Journal
of Sex & Marital Therapy, 19, 301-307. (1993)
Blanchard R.
Gender Identity Clinic, Clarke Institute of Psychiatry, Toronto, Ontario,
Canada.
Partial versus complete
autogynephilia and gender dysphoria.
Autogynephilia (sexual arousal in men produced by the thought or image of themselves as women) is often associated with gender dysphoria (the desire to belong to the opposite sex). Previous research has shown that autogynephiles who are principally aroused by images of themselves as nude women are more gender dysphoric than those principally aroused by images of themselves as partially or fully dressed women. This study tested the hypothesis that the feature of the nude self-image most responsible for its correlation with gender dysphoria is the imagined vulva. The subjects were 220 nonhomosexual male outpatients who reported sexual arousal while imagining themselves with one or more features of the female anatomy. Autogynephilia and gender dysphoria were assessed with questionnaires. The findings confirmed that men who are sexually aroused at the thought of having a vulva are more likely to want to be women.
************************
Archives of Sexual Behavior, 22, 241-251. (1993)
Blanchard R.
Gender Identity Clinic, Clarke Institute of Psychiatry,
Toronto, Ontario, Canada.
Varieties of
autogynephilia and their relationship to gender dysphoria.
The relationship between gender dysphoria and autogynephilia (erotic arousal in men associated with the thought or image of themselves as women) was investigated. Subjects were 238 nonhomosexual male outpatients divided into three groups: 94 reporting they were most aroused sexually by images of themselves as nude women, 67 most aroused by images of themselves as women in underwear, and 77 most aroused by images of themselves as fully clothed women. These were compared on questionnaire measures of gender dysphoria and other psychosexual variables. The Nude group was significantly more gender dysphoric than the Clothed group, which, in turn, was significantly more gender dysphoric than the Underwear group. These results support the hypothesis that those nonhomosexual men most aroused sexually by the thought of having a woman's body are also those most interested in acquiring a woman's body through some permanent, physical transformation. A secondary finding was that the Nude group was the same age as the Underwear group and significantly younger than the Clothed group. This outcome makes it unlikely that erotic fantasies of having a woman's body are the end result of some progression that necessarily begins with erotic fantasies of wearing women's clothes.
************************
Journal
of Sex & Marital Therapy, 19, 69-76. (1993)
Blanchard R.
Gender Identity Clinic, Clarke Institute of Psychiatry, Toronto, Ontario,
Canada.
The
she-male phenomenon and the concept of partial autogynephilia.
The term autogynephilia denotes a male's propensity to be sexually
aroused by the thought or image of himself with female attributes. Some
autogynephiles imagine themselves, in their sexual fantasies, as complete women.
Others, here called partial autogynephiles, imagine themselves with a mixture
of male and female anatomic features, usually women's breasts and men's
genitals. Partial autogynephiles evince a particular sexual interest in those
individuals known in the vernacular as she-males. These are men, often involved
in prostitution or pornography, who have undergone breast augmentation while
maintaining their male genitals. Partial autogynephiles appear less likely to
pursue surgical sex reassignment than gender-dysphoric men whose erotic
self-image includes a vagina. Some patients with a persistent desire for
women's breasts but no or conflicted desires to live as women full-time or
undergo vaginoplasty may be pacified with mildly feminizing doses of estrogenic
hormones.
************************
Journal
of Abnormal Psychology, 101, 271-276. (1992)
Blanchard R.
Gender Identity Clinic, Clarke Institute of Psychiatry, Toronto, Ontario,
Canada.
Nonmonotonic relation of
autogynephilia and heterosexual attraction.
In this study I investigated the relation between normal heterosexual
attraction and autogynephilia (a man's propensity to be sexually aroused by the
thought or image of himself as a woman). The subjects were 427 adult male
outpatients who reported histories of dressing in women's garments, of feeling
like women, or both. The data were questionnaire measures of autogynephilia,
heterosexual interest, and other psychosexual variables. As predicted, 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.
************************
Journal of Sex & Marital Therapy, 17, 235-251. (1991)
Blanchard R.
Gender Identity Clinic, Clarke Institute of Psychiatry, Toronto, Ontario,
Canada.
Clinical
observations and systematic studies of autogynephilia.
