American Psychiatric Association Supports The Two Type Transsexual Taxonomy

Very frequently, I and others are challenged with claims that the two type taxonomy of transsexuality had been “debunked”.  When I show that that isn’t true, my interlocutors said something to the effect that, “Well, I’ll go with the American Psychiatric Association (APA) over your fringe science.”  They were assuming that the APA had “debunked”, or otherwise disavowed, the taxonomy.  Nothing could be further from the truth as we explore what APA documents show; most critically, how the Diagnostic & Statistical Manual of Mental Disorders, Revision Five (DSM-5) explains and supports the taxonomy and describes the two types.

But first, we need to explore a bit of nomenclature and its history.  Over the decades, the two types have been given different labels:

Homosexual         Non-Homosexual / Autogynephilic or Autoandrophilic
nuclear                  non-nuclear / marginal
core                        non-core / marginal
Ego-syntonic         Ego-dystonic
Androphilic           Gynephilic (for MTF only, the reverse is used for FtM)
True-                        Pseudo-
Primary                   Secondary
Group One              Group Three (Anne Vitale 2001) (For MTF only, “Group Two” for FtM)
Early Onset            Late Onset
Young                      Older  Transitioner
Early                        Late Transitioner
Transkid                 Adult

Most people who have recently learned of the taxonomy ascribe it to just one researcher, Dr. Ray Blanchard.  While he was a prolific publisher of studies of the taxonomy, he did NOT discover or create it.  He did, however, coin one of the terms used to describe one of the types, “autogynephilic” (AGP) to fully and correctly articulate their nature and the role of autogynephilia in the etiology of their gender dysphoria.  He contrasted this type with the description of the sexuality of the other type, using the then common convention of describing transsexuals’ sexual orientation based on their natal (biological / “assigned at birth”) sex, as “homosexual transsexual” (HSTS).

So, when exploring APA documents, we need to keep in mind that for MTF transsexuals, “homosexual” = “early onset” and “autogynephilic” = “late onset”.

Thus HSTS/AGP = early onset / late onset taxonomy.

I know that some will object and falsely claim that this is not the equivalent taxonomy or theory.  But we have examples of scientific papers where they are used interchangeably.  And more importantly, in the DSM-5 itself, the description and explication of the two types make it very clear that they are the same taxons and theory.  There can be no honest quibbles.  The DSM-5 fully documents, describes, and supports as our best current scientific understanding, the two type taxonomy and theory.

First, the DSM-5 defines (and thus acknowledges the existence of) autogynephilia in its glossary of technical terms on page 818,

“autogynephilia Sexual arousal of a natal male associated with the idea or image of being a woman.”

This definition is literally the same as Blanchard articulated.  One cannot say the APA has “debunked” the existence of autogynephilia when they helpfully define it for use by their members and the public.

But let us continue.  One of the key points of the two type taxonomy is that autogynephilia is often expressed as sexual arousal to cross-dressing, and though not always, it can be progressive and lead to gender dysphoria.  The DSM-5 describes this very phenomena in its description of ‘transvestic disorder’ on pages 703-4,

“Transvestic disorder in men is often accompanied by autogynephilia (i.e., a male’s paraphilic tendency to be sexually aroused by the thought or image of himself as a woman).  Autogynephilic fantasies and behaviors may focus on the idea of exhibiting female physiological functions (e.g., lactation, menstruation), engaging in stereotypically feminine behavior (e.g., knitting), or possessing female anatomy (e.g., breasts). … Some cases of transvestic disorder progress to gender dysphoria. The males in these cases, who may be indistinguishable from others with transvestic disorder in adolescence or early childhood, gradually develop desires to remain in the female role for longer periods and to feminize their anatomy.”

One could not get a more clear description of the progression of autogynephilic cross-dressing to gender dysphoric transwoman.

The DSM fully describes and supports the two type taxonomy of gender dysphoria as can be found starting on page 455,

“In both adolescent and adult natal males, there are two broad trajectories for development of gender dysphoria: early onset and late onset. Early-onset gender dysphoria starts in childhood and continues into adolescence and adulthood; or, there is an intermittent period in which the gender dysphoria desists and these individuals self-identify as gay or homosexual, followed by recurrence of gender dysphoria. Late-onset gender dysphoria occurs around puberty or much later in life. Some of these individuals report having had a desire to be of the other gender in childhood that was not expressed verbally to others. Others do not recall any signs of childhood gender dysphoria. For adolescent males with late-onset gender dysphoria, parents often report surprise because they did not see signs of gender dysphoria in childhood.  Adolescent and adult natal males with early-onset gender dysphoria are almost always sexually attracted to men (androphilic). Adolescents and adults with late-onset gender dysphoria frequently engage in transvestic behavior with sexual excitement. The majority of these individuals are gynephilic or sexually attracted to other posttransition natal males with late-onset gender dysphoria. A substantial percentage of adult males with late-onset gender dysphoria cohabit with or are married to natal females. After gender transition, many self-identify as lesbian. Among adult natal males with gender dysphoria, the early-onset group seeks out clinical care for hormone treatment and reassignment surgery at an earlier age than does the late-onset group. The late-onset group may have more fluctuations in the degree of gender dysphoria and be more ambivalent about and less likely satisfied after gender reassignment surgery.  In both adolescent and adult natal females, the most common course is the early-onset form of gender dysphoria. The late-onset form is much less common in natal females compared with natal males. As in natal males with gender dysphoria, there may have been a period in which the gender dysphoria desisted and these individuals self-identified as lesbian; however, with recurrence of gender dysphoria, clinical consultation is sought, often with the desire for hormone treatment and reassignment surgery. Parents of natal adolescent females with the late-onset form also report surprise, as no signs of childhood gender dysphoria were evident.”

Note the full concurrance with the description of “early onset” gender dysphoria begining in childhood, persisting into adulthood and their sexual orientation as being “homosexual” with respect to their natal sex.  Note the description of “late onset’ as having the opposite sexual orientation as “early onset”, and then in natal males, “transvestic behavior” (an expression of autogynephilia) as a precursor to their gender dysphoria.  One could not get a more definitive proof of the APA’s acknowledgement and support for the two type taxonomy as the actual text from the DSM-5.

Further Reading:

Minority Report: APA Transgender Taskforce

Reference:
DSM-5