“Autogynephilia”: a disputed diagnosis

“Autogynephilia” (AGP) is a sex-fueled mental illness created by Ray Blanchard in 1989. Blanchard defines it as “a man’s paraphilic tendency to be sexually aroused by the thought or image of himself as a woman.”

Support for this disease model of gender diversity is almost nonexistent, limited to a small group of conservative activists and supporters. The many critics of the diagnosis include professional organizations and the vast majority of trans and gender-diverse people.

The disease was also prominently featured in the transphobic book The Man Who Would Be Queen by anti-trans activist J. Michael Bailey and has been heavily promoted by Anne Lawrence, a disgraced anesthesiologist who took up “autogynephilic transsexual” as a personal identity.

What does it mean?

Blanchard believes that trans women are males with one of two “male” sexual interests:

• “homosexual transsexuals” exhibit extreme homosexuality
• “autogynephilic transsexuals” exhibit extreme paraphilia

In other words, according to Blanchard, “homosexual transsexual males” (HSTS) are trans women exclusively attracted to “other males.”

Blanchard calls trans women with any other kind of sexual identity “non-homosexual” or “autogynephilic transsexual males.”

Among the few people who identify with this term, many do not think this is what “autogynephilia” means. They think it means “love of oneself as a woman,” or that a –philia (love) is the opposite of a -phobia (fear). This is not how -philia is used in the context of psychology or sexology.

Many people have proposed value-neutral terms for transgender sexuality that do not frame gender diverse fantasies as a sex disease. These include:

• genderplay or gender play (used since middle 20th century)
• crossdreaming (proposed by Jack Molay)
• interest in feminization and interest in masculinization (proposed by Andrea James)
• female embodiment fantasies and male embodiment fantasies (proposed by Julia Serano)
• erotic femaling and erotic maling (proposed by Richard Ekins and Dave King)
• Tiresian fantasies (proposed by Will Powers)

There are also community-specific terms of identity, like sissy and fujoshi/fudanshi.

Many mental health professionals and theorists have been highly critical of the terms “transsexual,” “homosexual transsexual,” and “autogynephilic transsexual.” The terms reflect the biases of their creators. They are not value-neutral and therefore not scientific. See parallels with other discredited illnesses below.

“Autogynephilia” describes a paraphilia

Blanchard continues to describe this illness as “a distinct paraphilia” worthy of differential diagnosis. Blanchard claims it is an improvement in terminology over what mentor Kurt Freund labeled “cross-gender fetishism.”

When Blanchard says this is a paraphilia, what does paraphilia mean?

“Paraphilia” is a term promoted by sexologist John Money for “problematic” sexual desire or behaviors involving:

• nonhuman objects
• the suffering or humiliation of oneself or one’s partner
• children or other nonconsenting persons.

Note that “paraphilias” can be diagnosed even if the person has no subjective distress or impaired function. According to Blanchard, “autogynephilia” is “a distinct paraphilia,” but people with his disease fall in the same clinical class as people who are attracted to corpses, animals, children, feces, etc.

In other words, proponents of this diagnosis are claiming that people express gender diversity not only because they are aroused by possessing a certain body part, but also because they are sexually aroused by humiliating themselves or their loved ones, and that they get a sexual kick out of public response to their gender expression, because they respond sexually to the reactions of nonconsenting persons like strangers, coworkers, and friends, in the same way an exhibitionist gets off by flashing people.

In fact, one of Blanchard’s theories is that paraphilias cluster, so if a gender-diverse or transfeminine person is not attracted exclusively to men, they believe that person is far more likely to be sexually aroused by children, animals, corpses, etc.

Blanchard’s mental institution saw people who came there by force or choice to discuss a sexual issue. Many had committed sex crimes.

Blanchard’s studies have never been replicated, and these ideas were widely ignored until Anne Lawrence latched onto “autogynephilia” as a political identity. People with erotic interest in genital modification were described as “pseudotranssexual” or “non-transsexual” in other disease models at the time. This motivated Lawrence to promote Blanchard’s diagnosis as a legitimate descriptor, because it was more “socially desirable.”

“Autogynephilia” describes a psychosexual pathology

In the same way that some gay people feel they are mentally ill, some people interested in transition consider themselves to be mentally ill. Unfortunately, in both cases, they do not think only they are mentally ill, but that all of us are.

The small number of self-identified “autogynephiles” frequently conflate the phenomenon with the diagnosis. They seem to think that people concerned about the term “autogynephilia” are claiming that the observed phenomena do not exist. Many people have suggested more scientific and value-neutral terminology. In a 2006 paper published in the peer reviewed journal Gender Medicine, I observed that three kinds of interest are being conflated:

• interest in feminization
• erotic interest in feminization
• autoerotic interest in feminization

“Autogynephilia” collapses all three common interests into one mental illness. In Blanchard’s world, a cisgender woman who feels sexy is normal, but a trans woman who feels sexy and thinks they are attractive has a “paraphilia” Blanchard created.

