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Early History of the Concept of Autogynephilia

Abstract

Since the beginning of the last century, clinical observers have described the propensity of certain males to be erotically aroused by the thought or image of themselves as women. Because there was no specific term to denote this phenomenon, clinicians' references to it were generally oblique or periphrastic. The closest available word was transvestism. The definition of transvestism accepted by the end of the twentieth century, however, did not just fail to capture the wide range of erotically arousing cross-gender behaviors and fantasies in which women's garments per seplay a small role or none at all; it actually directed attention away from them. The absence of an adequate terminology became acute in the writer's research on the taxonomy of gender identity disorders in biological males. This had suggested that heterosexual, asexual, and bisexual transsexuals are more similar to each other-and to transvestites-than any of them is to the homosexual type, and that the common feature in transvestites and the three types of non-homosexual transsexuals is a history of erotic arousal in association with the thought or image of themselves as women. At the same time, the writer was becoming aware of male patients who are sexually aroused only by the idea of having a woman's body and not at all by the idea of wearing women's clothes. To fill this terminological and conceptual gap, the writer introduced the term autogynephilia(love of oneself as a woman).
Archives of Sexual Behavior, Vol. 34, No. 4, August 2005, pp. 439–446 (
C
2005)
DOI: 10.1007/s10508-005-4343-8
Early History of the Concept of Autogynephilia
Ray Blanchard, Ph.D.
1,2,3
Received August 4, 2004; revision received November 27, 2004; accepted November 27, 2004
Since the beginning of the last century, clinical observers have described the propensity of certain
males to be erotically aroused by the thought or image of themselves as women. Because there was
no specific term to denote this phenomenon, clinicians’ references to it were generally oblique or
periphrastic. The closest available word was transvestism. The definition of transvestism accepted
by the end of the twentieth century, however, did not just fail to capture the wide range of erotically
arousing cross-gender behaviors and fantasies in which women’s garments per se play a small
role or none at all; it actually directed attention away from them. The absence of an adequate
terminology became acute in the writer’s research on the taxonomy of gender identity disorders
in biological males. This had suggested that heterosexual, asexual, and bisexual transsexuals are
more similar to each other—and to transvestites—than any of them is to the homosexual type, and
that the common feature in transvestites and the three types of non-homosexual transsexuals is a
history of erotic arousal in association with the thought or image of themselves as women. At the
same time, the writer was becoming aware of male patients who are sexually aroused only by the
idea of having a woman’s body and not at all by the idea of wearing women’s clothes. To fill this
terminological and conceptual gap, the writer introduced the term autogynephilia (love of oneself as a
woman).
KEY WORDS: autogynephilia; DSM; gender dysphoria; gender identity disorder; transsexualism; transvestism.
INTRODUCTION
Fifteen years ago, I coined the term autogynephilia
from Greek roots meaning “love of oneself as a woman”
and defined it as a male’s propensity to be erotically
aroused by the thought or image of himself as a woman
(Blanchard, 1989a). My identification of this erotic
orientation was not the result of any advance in imaging
technologies, laboratory assays, or computationally inten-
sive statistical procedures. It was the result of a perceptual
shift—a shift in the way I saw, heard, and understood
statements that patients had been making to clinicians for
decades. In this essay, I review the perceptions of earlier
1
Law and Mental Health Program, Centre for Addiction and Mental
Health—College Street Site, Toronto, Ontario, Canada.
2
Department of Psychiatry, University of Toronto, Toronto, Ontario,
Canada.
3
To whom correspondence should be addressed at Law and Mental
Health Program, Centre for Addiction and Mental Health—College
Street Site, 250 College Street, Toronto Ontario M5T 1R8, Canada;
e-mail: Ray
Blanchard@camh.net.
clinicians and attempt to show how these led to my own
formulation.
The study of autogynephilia is, more than anything
else, the study of what people say about their experiences.
The reader who has never heard or read autogynephiles
describe their own feelings in their own words can consult
the self-reports of 59 individuals compiled by Lawrence.
