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What Many Transgender Activists Don't Want You to Know: and why you should know it anyway

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Currently the predominant cultural understanding of male-to-female transsexualism is that all male-to-female (MtF) transsexuals are, essentially, women trapped in men's bodies. This understanding has little scientific basis, however, and is inconsistent with clinical observations. Ray Blanchard has shown that there are two distinct subtypes of MtF transsexuals. Members of one subtype, homosexual transsexuals, are best understood as a type of homosexual male. The other subtype, autogynephilic transsexuals, are motivated by the erotic desire to become women. The persistence of the predominant cultural understanding, while explicable, is damaging to science and to many transsexuals.
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Title: What many transgender activists don't want you to know: and why you should know it anyway
Author(s): J. Michael Bailey and Kiira Triea
Source: Perspectives in Biology and Medicine. 50.4 (Autumn 2007): p521.
Document Type: Article
Copyright: COPYRIGHT 2007 Johns Hopkins University Press
http://www.press.jhu.edu.turing.library.northwestern.edu
Full Text:
ABSTRACT Currently the predominant cultural understanding of male-to-female transsexualism is that all male-to-female
(MtF) transsexuals are, essentially, women trapped in men's bodies. This understanding has little scientific basis, however,
and is inconsistent with clinical observations. Ray Blanchard has shown that there are two distinct subtypes of MtF
transsexuals. Members of one subtype, homosexual transsexuals, are best understood as a type of homosexual male. The
other subtype, autogynephilic transsexuals, are motivated by the erotic desire to become women. The persistence of the
predominant cultural understanding, while explicable, is damaging to science and to many transsexuals.
**********
A COMMON UNDERSTANDING OF male-to-female transsexualism is that all MtF transsexuals are, essentially, women
trapped in men's bodies. The standard narrative of men who become women goes something like this: "I have always felt
that I was born in the wrong body. I have always been feminine in my interests and feelings. My desire to change sex is
about my gender identity and not my sexuality." This narrative, which Dreger (2007) has termed "the feminine essence
narrative," represents both what most laypeople believe to be true, as well as what transsexuals are likely to say publicly.
The narrative has been extended to an etiological theory, which Lawrence (2007b) has called "the brainsex theory of
transsexualism." The transsexual advocacy website, transsexual.org, puts this theory succinctly: "A transsexual is a person
in which the sex-related structures of the brain that define gender identity are exactly opposite the physical sex organs of
the body."
The standard, feminine essence narrative, and the associated brain-sex theory, are incorrect, in the sense that they do not
represent reality, even if they do correspond with many transsexual individuals' beliefs and identities. The best scientific
evidence (discussed below) indicates that there are two distinct subtypes of MtF transsexuals, and that the feminine essence
narrative at best approximates the life history of only one subtype. Paradoxically, this explanation of MtF transsexualism
persists because it is the explanation preferred by the other subtype, to which it does not apply at all. The popularity of the
feminine essence narrative reflects factors other than the strength of scientific support. Its persistence has likely had
negative consequences for both science and transsexuals themselves.
TWO KINDS OF MALE-TO-FEMALE TRANSSEXUALS
The classification system of MtF transsexuals that we believe to be correct was developed by the psychologist Ray
Blanchard in a series of studies conducted at the Clarke Institute of Psychiatry in Toronto and published between 1985 and
1995. (Blanchard's relevant oeuvre includes more than 20 articles; we provide only a summary of his conclusions.)
Blanchard's studies reported data on hundreds of transsexual males (that is, males who hoped to become or had become
women), as well as other individuals who were male with respect to birth sex and did not desire sex reassignment surgery,
but who sometimes presented themselves, or thought of themselves, as female. Participants in these studies were
representative of gender patients in Canada, and were probably also quite similar to patients seen in the United States and
Western Europe. Blanchard's goal was to make sense out of the diversity of patients that gender clinics saw.
With respect to sexual orientation, Blanchard studied four groups of seemingly diverse male participants: homosexual
(entirely attracted to other males), bisexual, heterosexual, and asexual. In three key studies, Blanchard (1985, 1988, 1989a)
showed that homosexual transsexuals were different in a number of respects from members of the three other groups, and
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that members of the latter groups did not differ much among themselves. These differences included age of presentation at
the gender clinic, history of childhood femininity, and most importantly, history of erotic arousal in association with cross-
dressing and cross-gender fantasy. These findings supported the division of MtF transsexualism into two types: homosexual
and nonhomosexual. Blanchard's work provided a parsimonious and compelling taxonomy for the apparent sexual diversity
among MtF transsexuals, reducing the four types of MtF transsexuals to two fundamentally distinct subtypes.
Autogynephilic Male-to-Female Transsexualism
Arguably, Blanchard's most important contribution was recognizing and elaborating the phenomenon that united the three
nonhomosexual transsexual subtypes: autogynephilia. Autogynephilia is "a male's propensity to be attracted to the thought
or image of himself as a woman" (Blanchard 2005). One common manifestation of autogynephilia is fetishistic cross-
dressing, which is an extremely common antecedent to seeking sex reassignment among nonhomosexual (but not
homosexual) transsexuals (Blanchard, Clemmensen, and Steiner 1987). Some autogynephilic individuals, however, do not
cross-dress fetishistically. Indeed, a seminal case in Blanchard's conceptualization was "Philip," who did not cross-dress
but fantasized sexually about being a nude woman by focusing on desired anatomical features (Blanchard 1991).
Autogynephilia may be conceived as inner-directed heterosexuality. That is, autogynephilic males are like heterosexual
men, except that their primary sexual attraction is to the image or idea of themselves as women.
Blanchard hypothesized that nonhomosexual transsexuals are motivated by autogynephilia. That is, nonhomosexual
transsexuals experience erotic arousal at the idea of becoming a woman, and this arousal motivates them to become
women. (We agree with Lawrence's recent theoretical modification [2007a] hypothesizing that romantic attachment can
play an important role in some cases. It is probable, however, that such attachment is usually preceded by substantial erotic
arousal to the idea of being a woman.)
