to Discussion ............................................................. 58
Finding a Theory That Feels Applicable .................................................. 58
Discovering Others Feel Similarly ........................................................... 59
Feeling Legitimately Transsexual ............................................................ 59
No Longer Feeling Crazy ......................................................................... 60
Disconcerting Self-Recognition ............................................................... 61
Anxieties About Consequences ................................................................ 62
Invalidation by Psychotherapists ............................................................. 63
Reluctance to Discuss Autogynephilia with Therapists ........................... 63
Counternarratives: Acceptance by Psychotherapists ............................... 65
Invalidating Reactions from Peers ........................................................... 65
Reluctance to Alienate or Upset Others ................................................... 66
Considering Autogynephilia as a Motive ................................................. 66
Autogynephilia as a Principal Motive .................................................. 67
Autogynephilia as a Possible or Partial Motive ................................... 68
Desire to Engage in Sex as a Woman as a Principal Motive ............... 69
Autogynephilia Not a Motive .............................................................. 70
Must Revelatory Knowledge Remain Private Knowledge? .................... 71
5 Developmental Histories ........................................................................ 73
Theorizing Developmental History
in Autogynephilic Transsexualism ........................................................... 73
Age of Onset of Cross-Gender Fantasies, Behaviors,
and Associated Arousal ............................................................................ 74
Early Childhood Onset of Cross-Dressing
and Associated Arousal ........................................................................ 75
Early Childhood Onset of Cross-Dressing
and Possible Erotic Feelings ................................................................ 77
Early Childhood Onset of Cross-Dressing,
Pubertal Onset of Erotic Feelings ........................................................ 78
Other Patterns of Onset of Cross-Gender Behavior
and Erotic Feelings .............................................................................. 79
xi
Contents
Gender Expression in Childhood and Adulthood .................................... 81
Male-Typical Interests and Behaviors in Childhood
and Adulthood ...................................................................................... 83
Male- and Female-Typical Interests
and Behaviors in Childhood ................................................................. 84
Female-Typical Interests and Behaviors in Childhood ........................ 84
Male-Typical Versus Female-Typical Occupational
Choices in Adulthood ............................................................................... 85
Applicability of the “Woman Trapped
in a Man’s Body” Trope ........................................................................... 87
Autogynephilia Over the Life Course and After SRS .............................. 89
Continuation of Autogynephilic Arousal
over the Life Course ............................................................................. 90
Continuation of Autogynephilic Arousal
After Sex Reassignment ....................................................................... 90
Cessation of Autogynephilic Arousal After SRS ................................. 92
Concluding Comments on Developmental History ................................. 93
6 Manifestations of Autogynephilia ......................................................... 95
Four Main Types of Autogynephilia ........................................................ 95
Transvestic Autogynephilia ...................................................................... 96
Transvestism as a Relaxing or Comfortable Activity .......................... 99
Anatomic Autogynephilia ........................................................................ 100
Anatomic Autogynephilia Without the Desire
to Live in Cross-Gender Role .............................................................. 103
Physiologic Autogynephilia ..................................................................... 105
Behavioral Autogynephilia ...................................................................... 106
Concluding Comments on the Diverse Manifestations
of Autogynephilia ..................................................................................... 110
7 Autogynephilia and Heterosexuality .................................................... 111
Autogynephilia Resembles and Complicates
Heterosexuality ........................................................................................ 111
Autogynephilia Feels Closely
Related to Heterosexual Attraction .......................................................... 112
Autogynephilia Competes with Heterosexual Attraction ........................ 114
Autogynephilia Complicates Heterosexual Expression ........................... 116
Integration of Autogynephilic Elements into
Heterosexual Lovemaking ....................................................................... 119
Autogynephilia Is Sometimes Associated
with Marital Discord or Divorce .............................................................. 120
Autogynephilia Sometimes Overshadows
and Replaces Heterosexual Attraction ..................................................... 121
Late Loss of Virginity in Autogynephilic Transsexuals ........................... 123
Autogynephilia Versus Heterosexuality ................................................... 124
xii Contents
8 Sex with Men .......................................................................................... 127
Autogynephilic Fantasies of Sex with Men Are Prevalent ...................... 127
Attraction to Men Often Reflects Desire for Validation
of One’s Femininity ................................................................................. 129
Imagined Male Partners Are Often Vague
or Anonymous Figures ............................................................................. 130
Male Partners Are Often Arousing in Fantasy
but Unattractive in Reality ....................................................................... 131
Attraction to Men Rarely Extends to Feelings
of Romantic Love .................................................................................... 133
Attraction to Men Sometimes Reflects Men’s
Propensity to Mistreat Women ................................................................. 134
Reports of Increased Attraction to Men During
Transition Are Frequent ........................................................................... 134
Repression of Genuine Attraction to Men Due
to Homophobia ......................................................................................... 136
An Autogynephilic Transsexual “Exclusively
Attracted to Men” (with Limitations) ...................................................... 138
An Autogynephilic Transsexual with Substantial
Sexual Experience with Men ................................................................... 139
Making Sense of Autogynephilic Attraction to Men ............................... 140
9 Other Aspects of Autogynephilic Sexuality .......................................... 143