These are accessible in two electronic documents, “28
Narratives About Autogynephilia” (Lawrence,1999a)and
“31 New Narratives About Autogynephilia” (Lawrence,
1999b). The following quotes from these documents give
something of the flavor of autogynephiles’ accounts. Nar-
ratives numbered 1–28 are from the “28 Narratives” and
those numbered 29–59 are from the “31 New Narratives.
The defining feature of autogynephilia is reported
quite simply in many of Lawrence’s collected narratives,
for example: “The very earliest of my masturbation
fantasies at around 12 years of age were of being somehow
turned into a girl. They have always been the primary
theme for me all through my life” (Narrative #8). “It is
very much the idea and fantasy of having a woman’s body
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440 Blanchard
and enjoying it that I find intensely arousing. I have had
that desire since puberty, and it is the one thing that drives
me to sexual arousal reliably and strongly, without fail”
(Narrative#10).Otherdeclarations include more personal,
specific detail:
An early experience I can still vividly remember of
becoming aroused at the thought of becoming female
was when I was approximately 9 or 10 years old. I was
overweight and I had begun to develop breasts, solely
from my weight. I would soap my breasts in the shower
and imagine I was really a woman with a real woman’s
breasts, and I would become extremely aroused. ...
...It wasn’t until I actually started therapy that I began
appearing in public dressed as a female. In the early
days I would become aroused whenever anyone, a
sales clerk, a casual stranger, would address me as
“Ma’am” or perform some courtesy such as holding a
door for me. This arousal led to a heightened fear of
discovery, i.e., that my erection would give me away.
(Narrative #13)
It is notable that the idea of having women’s breasts
appears to arise quite often in autogynephilic fantasy
(Blanchard, 1993a).
In other narratives, individuals talk about negative,
ambivalent, or paradoxical reactions to their own autogy-
nephilia:
I wasimaginingmyself telling my parents, and my doctor,
that I was really a girl. I imagined, in fact, lying down on
the operating room table for my sex reassignment surgery.
I was also imagining with horror that I would become
sexually aroused. How would I explain this? How could
I even understand for myself? (Narrative #1)
I too have always had these feelings of arousal at the
mere thought of being female. And it always pissed me
off! I hated it that putting on a dress, or wearing other
feminine attire, or even just fantasizing about being a
normal woman would elicit such an un-female response,
both physically and mentally. I wanted so badly for the
things I was doing to simply feel “normal. I didn’t
WANT to be aroused by them! (Narrative #41)
The reactions described by the writer of Narrative #41 do
not appear to be rare. Systematic research has found that
a substantial proportion of cross-dressers report that they
experience sexual arousal as an unwanted and bothersome
by-product of wearing, or changing into, women’s apparel
(Blanchard & Clemmensen, 1988; see also Buhrich,
1978).
Clinical vignettes and longer descriptions of auto-
gynephilic behavior published elsewhere (e.g., Bailey,
2003, pp. 151–156; Blanchard, 1990, pp. 56–69, 1991,
1993b; Lawrence, 2004) show that there is a great variety
of ways in which the erotic idea of being a woman
may be symbolized, and the erotic fantasy of being a
woman enacted. This point can also be illustrated with
the Lawrence narratives:
Wearing women’s clothing and feminizing my body has
always been sexually exciting for me—even after SRS
[sex reassignment surgery]. ...it was and still is sexually
exciting for me to have female body “functions.” Before
my SRS, I would pretend to menstruate by urinating
in sanitary pads. I particularly enjoyed wearing the old
fashion belted pad with long tabs. (Narrative #16)
My first experiences reading Playboy found me almost
instantly aroused by the idea of being the model. When I
was about 18, some friends took me to an old fashioned
strip show, and I got aroused, all right—as soon as I got
home, I put Noxzema cream on my nipples to simulate
pasties! Even the idea of owning a girl’s bike has aroused
me. (Narrative #53)
The fusion of the longing to have a woman and the
longing to be a woman—the confounding of desire and
envy—which is often apparent in clinical interviews with
autogynephiles, is typified by this statement:
At the very moment that most young males are first be-
coming aroused by the opposite sex, there are apparently
a few of us who are becoming aroused at [the idea of]
being the opposite sex. I remember this with a great deal
of clarity—I became aroused by those blossoming young
girls in their short skirts, wishing I was them. (Narrative
#42)
Some autogynephiles conceptualize their rather compli-
cated erotic dynamics in language similar to that of
clinical observers whom I quote in the next section: “The
person I was looking for in a woman turned out to really
be me. I never found that person, except in myself
(Narrative #11). “Real girls come and go, but my one
true and permanent girlfriend was myself in female role”
(Narrative #52). “Indeed, I do believe that, underneath it
all, the overpowering desire to be female is simply the
urge to procreate turned inside out” (Narrative #3).
