On the Science of Changing Sex

Counting Noses…

Posted in Confirming Two Type Taxonomy by Kay Brown on February 13, 2010

Among those who acknowledge that there are indeed autogynephilic males who seek and obtain somatic feminization there is a common belief that they must be the odd man out, so to speak.  However, the data does not support this belief.  On the contrary, the data says quite the opposite.  Consider the 2005 Netherlands study, looking at self-report of sexual arousal to cross-dressing, by definition, an expression of autogynephilic arousal.  Those who report Erotic Cross Dressing are nearly half of the total population:

ECD  46  (45%)

Not  56  (55%)

However, if we look at those who self-report being presently gynephilic, we see that percentage climb significantly:

ECD  28  (64%)

Not  16  (36%)

Fully two thirds of those transsexuals who self-identify as gynephilic readily admit to being autogynephilic.  This is hardly a small handful!  In addition, Blanchard has shown that many transgendered males who state that they do not have sexual arousal to cross-dressing, none-the-less experience physiological arousal as measured by increases in penile volume when listening to narration of cross-dressing literature.  Thus, for a number of TS folk, the self-report of no arousal is likely unintentionally inaccurate, leading to smaller reported numbers.  If we also consider that acknowledging erotic cross-dressing is potentially shame provoking and that some individuals may also believe that such admissions may hurt one’s chances of receiving medical services, they may fail to report it. Further, this is only an assessment of erotic cross-dressing.  There are also TS folk who acknowledge other forms of autogynephilic arousal which do not include the use of cross-dressing.  Some report arousal to the thought of being or becoming female in an of itself.  They find the thought of being female, of having female anatomy, sexually arousing and may use such imagery as an aid to arousal during masturbation or even partnered sex.  If an individual uses autogynephilic ideation in which she is a nude female, use of cross-dressing is not going to useful, nor reported.  The Netherlands study did not capture this data, so we must count these percentages as a lower bound to the percentage of transsexuals who are autogynephilic.

Contrast this with Lawrence’s resorted Netherlands (Smith) exclusively androphilic group combined with the group from Leavitt and Burger (L&B) who also had no sexual experience with women:

Study:  Smith         L&B               Total

ECD   5 (15%)     1 (7%)         6   (12%)

Not  29 (85%)   14 (93%)   43  (88%)

Thus, when we look at those individuals who self-identify as androphilic and that they have not had sexual experience with women, we see a very different pattern.  Very few report erotic cross-dressing.  We know that there are individuals who originally self-identified as gynephilic before transition, but report that they are are self-identified as androphilic post-transition.  (How this happens is perhaps a subject for another post?)  We also know that there are transsexuals who self-identify as asexual, who Blanchard has shown have similar levels of self-reported autogynephilic arousal as those who self-identify as bisexual and gynephilic, so it isn’t a stretch to imagine that there would be a small number of TS folk who would be more like a cross between the asexual and bisexual group, having no experience with women, but still self-identifying as androphilic.  Indeed, we see that in Leavitt and Burger’s study, that there are those who self-identify as being androphilic but have never actually had sex with a man! This may explain the small number of self-identified autogynephilic “androphilic” transsexuals.

In addition to showing a significantly reduced number of individuals reporting erotic cross-dressing, exclusively androphilic transsexuals show a distinctly different clinical profile.  They have been obviously feminine from early childhood and begin living full time as women at a much younger age than those who are not exclusively androphilic.  In fact, the clinical presentation difference is so noticeable, as to lead us to conclude that they are a distinctly different population, with a different etiology.

If we take these differences between the two groups, and the similarities within each group, we can create a description of the “prototypical” member of each.  While no one individual will conform to the prototype in all respects, it still has clinical value to describe each.

The prototypical feminine androphilic transsexual was called a “sissy” by her peers growing up.  She avoided rough & tumble activities.  Her primary social circle consisted of one or two girls.  She actively participated in girls games and imaginary play.  Her parents were embarrassed by her femininity, and may or may not have sought professional help in trying to discourage her behavior.  As a young teen, she became interested in girls fashion and make-up, often exploring how she might look as a girl by dressing up and experimenting with make-up.  This did not involve erotic cross-dressing.  She had crushes on boys at school.  Her peers thought she might be homosexual.  She was hassled, perhaps even bullied, by homophobic boys, but otherwise was reasonably popular in her chosen circle.  She was considered very neat and well dressed in boy’s clothes.  She sought out opportunities to interact with small children and infants, taking on babysitting jobs.  As she approached adulthood, looking at her own nature, her potential future, both romantic and economic, made a rational decision to transition to living as a girl so as to grow up to be a woman socially.  Her family may or may not have disowned her in late adolescence.  As she is naturally feminine, she found that she was socially and romantically more successful as a woman.  She actively dated men while pre-op, but assiduously avoided direct contact with her penis, finding that emotionally uncomfortable.  She lived several years as a woman, taking feminizing hormones, before having SRS to improve her sex life, replacing genitalia that she didn’t use with those that she did.

