On the Science of Changing Sex

We’re freakin at the freakers ball…

Posted in Editorial, Transsexual Theory by Kay Brown on March 24, 2012

Kay BrownWhere all the fags and the dykes, they’re boogyin’ together
The leather freaks are dressed in all kinds of leather
The greatest of the sadists and the masochists too
Screaming “Please hit me, and I’ll hit you”

-Dr. Hook and the Medicine Show

Last summer, I had dinner at a restaurant in the City with a transactivist friend of mine that I hadn’t seen in nearly a decade.  It was pleasant enough, until she started on a rant about Anne Lawrence, with whom we have both been acquainted for many years.  My friend wanted me to agree with her that Anne was doing the “community” a horrible disservice, “She’s trying to turn us all into paraphiliacs!”  I replied, quite honestly and ironically, “No, she isn’t…”  But left the rest of my droll thought unsaid: “… she can’t make you be what you already are.”  But, although I didn’t voice my real opinions, she kept up her rant.  She argued that Anne was wrong because it would harm the community. She never asked me about this blog, nor did I volunteer that I was writing it.  She seemed to take it for granted that I, as a long time transactivist, would agree with her that we should all fight against Dr. Lawrence’s work, ignoring my personal history, and what that might mean regarding my personal views on the subject.  What struck me later about the evening’s discussion, that while always friendly, despite our not agreeing, was that my friend, though a biological scientist herself, never once tried to argue her point based on the science, but rather on the politics.  That it was wrong to do the science, if the science itself would lead to certain knowledge that most transwomen were autogynephilic, and that autogynephilia was the cause of their gender dysphoria and cross-gender identity, as that would lead to the public no longer seeing MTF transsexuals as “women in men’s bodies”.    I countered that science is what it is, and the truth is what it is.  I made it clear that I support science, and that the truth is always a good thing to know.  I came away with the certain knowledge that among the transactivist community, it was very well understood that the science did, and would continue, to support the Freund / Blanchard two type taxonomy of MTF transsexuality.

There are several elements to this story.  First, is Anne Lawrence really demonstrating that non-homosexual transsexuality is a manifestation of a paraphilia, to wit, autogynephilia?  Second, is autogynephilia a “mental disorder”?  Third, is that really so bad?

First, is Lawrence demonstrating that non-homosexual transsexuals are autogynephilic?  Yes, but her work is largely redundant to the science that has been so meticulously done by Freund, Blanchard, and even, if unintentionally, Nuttbrock.  Further, one of the best documentations that autogynephilia is the root cause of non-homosexual transsexuality was done by Doctor and Prince, who showed that cross-gender identification was most commonly preceded by years of autogynephilic cross-dressing, that transvestism and non-homosexual transsexuality are both a continuum and a progression.

Among our subjects, 79% did not appear in public cross dressed prior to age 20; at that time, most of the subjects had already had several years of experience with cross dressing. The average number of years of practice with cross dressing prior to owning a full feminine outfit was 15. The average number of years of practice with cross dressing prior to adoption of a feminine name was 21. Again, we have factual evidence indicative of the considerable time required for the development of the cross-gender identity.

So, MTF transactivists can hardly blame Lawrence for merely adding to what has already been very convincingly demonstrated.  The real value of her work has been to expand on the theme, adding weight to the need for compassionate therapeutic and surgical intervention to allow AGP transsexual women to live fulfilling lives.

Does Lawrence consider autogynephilia, and by extension, autogynephilic transsexuality a paraphilia?  Again, Yes, as her 2004 paper states that explicitly in its title, “Autogynephilia: A Paraphilic Model of Gender Identity Disorder”, and in the text,

…Blanchard’s autogynephilia theory helps explain why transvestism and transsexualism are often associated with other unusual erotic interests. Sexual scientists have observed for decades that unusual sexual interests— sadomasochism, bondage, autoerotic asphyxia, interest in leather and rubber, exhibitionism, voyeurism, infantilism, pedophilia—frequently do not occur in isolation, but instead tend to co-occur. Males who have one unusual sexual interest are far more likely to have one or more other unusual sexual interests than would be expected simply by chance (Abel & Osborn, 1992; Wilson & Gosselin, 1980). And other unusual erotic interests are very common among transvestites and some MtF transsexuals. Wilson and Gosselin (1980) found that 63% of their sample of transvestites and transsexuals also described fetishistic or sadomasochistic interests. Blanchard and Hucker (1991) reported that transvestism accompanied many cases of autoerotic asphyxia. Abel and Osborn (1992) documented the co-occurrence of transvestism and transsexualism with other paraphilias. If transsexualism and transvestism are purely gender-identity-based phenomena, then these associations makes no sense. But if transsexualism and transvestism sometimes represent unusual sexual interests—as Blanchard’s autogynephilia theory proposes—then their association with other uncommon sexual interests does make sense.