Even the briefest introduction to the erotic fantasies
of being a woman must include a description of their
role in autogynephiles’ sexual interactions with real (i.e.,
external) women:
I have been in a steady relationship with a lady some
eight years older than me. ...We regularly have sex and
I really enjoy getting her excited and giving her orgasms.
She gets to a point where she wants me inside her, and
I do this, but I usually have to imagine I am the woman
to have an orgasm myself. For some reason she likes
to have her legs closed, so I am usually the one with
my legs spread, which reinforces my fantasy of being the
one who is penetrated. I have not told her what I fantasize
about during sex, and have not told her that I have started
hormones. (Narrative #54)
In some cases, unsuspecting wives may be disconcerted
by their husbands’ behavior during intercourse: “I still
Early History of Autogynephilia 441
remember that odd look she gave me when I once
used the words ‘my pussy’ in sex talk” (Narrative #15).
In other cases, wives are aware of, and sometimes
cooperative regarding, their husband’s erotic preferences:
“Even though my wife is a natural female, I can block her
out and make believe she is penetrating me; or when I am
lucky, she will play along and kiss me with her tongue
and tell me what a pretty girl I am” (Narrative #47).
Another aspect of autogynephiles’ interpersonal
sexual behavior is also noteworthy. Autogynephiles some-
times develop a special type of erotic interest in men, an
interest that depends on their erotic fantasy of themselves
as women:
I have also had sexual encounters with eight men. ...I
found I enjoyed the physical aspects of this type of sex
and felt I was confirming my womanhood by being a
passive partner. All these encounters occurred while I
was [cross-] dressed and were all one night stands. I
have never been interested in sex with a man when I was
presenting as a man myself. (Narrative #54)
It is common for autogynephiles to fantasize that their
anus is a vagina while they experience anal penetration,
either by a real male partner or by a self-inserted dildo
during solitary masturbation. In rare cases, the dildo may
be attached to some mechanical device representing the
full male anatomy, for example, a mannequin or dummy
with movable arms (e.g., Bailey, 2003, p. 154).
The retrospective accounts of adult autogynephiles
indicate that some individuals begin to experience au-
togynephilic behaviors or fantasies prior to puberty.
This has not yet been confirmed by statements obtained
directly from children. There have, however, been parental
observations of penile erection in cross-dressing boys as
young as 3 years old (Zucker & Blanchard, 1997).
EARLY AND MIDDLE TWENTIETH
CENTURY THOUGHT
There is ample evidence in the clinical literature that
clinical practitioners have been aware of the phenomenon
of autogynephilia since early in the last century. Because
they had no label or definition for this phenomenon,
however, their references to it were oblique or epi-
grammatic. In some cases, clinicians described patients’
behaviors that clearly struck them as having some special
significance, but they did not have the terminology or
conceptual tools to identify the underlying motivation as
autogynephilic.
Epigrammatic allusions to autogynephilia may be
found in the writings of Magnus Hirschfeld (1868–
1935). Hirschfeld was the brilliant German physician who
coined the term transvestism in 1910. He is generally
credited with being the first clinician to distinguish
homosexuality per se from transvestism and other cross-
gender phenomena. He identified the erotic idea of being
a woman in a subgroup of cross-dressing males:
We are almost tempted to believe that we are here faced
with a splitting of the personality in the sense that the
masculine component in the psyche of these men is
sexually stimulated by the feminine component and that
they feel attracted not by the women outside them, but
by the woman inside them. (1948, p. 167)
Hirschfeld appears to have been, or to have become, aware
that autogynephilia does not always completely obliterate
erotic interest in (external) women, and in other writings
(e.g., 1925, pp. 199–200) he modified his own aphorism
to the effect that certain cross-dressers love the woman
inside them in addition to the women outside them.
