Four Out of Five…

… Gynephilic Transwomen Openly Acknowledge Autogynephilia

Or, Which Came First?  Chicken Or Egg?

Not too long ago, I got an email from a transwoman, an ‘older transitioner’ who acknowledged without reservation that there was a “correlation” between later transition / gynephilia (non-exclusive androphilic) transwomen and autogynephilia, while tacitly acknowledging that exclusively androphilic early transitioners do not.  This was great, but not too surprising, since four out of five such transwomen acknowledge experiencing autogynephilia either currently, or in the past.  But she asked, does it mean causation?  That is to say, is autogynephilia the prime mover in causing gynephilic (and bisexual / asexual) transwomen to become gender dysphoric and develop a ‘female identity’?

I would have thought it was obvious that it does, and that we don’t need to explicate why.  But, no, Sillyolme, nothing in science is self-evident.  One really does need to explore the question fairly, making the assumption, the null hypothesis, that it does not, then look to see if the evidence supports that null hypothesis.  Only if the data fails to support the null hypothesis should we state that it does.

Let’s start at the beginning shall we?  First, does autogynephilia exist?  Yes, we need to ask this first, as it can’t be a cause of gender dysphoria if it doesn’t exist.  And, indeed, many ‘older transitioners’ insist that autogynephilia does not exist.  Well, that one is easily answered, because we have at least 100 years of sexologist observations of a minority of males who definitely become sexually aroused when wearing women’s clothing and/or when thinking of themselves being or becoming female.  Consider this typical description of a teenaged male experiencing an autogynephilic episode from Richard Ekins book Male Femaling – A grounded theory approach to cross-dressing and sex-changing,

“… I was 13 when I stepped, quivering with excitement into a pair of French knickers belonging to my sister.  I ejaculated almost immediately… The feeling was glorious and yet quite alarming and I felt as though I was leaking urine. … Some three days after this first ‘event’ I got home from school to find my mother out.  I went upstairs to do my homework and through the half-opened door of my mother’s bedroom I saw, hanging over a chair, a pair of her pink directoire knickers, obviously discarded in a hurry as she changed before going out.  That soft gleaming bundle turned my whole body and senses into a jelly-like state of desire and longing.  I had to wear them, to try and see if I was all right.  Would it happen again?  My answer was there almost immediately in my swift gathering erection as I struggled out of my clothes.  …”

We can find hundreds of such examples, very often showing that this behavior is most noted in early adolescence, but continues into adulthood. In fact, we have an entire genre of erotic fiction and images (still and motion picture porn) dedicated to the tastes of autogynephilic adult male individuals.  These examples and the males that experience it are common enough that they also form organizations to join together to support each other emotionally and even politically.  So, no, we can’t say that autogynephilia does not exist.  The null hypothesis is easily proven wrong.  Autogynephilia in some males exists.

OK, now that we know that autogynephilia exists in some males, we can take a known group of autogynphilic males, conduct in-depth interviews into just what sorts of things they erotically respond to that the majority non-autogynephilic males don’t.  From that we can construct trial psychometric inventories, test items (questions), for an autogynephilia scale, so that we can measure the degree of and autogynephilic factors (types) present in, autogynephilic males.  Then carefully test and validate it against known autogynephilic males and a set of control males.

However, some transwomen insist that autogynephilia can’t be the cause of their trans identity, because autogynephilia is common, perhaps near universal, in females.  Thus, that would demonstrate that autogynephilia is just part of normal female sexuality.

Does autogynephilia exist in females?  Now, remember, we START with the null hypothesis.  So, assuming it does NOT exist, can we find (credible) evidence that would disprove the null hypothesis?  First, how many sexologists have observed, documented, and remarked on autogynephilic sexual arousal in females?

Wow… I’m hearing an empty, hollow echo in that department.  Not one observation, study, or anything… oh wait, I hear some tiny voices outside the hall?  Could it be?  Why there ARE some folks saying that females do experience autogynephilia… but… what?  Oh, yeah… that… ALL of them are autogynephilic males who are claiming that their autogynephilia is the same as what women feel when they wear women’s clothing… after all, wearing “sexy” panties gets them all going, so it must get women going too?  Right?  Ummmm no.

Seriously, where in the many thousands of diaries, autobiographies, and now online social media blogs published, is there ANY (credible, not catphishing by an AGP male) female individual accounts of anything remotely like the autogynephilia so easily found in a minority of males?  Seriously?  Where are the copious accounts of how, when they were pre and early teens, that they became intensely sexually aroused upon trying on their big sister’s bra, panties, and pantyhose?  Or looking in the mirror at their blossoming breasts and become intensely sexually aroused?  Or examining their genitals and finding them so arousing that they masturbate while examining them… cause being female is just so sexy?  No?  Again that hollow echo.