So, I believe that Lawrence convincingly demonstrates, from prior studies, that autogynephilic transsexuality is most definitely a paraphilia.  But is it a “mental disorder”?  Again, from another, more recent paper from Lawrence,

Does the desire for sex reassignment in autogynephilic MtF transsexuals represent a mental disorder? I contend that it does. To meaningfully address the question, one must attempt to define the term mental disorder, an obligation that writers who discuss this topic — including Meyer-Bahlburg (2010) — too often neglect. For purposes of discussion, I will use the definition proposed by Wakefield and First (2003), in an article cited by Meyer-Bahlburg; similar definitions have recently been proposed by Stein et al. (2010) and First and Wakefield (2010). According to Wakefield and First, a mental disorder is “a ‘harmful mental dysfunction,’ with harm being determined by social values and the word dysfunction referring to the failure of a mental mechanism to perform its natural (i.e., evolutionarily selected) function” (p. 28). Wakefield and First recognized that an evolutionary analysis created potential epistemological challenges but argued that often “one can judge with some plausibility the functions and dysfunctions of a [mental] mechanism (or at least that a function or dysfunction likely exists), with no need for detailed direct knowledge of the evolution of the mechanism.” (p. 39). They added that, in many cases, “one can make such inferences without knowing anything about the actual mechanisms. . . . Indeed, many of the DSM’s categories (e.g., sleep disorders, sexual and gender identity disorders) clearly correspond to types of inferred designed mechanisms that have gone wrong.” (p. 36). Wakefield and First considered a dysfunction to be harmful if it carried significant “negative implications for the individual’s overall well-being” (p. 34), or perhaps sometimes for the well-being of others (p. 41). They also emphasized that the dysfunction must be “in the individual” (p. 34) and “cannot be due only to social deviance, disapproval by others, or conflict with society or others” (p. 34). Although Wakefield and First’s definition may not be perfect, it provides a starting point for discussion, and the analysis that follows is not highly dependent on its specific details.

In autogynephilic MtF transsexuals, it is reasonable to infer that the mental mechanism responsible for accurately “locating erotic targets in the environment” (Freund & Blanchard, 1993, p. 558) has failed to perform its natural function: Specifically, there has been a partial or complete failure of the evolutionarily selected mechanism that keeps heterosexual erotic interest (i.e., gynephilia) directed toward erotic targets external to the self. Autogynephilic MtF transsexuals experience a powerful erotic interest in turning their own bodies into facsimiles of their preferred erotic targets (females), an interest that competes with and sometimes completely overshadows erotic interest directed toward external female partners (Blanchard, 1992). It is easy to understand why evolutionary selection might favor the development of a mental mechanism that would keep gynephilic men’s erotic interest focused on external female partners. When a gynephilic man’s erotic interest is instead directed primarily toward his own feminized body, one can reasonably infer that this putative mental mechanism has wholly or partly failed. If the foregoing analysis is correct, then the desire for sex reassignment in autogynephilic MtF transsexuals — that is, in many or most nonhomosexual MtF transsexuals — represents a genuine mental dysfunction.

Again, Lawrence convincingly argues that autogynphilic transsexuality is a “mental disorder”?  But is this a “bad thing” in and of itself?  That is to say, it it morally reprehensible?  Who is harmed?  No one.  As Cantor poignantly states regarding all human beings with paraphilic sexualities,

It is here that I must draw an important, but usually unmarked, distinction: I personally agree wholeheartedly that everyone with atypical sexual interests deserves respect and full recognition of all their civil rights; however, I disagree that answers to scientific questions can be identified by presuming the desired outcome and then backwards-engineering one’s interpretation of the research data to guarantee arrival at that outcome. Moreover, and perhaps more importantly, questions of rights fall outside the purview of science. People deserve respect and civil rights regardless of the scientific classification of their sexual interests.

Herein lies an important point, an atypical sexuality, per se, should never be the cause of unreasoning stigma or discrimination.  But, it often does.  In point of fact, homosexuality itself, though generally not thought of as either a paraphilia nor a mental disorder, has still a very negative stigma and even legal sanctions against it.  So, whether a phenomena is officially, or unofficially, recognized as a paraphilia has no bearing on whether it will or will not be stigmatized.  Transsexuality, like homosexuality, is stigmatized regardless of whether it is understood to be a paraphilia or a mental disorder.

Anne Lawrence, and all of the scientists and clinicians working to better understand the transsexual phenomena, are not responsible for the stigma and discrimination.  But, hopefully, with better understanding of our two, separate, conditions, both autogynephilic and homosexual transsexuals will each be better off, with appropriate and compassionate medical care.

Further Reading:

Essay on Co-occurance of Paraphilias


Lawrence, A., “Autogynephilia: A Paraphilic Model of Gender Identity Disorder”

Lawrence, A., “Do Some Men Who Desire Sex Reassignment Have a Mental Disorder? Comment on Meyer-Bahlburg (2010)”, Archives of Sexual Behavior (in press)

Cantor, J., “Is Homosexuality a Paraphilia? The Evidence For and Against”


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