Hirschfeld may have had autogynephilia in mind,
among other things, when he made the following com-
ments about his invented term transvestism:
We have denoted this impulse as “transvestite, from
“trans, “across, and “vestitus, “clothed, and readily
admit that this name indicates only the most obvious
aspect of this phenomenon, less so its inner, purely
psychological kernel. (1948, p. 158)
It is unlikely that Hirschfeld was referring solely to
autogynephilia as the “inner, purely psychological kernel”
of transvestism, because, in his later writings, he also
applied the term transvestite to homosexual male-to-
female transsexuals and to female-to-male transsexuals,
neither of which manifests autogynephilia. One thing,
however, is for certain. Many later (and lesser) clinicians
who wrote about erotically motivated cross-dressing went
in precisely the opposite direction to that indicated by
Hirschfeld, and focused on the individual’s use of clothing
rather than his mental content. This literalist approach
is exemplified by the diagnostic criteria for “Transvestic
Fetishism” in the Diagnostic and Statistical Manual of
Mental Disorders (American Psychiatric Association,
2000), which make no mention of erotic ideation re-
garding the female persona. The emphasis placed by
many writers on the physical properties of clothing used
for cross-dressing (silky textures, striking colors) likely
militated against the realization that erotic arousal at the
thought of being a woman could arise with no ideas or
actions involving women’s apparel at all.
Havelock Ellis (1859–1939), another of the
great, classic sexologists, had perceptions similar to
Hirschfeld’s, although he couched them in somewhat
different language. Ellis used the term Eonism, usually
in regard to nonhomosexual males, to designate overt
cross-gender behavior as well as subjective feelings;
442 Blanchard
he sometimes used an alternative term, sexo-aesthetic
inversion, for the same thing. In his view:
The Eonist is embodying, in an extreme degree, the
aesthetic attribute of imitation of, and identification with,
the admired object. It is normal for a man to identify
himself with the woman he loves. The Eonist carries that
identification too far. (1935, p. 244)
In other writings, Ellis reiterated his opinion that
“Eonism” and normal heterosexual interest have some
common point of origin: “Psychologically speaking, it
seems to me that we must regard sexo-aesthetic inversion
as really a modification of normal hetero-sexuality” (1928,
p. 103).
Throughout most of the 20th century, psychiatry and
psychology were dominated by psychodynamic theories,
and simple descriptions of patients’ behavior were less
interesting to clinical authors than their theories about
this behavior. This propensity can be seen in the next few
examples of early clinical commentary on autogynephilic
phenomena. The reader should bear in mind when reading
these examples (and when studying the old literature
generally) that many writers used the term transvestite
for persons who would today be called transgendered or
transsexual.
Otto Fenichel (1897–1946) was a prominent psy-
choanalyst and author. Fenichel (1930), writing on
transvestism, also noted autogynephilic phenomena in
terms not dissimilar from Hirschfeld and Ellis. He did
not, however, dwell long at the descriptive level:
Love for the subject’s own self—phantasies that the
masculine element in his nature can have intercourse
with the feminine (i.e. with himself) are not uncommon.
Love for the phallic mother is often transformed into
love for the ego in which a change has been wrought
by identification with her. This is a feature in the psychic
picture which has struck even non-analytical writers, who
have described a narcissistic type of transvestist. (p. 214)
Although Fenichel noted the same fantasies as Hirschfeld
and Ellis, he also, in a sense, denied their importance. In
Fenichel’s view, the transvestite’s driving fantasy was not
the conscious thought of himself as a woman with a vulva
but rather the unconscious thought of himself as a woman
with a penis.