The term autogynephilia denotes a male's paraphilic tendency to be sexually
aroused by the thought or image of himself as a woman. This term subsumes
transvestism as well as erotic ideas or situations in which women's garments
per se play a small role or none at all. This review article presents clinical
examples of the lesser known types of autogynephilia (i.e., those in which the
element of cross-dressing is secondary or entirely absent), sketches earlier
attempts to label and conceptualize these phenomena, summarizes recent
quantitative studies exploring the relationships between autogynephilia and
other psychosexual variables (e.g., heterosexual attraction), and speculates on
the etiology of autogynephilia and its relationship to transsexualism. It is
concluded that the concept of autogynephilia is needed to fill a gap in our
current battery of concepts and categories for thinking about gender identity
disorders.
************************
Archives of Sexual Behavior, 34, 439-446 (2005)
Law and Mental Health Program, Centre for Addiction and Mental Health—College Street Site, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Early History of the Concept of Autogynephilia
Since the beginning
of the last century, clinical observers have described the propensity of
certain males to be erotically aroused by the thought or image of themselves as
women. Because there was\no specific term to denote this phenomenon,
clinicians’ references to it were generally oblique or periphrastic. The
closest available word was transvestism. The definition of transvestism
accepted by the end of the twentieth century, however, did not just fail to
capture the wide range of erotically arousing cross-gender behaviors and
fantasies in which women’s garments per se play a small role or none at
all; it actually directed attention away from them. The absence of an adequate
terminology became acute in the writer’s research on the taxonomy of gender
identity disorders in biological males. This had suggested that heterosexual,
asexual, and bisexual transsexuals are more similar to each other—and to
transvestites—than any of them is to the homosexual type, and that the common
feature in transvestites and the three types of non-homosexual transsexuals is
a history of erotic arousal in association with the thought or image of
themselves as women. At the same time, the writer was becoming aware of male
patients who are sexually aroused only by the idea of having a woman’s body and
not at all by the idea of wearing women’s clothes. To fill this terminological
and conceptual gap, the writer introduced the term autogynephilia (love
of oneself as a woman).
************************
Journal
of Nervous and Mental Disease, 177, 616-623. (1989)
Blanchard R.
Gender Identity Clinic, Clarke Institute of Psychiatry, Toronto, Ontario,
Canada.
The concept of
autogynephilia and the typology of male gender dysphoria.
This study tested the hypothesis that all gender-dysphoric males who are not
sexually aroused by men (homosexual) are instead sexually aroused by the
thought or image of themselves as women (autogynephilic). Subjects were 212
adult male-to-female transsexuals. These were divided into four groups; one
homosexual and three nonhomosexual. The three nonhomosexual groups were
heterosexual, bisexual, and analloerotic (unattracted to male or female
partners, but not necessarily devoid of all erotic behavior). A Core
Autogynephilia Scale was developed to assess a subject's propensity to be
sexually aroused by the fantasy of being a woman. The four transsexual groups
were compared on this measure (and on several others), using Newman-Keuls
multiple-range tests at p less than .05. As predicted, all three nonhomosexual
groups were more likely than the homosexual group to report sexual stimulation
by cross-gender fantasy. This finding supports the hypothesis that the major
types of nonhomosexual gender dysphoria constitute variant forms of one
underlying disorder, which may be characterized as autogynephilic gender
dysphoria.
************************
Archives
of Sexual Behavior, 18, 315-334. (1989)
Blanchard R.
Gender Identity Clinic, Clarke Institute of Psychiatry, Toronto, Ontario,
Canada.
The classification and
labeling of nonhomosexual gender dysphorias.
This report suggests systematic strategies for the descriptive classification
of nonhomosexual gender identity disorders, based on clinical observations and
research findings. The classification of biological males is considered first.
A review of cross-gender taxonomies shows that previous observers have
identified and labeled a homosexual type far more consistently than any other
category of male gender dysphoric. It is suggested that the apparent difficulty
in differentiating reliably among the nonhomosexual types results from the
sharing of many overlapping characteristics by the various groups. This is supported
by a review of informal, mostly clinical, observations and by the findings of
three studies designed to test the hypothesis that the nonhomosexual gender
dysphorias, together with transvestism, constitute a family of related
disorders in men. It is concluded that the main varieties of nonhomosexual
gender dysphoria are more similar to each other than any of them is to the
homosexual type. Two recommendations, based on the foregoing review, are
offered for the classification of male gender dysphorics in research studies.