Similar discredited mental illnesses

“Autogynephilia” is one of many diseases created by psychologists to describe traits and behaviors that annoy or offend others.

• “Nymphomania”
• “Hysteria”
• “Hystero-epilepsy”
• “Ego-dystonic homosexuality”
• “Partial autogynephilia”

These were all once considered legitimate diseases. For more on each of these, see similar discredited diseases.

Differential diagnosis

“Autogynephilia” proponents wish to see a differential diagnosis, meaning they want to separate gender-diverse people into two distinct illnesses. Although the axis of sexual preference is the most persistent, it is not the only one proposed. Bailey calls this “lumping and splitting.” As they explain, some disorders have similar symptoms. The clinician, therefore, in a diagnostic attempt, has to differentiate against disorders which need to be ruled out to establish a precise diagnosis.

Below are some other diagnoses sometimes suggested for gender diverse people:

• Factitious disorder / Munchausen syndrome by proxy
• Somatoform disorder
• Hypochondriasis 
• Conversion disorder 
• Somatization disorder
• Briquet’s Syndrome
• Pain associated with psychological factors 
• True medical or psychiatric illness related to presenting complaints

Differential diagnosis is appealing to some gender-diverse people and practitioners who wish to separate people who transition into different groups.

It is my hunch that “autogynephilia” and differential diagnoses are especially appealing to those with a deep-seated homophobia. It seems rooted in the same motivations that some cross-dressing social groups use to exclude gay members. I will be discussing this theory in upcoming revisions.

“Autogynephilia” is quackery

The pathologization of socially unacceptable erotic interests has a long history. Recent clinical diagnoses such as “ego-dystonic homosexuality” and “nymphomania” have fallen into disrepute. Many expect “autogynephilia” will be similarly discredited as a diagnosis in time.

In fact, the diagnosis is an example of quackery, which is defined as “overpromotion in the field of health.”

Below is an example of how “autogynephilia” proponents like Ray Blanchard cannot separate the observed phenomena from the diagnosis:

“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.” [2]

This conflation creates a false dilemma. Let’s replace “autogynephilia” with another spurious diagnosis as an example:

“In the meantime, it is important to distinguish between the truth or falseness of theories about nymphomania, on the one hand, and the existence or nonexistence of nymphomania, on the other. The latter is also an empirical question, but it appears, at this point, to be settled.”

Quacks like Blanchard used to say exactly this before “nymphomania” was discredited as a diagnosis or a scientifically useful descriptor. “Nymphomania” is not a legitimate diagnosis or classification simply because there are observable phenomena that fit the denotation or clinical criteria. Saying that “nymphomania” does not exist is not the same as saying women who are extraordinarily sexually active do not exist. Of course they exist. That doesn’t mean that “nymphomania” exists, though. This is the primary problem with Blanchard’s thinking.

Let’s replace “autogynephilia” with another pseudoscientific concept that could be written by a similar type of quack:

“In the meantime, it is important to distinguish between the truth or falseness of theories about clairvoyance, on the one hand, and the existence or nonexistence of clairvoyance, on the other. The latter is also an empirical question, but it appears, at this point, to be settled.”

Just because someone observes something that fits the criteria for clairvoyance does not settle the empirical question of whether it exists or not. That’s not how science works. That’s called confirmation bias, or less formally, “begging the question.” Blanchard comes to a questionable conclusion (“autogynephilia” exists) based on an assumed premise (“autogynephilia” is a scientifically useful term).

“Autogynephilia” is based on interlocking pseudoscientific claims and methodologies

Real discoveries of phenomena contrary to all previous scientific experience are very rare, while fraud, fakery, foolishness, and error resulting from overenthusiasm and delusion are all too common. (Cromer 1993)

There are several established phenomena common to pseudoscientists and quacks. Empiricists tend to emphasize the tentative and probabilistic nature of knowledge, while rationalists tend to be dogmatic and assert they have found a method to discover absolutely certain knowledge.

Some pseudoscientific theories can’t be tested because they are so vague and malleable that anything relevant can be shoehorned to fit the theory, e.g., the theory of multiple personality disorder, ”partial autogynephilia,” or the Myers-Briggs Type Indicator ®.

As a proud member of QuackWatch, I have helped debunk a number of pseudoscientific claims that affect the transgender community. Blanchard’s taxonomy is textbook quackery. As Dr. Madeline Wyndzen points out in a psychology trade newsletter [4] , Blanchard’s key empirical findings:

1. have never been replicated
2. failed to include control groups of typically-gendered women
3. failed to covary the acknowledged age-difference from ANOVA
4. drew conclusions about causality from entirely observational data

Plethysmography

A plethysmograph is a primitive “lie detector” attached to the genitals. It is also one of Ray Blanchard’s “scientific” tools, since it was invented by his mentor Kurt Freund.