Buckner (1970) advanced an elaborate theory of
the developmental events leading to transvestism. In
his theory, the future transvestite begins with fetishistic
masturbation, but then
begins to build in fantasy a more complete masturbation
image.... Through a process of identification and fan-
tastic socialization he takes the gratificatory object into
himself ... [The next step] involves this elaboration of
masturbation fantasies into the developmentof a feminine
self. ...[which is] gratifying in both sexual and social
ways. When it becomes fixed in his identity, he begins
to relate toward himself in some particulars as if he were
his own wife. (pp. 383–384, 387)
Thus, Buckner also recognized the erotic idea of being
a woman, although it is debatable whether he located it
correctly in the developmental sequence.
The 20th century writers varied considerably in
their ability or willingness to differentiate autogynephilia
(erotic interest in the idea of being a woman) from
homosexuality (erotic interest in men and men’s bodies).
The following quote from Karpman (1947) provides a
good example of failure to make this distinction:
If a married man insists in his relations with his wife in
occupying the succubus position and at the same time
demands of her that she massage his breasts, this can
hardly be interpreted as anything else but an expression
of unconscious or latent homosexuality. (p. 293)
It was self-evident to Karpman that such behavior beto-
kened a sexual interest in men; he never even considered
that the fundamental and irreducible sexual stimulus was
the idea of being a woman.
There is evidence that other writers, in contrast,
were aware of the difference between true homosexual
attraction and autogynephilically mediated attraction—
the difference between sexual interest in men for their
bodies and sexual interest in men for their symbolic
value as accoutrements of femininity. Thus, Henry (1948),
writing at almost the same time as Karpman, reported
as simple fact the remark of a married cross-dresser
concerning one of his homosexual encounters: “It was
all from the point of vanity of being a woman. I have
absolutely no taste for homosexuality itself” (p. 495).
In summary, the generations of clinicians following
Hirschfeld and Havelock Ellis had, to varying degrees,
some awareness of the existence of autogynephilia. In the
absence of a label and a definition for this phenomenon,
however, they were unable to systematize their obser-
vations or to communicate them very effectively to any
audience.
THE PIVOT POINT
The first real advance in this area, after the seminal
observations of Hirschfeld, was made by another of the
great 20th century sexologists, Kurt Freund (1914–1996).
Although he was born and educated in Prague, Freund
was, like Hirschfeld, a native German speaker. This is
likely more than coincidence. During his formative years
as a sexologist, Freund had read and absorbed the works
of Hirschfeld (as well as other German sexologists of
Early History of Autogynephilia 443
the pre-World War Two period). A North American-born
psychiatrist or psychologist would have been considerably
less likely to be familiar with Hirschfeld’s thinking, first,
because many of Hirschfeld’s books were destroyed by the
Nazis—Hirschfeld was a Jew—and second, because none
of Hirschfeld’s major original writings (even the famous
Die Transvestiten) was translated into English until more
than 50 years after his death (Hirschfeld, 1910/1991).
In the late 1970s, when I first met him, Freund
was working on a study that he eventually published
under the title “Two Types of Cross-Gender Identity”
(Freund, Steiner, & Chan, 1982). Freund was interested in
determining whether cross-gender identity in homosexual
males is the same clinical entity as cross-gender identity in
heterosexual males. His eventual conclusion was captured
in the title of the article: There are two distinct types
of cross-gender identity. The feminine gender identity
that develops in homosexual males is different from the
feminine gender identity that develops in heterosexual
males. In other words, homosexual and heterosexual men
cannot “catch” the same gender identity disorder in the
way that homosexual and heterosexual men can both
“catch” the identical strain of influenza virus. Each class
of men is susceptible to its own type of gender identity
disorder and only its own type of gender identity disorder.
The reason that I stress this 1982 article is that in it
Freund, perhaps for the first time of any author, employed
a term other than “transvestism” to denote erotic arousal
in association with cross-gender fantasy. His reasons for
doing so are not clear in the article, and I cannot fully trust
my recollections of conversations about the manuscript
from 25 years ago. I suspect, however, that he wanted
to reserve the term “transvestism” for his definition of
a particular syndrome: “Transvestism is the condition in
which a person fantasizes her- or himself as a member
of the opposite sex only when sexually aroused” (Freund
et al., 1982, p. 54). This left Freund with a terminological
problem. He now needed a separate term to denote erotic
arousal in association with cross-gender fantasy, because
this phenomenon could occur in individuals who would
not meet his definition of transvestites. He therefore
coined the term cross-gender fetishism, which he was very
careful to distinguish from “fetishism proper”:
cross-gender fetishism is characterized by the subject’s
fantasizing, during fetishistic activity, that she or he
belongs to the opposite sex ...the fetish, in such cases
always an object characteristic of the opposite sex, is used
to induce or enhance cross-gender identity. (p. 50)
Elsewhere in the article, Freund pointed out that clothing
characteristic of the opposite sex is usually, but not always,
the individual’s favorite symbol of his own femininity.
