While I’ve barely started to delve into the Nuttbrock et al. study, Anne Lawrence has already published a Letter in response. In it she also points out that the Nuttbrock study fully confirms the Freund/Blanchard two type taxonomy of MTF transsexuality, plus disproves several points where Nutbrock believed they had demonstrated differences from Blanchard’s earlier work.
First, Nuttbrock stated that they had found differences between the non-homosexual subtypes in the amount of reported autogynephilic arousal to cross-dressing where Blanchard didn’t. Lawrence pointed, in graphical format, that the two studies essentially agree. The only point that Blanchard had made, quite correctly, that since his study had fewer subjects, the level of statistical signal to his differences did not meet the mathematical standard of “significance”, and could not be accepted as gospel. Meaning, that this difference might have been merely noise. With the Nuttbrock data confirming the differences, we can now consider the possibility that these differences are real. We are then left with the task of interpreting what these differences could mean. Likely, we will need to do more in depth research to test new hypotheses, as we can now accept the basic taxonomy as convincingly validated.
Another point that Nuttbrook et al. made is that they failed to duplicate Blanchard’s later work that showed that there was a slight non-linearity in the correlation between gynephilia intensity and the expression of autogynephilia. Lawrence showed that this was purely a mathematical artifact, given that Blanchard had measured gynephilic intensity in six levels, while Nutbrook had only measure them in three. If we lump Blanchard’s data into only three levels, we get essentially the same data plot as Nuttbrock. Thus, it is likely this minor dip in the correlation is, extant, likely to be buried in the Nuttbrock population, but was not adequately measured.
All in all, Lawrence has put to rest any remaining questions about the Nuttbrock study differences from Blanchard’s. Once again, we can state with assurance, that Blanchard’s work is fully replicated and validated.
The only difference between Nuttbrock and Blanchard remaining is one of theoretical interpretation. Nuttbrock opines that Blanchard’s interpretation is essentialist. That is to say, that Blanchard’s theory is that autogynephilia as a phenomena and etiology arises from an essential difference between typical heterosexual males and AGP transsexuals. For example, this could mean that there is a biological etiology to this difference, perhaps prenatal hormones, perhaps differences in genes that code some subset of hormone receptors in the brain, perhaps epigenetic changes in gene expression. While Nuttbrock rejects this notion and invokes instead, Bem’s sexual conditioning model, described by Bem as “exotic becomes erotic”. Thus, interestingly, Nuttbrock would seem to see sexual arousal to cross-dressing as truly being “fetishistic transvestism”… that is to say, that it is a conditioned response akin to conventional fetishes!
Lawrence points out that invoking Bem’s theory is a misinterpretation of his theory, that Bem theorized that ‘‘individuals can become erotically attracted to a class of individuals from whom they felt different during childhood’’
Nuttbrock is right that Blanchard, and other researchers, do personally hold the suspicion that autogynephilia is essential and likely of biological origin. In fact, Blanchard has recently argued that autogynephilia is not a fetish and should be removed from that category in the DSM. Of course, traditionalists in the DSM review committee are resisting this change, so as a compromise, it has been proposed that autogynephilia be listed as a descriptor, an ‘add-on’ to Fetishistic Transvestism.
As a consequence of their analysis of the data from their study, Nuttbrock et al. seemingly ignoring the fact that it exactly duplicates previous studies going back twenty-five years and more, make the rather astounding conclusion that only the older generation of trans-folk have or will have autogynephilic arousal to cross-dressing, since in their view, the “exotic” nature of cross-dressing will become a thing of the past, and thus not lead to the development of sexually arousing fetishistic cross-dressing. Science is done best when it makes predictions. So, this prediction can be tested in thirty years time.