Not all autogynephilic males become transsexuals. Autogynephilic interests run a gamut from cross-dressing to engaging in
stereotypic female activities (e.g., knitting alongside other women) to possessing female breasts and genitalia. It is the
latter interest that is most strongly associated with autogynephilic transsexualism (Blanchard 1993b). Other than the precise
nature of their autogynephilic fantasy, there is no obvious difference between nonhomosexual cross-dressers who will
become transsexuals and those who will not. They are all auto-gynephiles.
Blanchard's work also clarified the diversity of self-reported sexual orientations among nonhomosexual transsexuals
(Blanchard 1989a). Autogynephilia (inner-directed heterosexuality) appears to compete with outward-directed
heterosexuality. Many autogynephilic transsexuals experience enough outward-directed heterosexuality to label themselves
as heterosexual pre-transition. Those whose autogynephilia is strong enough that they experience no other-directed sexual
feelings identify as asexual. Finally, a common aspect of autogynephilia is the erotic fantasy of being admired, in the
female persona, by another person. Autogynephiles for whom this fantasy is sufficiently strong tend to identify as bisexual.
However, this bisexuality is not characterized by equal or even similar kinds of attraction to male and female bodies.
Blanchard (1989b) thus suggests that it be characterized as "pseudobisexuality."
Autogynephilia appears to be a paraphilia. Paraphilias are unusual, intense, and persistent erotic interests. The concept of
paraphilia is a controversial one, with some arguing that it is merely a word used to stigmatize sexual behavior that most
people find undesirable (Moser 2001). Some paraphilias (e.g., pedophilia and sadism) are harmful to other people, while
others (e.g., autogynephilia and fetishism) are not. Two non-obvious facts about paraphilias suggest that the label
paraphilia may represent more than a mere value judgment. First, paraphilias are found nearly exclusively in males (APA
2000, p. 568). Second, at least some paraphilias tend to occur together. Autogynephilia, for example, appears to be
correlated with other paraphilias, especially masochism (Lawrence 2006). Advertisements of dominatrixes frequently offer
services to cross-dressers, and autogynephilic males are more likely than other males to become sexually aroused to stimuli
depicting masochistic themes (Chivers and Blanchard 1996; Wilson and Gosselin 1980). Of men who die practicing the
dangerous masochistic activity of autoerotic asphyxia, approximately 25% are cross-dressed, a much higher percentage
than one would expect based on the number of nonhomosexual cross-dressers in the general population (Blanchard and
Hucker 1991).
Homosexual Male-to-Female Transsexualism
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Homosexual MtF transsexuals are much easier than autogynephilic transsexuals for most people to comprehend.
Homosexual transsexuals are best understood as a subset of homosexual males who were very feminine from early
childhood. In some ways, then, they do appear to fit the feminine essence narrative: they had male bodies as children, but
behaviorally and psychologically they were different, in some respects, from typical boys and more similar to typical girls.
Most males who begin life as extremely feminine boys, even those whose femininity includes the wish to become girls, do
not become transsexual. In the contemporary United States, most become homosexual men (Bailey and Zucker 1995;
Green 1987; Zuger 1984). Homosexual MtF transsexuals, in contrast, persist in their wish to become female (Bailey 2003;
Blanchard 1990). The reasons for this atypical persistence are unclear. However, these individuals often have a difficult
time socially, romantically, and sexually, and their transition appears to be largely motivated by a desire to improve their
lives in these domains.
As their label implies, homosexual MtF transsexuals are homosexual with respect to their birth sex. That is, they are
attracted exclusively to men. Although some writers have objected to the use of the word homosexual to refer to
individuals who have sex with men as women (e.g., Gooren 2006), we retain the terminology because it emphasizes the
fact that homosexual MtFs are a subset of, and developmentally related to, other homosexual males. Furthermore, it
emphasizes the most efficient and practical way of distinguishing homosexual and autogynephilic transsexuals.
Homosexual transsexuals are unambiguously, exclusively, and intensely attracted to attractive men; autogynephilic
transsexuals have some other pattern of sexual attraction. That is, an MtF transsexual who reports attraction to both men
and women, or a history of sexual attraction to women, or considerable sexual experience with women, or attraction to
neither men nor women--any clearly nonhomosexual pattern--is almost certainly autogynephilic (Blanchard 1989a;
Blanchard, Clemmensen, and Steiner 1987).
EVIDENCE FOR THE FEMININE ESSENCE NARRATIVE AND BRAIN-SEX THEORY
The main theory competing with Blanchard's theory of MtF classification is the theory that all MtF transsexuals have a
(probably innate) female gender identity. By this theory, homosexual and nonhomosexual transsexuals have different
sexual orientations because sexual orientation and gender identity are distinct, perhaps even uncorrelated, phenomena.
Both homosexual and nonhomosexual transsexuals share the same psychological condition, female gender identity, which
they experience in similar ways. Furthermore, both kinds of transsexuals, as well as natal women, have in common neural
circuitry that differs from that of nontranssexual men, and that causes female gender identity.
Transsexual Narratives
The claim that MtF transsexuals are "women trapped in men's bodies" is commonly made both by and about transsexuals.
The evidentiary value of such claims depends on their plausibility and the lack of alternative, more plausible explanations.
Nonhomosexual MtF transsexuals are not especially feminine in their interests and behaviors compared with most women
(Herman-Jeglinska, Grabowska, and Dulko 2002; Lippa 2001) or with homosexual MtF transsexuals (Bailey 2003;
Blanchard 1988). Furthermore, they often acknowledge autogynephilia (Lawrence 2005), such as fetishistic cross-dressing
(in contrast to most women and homosexual MtF transsexuals [APA 2000; Blanchard, Clemensen, and Steiner 1987]).
Thus, the contention that women and all MtF transsexuals have feminine minds that motivate their feminine identification
strikes us as implausible.
The Transsexual Brain Studies
In 1995, Zhou et al. described a sex difference in the size of a brain region, the central subdivision of the bed nucleus of the
stria terminalis (BSTc), a collection of cells in the hypothalamus. This article included data from the brains of six MtF
transsexuals, whose BSTc volumes were female-typical. A follow-up paper by Kruijver et al. (2000) added another MtF
transsexual's brain and confirmed the earlier finding using different measurement techniques.