The significance of Freund’s terminological innova-
tion for my own thinking was the following: It freed up, if
ever so slightly, the erotic idea of being a woman from the
word “transvestism” and from any necessary association
with women’s garments. This set the stage for me later to
free up the idea completely.
THE INTRODUCTION OF THE
TERM AUTOGYNEPHILIA
In 1980 I accepted a full-time position in the Gender
Identity Clinic at the former Clarke Institute of Psychiatry
in Toronto, Ontario, Canada (now officially called the
College Street Site of the Centre for Addiction and
Mental Health). I shortly thereafter decided, like many
investigators before me, that further typological research
on gender identity disorders was needed.
The clinical literature at that time included a confus-
ing array of classification schemes for gender identity
disorders in biological males (see Blanchard, 1989a).
One thing on which most authorities did agree was
that gender identity disorders are phenomenologically
and probably etiologically heterogeneous. The taxonomic
question, therefore, was not whether there is more than
one type of transsexualism in males, but rather, how
many more than one type, and how these should be
characterized.
The research strategy that I used for this question was
to start by distinguishing a larger number of groups and
then reduce this to a smaller number by combining groups
that seem to be merely superficially different variants.
Although I was a frequent collaborator of Kurt Freund’s in
those days—and still very much his student and prot
´
eg
´
e—
I did not begin this project with his 1982 typology. Instead,
I started this research program by returning to the first
taxonomic scheme ever proposed, namely, that advanced
by Hirschfeld.
Hirschfeld (1918) basically distinguished four main
types of “Transvestiten,” according to their erotic interest
in men, women, both, or neither. (The last type lacks
erotic interest in other people but not necessarily all sexual
drive.) Hirschfeld labeled these types the same way that he
labeled non-transsexual individuals, that is, according to
their biological sex. Thus, in Hirschfeld’s terminology, a
male-to-female transsexual who was erotically attracted to
men would be labeled a homosexual transsexual. I began
my research by defining and labeling the same groups
of male-to-female transsexuals identified by Hirschfeld:
homosexual, heterosexual, bisexual, and asexual (i.e.,
transsexuals attracted to men, women, both, or neither,
respectively).
444 Blanchard
The core of the research consisted of three stud-
ies (Blanchard, 1985, 1988, 1989b). The participants
were gender-dysphoric, biologically male patients who
presented at the then Clarke Institute of Psychiatry.
The data were individual items or multi-item measures
from a self-administered, paper-and-pencil questionnaire.
The participants were classified as heterosexual, asexual,
bisexual, or homosexual according to their scores on two
of these measures, the Modified Androphilia and Modified
Gynephilia Scales (Blanchard, 1985). A patient’s data
were used in one or more of these studies if he indicated,
in response to a key questionnaire item, that he had
felt like a woman at all times for at least 1 year. The
dependent variables included age at clinical presentation
as well as various measures of fetishistic response to cross-
dressing, degree of recalled childhood femininity, amount
of interpersonal heterosexual experience, and history of
erotic arousal in association with thoughts of being a
woman.
The results of this taxonomic research indicated that
heterosexual, asexual, and bisexual transsexuals are more
similar to each other—and to transvestites—than any of
them is to the homosexual type. Asexual and bisexual
transsexualism seemed to be variant forms of heterosexual
transsexualism, and transvestism to be a not-too-distant
cousin. This left me to answer the question: What is it
that transvestites and the three types of non-homosexual
transsexuals have in common? It was clear to me, by this
point, that the common feature is a history of erotic arousal
in association with the thought or image of oneself as a
woman.