My own prediction is that nothing of the sort will happen. Late transitioning, autogynephilic transsexuals of the future are already in the making, marrying their girlfriends, dealing with their autogynephilic nature as best they can, dreaming that someday that they too will be ready to live full-time as women and get SRS and HRT. After-all… I heard this very same prediction 30 years ago… that everyone in the near future would be transitioning young, as it was no longer difficult to seek out SRS/HRT, given the easy availability. Nothing changed.
Time will tell…
A validation of Blanchard’s Typology: Comment on Nuttbrock et al. (2010)
Lawrence, A., Archives of Sexual Behavior
A Further Assessment of Blanchard’s Typology of Homosexual versus Non-Homosexual or Autogynephilic Gender Dysphoria
Nuttbrock, et al., Archives of Sexual Behavior
The DSM Diagnostic Criteria for Transvestic Fetishism
Blanchard, R., Archives of Sexual Behavior
A careful analysis of a large study like the Nuttbrock, et al. gives us a chance to have fun with numbers. From this may glean additional insights. It took a bit of doing, recalculating, but I was able find the data on the Asexual population and add it to the table I showed earlier. Consider the results:
Self-reported Homosexual Heterosexual Bisexual Asexual AGP AGP
Sexuality (androphilic) (gynephilic) Actual Expected
Number: (n=391) (n=71) (n=96) (n=12)
Autogynephilia 23.0 81.7 67.7 66.7
White (n=150) 18.6 38.0 37.3 6.0 78.7 64.4
Black (n=120) 90.0 2.5 7.5 0.0 23.1 27.8
Hispanic (n=246) 90.2 1.6 7.3 0.8 22.8 27.2
Other (n=54) 61.1 13.0 24.1 1.9 27.9 46.8
From the percentage that of each sexual identity report erotic cross-dressing, we can calculate an expected percentage for each ethnicity based upon the relative number of each sexual identity, assuming that ethnicity should have no effect on the likelihood of a given sexual identity group reporting such autogynephilic arousal to cross-dressing. However, looking at the expected and the actual percentages, we see a very striking pattern. Our assumption that ethnicity has no effect isn’t supported. In fact, we see a far different pattern in that the White population reports far higher than expected amounts of autogynephilia, while the other ethnicities report significantly lower amounts than expected. A higher number of white folk reported experiencing autogynephilic arousal, even when controlling for sexual identity. Also of interest is that most of the Asexual group (75%) are White, when we would have expected only 25% of them to have been White if there had been no correlation with ethnicity.
Only a truthful exploration of who we really are can have any hope of bringing to an end the long suffering of so many in our community. I lost my dear friend JoAnna McNamara, when post-op life could not end the real pain that she felt. Over coffee, in my kitchen, she poured out her heart, telling me of so many painful events and unfulfilled hopes, losing her wife to divorce when she transitioned, not being able to find another, in-between strategizing about our transactivism and how to defeat an odious anti-trans-bill in the Oregon legislature. (We won, BTW.) When I learned that she had taken her own life, I was not surprised, but I was deeply saddened. For years, and even today, I would see something in the news and would think, I need to send a note to JoAnna… and then I remember.
So, I dedicate this blog to her memory, in the hope that we can learn more of who we are, who we really are, which may guide us towards better ways of dealing with our situations.
So who are we really? The evidence, both scientific and simply by observation, shows that MTF transgendered people come in two flavors… and that there is a range of experiences for those two flavors. One of those flavors is primarily gynephilic and autogynephilic, with identities and accommodations ranging from occasional cross-dressing to living full time as women with SRS and HRT. The other flavor smoothly blends from very feminine androphilic males who live as women but don’t seek SRS/HRT to those who’ve had SRS/HRT, and finally to those who would be indistinguishable, in appearance and behavior, from girls/women by any save a physician.
I’ve been informed that many in the TG/TS community believe that this understanding of who we are means that those who accept this see TS women as less than women. Frankly, there may be those… but I’m not one of them!
For the record:
I whole-heartedly experience and accept transfolk as they experience themselves. We as transmen and transwomen deserve full respect as men and women, period.