I have found over my years of exposing medical fraud and quackery that inventors are frequently the most tenacious quacks. Not only do they want to herald their invention, they are also most likely to make scientific errors when fitting the device or concept to use. Because they see their reputation as tied closely with the reception of their device or their writings, and because many inventors have a certain eccentricity and sense of individualism, they will rarely back down from a position, even when they have proven to be frauds. Fortunately, we don’t have to convince quacks they are wrong (which is frequently impossible); we only have to convince everyone else the quack is wrong.

For more on this, please see Plethysmograph: a disputed device.

Testimonials and anecdotal evidence

This is classic advertising trick: watch any infomercial, and you will see all sorts of glowing testimonials and anecdotes supporting the promotional claims being made. Testimonials are always unscientific and are of little value in establishing the legitimacy of the claims they are put forth to support.

Bailey’s book and Lawrence’s essays are primarily supported by anecdotal evidence (or “narratives” as Anne Lawrence calls them). Quacks typically use testimonials which only back their side of the story. Lawrence and Bailey only present anecdotal evidence that supports their point. See the discussion of bias below. This pseudoscientific evidence is further aided by communal reinforcement: the process by which a claim becomes a strong belief through repeated assertion by members of a community.

Bias

One of the most insidious problems with the science proposed by proponents of “autogynephilia” is the profound bias inherent in their unproven assumptions.

These types of bias are also sometimes called hidden persuaders:

“Technically these hidden persuaders can be described as ‘statistical artifacts and inferential biases’ (Dean and Kelly 2003: 180).” Dean and Kelly argue that hidden persuaders explain why many astrologers continue to believe in the validity of astrology despite overwhelming evidence that astrology is bunk. 

Psychologist Terence Hines, who has explored many varieties of hidden persuaders (Hines 2003), blames them for the continued use by psychologists of such instruments as the Rorschach test, despite overwhelming evidence that the test is invalid and useless: 

“Psychologists continue to believe in the Rorschach for the same reasons that Tarot card readers believe in Tarot cards, that palm readers believe in palm reading, and that astrologers believe in astrology: the well-known cognitive illusions that foster false belief. These include reliance on anecdotal evidence, selective memory for seeming successes, and reinforcement from colleagues.”

This bias takes many forms, and the major problems are outlined below:

Experimenter effect

Research has demonstrated that the expectations and biases of an experimenter can be communicated to experimental subjects in subtle, unintentional ways, and that these cues can significantly affect the outcome of the experiment ( Rosenthal 1998 ). i.e., people who wanted free treatment presented to Ray and told him what he wanted. People who think Anne Lawrence is a dangerously disturbed psychotic did not fill out a questionnaire.

Ad hoc hypothesis

Bailey, Blanchard, and Lawrence explain away facts that refute the hypothesis: i.e., those who disagree are lying, and those whose stories match the model are open and honest.

Cognitive dissonance

This theory of human motivation that asserts that it is psychologically uncomfortable to hold contradictory cognitions. Particularly confusing for Bailey and Lawrence are people who are clearly quite open about their erotic interests (like Deirdre McCloskey) but do not consider “autogynephilia” to be a valid diagnosis. This is clearly incomprehensible to them; Bailey notes that Deirdre shows “all the hallmarks of autogynephilia” and Anne Lawrence asks (apparently rhetorically) can someone explain how this isn’t autogynephilia?

This is equivalent to someone who believe “nymphomania” is a valid diagnosis. Because they cannot comprehend the possibility that the condition does not exist, their inability colors every observation they make.

Confirmation bias

This refers to a type of selective thinking, where favorable evidence is selected for remembrance and focus, while unfavorable evidence for a belief is ignored.

A pseudoscientist tends to notice and to look for what confirms one’s beliefs (supportive data), and to ignore, not look for, or undervalue the relevance of what contradicts one’s beliefs. Bailey, Blanchard and Lawrence do this by claiming those who disagree are lying, or by presenting only evidence that supports their arguments.

This type of biased thinking can be quite subtle. Some pseudoscientists seriously consider data contrary to their beliefs, but are much more critical of such data than they are of supportive data.

Pathological science

Nobel Prize winner Irving Langmuir described pathological science as “the science of things that aren’t so”, using as examples the Davis-Barnes Effect, N-rays, mitogenetic rays, the Allison Effect, extrasensory perception, and flying saucers (Langmuir 1968). 

Langmuir offered six characteristics of pathological science :

1. The magnitude of the effect is substantially independent of the intensity of the causative agent. 
2. The effect is of a magnitude that remains close to the limits of detectability; or, many measurements are necessary because of the very low statistical significance of the results. 
3. It makes claims of great accuracy. 
4. It puts forth fantastic theories contrary to experience. 
5. Criticisms are met by ad hoc excuses. 
6. The ratio of supporters to critics rises up to somewhere near 50 percent and then falls gradually to oblivion.