By the late 1980s, the lack of a word to denote a
male’s propensity to be sexually aroused by the idea of
himself as a woman was becoming a constant problem in
my writing. Freund’s term cross-gender fetishism came
closer to describing this phenomenon than the familiar
term transvestism, in that the definition of cross-gender
fetishism explicitly included the element of cross-gender
ideation. Freund’s concept of cross-gender fetishism
still, however, implied the presence of a fetish-object,
even if it allowed that object to be some symbol of
femininity other than clothing. (I have already given the
example of sanitary napkins, which some men use to
simulate menstruation during masturbatory rituals.) The
term cross-gender fetishism therefore did not seem quite
satisfactory for my purposes. I was becoming increasingly
convinced that, at least for some men, the idea of being
a woman was central to their erotic excitement, and
that the specific objects they used to symbolize their
femininity were secondary and interchangeable. I was
strengthened in this conviction by the following patient,
whom I described at length in one report (Blanchard,
1991) and more briefly as below:
Philip was a 38-year-old professional man referred
to the author’s clinic for assessment. His presenting
complaint was chronic gender dysphoria, which had led,
on occasion, to episodes of depression severe enough to
disrupt his professional life. Philip began masturbating
at puberty, which occurred at age 12 or 13. The earliest
sexual fantasy he could recall was that of having a
woman’s body. When he masturbated, he would imagine
that he was a nude woman lying alone in her bed. His
mental imagery would focus on his breasts, his vagina,
the softness of his skin, and so on—all the characteristic
features of the female physique. This remained his
favorite sexual fantasy throughout life. Philip cross-
dressed only once in his life, at the age of 6. This consisted
of trying on a dress belonging to an older cousin. When
questioned why he did not cross-dress at present—he
lived alone and there was nothing to prevent him—he
indicated that he simply did not feel strongly impelled to
do so. (Blanchard, 1993b, p. 70)
This patient had not the slightest motivation that I could
detect for distorting his self-report in this particular way,
and his presentation seemed to me the final evidence
that the erotic idea of being a woman could exist in the
complete absence of any interest in women’s clothing or
any other fetish-object.
I therefore reluctantly concluded that I had no
alternative but to invent a new word. My colleagues
and I at the Clarke Institute were accustomed—again,
under the influence of Kurt Freund—to referring to the
erotic preference for adult women as gynephilia rather
than heterosexuality, because the former denotes both the
gender and the age of an individual’s preferred partners,
whereas the latter denotes only the gender. It was thus a
small step for me to prefix gynephilia with auto to produce
autogynephilia.
THE PHENOMENON OF AUTOGYNEPHILIA
VERSUS THEORIES INVOLVING
AUTOGYNEPHILIA
It is important to distinguish between the phe-
nomenon of autogynephilia and theoretical statements
involving autogynephilia. The existence of autogynephilia
as a distinguishable form of sexual behavior is scarcely
in doubt. During the past 15 years, numerous individuals
have come forward, outside of clinical contexts, to say
that, yes, indeed, the published descriptions of autogy-
nephilic behavior and feelings closely match their own
histories (e.g., Ekins & King, 2001). Their testimonials are
sometimes accompanied by expressions of comfort and
relief at learning of the existence of fellow travelers, some-
times by expressions of grief and anger at the confirmation
Early History of Autogynephilia 445
that their feelings represent a distinct paraphilia and by
moving requests for help. Unless all these individuals
have been motivated by obscure and perverse desires to
claim emotions they havenever really felt, their statements
constitute further evidence that autogynephilia exists and
that it is not extraordinarily rare.
Theoretical statements involving autogynephilia are
a rather different matter. I have, at one time or another,
advanced several of these, for example:
1. All gender-dysphoric biological males who are
not homosexual (erotically aroused by other
males) are instead autogynephilic (erotically
aroused by the thought or image of them-
selves as females) (Blanchard, 1989a; Blanchard,
Clemmensen, & Steiner, 1987).
2. Autogynephilia does not occur in women, that
is, biological females are not sexually aroused by
the simple thought of possessing breasts or vulvas
(see Lawrence, 1999c).