These studies have been widely touted by transsexual activists as supporting the brain-sex theory of MtF transsexualism.
Furthermore, a remarkable statement by the British group, the Gender Identity Research and Education Society (GIRES
2006), appeared to base its support of transsexual treatment and rights largely on the studies and their alleged implication
that "transsexualism is a neuro-developmental condition of the brain." Several of the signatories of this statement are
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distinguished researchers. The transsexual brain studies have also received considerable scientific attention. As of February
1, 2007, the study by Zhou et al. (1995) has been cited by 117 scholarly articles, and that of Kruijver et al. (2000) has been
cited by 43 scholarly articles. In contrast, Blanchard's three most highly cited autogynephilia-related studies (Blanchard
1985, 1989b; Blanchard, Clemmensen, and Steiner 1987) have each earned 38 such citations.
In our view, the influence of the transsexual brain studies is disproportionate compared with their scientific value to
understanding the etiology of MtF transsexualism. Their relevance as support for the feminine essence narrative, as
opposed to Blanchard's theory, is extremely weak--indeed, it is arguably absent. There are several important limitations that
prevent the brain studies from being relevant in this regard (Lawrence 2007b). The most critical problem is that neither
study includes the necessary hormonal controls to exclude the possibility that the feminization of the BSTc in MtFs was
due to hormone treatment, especially estrogen therapy, received for transsexualism. Recent research shows that the volume
of the hypothalamus is highly dependent on such hormonal treatment, with smaller volumes associated with estrogenic
treatment (Hulshoff Pol et al. 2006). We concur with Lawrence (2007b) that this is the most likely explanation of the Zhou
et al. (1995) and Kruijver et al. (2000) findings. Certainly those findings should be regarded cautiously until a study has
ruled out the concern regarding hormonal treatment.
Evidence from Sex-Reassigned Children
In principle, the feminine essence narrative and brain sex theory could be instantiated by selecting a normal girl, medically
masculinizing her body, and rearing her as a boy from an early age. If anyone could be a female trapped in a male body, or
have a female brain in a male body, it would be a female such as this. What we know about such cases suggests that they
are similar to homosexual, and different from nonhomosexual, MtF transsexuals.
There have been a few rare cases of females born with virilized genitalia due to prenatal maternal use of a progestin, in
which the attempt was made to rear them as boys. The second author of this article is one such case, and she has known
two others personally. All three cases were quite similar in presentation to homosexual MtF transsexuals: noticeably
feminine presentation and interests, early expression of dissatisfaction with the male role, and sexual interest in males.
None of these cases had signs of autogynephilia, such as fetishistic cross-dressing. Finally, their decisions to transition
were made on the basis of optimizing sexual and social functioning, rather than because of a deep conviction that they were
women trapped in men's bodies.
BLANCHARD'S THEORY VERSUS THE FEMININE ESSENCE NARRATIVE
We believe that Blanchard's theory of MtF transsexualism is far better supported, and far more likely to be true, than the
feminine essence narrative and the associated brain-sex theory. It is based on far more data, with respect to the number of
both studies and subjects; no published scientific data in the peer-reviewed literature contradict it; and other investigators in
other countries have obtained similar findings (Smith et al. 2005). It also provides a plausible explanation for phenomena
that are problematic for the feminine essence narrative (e.g., fetishistic cross-dressing and lack of early femininity among
nonhomosexual transsexuals).
Why, then, has Blanchard's theory remained underappreciated, compared with the standard, feminine essence narrative? In
the remainder of this section, we try to explain this. First, however, we wish to emphasize some important respects in
which the two approaches to MtF transsexualism do not differ. Perhaps most importantly, both proponents of the feminine
essence narrative and of Blanchard's theory support the treatment of transsexuals by sex reassignment surgery. Indeed,
Blanchard (2000) has been a consistent advocate of such treatment for both homosexual and autogynephilic transsexuals,
as has one of the authors of this article (Bailey 2003).
In addition, proponents of both theories see the histories people tell of their lives as an important source of understanding.
In a recent paper on autogynephilia, Blanchard (2005) quotes extensively from self-reports of people with autogynephilia,
primarily from collections compiled by Lawrence (Lawrence 1999a, 1999b). We ourselves have learned much about
diversity among MtF transsexuals from our own interactions with members of each type. We believe, however, that in this
domain, as in others, people's own narratives do not always correspond to the true reasons for their choices and behaviors.
Finally, proponents of both theories recognize that MtF transsexuals are a diverse population who differ among themselves
in many ways due to life circumstances and personal characteristics. Nonetheless, we maintain that those who promote the
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feminine essence narrative fail to acknowledge one important source of that diversity, the distinction between homosexual
and autogynephilic MtF transsexuals.
Denial of Autogynephilia
Few nonhomosexual transsexuals publicly identify as autogynephilic, and most neither admit a history of sexual arousal to
the idea of being a woman, nor accept that such arousal was a motivating factor for their transsexualism. Indeed, although
most public transsexual activists appear by their histories and presentations to be nonhomosexual MtF transsexuals, they
have generally been hostile toward the idea that nonhomosexual transsexualism is associated with, and motivated by,
autogynephilia. Prominent MtF transsexuals and transgenders who have expressed outrage at the theory include Becky
Allison (1998), Christine Burns (2004), Lynn Conway (2006), Andrea James (2006), Deirdre McCloskey (2003), Nancy
Nangeroni (Grubb 2004), and Joan Roughgarden (2003). The most visible exception has been Anne Lawrence, a physician,
researcher, and psychotherapist, who both identifies as autogynephilic and has done most of the recently published research
on autogynephilia. Willow Arune (2004) is another exception.
There are a number of reasons why autogynephilic individuals may prefer the feminine essence narrative as an account of
their condition, even if autogynephilia is in fact the driving force. These include the concern (pre-transition) that clinicians
will deem them unacceptable for sex reassignment if their transsexualism is erotically motivated, or that people will
consider them sexually deviant (Bailey 2003; Lawrence 2004). Because autogynephilia produces a strong desire to imagine
oneself as a woman, the feminine essence narrative is intrinsically appealing to autogynephilic individuals, even if it is
implausible. In contrast, an explanation based on autogynephilia may be experienced as a narcissistic injury.