Oh, but wait, I hear a rising chorus (of autogynephilic males) saying that a Dr. Charles Moser created an autogynphilic inventory for females and tested a group of women.  So we ask, as we must assume the null hypothesis, where did he find the known autogynephilic females to interview to create a valid test?  How did he validate it? What are the psychometric properties of the instrument?  What?  No?  He did none of that?  Well, then what did he do?  He carefully rewrote questions from an instrument intended for and validated only for males in a gender clinic setting?  Well, looking carefully at the rewrite, they don’t seem to have even a passing bearing on what autogynephilia would theoretically look like in women, or even in androphilic transsexuals. The questions were very carefully written to get positive answers from heterosexual females, as that was the intended (political) goal, to “prove” that straight women were also autogynphilic… but they have no meaning.  They don’t measure autogynephilia, they measure mostly anticipatory arousal before dates with men.  Well that was disappointing.  One and only one demonstrably invalid study.  We still have no evidence to disprove the null hypothesis.  So, for now, we must accept that females do NOT experience autogynephilia.

OK, so now we know that autogynephilia exists in males, but there’s no (credible) evidence that it exists in females.  But are there really two types of MTF transsexual?  Does autogynephilia exist equally as much in exclusively androphilic transwomen?  Let’s assume the null hypothesis, that there is only one type, not two.  We can use the previously developed and validated, instruments to measure any putative autogynephilia in both exclusively androphilic and non-exclusively-androphilic transwomen and see if there is a difference.  Here, we have a number of studies done over the years, Buhrich (1977), Freund (1982), Blanchard (1985), Doorn (1994), Smith (2005),  Lawrence (2005), and Nuttbrock (2009).

These studies all clearly indicate a strong correlation with non-exclusively androphilic reporting a high, nearly universal, percentage of individuals acknowleging autogynephilic arousal, either currently, or in early adolescence, and a strong anti-correlation with exclusive androphilia.  Diving deeper, consider that in the largest and most recent of these studies by Nuttbrock (N=571), the grouping that had the highest percentage reporting sexual arousal to crossdressing was the gynephilic at 82%, while the group with the least non-exclusively androphilic was those who had begun Hormone Replacement Therapy (HRT) as teenagers, who had the lowest percentage reporting sexual arousal to cross-dressing at 14%.

To support the null hypothesis, there should have been no correlation with sexual orientation.  The null hypothesis is NOT supported, there is NOT one group, but two.  Further, the null hypothesis regarding autogynephilia not being correlated with gynephilic/bisexual/asexual transwomen, and only these transwomen, is not supported.  Androphilic transwomen and natal female women do not experience autogynephilia.

But this only brings us back to where we started, with my correspondent fully conceding to the above.  But she still has a valid question, does this mean causation?  After all, we all know that correlation does not imply causation.  But here we need to bring up a point, actually, it doesn’t imply it… but causation does require correlation.  So, we have our first step toward answering the question.  With correlation, we may have causation.  But we need to explore further.

One of the most accepted methods of deducing whether there is a cause and effect relationship in medicine, including psychiatric epidemiology, is found in Bradford Hill’s Criteria.

The list of the criteria is as follows:

1. Strength (effect size): A small association does not mean that there is not a causal effect, though the larger the association, the more likely that it is causal.
2. Consistency (reproducibility): Consistent findings observed by different persons in different places with different samples strengthens the likelihood of an effect.
3. Specificity: Causation is likely if there is a very specific population at a specific site and disease with no other likely explanation. The more specific an association between a factor and an effect is, the bigger the probability of a causal relationship.
4. Temporality: The effect has to occur after the cause (and if there is an expected delay between the cause and expected effect, then the effect must occur after that delay).
5. Biological gradient: Greater exposure (dosage or intensity of cause) should generally lead to greater incidence of the effect. However, in some cases, the mere presence of the factor can trigger the effect. In other cases, an inverse proportion is observed: greater exposure leads to lower incidence (as found in vitamin deficiencies).
6. Plausibility: A plausible mechanism between cause and effect is helpful (but Hill noted that knowledge of the mechanism is limited by current knowledge).
7. Coherence: Coherence between epidemiological and laboratory findings increases the likelihood of an effect. However, Hill noted that “… lack of such [laboratory] evidence cannot nullify the epidemiological effect on associations”.
8. Experiment: “Occasionally it is possible to appeal to experimental evidence”.
9. Analogy: The effect of similar factors may be considered.