3. The desire of some autogynephilic males for
sex reassignment surgery represents a form of
bonding to the love-object and is analogous to the
desire of heterosexual men to marry wives and
the desire of homosexual men to establish perma-
nent relationships with male partners (Blanchard,
1991, 1993c).
4. Autogynephilia is a misdirected type of hetero-
sexual impulse, which arises in association with
normal heterosexuality but also competes with it
(Blanchard, 1992).
5. Autogynephilia is simply one example of a
larger class of sexual variations that result from
developmental errors of erotic target localization
(Blanchard, 1993b; Freund & Blanchard, 1993).
All or none of the foregoing propositions may be
true, false, or something in between. Their accuracy
is an empirical question that can be resolved only by
further research. In the meantime, it is important to
distinguish between the truth or falseness of theories about
autogynephilia, on the one hand, and the existence or
nonexistence of autogynephilia, on the other. The latter
is also an empirical question, but it appears, at this point,
to be settled. The primary evidence that autogynephilia
exists is the self-report of biological males who say
“I am sexually excited by the idea of having breasts,
“I am sexually excited by the idea of having a vagina,
“I am sexually excited by the idea of being a woman.
There is no particular reason to believe that these individu-
als are merely distorting the familiar transvestitic narrative
to make it more acceptable to others. How is it more
socially desirable for a man to admit that he is sexually
excitedby the idea of havingbreasts than to admit that he is
sexuallyexcited by wearing a brassiere? How does a man’s
behavior sound more normal if he admits to pretending
that his anus is a vagina while he inserts dildos into it than
if he admits to a predilection for wearing panties? Thus,
even a skeptical view of the data provides little reason
for doubting that autogynephilia exists as a discriminable
erotic interest—either a superordinate category including
transvestism or a correlate of it.
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Autogynephilia is defined as a male's propensity to be sexually aroused by the thought or image of himself as female. Autogynephilia explains the desire for sex reassignment of some male-to-female (MTF) transsexuals. It can be conceptualized as both a paraphilia and a sexual orientation. The concept of autogynephilia provides an alternative to the traditional model of transsexualism that emphasizes gender identity. Autogynephilia helps explain mid-life MTF gender transition, progression from transvestism to transsexualism, the prevalence of other paraphilias among MTF transsexuals, and late development of sexual interest in male partners. Hormone therapy and sex reassignment surgery can be effective treatments in autogynephilic transsexualism. The concept of autogynephilia can help clinicians better understand MTF transsexual clients who recognize a strong sexual component to their gender dysphoria.
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This study sought to determine the proportion of adult, male, heterosexual cross‐dressers who acknowledge both gender dysphoria and at least occasional fetishistic response to cross‐dressing. Subjects were 193 outpatients of the gender identity clinic or behavioral sexology department of a psychiatric teaching hospital. Questionnaire items were used to assess subjects' current level of gender dysphoria and their recent history of sexual response to cross‐dressing. Subjects who reported higher levels of gender dysphoria tended to report lower frequencies of sexual arousal with cross‐dressing (r = ‐.56, p < .0001) and lower frequencies of masturbation with cross‐dressing (r = ‐.62, p < .0001). About half of even the most strongly gender dysphoric subjects, however, acknowledged that they still become sexually aroused or masturbate at least occasionally when cross‐dressing. These findings indicate a need for revision in the DSM‐III‐R's diagnostic criteria for transvestism and gender identity disorders, which presuppose that gender dysphoria and fetishistic reactions are mutually exclusive.
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The literature concerning the motivation for corss-dressing in heterosexual transvestism is briefly reviewed. Thirty-three members of a club estiblished for hetersexual transvestities were interviewed. The sensations they derived fro cross-dressing and the importance of compulsive and nacissistic aspects in their transvestite behaviour were assessed and compared with those reported by 24 transsexual subjects. While cross-dressed, transvesitite and transsexula subjects frequently reorted feeling relaxed, comfortable and relieved of masculine demands. Transvestite subjects showed significantly more compulsive and nacrissistic aspects in their transvestite behaviour than transsexula subjects. Fetishistic pleasure was infrequently given as a motivation for cross-dressing.