When the number of subjects is small, they may be classified simply as
homosexual or nonhomosexual. When the number is larger, the nonhomosexual cases
may be classified as heterosexual, bisexual, or analloerotic (unattracted to male
or female partners, but not necessarily devoid of sexual drive or activities).
************************
TYPOLOGY
Journal
of Sex Research, 25, 426-432.(1988)
Clark
Institute of Psychiatry
A Test of the DSM-III-R'S implicit assumption that fetishistic arousal and gender dysphoria are mutually exclusive
This
study sought to determine the proportion of adult, male, heterosexual
cross-dressers who acknowledge both gender dysphoria and at least occasional
fetishistic response to cross-dressing. Subjects were 193 outpatients of the
gender identity clinic or behavioral sexology department of a psychiatric
teaching hospital. Questionnaire items were used to assess subjects' current
level of gender dysphoria and their recent history of sexual response to
cross-dressing. Subjects who reported higher degrees of gender dysphoria tended
to report lower frequencies of sexual arousal with cross-dressing (r = -.56, p
< .0001) 1 and lower frequencies
of Masturbation with cross-dressing (r= -62, p < .0001). About
half of even the most gender dysphoric
subjects, however, acknowledged that they still become sexually aroused or masturbate
at least occasionally when cross-dressing. These findings indicate a need for
revision in the DSM III-R’s diagnostic criteria for transvestism and gender
identity disorders, which presuppose that gender dysphoria and fetishistic,
reactions are mutually exclusive.
************************
Journal
of Sex Research, 24, 188-193. (1988)
This study produced two
findings: (a) There were no differences in the average age at which the
asexual, bisexual, and heterosexual transsexuals first presented for
assessment. All three groups were significantly older at initial presentation
than the homosexual transsexuals. b) There were no differences in the average
degree of childhood femininity reported by the asexual. bisexual, and
heterosexual transsexuals. All three groups reported significantly less
feminine identification than did the homosexual group. Both results paralleled
Blanchard's (1985b) finding that similar majorities of asexual, bisexual, and
heterosexual transsexuals acknowledged some history of erotic arousal in
association with cross-dressing, whereas only a small minority of homosexual
subjects did so. The results support the hypothesis that asexual, bisexual, and
heterosexual transsexualism are akin to one another and to transvestism. This
conjecture is further supported by the epidemiological observation that
asexual, bisexual, and heterosexual transsexualism are rare or nonexistent in
females, and fetishistic cross-dressing is also rare or nonexistent in females
(Blanchard, Clemmensen, 8r, Steiner. 1987).
************************
Archives of Sexual Behavior, 16, 139-152. (1987)
Blanchard R, Clemmensen LH, Steiner BW.
Heterosexual and homosexual gender dysphoria.
This study investigated why more males than females complain of dissatisfaction
with their anatomical sex (gender dysphoria). New referrals to a university
gender identity clinic were dichotomously classified as heterosexual or
homosexual. There were 73 heterosexual and 52 homosexual males; 1 heterosexual
and 71 homosexual females. The average heterosexual male was 8 years older at
inception than the homosexual groups. The heterosexual males reported that
their first cross-gender wishes occurred around the time they first
cross-dressed, whereas the homosexual groups reported that cross-gender wishes
preceded cross-dressing by 3-4 years. Some history of fetishistic arousal was
acknowledged by over 80% of the heterosexual males, compared to fewer than 10%
of homosexual males and no homosexual females. The results suggest that males
are not differentially susceptible to gender dysphoria per se, but rather that
they are differentially susceptible to one of the predisposing conditions,
namely, fetishistic transvestism.
************************
Archives
of Sexual Behavior, 14, 247-261 (1985)
Blanchard R.
Typology
of male-to-female transsexualism.
This study tested a prediction derived from the hypothesis that asexual and
bisexual transsexualism are actually subtypes of heterosexual transsexualism.