Transsexuals who have successfully accomplished the MtF transition sometimes see themselves as mentors to younger
people attempting or considering this path. They may feel that public acceptance of the feminine essence narrative will
facilitate the transition for these younger individuals. For example, parents may be more accepting era child whom they
think of as a female unfortunately born with a male's body than of one whom they think of as a male erotically aroused by
the idea of being female. Finally, as Lawrence (2007a) notes, postoperative transsexuals whose desire and attachment to
being women persists as their sex drive diminishes with age may come to doubt that this desire has anything to do with
eroticism. She also explains how this pattern is explicable via autogynephilia.
Attempts to Intimidate Proponents of Blanchard's Theory
Beyond denying the role of autogynephilia in MtF transsexualism, some transsexual activists have mounted attacks on
those who publicly disagree with them. In 2003, the first author published a book, The Man Who Would Be Queen, about
male femininity, including MtF transsexualism. The section on transsexualism included summaries of Blanchard's theory
illustrated by transsexual women of both types whom he had met, and who agreed to let their stories be included. Upon
publication, there was a firestorm of controversy among some MtF transsexuals. Most notably, the transsexual activists
Lynn Conway (2006) and Andrea James (2006) led an internet "investigation" into the publication of the book. Conway
(2004) likened the book to "Nazi propaganda" and said that it was "transsexual women's worst nightmare."
As a result of Conway's and James's efforts, a number of very public academic, personal, and professional accusations were
made against the first author. None of these accusations was true (Bailey 2005). (For an historical investigation into the
controversy surrounding The Man Who Would Be Queen, including a description of the substance and the merits of the
accusations, see Dreger 2007.) The attacks on The Man Who Would Be Queen were precisely an attempt to punish the
author for writing approvingly about Blanchard's ideas, and to intimidate others from doing so.
The second author was also attacked by some of the same transsexuals after she helped create the Website transkids.us.
This website was created by a group of homosexual transsexuals, or "transkids," their nonclinical name for themselves, to
educate the clinical and research communities in the wake of the controversy regarding The Man Who Would Be Queen.
The writings on the site both endorsed Blanchard's distinction between homosexual and autogynephilic MtF transsexuals
and criticized the standard feminine essence narrative as being both false and harmful to homosexual MtF transsexuals.
Subsequently, Andrea James (2007) conducted highly personal attacks on individual transkids (including the second
author), urging that these transkids be exposed and asserting that they were "fakes" because they would not reveal their
identities publicly.
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HOW DENIAL OF AUTOGYNEPHILIA CAN BE HARMFUL
We believe that advocacy for the standard feminine essence narrative, and against Blanchard's theory, is primarily
conducted by, or at least on behalf of, nonhomosexual transsexuals who incorrectly deny their autogynephilia. We have
outlined why some autogynephilic transsexuals might want to deny that they are autogynephilic, and why they might
strongly prefer the standard (but false) feminine essence narrative. Those who advocate on behalf of autogynephilic
transsexuals in denial include many gender clinicians; their motives may include their unwillingness to disbelieve or
displease their patients and their greater comfort with the idea of facilitating sex reassignment for reasons related to gender
than to eroticism (Lawrence 1998). Some clinicians may also think that belief in the feminine essence narrative may be
beneficial for their patients' psychological health and social interactions, even if it does not correspond to the true etiology
of their desire for sex reassignment. Nevertheless, there are both scientific and human costs to colluding with
autogynephilies in denial by propping up the feminine essence narrative as an explanation for all MtF transsexualism.
Impeding Scientific Progress
Obviously, the extreme, highly personal attacks on those who agree with Blanchard's theory of transsexualism are likely to
deter people from researching, agreeing with, or publicizing the theory. That is, indeed, the intended function of the attacks.
Most theories can benefit by scientific criticism, but the attacks on The Man Who Would Be Queen and its author by
transgender activists were not scientific criticism. We have argued that Blanchard's "two types" theory has greater
explanatory value than the feminine essence narrative and the associated brain-sex theory. Whether or not we are right,
deciding between the two views via political pressure cannot be the right way to advance science. The scientific costs of
this pressure include embracing a less plausible theory and failure to advance the better theory. For example, it is possible
that some transsexuals' resistance to the current theory is due to its incompleteness, which prevents it from explaining their
inner experiences to their satisfaction (Lawrence 2007a). Progress toward a more complete theory is impeded by the kinds
of pressure we have described, but it would be facilitated by thoughtful criticism.
Harm to Homosexual Transsexuals
Clinicians who work with transgender patients and who believe in the feminine essence narrative of MtF transsexualism
sometimes take a similar approach to both homosexual and nonhomosexual MtF transsexuals. For example, the second
author knows transkids whose therapists have offered them, and their families, readings by and about nonhomosexual
transsexuals (e.g., She's Not There, by Jennifer Boylan [2003] and Conundrum by Jan Morris [1987]). The narratives in
these readings did not even approximate the transkids' lives, and the therapists' assumptions that they did had a highly
negative effect on the transkids' attitudes toward therapy. Inevitably, they dropped out early.
Homosexual and nonhomosexual MtF transsexuals have different life issues and goals, and the persistence of the belief that
they are similar prevents development of clinical interventions likely to benefit the homosexual subtype. Velasquez (2004)
has argued that there is a lack of meaningful therapy for young homosexual transsexuals like herself, and that this is
because transkids are not recognized as a subtype distinct from nonhomosexual transsexuals. The denial of autogynephilia
helps make this possible.
Harm to Autogynephilic Male-to-Female Transsexuals
There are also substantial human costs to autogynephilic transsexuals due to insistence on the false, feminine essence
narrative. We consider two groups whom we believe are harmed by embracing the false narrative at the expense of
Blanchard's categorical theory: autogynephiles not in denial, and autogynephiles in denial.
Although few nonhomosexual MtF transsexuals publicly identify as autogynephilic, many more do so privately. Of the e-
mail correspondence the first author received regarding The Man Who Would Be Queen, about a third was from
individuals who understood themselves to be autogynephilic. Some of these individuals said that reading about Blanchard's
theory in the book had been revelatory and that they understood themselves for the first time, and all of them were happy
that autogynephilia was being discussed openly.