The prototypical autogynephilic transsexual was accepted as a boy as a child, though she wasn’t the most masculine.  She was often a “loner”, finding her hobbies and reading to be more rewarding, but still willing and ready to participate in rough & tumble play.  She often envied girls and observed them more often than most masculine boys.  As she entered puberty, she began erotic cross-dressing in private, often masturbating while dressed, usually with lingerie.  She found this shameful and hid her cross-dressing as best she could.  She entertained thoughts of living as a woman, often in very idealized situations.  As a young adult, she dated women, often finding it necessary to imagine that she was female to “perform”.  She typically hid this fact from her dates.  She fell in love and found that the previously growing desire to live as a woman abated for a while.  She married and had children.  Her need to cross-dress… and use autogynephilic ideation grew, as the first blush of their romance matured into committed love.  She agonized about it obsessively, trying alternatively to push it out of her thoughts and trying to appease it by cross-dressing.  At one point, perhaps in her early 30s, or in her late 50s, a set-back or other significant personal change brought all of these feelings to the fore… and she made the fateful decision that she could no longer ignore her sexuality.  After having tried to ignore the cognitive dissonance between her successful social identity as a man, husband, and father, and her obligatory autogynephilic image of being female, concluded that the female image is her “true” image.  She then made steps to begin counseling with a gender therapist, obtained prescription for feminizing hormones, and then began the painful steps to living full time as a “transsexual”, since she had too many social connections who know of her previous status as a man.  She had SRS within a short time of nominally living as a woman, as she was impatient, feeling like she had waited long enough in her previous life as a man.  Her wife may or may not have demanded a divorce.

Again, although recognizing not every individual will fit the prototype (lest we fall into believing stereotypes), these profiles still describe a large number.  However, it should be noted that feminine androphilic transsexuals are much more likely to be like the prototypic description than autogynephilic type.  There is simply more variation in the autogynephilic population in their responses to their condition.  Having described the prototypical autogynephilic transsexual, we can see that even those who report, nay, insist, that they do not experience autogynephilic arousal, still closely fit the clinical profile.  We can, as makes sense in evidence based medicine, assume if an individual fits the clinical profile, then they belong to that class.  Indeed, common sense would demand, that if they “walk like a duck”…

Although difficult to sort out, I am interested in trying to calculate how many folk are likely feminine androphilic (homosexual) transsexuals (HSTS) and how many are non-exclusively androphilic, likely autogynephilic (AGP) transsexuals, as percentages.  If we make the assumption that Lawrence accidentally excluded the same number of feminine androphilic transsexuals as the number of AGPs she accidentally included, we can ignore the small number of self-reported AGP TS folk in her androphilic sample.  (I believe this is valid because human lives are messy.  One can imagine that under certain circumstances an MTF transkid may have been briefly married, and thus accidently excluded.  e.g. I personally know an MTF transkid who, because of parental expectations and community pressure, married her best friend, both were still virgins… that “marriage” lasted only long enough to find out that this had been a very bad idea, and ended with them jointly, happily, hiring a lawyer to process the paperwork.)  This would give us a rough estimate of the ratio:

Transkid    37  (33%)

AGP             75  (66%)

Thus, we find that the majority of transsexuals are autogynephilic, likely out-numbering the feminine androphilic transsexuals two to one.  However, if we assume that Lawrence did not accidentally exclude any transkid, then we must remove all of those that report erotic cross-dressing, as well as removing those that didn’t report either way just for good measure:

Transkid    29  (26%)

AGP             80  (74%)

Which would mean that AGPs out number MTF transkids by three to one.  It could even be higher, if several of those self-identifying as androphilic had failed to report their autogynephilic arousal.  If we assume that the number that reported is the same as those that didn’t report, that would move another five from the Trankid to the AGP catagory:

Transkids    24  (22%)

AGP                85  (78%)

Which is about four to one.  From personal experience, over the years, this number seems more realistic to me.  But in any case, we have numbers that range from 45% that absolutely admit to being AGP up to 80% that are likely to be.  Far from being rare, the autogynephilic transsexual is the majority, no matter how you slice it.

Addendum 4/2/2013:

The ratio of AGP vs. exclusively androphilic transwomen varies by culture, as Anne Lawrence has shown.  The Anglo-American culture has the highest ratio and more extended family (collectivist) cultures have the lowest.  See the this essay for more information.


Male-to-female transsexual subtypes: Sexual arousal with cross-dressing and physical measurements
Lawrence, A.

Transsexual subtypes: Clinical and theoretical significance
Yolanda L.S. Smith, Stephanie H.M. van Goozen, A.J. Kuiper, Peggy T. Cohen-Kettenis

Clinical Patterns Among Male Transsexual Candidates with Erotic Interest in Males
Frank Leavitt, Ph.D., Jack C. Berger, M.D.


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