Two questionnaire scales measuring erotic attraction to males and females were
administered to 163 male-to-female transsexuals. A cluster analysis of their
scores divided the subjects into four groups: heterosexual, homosexual,
bisexual, and asexual. Fisher Exact tests were used to compare the frequency with
which subjects in the four clusters reported a history of erotic arousal in
association with cross-dressing. As predicted, there were no differences among
the asexual, bisexual, and heterosexual transsexuals, and all three groups
included a much higher proportion of fetishistic cases than the homosexual
group (p less than or equal to .0001, two-tailed). These findings support the
view that male transsexuals may be divided into two basic types: heterosexual
and homosexual.
************************
METHODOLOGY
Journal
of Sex Research, 22, No 4 452-462. (1986)
Ray
Blanchard, I. G. Racansky, and Betty W. Steiner
Phallometric detection of fetishistic arousal in
heterosexual male cross-dressers
We
examined whether an erotic response to cross-dressing fantasies could be
detected in heterosexual male cross-dressers (HCDs) who verbally denied any
erotic arousal in association with cross-dressing for at least the past year.
Subjects were 37 HCD patients and 10 paid heterosexual controls. HGDs were
divided into groups according to their response to a questionnaire item asking
the proportion of occasions that cross-dressing was erotically arousing during
the past year and offering response options from always to never. Penile blood
volume was monitored while subjects listened to descriptions of cross-dressing
and sexually neutral activities. All HCD groups responded significantly more to
cross-dressing than to neutral narratives {p < .O1}; controls did not.
Results suggest that only those causal hypotheses of heterosexual
cross-dressing need be considered that can account, also, for the presence of
fetishism.
************************
Archives
of Sexual Behavior, 14, 505-516.
Blanchard R, Clemmensen LH, Steiner BW.
Social desirability
response set and systematic distortion in the self-report of adult male gender
patients.
This study showed that the "socially desirable" presentation for a heterosexual male gender dysphoric is one that emphasizes traits and behaviors characteristic of "classic" transsexualism. Fifty-one homosexual and 64 heterosexual adult male gender patients were administered the Crowne-Marlowe (1964) Social Desirability Scale as well as eight questionnaire measures that tapped various features of the clinical history commonly given great weight in differential diagnosis. The tendency for a heterosexual subject to describe himself in terms of moral excellence or admirable personal qualities was significantly correlated with scores in the "transsexual" direction on all eight sexological measures; for the homosexual subjects, only one correlation was significant. It is argued that the patients most motivated to create a favorable impression on the examiner are likely to be those most anxious to obtain approval for sex reassignment surgery. Because, in this population, the socially desirable presentation is "feminine," it is possible that the differences in the histories produced by transvestites and heterosexual transsexuals are exaggerated to an unknown degree by the motivation of the latter to obtain approval for this operation. The findings do not diminish the important distinction between these groups, but they do suggest caution in interpreting the self-report data that have been used in comparing them.
************************
Journal
of Sex & Marital Therapy,22, 97-102 (1996)
Chivers M, Blanchard R.
Clarke Institute of Psychiatry, Toronto, Ontario, Canada.
Prostitution advertisements
suggest association of transvestism and masochism.
Previous research and clinical observation have suggested that the sexual
interest of many transvestites include involvement in sadomasochistic sexual
acts. Through data gathered via prostitution advertisements in print media, we
tested the hypothesis that prostitutes welcoming cross-dressing client would be
primarily those describing themselves as dominant. The specialty of the
prostitute was recorded by coding the advertisements for the presence or
absence of the features of dominance, submissiveness, acceptance of
cross-dressing clients, and whether the prostitute was a biological male
presenting as a woman or quasi-woman. The findings showed that 20% of
prostitutes describing themselves as dominant welcomed cross-dressing clients,
whereas none of the other subgroups of prostitutes mentioned cross-dressing
clients in their advertisements. These findings reinforce other lines of
indirect evidence suggesting that, in heterosexual men, the presence of
masochism increases the likelihood of transvestism, and vice versa.
************************
Archives of Sexual Behavior, 23, 311-320. (1994)
Blanchard R.
Gender Identity Clinic, Clarke Institute of Psychiatry, Toronto, Ontario,
Canada.
A structural equation
model for age at clinical presentation in nonhomosexual male gender dysphorics.