Even before the controversy concerning the book, transsexuals sympathetic to Blanchard's ideas have found themselves
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unwelcome in transsexual forums (e.g., online forums discussing transgender issues). Typically, any endorsement of
Blanchard's theory, or admission of significant autogynephilic motivation, is met with hostility. This hostility appears to
emanate primarily from individuals who fit the profile of autogynephiles in denial. The extreme stigmatization of the (true)
idea of autogynephilia harms autogynephiles not in denial in obvious ways. It makes it much less likely that they can find
resources that help them understand themselves, forces them into the closet, invalidates their self-concepts, and heightens
feelings of shame.
Although autogynephiles in denial prefer the standard feminine essence narrative, this does not necessarily mean that wide
acceptance of that narrative is in their best interests. In general, it seems likely that the best clinical and personal decisions
are made on the basis of accurate conceptualizations. For example, we have noticed that some transsexuals we would
classify as autogynephilic have chosen to pursue sex reassignment surgery after being diagnosed as "transsexual" rather
than "transvestite," a diagnostic moment they often recount with a sense of relief. Currently, in the psychiatric
nomenclature, the official name for transsexualism is gender identity disorder, highlighting the centrality of gender identity,
consistent with the feminine essence narrative (American Psychiatric Association 2000). However, the differential
diagnosis between transsexualism (gender identity disorder) and transvestism ("transvestic fetishism" in the DSM) is not
clearly meaningful. Both nonhomosexual transsexuals and transvestites are motivated by autogynephilia; many (perhaps
most) nonhomosexual transsexuals were transvestites prior to transitioning; and most importantly, the main difference
between the two conditions is that transsexuals, but not transvestites, decide to take steps to achieve women's bodies. As
we have noted, the precise nature of one's autogynephilic fantasies is a key factor in this decision. It seems detrimental to
us that what should be an explicit cost-benefit decision, with important consequences to the lives of autogynephilic patients
and their families, might be unduly influenced by a differential diagnosis of questionable validity.
It is unfortunate that the public face of MtF transsexualism is so different from reality. The controversy concerning The
Man Who Would Be Queen has raised awareness of Blanchard's ideas within the transgender community, but it has not yet
encouraged open-mindedness to those ideas. Those who value scientific truth and the well-being of transsexuals are
advised to do better.
REFERENCES
Allison, B. 1998. Janice Raymond and autogynephilia, http://www.drhecky.com/raymond.html.
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children and adults, ed. R. Blanchard and B.W. Steiner, 47-76. Washington, DC: American Psychiatric Press.
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J. MICHAEL BAILEY * AND KIIRA TRIEA
* Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, Illinois 60208-2710.
E-mail: jm-bailey@northwestern.edu.
Bailey, J. Michael^Triea, Kiira
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Bailey, J. Michael, and Kiira Triea. "What many transgender activists don't want you to know: and why you should know it
anyway." Perspectives in Biology and Medicine Autumn 2007: 521+. Academic OneFile. Web. 24 June 2015.
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... Due to this they may be more likely to experience physiological morbidities than those researched in adults. Oral estrogen administration to males put them at potential risk for experiencing: thrombosis/thromboembolism; cardiovascular disease; weight gain; hypertriglyceridemia; elevated blood pressure; decreased glucose tolerance; gallbladder disease; prolactinoma; and breast cancer [15]. Females who receive testosterone may be at risk for low HDL and elevated triglycerides; increased homocysteine levels; hepatotoxicity; polycythemia; increased risk of sleep apnea; insulin resistance; and unknown effects on breast, endometrial and ovarian tissues [15]. ...
... Oral estrogen administration to males put them at potential risk for experiencing: thrombosis/thromboembolism; cardiovascular disease; weight gain; hypertriglyceridemia; elevated blood pressure; decreased glucose tolerance; gallbladder disease; prolactinoma; and breast cancer [15]. Females who receive testosterone may be at risk for low HDL and elevated triglycerides; increased homocysteine levels; hepatotoxicity; polycythemia; increased risk of sleep apnea; insulin resistance; and unknown effects on breast, endometrial and ovarian tissues [15]. In addition gender altering surgeries offered after cross-hormone completion carry its own set of irreversible risks. ...
... For example, in many communities, there are entire peer groups coming out or being diagnosed with gender dysphoria and identifying as transgender at the same time [14]. Strong consideration should be given to investigating a causal association between adverse childhood events, including sexual abuse, and transgenderism, as addressed in previous sections there is large body of literature documenting many potential causes for the onset of GD [15]. It must be considered possible that some individuals develop GD and later claim a transgender identity as a result of childhood maltreatment and/or sexual abuse. ...
... (Lawrence, 2017, p. 50) Indudablemente, la idea de que la autoginefilia se encuentra en la base de la experiencia de DG de algunos varones puede resultar extremadamente incómoda y difícil de encajar, especialmente en un momento social e histórico en el que tanto la aceptación como la protección social de la identidad de las personas trans se encuentran en el centro del debate público. En este sentido, para muchas personas-incluidos muchos profesionales que trabajan en clínicas de identidad de género-es mucho más sencillo comprender la posibilidad de que un individuo haya nacido en el "cuerpo equivocado" que integrar el hecho de que algunos varones desarrollen DG a raíz de un interés erótico inusual (Bailey y Triea, 2007), 18 una motivación que sigue ostentando el estatus de "ilegítima" dentro de la comunidad. Sin embargo, decidir entre cuál de estas dos teorías tiene mayor poder explicativo es una cuestión empírica que ha de verse facilitada por la investigación sistemática y la crítica reflexiva, no impedida por el peso de la presión social y política (Bailey, 2019). ...