So, why do I discuss the science in the language that I do? Because that is how the literature is set up, both historically and presently. For clarity sake, scientific descriptions of us have always used our original reproductive potential sex classification. If I discuss the science in any other terms, I risk losing that clarity. Although personally and socially, I am a woman (just ask my very straight husband !!!), and in no way “identify” as “homosexual” or any other term, I fully acknowledge that my apparent reproductive potential at birth was male. Is that so shocking? Is acknowledging that so hurtful of our community? No.
Is discussing the biological and social etiology of who we are, and how we developed, so shocking, or hurtful of our community? No.
Transphobic bigots don’t care what the science says… they would hate us even if we had 100% proof that our brains were 100% in accordance with our preferred social gender. Those that support and accept us would do so even if there was 100% proof that our brains were not so aligned.
Consider that the homophobes of the world are still hateful, though the DSM fully accepts being gay as a healthy variant of human sexuality. Someday, autogynephilia will be accepted as such a healthy variant as well. Heck, France has already acknowledged this.
Would not such acceptance come sooner, if those individuals who are autogynephilic, throw off the yoke of shame themselves first?
Addendum 4/7/2016: JoAnna McNamara was a lovely woman with an amazing life. While in college in the ’60s, she witnessed the senseless deaths of four of her classmates when the National Guard open fire on a peaceful anti-war protest at Kent State. She earned a degree in engineering, married, had children. But by the late ’80s, her gender dysphoria had grown to the point where she could no longer push it back. Her transition cost her her family. She returned to school to earn a law degree. She then served on the staff of an openly gay male legislature in the Oregon House. There she personally witnessed a backroom deal in which the transcommunity was thrown under the bus, excluded from the Oregon Employment Non-Discrimination Act (ENDA) that was to protect gays and lesbians, as bargaining chip in negotiations. She then changed her focus to helping transfolk with their legal wranglings with various government agencies. In one case, she brought a complaint of employment discrimination to the Oregon Bureau of Labor and Industry, using the laws against discrimination against individuals with medical conditions to argue her case. She won! This became known in the local transcommunity as the BOLI Decision. The forces of bigotry fought back the next legislative session by including a provision in a bill that would exclude transsexuals from such protections. JoAnna asked me to work with her to lobby against the bill.
Using a one-two punch strategy, we would set up an appointment with a member of the legislature, then during the first part of the meeting, I would act like I was JoAnna’s assistant. JoAnna did not pass well, so during this time, the legislative member and staff would assume that SHE was THE TRANSSEXUAL… and I was her non-transsexual female assistant… until the right moment came when I would out myself to explain that it was not just the inability to get hired as a known transsexual that was at stake, but that if one was already employed and one was discovered to be transsexual, one would then be fired, passed over for promotion, demoted, or harrassed to force one to quit, giving personal anecdotes of just such occurances. The strategy worked. We gained support for removal of the anti-trans language. Then, when anti-trans forces clandestinely rearranged the public hearing schedule on the bill, JoAnna was apprised by a simpathetic staffer. We had only 24 hours to rally the transcommunity, but using the It’s Time Oregon phone tree, we packed the house. We won. The language was removed.
The recent Nuttbrock study gives us a snapshot of the current transfolk. From this we may be able to test some of the long held stereotypes that have developed from various observers and authors over the years. This study is not only the largest done to date, but it was also conducted in New York, possibly the most ethnically diverse city in the world.
One of the observations is that there is a difference between transkids and AGP ethnic mix, that is, that autogynephilic transfolk are more likely to be white, while “homosexual” transsexuals (HSTS) folk are more likely to be more mixed, with many ethnic minorities.
Another item is the widely observed comment that androphilic transsexuals transition far younger than AGPs. This too is strongly supported by the Nuttbrock data.