Taking each in turn:

1. Strength of the correlation is very high.  Four out of five gynephilic transwomen acknowledge experiencing, currently or in the past, autogynephilia.  Considering that autogynephilia is very rare in the general male population and non-existent in the female population, this correlation is very, very high.  But it gets even higher when considering the experimental results of phallometry of those cross-dressers experiencing gender dysphoria who claim that they did not experience sexual arousal to cross-dressing, did in fact demonstrate mild sexual arousal to cross-dressing narration (autogynephilic erotic fiction) compared to control males.
2. Consistency of the correlation is easily shown by looking at the literature referenced above, in which study after study, over four decades, involving around a thousand transwomen, consistently shows the same data, even using different measures of sexual orientation and autogynephilia.
3. Specificity is shown in that it is only non-exclusively-androphilic males who experience autogynephilia and that a subset of those males develop gender dysphoria.
4. Temporality is demonstrated in that the majority of non-exclusively-androphilic males who become gender dysphoric and come to identify as women report autogynephilia in adolescence which seems to mellow even as their need to cross-dress and their gender dysphoria increases, reaching a threshold, a crisis point, most commonly in their mid-30’s.  As Prince (herself an autogynephile) and Doctor documented, “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.”
5. A gradient effect is easily found in autogynephilia in that men who have only very mild autogynephilia typically are content to cross-dress in private, never developing severe gender dysphoria or a female gender identity.  There are individuals with partial autogynephilia who only wish to have breasts, who are content with mildly feminizing HRT, cross-dressing in public only occasionally.  There are those who come to identify as “Bi-Gendered” or “Gender Fluid” who go back and forth.  And finally, there are those whose autogynephilic ideation was intensely focused on being completely female and develop intense and all-consuming gender dysphoria who go on to live full-time as women, obtain HRT, and SRS.  A number of studies have found that intensity and the specific nature of their autogynephilia correlates with these differential outcomes.  Further, these effects seem to indicate both a continuum and a progression (criterion #4).  There is another dosage effect that though subtle, is of high importance to the question of causation and the nature of autogynephilia itself found by Blanchard in “Nonmonotonic relation of autogynephilia and heterosexual attraction”, from the abstract, “the highest levels of autogynephilia were observed at intermediate rather than high levels of heterosexual interest; that is, the function relating these variables took the form of an inverted U. This finding supports the hypothesis that autogynephilia is a misdirected type of heterosexual impulse, which arises in association with normal heterosexuality but also competes with it”.  This non-monotonic relationship was questioned in the Nuttbrock study, as they hypothesized that autogynephilia was a classic conditioned sexual fetish that had arisen as a consequence of cross-dressing and gender dysphoria, and not the cause.  But Lawrence easily demonstrated that Nuttbrock missed the relationship due to improper mathematical treatment of the data… and thus the dosage relationship evidence remains valid.
6. Plausability.  This is almost self-evident.  If one’s sexual ideation is exclusively autogynephilic, if each time such an individual sees herself as obligatorially female during sex, that would be strong drive towards gender dysphoria and an incentive to adopt a female gender identity, over time.
7. Coherence with laboratory tests are found by looking at brain sex research which shows that non-exclusively-androphilic transwomen are different from exclusively androphilic transwomen AND females, as expected by the theory that autogynephilia is the cause, not the result, of gender dysphoria and a female gender identity.
8. Experiments with animals are not possible as we have no animal models of autogynephilia.
9. Analogy is found in the amazing similarity of autogynephilia and its effects are found in males with apotemnophilia, the sexual desire for limb amputation, and autopedophilia, the sexual desire to be a child.  In fact, a very high percentage of heterosexual apotemnophiliacs are also autogynephilic, experiencing an Erotic Target Location Error in which they wish to become female amputees.

So, we can see that we meet nearly all, saving only experimental evidence, to support the conclusion that autogynephilia is the cause, and not the result or merely a co-occuring factor, of gender dysporia and female gender identity in non-exclusively-androphilic transwomen.

Additional Reading:

Essay on the development of an Autogynphilia Instrument in Males

Essay on the Non-Validity of Moser’s “Autogynephilia in Women”

Essays on evidence to support the two type taxonomy of MTF transsexuality

Essay on the Origins of Cross-Gender Identity in Transsexuals

Essays on Brain Sex in Transsexuals

Essay on analogy between autogynephilia and apotemnophilia

References:

Textbook of Psychiatric Epidemiology, 3rd Edition, Wiley Press