Thesis
El objetivo de este trabajo consiste en examinar el desarrollo de la ciencia en torno a la disforia de género (DG) a través del marco analítico de la filosofía de la ciencia. En concreto, mi intención es estudiar qué factores han contribuido a la politización progresiva de la ciencia producida en este ámbito. Para ello utilizaré el modelo propuesto por la filósofa estadounidense Heather Douglas, para quien los valores no epistémicos sólo deben desempeñar un rol indirecto en los procesos de inferencia científica. Hablamos de ciencia politizada cuando dichos valores juegan un papel directo en el funcionamiento interno de la ciencia, siendo los únicos determinantes de la aceptación o el rechazo de hipótesis. Aplicando este modelo al caso específico de la tipología de la transexualidad de Blanchard, la disforia de género de inicio rápido (ROGD) y el tratamiento de niños y adolescentes con DG, trataré de demostrar que la ciencia en torno a la DG está politizada, de modo que son los valores no epistémicos de los profesionales e investigadores los que determinan qué ideas y procedimientos terapéuticos resultan aceptables. Todo ello tiene implicaciones para la disciplina en su conjunto y plantea importantes desafíos de cara al futuro.
... As noted by Joy Diane Shaffer, 'academic physicians and psychologists were often more interested in validating their own theories of the etiology of transsexualism than in helping transsexuals to live happier lives' (Israel, G. E., & Tarver II, D. E, 1997, p. xi). The work of academic clinicians who have attempted to pathologise transgender identities and sexualities (among the most heavily criticised being work by Kenneth Zucker, and Ray Blanchard) has been accompanied by an 'us versus them' distain for trans-identified critics of their methods (Bailey & Triea, 2007). It has taken significant time to debunk this work as seriously methodologically flawed (Moser, 2010;Namaste, 2000;Richards et al., 2015;Serano, 2010;Veale, Clarke, & Lomax, 2012). ...
Article
The transgender population has been subject to a troubled history of ethically and methodologically flawed research practices. Whilst interest and ethical standards have both risen, there remains little specific methodological consideration of research with transgender participants. This article draws on practical experiences of doing research with transgender communities, and insider group status, to construct six categories to consider when working on trans-focused research. These categories include the importance of transgender history, the assurance of transparency, the significance of nuanced language use, the benefits of feminist methodological contributions, the value of intersectionality and the necessity of respecting trans spaces. The article concludes by reflecting on the overlapping and non-exhaustive nature of these categories, and wider structural concerns that may trouble knowledge production more generally.
... Autogynephilia is a natal male's paraphilic tendency to be sexually aroused by the thought or image of being a woman (Blanchard, 1989a). Autogynephilia has been a controversial topic, but this controversy has reflected sociopolitical concerns more than the quality of scientific evidence (Bailey & Triea, 2007;Dreger, 2008;Lawrence, 2004). There is little question that autogynephilia existsinsomenatalmalesandfiguresimportantlyintheirlives.For example, autogynephilia is the motivation why some males crossdress fetishistically (Bailey, 2003;Blanchard, 1989aBlanchard, , 1991Lawrence, 2013). ...
Article
Full-text available
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.
Book
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Durante el siglo pasado, los profesionales de la medicina intentaron aliviar las tensiones internas de los transexuales ajustando su apariencia externa a sus identidades de género preferidas. En repetidos estudios se constató una reducción de la disforia de género mediante cirugías de reasignación de sexo y terapias hormonales. Aunque bienintencionados, estos esfuerzos fueron por sí solos insuficientes para aliviar la angustia subyacente causada por la disforia de género. Además, las personas transexuales, incluso después de los procedimientos de reasignación de sexo, tienen mayores riesgos de mortalidad, neoplasias, comportamientos suicidas y morbilidad psiquiátrica que la población general. Las terapias de conversión basadas en la fe duplican las tasas de morbilidad de los individuos transgénero. Un enfoque religioso no basado en la ciencia médica produce peores resultados que no proporcionar ningún tipo de apoyo. La falta de apoyo familiar y comunitario a los jóvenes transexuales conduce a un aumento de la falta de vivienda, la prostitución y el abuso de sustancias. El enfoque intransigente y de amor-duro no conduce a resultados positivos para muchos jóvenes transexuales. Las pruebas médicas de la década anterior sugieren una causa del neurodesarrollo para las identidades transgénero; sin embargo, los estudios sobre la disforia de género de inicio rápido apuntan a causas sociales para el pico de adolescentes que se identifican como transgénero. Mientras que las altas tasas de niños preadolescentes diagnosticados como transgénero desisten de su disforia, algunos estudios han demostrado que los adolescentes que toman bloqueadores hormonales no desisten hasta los veinte años. Se necesitan estudios de seguimiento a más largo plazo para conocer los efectos que tienen los bloqueadores hormonales en el desistimiento cuando se prescriben a tiempo. Los teóricos nominalistas del género han integrado las identidades transgénero en su ideología, según la cual el cuerpo, la mente y el espíritu no están esencialmente unidos. Aunque estas ideologías intentan liberar a los individuos de las restricciones del realismo biológico, esta ideología no ha ofrecido a las personas transgénero una sensación de paz interior. Según un estudio de la Campaña de Derechos Humanos de 2018, los individuos que se identifican como no binarios y otras identidades de género recién nombradas sufren los niveles más altos de depresión, ansiedad e intentos de suicidio. Bajo el paraguas transgénero se encuentran tres grupos de personas: (1) los que tienen disforia de género de inicio temprano, (2) los que tienen disforia de género de inicio rápido y (3) los teóricos del género que forman parte de la 4ª ola del feminismo. Las personas con disforia de género de inicio temprano padecen una condición médica que desiste en un 80% en la adolescencia; el 20% que persiste se beneficia de alguna forma de transformación social en el sexo opuesto. La gran mayoría de las personas que se autodenominan transgénero pertenecen a la segunda categoría, que son principalmente mujeres adolescentes. Al igual que las autolesiones y los trastornos alimentarios, este contagio social alcanza su punto álgido a los diecisiete años, desistiendo en la edad adulta. Los jóvenes autistas están muy afectados. Este grupo busca principalmente una identidad y una comunidad de apoyo. El teórico del género ha aprovechado este caos y ha presentado eficazmente la identidad transgénero como una forma de reinvención. Las personas con disforia de género necesitan apoyo, las que tienen confusión de género necesitan orientación y los teóricos del género necesitan ser desafiados filosóficamente. El realismo tomista ofrece recursos adicionales para los individuos transgénero, que la ciencia secular no puede ofrecer por sí sola. El tomismo abarca todas las disciplinas de la ciencia y las humanidades para presentar una expresión holística de la verdad. La heurística tomista utiliza la ciencia médica y busca restaurar la naturaleza por los medios menos invasivos, al tiempo que depende de las virtudes y la gracia para proporcionar sabiduría y carácter para superar los obstáculos. Este libro sostiene que el uso de una heurística tomista en consonancia con la enseñanza de la Iglesia es mejor que las terapias médicas por sí solas, la terapia de conversión basada en la fe o la adopción de una ideología de teoría de género basada en el nominalismo.