First about age of transition, the Nuttbrock study did not directly measure this. Instead, they used the age of starting on feminizing hormones, HRT (Hormone Replacement Therapy). Sadly, they only broke it down to two age groupings, adolescent and adult. It would have been interesting to have a further breakdown between ages 20-25, as many have observed that this is the upper limit for androphilic transition and the lower limit for AGP. Age of beginning HRT for each sexual identity is shown below. Strangely, they didn’t include any data on any of the “asexual” group. Note that this gives a very strong signal. In fact, out of 571 subjects in the study, only one (1) exclusively gynephilic identified person had started HRT as an adolescent!! Data is given in percentage.
Self-reported: “Homosexual” “Heterosexual” Bisexual AGP
Sexuality (androphilic) (gynephilic)
Number: (n=391) (n=71) (n=96)
White (n=141) 19.9 40.2 39.9 78.7
Black (n=120) 90.0 2.5 7.5 23.1
Hispanic (n=244) 91.0 1.6 7.4 22.8
Other (n=53) 62.3 13.2 24.5 27.9
Adolescent(n=171) 91.8 0.6 7.6 14.0
Adult (n=242) 64.5 13.2 22.2 42.6
None (n=158) 54.2 25.5 20.2 59.5
Reworking the data from the above table so that we look at it from the other direction:
Start HRT: Adolescent Adult None
Androphilic 40 40 20
Bisexual 14 56 33
Gynephilic 1.4 44 56
From the data above, one can clearly see a very strong pattern, gynephilic individuals are extremely unlikely to have begun transition as an adolescent. It is unfortunate that we can’t have a “Young Adult” (20-25) category, as I believe that would have given us a bit more resolution into the life arcs of the different groups. We also see a very strong correlation between age of starting HRT and autogynephilia. The older one is before starting HRT, the greater the likelihood of being autogynephilic. The most striking inference from the data is that ethnically White transfolk are significantly more likely to be gynephilic and more likely to be autogynephilic. Another important piece of the puzzle is that the highest percentage of erotic cross-dressing in the Nuttbrock study was reported by those who were identified as exclusively and intensely gynephilic at 82%, while the single lowest percentage reported erotic cross-dressing was 14% for those who had started HRT as adolescents.
Thus, we see that “young transitioners” are typically exclusively androphilic and not autogynephilic, and more likely to be a minority. While “older transitioners” are typically gynephilic (including bisexual), autogynephilic, and more likely to be white. Note that being White is not a bar to being an HSTS, young transitioner… they are just significanlty less likely to be.
Again the final word is that the Nuttbrock data absolutely, positively, with no reasonable doubt left, supports the two type taxonomy of MTF transsexuals, one type being exclusively androphilic that transitions quite young, and the other is autogynephilic and transitions later, as an adult.
A Further Assessment of Blanchard’s Typology of Homosexual versus Non-Homosexual or Autogynephilic Gender Dysphoria, Nuttbrock, et al. Archives of Sexual Behavior
Many transfolk make the claim that data supporting Blanchard’s hypothesis has not been replicated. Already I’ve shown how it had been replicated by both the Leavitt&Burger study and the Smith Study, which was further refined by Lawrence when she showed that the statistical signal strength is increased when one carefully sorts by sexual history. Now, a recent paper has been added to the list: Nuttbrock, et. al. This study is important because it was conducted in such a way as to “cast a wider and looser net” and has the largest sample size of any study (N=571).
First, the conclusion, so as not to lose my reader’s attention: The Nuttbrock paper confirms, absolutely confirms, the Freund/Blanchard two type taxonomy for Male-To-Female (MTF) transsexuals, one that is exclusively androphilic and one that is autogynephilic. There can be no doubt now.
In analyzing the data of each paper, to compare the results, we must bear in mind both the similarities and the differences between each of the study’s sort method, as each will result in different signal strength’s for the same underlying populations.