The problem of induction

This gets into heady philosophy of science type stuff that’s lost and Bailey and friends. For a brief formulation of the problem of induction we can turn to Born, who writes: ‘. . . no observation or experiment, however extended, can give more than a finite number of repetitions’; therefore, ‘the statement of a law – B depends on A – always transcends experience. Yet this kind of statement is made everywhere and all the time, and sometimes from scanty material.

In other words, the logical problem of induction arises from (1) Hume’s discovery (so well expressed by Born) that it is impossible to justify a law by observation or experiment, since it ‘transcends experience’; (2) the fact that science proposes and uses laws ‘everywhere and all the time’. (Like Hume, Born is struck by the ‘scanty material’, i.e. the few observed instances upon which the law may be based.) To this we have to add (3) the principle of empiricism which asserts that in science only observation and experiment may decide upon the acceptance or rejection of scientific statements, including laws and theories. 

These three principles, (1), (2), and (3), appear at first sight to clash; and this apparent clash constitutes the logical problem of induction.

See my earlier discussion of McSynchronicity for this problem described in lay terms.

Apophenia

Dr. Martina Belz-Merk notes “There is currently a controversial debate concerning whether unusual experiences are symptoms of a mental disorder, if mental disorders are a consequence of such experiences, or if people with mental disorders are especially susceptible to or even looking for these experiences.”

Forer effect (also called subjective validation)

Forer found that people tend to accept vague and general personality descriptions as uniquely applicable to themselves without realizing that the same description could be applied to just about anyone. The “symptoms” and “hallmarks” of “autogynephilia” continue to spread to explain away inconsistencies.

Argument to ignorance

This is a logical fallacy of irrelevance occurring when someone claims that something is true only because it hasn’t been proven false. Bailey is especially fond of this one.

For more information

Below are some additional resources on this topic. Please see my essay A defining moment in our history for more on disease models of gender identity in historical context.

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Draft version of 16 November 2019

References:

1. In J. M. Bailey (Chair), Phenomenology and classification of male-to-female transsexualism. Symposium conducted at the meeting of the International Academy of Sex Research , Paris. June, 2000. Slide 38.

2. Blanchard R. Origins of the concept of autogynephilia. Published online February 2004 via http://www.autogynephilia.org/origins.htm

3. “Paraphilia.” Diagnostic and Statistical Manual of Mental Disorders, version IV-TR.

4. Wyndzen MH. A personal and scientific look at a mental illness model of transgenderism. APA Division 44 Newsletter, Spring 2004, p. 3.

Recommended reading:

• LINK: “Autogynephilia”: New Medical Thinking or Old Stereotype? by Dr. Katherine Wilson http://www.transgender.org/tg/gidr/kwauto00.html

• LINK: Bailey, Blanchard, Lawrence and the fallacy of “autogynephilia” by Jed Bland http://www.gender.org.uk/chstnuts/queen0.htm

• LINK: Everything You Never Wanted to Know About “Autogynephilia” but Were Afraid You had to Ask by Dr. Madeline Wyndzen http://www.genderpsychology.org/autogynephilia/

• LINK: “Autogynephilia” & Ray Blanchard’s Mis-Directed Sex-Drive Model of Transsexuality by Dr. Madeline Wyndzen http://www.genderpsychology.org/autogynephilia/ray_blanchard/

• LINK: A personal and scientific look at a mental illness model of transgenderism by Madeline H. Wyndzen, Ph.D. (PDF) http://www.apa.org/divisions/div44/2004Spring.pdf

• LINK: “Autogynephilia” and disabilityhttps://www.transgendermap.com/info/autogynephilia-disability.html

• LINK: “Autogynephilia” links compiled by Dr. Madeline Wyndzen http://www.genderpsychology.org/autogynephilia/autogynephilia_links.html

Further reading:

• LINK :”Autogynephilia”: Views of one non-transitioner• https://www.transgendermap.com/info/autogynephilia-essay.html

• LINK: BC on Gender: “Autogynephilia” by BC Holmes http://www.bcholmes.org/tg/autogyne.html

• LINK: Men Trapped In Men’s Bodies: an Introduction to the Concept of “Autogynephilia” by Dr. Anne Lawrence (taken offline in 2004)

• LINK: Sexuality and Transsexuality: A New Introduction to “Autogynephilia” by Dr. Anne Lawrence

• LINK: The “Autogynephilia” Resource (autogynephilia.org) by Lisanne Anderson https://www.transgendermap.com/info/lisanne-anderson.html

• LINK: Janice Raymond and “Autogynephilia” by Dr. Rebecca Allison http://www.drbecky.com/raymond.html