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Throughout the previous century, medical professionals aimed to ease the inner tensions found within transgender individuals by conforming their outer appearances to their preferred gender identities. Repeated studies have found a reduction of gender dysphoria through sex reassignment surgeries and hormone therapies. Although well-intentioned, these efforts were on their own insufficient for relieving the underlying distress caused by gender dysphoria. Moreover, transgender individuals, even after sex reassignment procedures, have higher risks of mortality, neoplasms, suicidal behaviors, and psychiatric morbidity than the general population. Faith-based conversion therapies double the morbidity rates of transgender individuals. A religious approach not based on medical science produces worse outcomes than providing no support at all. A lack of family and communal support of transgender youths leads to increased homelessness, prostitution, and substance abuse. The uncompromising, tough-love approach does not lead to positive outcomes for many transgender youths. Medical evidence from the previous decade suggests a neurodevelopmental cause for transgender identities; however, studies on Rapid-Onset Gender Dysphoria point to social causes for the spike of adolescents identifying as transgender. While high rates of pre-adolescent children diagnosed as transgender desist in their dysphoria, some studies have shown that adolescents who take hormone blockers do not desist into their early twenties. Longer-term follow-up studies are needed to know the effects hormone blockers have on desisting when prescribed early. Nominalist gender theorists have integrated transgender identities into their ideology, whereby the body, mind, and spirit are not essentially united. Although these ideologies attempt to liberate individuals from restrictions of biological realism, this ideology has not offered transgender people an inner sense of peace. According to a 2018 Human Rights Campaign study, individuals who identify as non-binary and other newly named gender identities suffer from the highest levels of depression, anxiety, and suicide attempts. Under the transgender umbrella are three groups of people: (1) those with early-onset gender dysphoria, (2) those with Rapid Onset Gender Dysphoria, and (3) gender theorists who are part of the 4th wave of feminism. Those with early-onset gender dysphoria suffer from a medical condition that desists at a rate of 80% by adolescence—the 20% who persist benefit from some form of social transformation into the opposite sex. The vast majority of people calling themselves transgender are from the second category who are mostly adolescent females. Like self-harm and eating disorders, this social contagion peaks at seventeen years of age, desisting in adulthood. Autistic young people are significantly affected. This group is primarily looking for an identity and supportive community. The gender theorist has capitalized on this chaos and effectively presented the transgender identity as a way of reinvention. Those with gender dysphoria require support, those with gender confusion need guidance, and gender theorists need to be philosophically challenged. Thomistic realism offers additional resources for transgender individuals, which secular science cannot offer on its own. Thomism embraces all disciplines of science and the humanities to present a holistic expression of the truth. The Thomistic heuristic utilizes medical science and seeking to restore nature by the least invasive means while depending on virtues and grace to provide wisdom and character to overcome obstacles. This book argues that using a Thomistic heuristic in line with church teaching is better than medical therapies alone, faith-based conversion therapy, or adopting a nominalist-based gender theory ideology.
Article
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Background One of the most prominent etiological theories of gender incongruence in trans women proposes a paraphilic erotic target location error (ie, autogynephilia) as a causal factor in gynephilic (ie, exclusively gynephilic and bisexual) trans women. We hypothesized that a paraphilic erotic target location should manifest itself in various aspects of sexual behavior, solitary and dyadic sexual desire, and psychosexual experience. Aim To compare sexual behavior, sexual desire, and psychosexual experience of exclusively gynephilic and bisexual trans women with that of androphilic trans women to explore whether their sexuality differs substantially. Methods Trans women diagnosed with gender dysphoria (Diagnostic and Statistical Manual of Mental Disorders–5) were recruited at 4 transgender healthcare centers in Germany. The present study analyzed items on sexual behavior, desire, and experience of a self-report questionnaire, collected as part of a cross-sectional multicenter study. Main Outcomes Multiple aspects of sexuality were examined using self-constructed items. Sexual desire was measured using the Sexual Desire Inventory and psychosexual experience using the Multidimensional Sexuality Questionnaire. Results Significantly more exclusively gynephilic than androphilic trans women reported a history of sexual arousal in relation to cross-dressing. However, little evidence was found that gynephilic and androphilic sexual desire, behavior, and psychosexual experience differ profoundly. Interestingly, a statistically non-significant trend indicated that gynephilic trans women who had not yet undergone gender affirming surgery showed the highest levels of sexual desire (solitary and dyadic), whereas the opposite was the case for androphilic trans women. Clinical Translation Data of this study indicate that sexual orientation does not appear to be a good predicator for sexual behavior, desire, and psychosexual experience in trans women. Strengths and Limitations We investigated sexual desire and experience using standardized and evaluated measures such as the Sexual Desire Inventory and Multidimensional Sexuality Questionnaire. Future studies with a larger sample size should investigate how different gender affirming medical intervention might have diverging influences on sexual behavior, desire, and experience. Conclusion Ultimately, this study found little evidence for the hypothesis that sexual behavior, sexual desire, and psychosexual experience differ substantially in gynephilic (exclusively gynephilic and bisexual) and androphilic trans women.