Blanchard (N=163) sorted by using a two dimensional survey instrument that measured the level of androphilia and gynephilia on separate axis. He then used a software program to find latent clusters in the two dimensional data. Looking at the data, as I’ve already explored, we note that there was a tight cluster of exclusively androphilic individuals that yeilded a strong signal of a low number of autogynephilic individuals. Also, Blanchard used another survey instrument, to measure autogynephila, which captured “dreamers”, individuals whose autogynephilia did not include erotic cross-dressing, as well as those who were classically erotic cross-dressers.
Leavitt and Berger used only Blanchard’s androphilia scale to find those who self-reported a strong erotic interest in men. Thus, it did not separate out those who would have scored high on gynephilia as well. However, as I showed in an earlier post, Leavitt&Berger did ask the all important question about sexual history, so I was able to demonstrate that the more a given group of transsexuals had had a sexual history of attraction to women (gynephilia), the more that group reported erotic cross-dressing.
The Smith study (N=111) used no other criteria to sort other than to ask, post-transition, whether the subject was exclusively attracted to men or not. This binary sort did not separate out those who had had a sexual history of attraction to women.
Lawrence took the Smith study data set and further sorted out those who self-reported being androphilic but had a sexual history of being attracted to women, as being non-homosexual.
Nuttbrock, et al. followed the Smith example and used self-report, but with Blanchard’s original four categories, sorting into exclusively androphilic, bisexual, exclusively gynephilic, and asexual. I must emphasize, this was self-reported sexual identity, not actual sexual history. Interestingly, the study, which was funded to explore risk factors for sexually transmitted diseases, did in fact study, in great depth, sexual history, but did not use that as a sort method (as was done in Lawrence). Another important difference between the Nuttbrock study and the others is that while all of the other subjects were from a gender reassignment clinic seeking somatic feminization, those in the Nuttbrock study were obtained through advertisements and direct contact, in the community at large. This means that potentially, an important personality type may have been missed, as it has been remarked that asexual transsexuals are typically schizotypal (fancy word for non-social, shy, loner). It also means that many of the subjects are not strongly motivated toward somatic feminization, instead simply identifying as “transgender” or “gender-queer”. Indeed, 28% of the subjects are not even taking feminizing hormones. These differences may change the absolute numbers in some fashion, however, we still expect to see a similar statistical effect if the two type taxonomy is correct, and indeed, the data clearly shows just that. The percentage of subjects reporting erotic cross-dressing (and other expressions of autogynephilia, in Blanchard’s study) for each type in each study is shown below here:
“Type” Nuttbrock Smith Lawrence L&B “Avoidant” Blanchard
HSTS 23% 31% 15% 36% 7% 15%
Non-HSTS 73% 63% 60% N/A N/A ~75%
Given that Nuttbrock and Smith are using similar self-reported sexuality, we would expect that these two studies would have both similar sorting efficiency and thus similar signal strengths, and we do. In fact, Nuttbrock’s is stronger, but not by much. Although not provided, I would predict that if we had access to the Nutbrock data set, we could resort it in the same fashion that Lawrence did with the Smith data set, and that Leavitt and Berger accidentally did for the “avoidant” group, and get a similarly increased signal strength.
It is important when reviewing the above data, that as in all sociological studies of taxa, because we have not yet found a perfect instrument by which to sort the taxa, and do not have a perfect instrument to detect autogynephilia, we are only able to statistically tease out the two types. After all, we are asking people to be self-reflective, honest, and accurate, about something that is very personal and as yet poorly understood. But about the existence of the two types, there is no doubt.
Thus, Blanchard’s taxonomy is very much alive and well… and won’t be fading away.
Please read additional entries and analysis:
A Further Assessment of Blanchard’s Typology of Homosexual versus Non-Homosexual or Autogynephilic Gender Dysphoria, Nuttbrock, et al. Archives of Sexual Behavior
Typology of male-to-female transsexualism, Archives of Sexual Behavior
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.
Male-to-female transsexual subtypes: Sexual arousal with cross-dressing and physical measurements