Autogynephilic Fantasies Required for Orgasm ...................................... 143
Discomfort with Autogynephilic Arousal ................................................ 144
Postorgasmic Reactions: Disgust, Remorse,
and Remission of Gender Dysphoria ....................................................... 145
Postorgasmic Remission of Gender Dysphoria
Implies that Transsexualism Is Paraphilic................................................ 147
Effects of Hormone Therapy .................................................................... 149
Co-occurring Paraphilias ......................................................................... 152
Sexual Masochism ............................................................................... 152
Forced Feminization ............................................................................ 153
Gynemimetophilia and Gynandromorphophilia .................................. 155
Pedophilia ............................................................................................ 156
Autonepiophilia (Paraphilic Infantilism
or Adult Baby Syndrome) .................................................................... 157
Abasiophilia and Autoabasiophilia (Leg Brace Paraphilia) ................. 157
Unspecified Paraphilias ........................................................................ 159
Concluding Comments on Other Aspects
of Autogynephilic Sexuality .................................................................... 159
10 Debating the Meaning of Autogynephilia ............................................ 161
What Is the Meaning and Explanatory Significance
of Autogynephilia? ................................................................................... 161
Autogynephilia Might Be a Symptom of Transsexualism ....................... 162
xiii
Contents
Desires to Be Female Begin Before Puberty
and Precede Autogynephilic Arousal ....................................................... 163
Cross-Gender Fantasies Might Become
Sexualized After Puberty ......................................................................... 166
Comment: Signs of Eventual Sexual Orientation
Are Often Evident in Childhood .............................................................. 169
Early Cross-Gender Wishes, Guarded Conclusions ................................. 171
An Alternative View: Autogynephilia Precedes
Cross-Gender Identity .............................................................................. 172
Correct Embodiment Feels Important;
Eroticism Feels Incidental ........................................................................ 173
Autogynephilic Arousal Is Infrequent,
Loss of Libido Is Acceptable ................................................................... 174
Autogynephilia Might Occur in Natal Women ........................................ 175
Transsexualism Might Reflect a Feminized
Brain in a Male Body ............................................................................... 176
The Case for Autogynephilia Having
Explanatory Meaning ............................................................................... 178
11 Narratives by Nontranssexual Autogynephiles ................................... 179
Transsexual and Nontranssexual Autogynephiles
Resemble Each Other ............................................................................... 179
Representative Narrative by a Nontranssexual
Autogynephile .......................................................................................... 180
Nontranssexuals’ Identification with the Concept
of Autogynephilia ..................................................................................... 182
Early Childhood Onset of Cross-dressing
and Associated Arousal ............................................................................ 182
Fantasizing Being Female During Cross-dressing ................................... 183
Comfort and Prolonged Erotic Arousal with Cross-dressing ................... 184
Autogynephilic Fantasies Are Necessary for Orgasm ............................. 184
Competition with Heterosexual Attraction .............................................. 185
Sex with Men ........................................................................................... 186
Specificity of Autogynephilic Arousal ..................................................... 186
Autogynephilia and Female Beauty ......................................................... 187
Desire to Eliminate or Control Autogynephilic Feelings ......................... 187
Wide-Ranging Autogynephilic Interests .................................................. 188
Partial Anatomic Autogynephilia ............................................................. 189
Co-occurring Paraphilias ......................................................................... 191
Sexual Masochism ............................................................................... 191
Acrotomophilia and Apotemnophilia
(Amputation Paraphilia) ....................................................................... 193
Gynemimetophilia and Gynandromorphophilia .................................. 194
Other Paraphilias .................................................................................. 195
Concluding Thoughts about Narratives
by Nontranssexual Autogynephiles .......................................................... 196
xiv Contents
12 Autogynephilic Transsexualism in Perspective ................................... 199
Making Sense of Autogynephilic Transsexualism ................................... 199
Autogynephilic Transsexualism:
Maybe Not So Rare After All? ................................................................. 199
What Do Autogynephilic Transsexuals Say
About Their Condition? ........................................................................... 200
How Can Understanding Autogynephilic
Transsexualism Inform Clinical Care? .................................................... 201
Can Autogynephilic Transsexualism Ever
Feel Less Shameful? ................................................................................ 202
Presenting Autogynephilia as a Sexual Orientation ................................. 204
Am I Really a Transsexual? Or Just a Transvestite? ................................ 205
The Existential Dilemma of the Gender
Dysphoric Autogynephile ........................................................................ 206
The Value of Devaluing Autogynephilia .................................................. 207
Unapologetic Autogynephilic Transsexualism? ....................................... 208
Solutions Short of Complete Sex Reassignment ..................................... 210
Better Treatment for Severely Gender
Dysphoric Autogynephiles? ..................................................................... 211
Puberty-Blocking Hormones for Autogynephilic
Gender Dysphoric Adolescents? .............................................................. 213
Investigating the Developmental History
of Autogynephilic Gender Dysphoria ...................................................... 215
Embracing Life as an Autogynephilic Transsexual Woman .................... 217
Appendix: Transsexual Informants .............................................................. 219
References ....................................................................................................... 225
Author Index .................................................................................................. 235
Subject Index .................................................................................................. 239