Presentation
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Badania empiryczne dotyczące transseksualizmu w Polsce i na świecie należą do rzadkości. Szczególnie zaznacza się brak danych naukowych o charakterystykach psychologicznych, które powinny zostać zbadane również w kontekście stresu mniejszościowego. Przeprowadzono badanie z użyciem ankiety internetowej wśród 20 osób, które zadeklarowały, że utożsamiają się z przynajmniej jednym z następujących określeń: transseksualizm, transgenderyzm, crossdressing, transwestytyzm, fetyszyzm transwestytyczny, autoginefilia (autogynofilia). Ogłoszenie o możliwości wzięcia udziału w badaniu zostało umieszczone na forum internetowym zrzeszającym osoby „trans”. Średni wiek uczestników badania wyniósł 37,71 lat (SD=12,13). Uczestnikom badania zaprezentowano m. in. polską adaptację Skali Samooceny SES Rosenberga. Średni wynik SES wyniósł M=31,70 (SD=4,67). W porównaniu z próbą normalizacyjną dorosłych w wieku 25-55 lat grupa uczestników badania cechowała się wyższym wynikiem średnim (d=0,36). Wyniki badania mogą wskazywać na to, że osoby „trans” wykazują wyższą samoocenę w porównaniu z populacją. Należy jednak wziąć pod uwagę znaczne ograniczenia metodologiczne, w tym małą próbę badawczą oraz wykorzystanie wyłącznie wielkości efektu d Cohena do porównania z próbą normalizacyjną – nie są one zatem reprezentatywne. Należy również podkreślić, że badane określenia (transseksualizm, transgenderyzm, crossdressing, transwestytyzm, fetyszyzm transwestytyczny, autoginefilia [autogynofilia]) nie są ze sobą tożsame, co poddaje w wątpliwość możliwość ich łącznego analizowania w ramach jednej kategorii.
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This chapter acquaints the reader with the various types of adult men most likely to seek treatment for gender identity disorders. I have thus devoted little space to the discussion of related types (e.g., homosexual "drag queens") who clearly have a gender identity disturbance of some type but rarely present for this reason. There is no "received view" on the causes of gender identity disorders, even on issues as basic as psychogenic versus organogenic etiology. I have therefore attempted, throughout this chapter, to emphasize straightforward descriptions of patients' behavior rather than theoretical interpretations of it. There is, of course, no such thing as "pure" description, because the simplest observations of all clinicians are influenced by their theories and expectations. I have tried as much as possible, however, to separate data from conjecture, particularly where the latter is based on my own research.
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This is the text of a live debate between J. Paul Fedoroff, M.D., and Ray Blanchard, Ph.D., on the justifiability of public funding for sex reassignment surgery for transsexuals. The debate took place in the auditorium of the College Street Campus of the Centre for Addiction and Mental Health in Toronto. The written version of the debate was prepared after the live debate.
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This article reviewed research examining the association between childhood sex-typed behavior and sexual orientation. Prospective studies suggest that childhood cross-sex-typed behavior is strongly predictive of adult homosexual orientation for men; analogous studies for women have not been performed. Though methodologically more problematic, retrospective studies are useful in determining how many homosexual individuals displayed cross-sex behavior in childhood. The relatively large body of retrospective studies comparing childhood sex-typed behavior in homosexual and heterosexual men and women was reviewed quantitatively. Effect sizes were large for both men and women, with men's significantly larger. Future research should elaborate the causes of the association between childhood sex-typed behavior and sexual orientation and identify correlates of within-orientation differences in childhood sex-typed behavior. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This is a long term follow-up of 55 boys with early effeminate behavior. It was possible to determine the outcome in sexual orientation in 38 of the boys, which included homosexuality or variants of it in 35 (63.6 per cent) of the total of 55 and heterosexuality in three (5.5 per cent). In 10 boys the outcome was uncertain, and seven were lost to follow-up. An analysis of the uncertain cases suggests that the overall outcome in terms of homosexuality may prove to have been higher than 63.6 per cent. These results agree with those of previous prospective and retrospective studies, which are reviewed. From both types of such studies, the prospective ones starting out with instances of early effeminate behavior and the retrospective with cases of established homosexuality, the conclusion is ventured that all male homosexuality begins with early effeminate behavior. This has implications for future research on homosexuality.
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We examined whether an erotic response to cross‐dressing fantasies could be detected in heterosexual male cross‐dressers (HCDs) who verbally denied any erotic arousal in association with cross‐dressing for at least the past year. Subjects were 37 HCD patients and 10 paid heterosexual controls. HCDs were divided into groups according to their response to a questionnaire item asking the proportion of occasions that cross‐dressing was erotically arousing during the past year and offering response options from always to never. Penile blood volume was monitored while subjects listened to descriptions of cross‐dressing and sexually neutral activities. All HCD groups responded significantly more to cross‐dressing than to neutral narratives (p < .01); controls did not. Results suggest that only those causal hypotheses of heterosexual cross‐dressing need be considered that can account, also, for the presence of fetishism.
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This landmark work reports the extensive research findings that address the questions: What is the role of the parents in the development of a son's sexuality? Why do some boys become "feminine"? Which "feminine" boys become homosexual? Why is there a link between being a "sissy boy" and a "gay man"? Parents, teachers, mental health professionals, social scientists, and anyone curious about the development of his or her sexual identity will find this book unusually informative and provocative. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Many theorists have suggested that sexual deviates adopt impersonal outlets because of difficulties in social interaction, particularly with adult members of the opposite sex. In order to investigate the personality and mental health of non-clinical fetishists, transvestites and sadomasochists, the Eysenck Personality Questionnaire was distributed to the members of clubs catering to these predilections. Completed questionnaires were obtained from 125 fetishists (mainly rubber and leather), 285 transvestites and transsexuals, and 133 sadomasochists. Comparison of personality scores with male controls revealed that these groups of men are relatively introverted, neurotic and slightly higher on psychoticism. However, their levels of neuroticism and psychoticism were not so high as to be comparable with clinical samples of neurotics, psychotics or even patients with sex problems. Analysis of individual items in the EPQ showed that the deviant groups were more shy, lonely, sensitive and depressed than controls and were less likely to enjoy telling jokes, all of which suggests some difficulty with social skills. Other questions concerning their social background and upbringing revealed that the deviant groups were more likely to be without a steady partner, to have perceived their upbringing as restrictive and to have disliked their mother. However, it was not possible to implicate the experience of corporal punishment in childhood with any of these sexual preferences.