Nonhomosexual male gender dysphorics often make their first requests for
clinical assessment when they are in or approaching middle age. This study
investigated how well patients' explanations for the timing of these requests
fit the objective data. Subjects were 194 outpatients presenting for the first
time at a gender identity clinic. Their common explanations for the timing of
their requests were incorporated into a formal path model, which was tested
using Bentler's structural equations program. The model provided an acceptable
fit to the data. The more times a patient has been married and the more
children he has fathered, the older he is likely to be when first presenting
for clinical attention. This outcome is consistent with the claims of patients
that they would have come to a gender clinic sooner if they had not been
restrained by commitments to wives and children.
************************
Journal of Nervous and Mental Disease, 181, 570-575 (1993)
Blanchard R, Collins PI.
Gender Identity Clinic, Clarke Institute of Psychiatry,
Toronto, Ontario, Canada.
Men with sexual interest
in transvestites, transsexuals, and she-males.
This study was a preliminary exploration of gynandromorphophilia, that
is, sexual interest in cross-dressed or anatomically feminized men. Subjects
were male subscribers to a voice mail system devoted to personal advertisements
for sexual or romantic partners. These comprised 51 gynandromorphophiles who
sought cross-dressers, transvestites, transsexuals, or she-males for such
relationships, 37 gynandromorphophilic cross-dressers who identified themselves
as cross-dressers and sought similar men, and 31 residual cross-dressers who
sought masculine or unspecified male partners. Analysis of advertisement
content suggested that gynandromorphophilia constitutes a distinct erotic
interest.
************************
British
Journal of Psychiatry, 162, 558-563.(1993)
Erotic Target Location Errors in Male Gender Dysphorics, Paedophiles, and Fetishists
Kurt Freund and Ray
Blanchard
A clinical series of male
paedophiles who dressed or fantasised themselves as children suggests that
certain paraphilias represent developmental errors in locating erotic targets
in the environment and that proneness to such errors is a paraphilic dimension
in its own right, apart from the specific nature of the erotic target
************************
Behavioral Sciences and the Law, Vol. 10, 509-523 (1992)
Death Scene Characteristics in 118 Fatal Cases of
Autoerotic Asphyxia compared with Suicidal Asphyxia
Stephen J. Hucker, M.B., B.S., F.1Z.C.Psych., F. R. C. P. (C) and Ray Blanchard, Ph.D.
A series of 118 autoerotic asphyxial deaths, recorded by the Coroners or Medical Examiners from the Canadian provinces of Ontario and Alberta, were compared with the same number of asphyxial suicides matched by province, year of death (within 3 years) and method of asphyxiation. Comparison of the death scenes revealed major differences between the two groups, with nudity of the body, evidence of a wade range of sexual activity at the time of death, and absence of verbal or written indication of suicidal intent being characteristic of the autoerotic asphyxia group. The data indicate that autoerotic asphyxia and suicidal asphyxia can usually be readily distinguished by death scene features.
************************
British
Journal of Psychiatry, 159, 371-377 (1991)
Age, transvestism, bondage,
and concurrent paraphilic activities in 117 fatal cases of autoerotic asphyxia.
Blanchard R, Hucker SJ.
Gender Identity Clinic, Clarke Institute of Psychiatry, Toronto, Ontario, Canada
Autoerotic asphyxia is the practice of self-inducing cerebral
anoxia, usually by hanging, strangulation, or suffocation, during masturbation.
This study investigated the relationships between: asphyxiators' ages; two
paraphilias commonly accompanying autoerotic asphyxia, bondage and
transvestism; and various other types of simultaneous sexual behaviour.
Subjects were two concurrent series totaling 117 males aged 10-56 who died
accidentally during autoerotic asphyxial activities. Data concerning sexual
paraphernalia at the scene of death or among the deceased's effects were
extracted from coroners' files using standardised protocols. Anal
self-stimulation with dildos, etc., and self-observation with mirrors or
cameras were correlated with transvestism. Older asphyxiators were more likely
to have been simultaneously engaged in bondage or transvestism, suggesting
elaboration of the masturbatory ritual over time. The greatest degree of
transvestism was associated with intermediate rather than high levels of
bondage, suggesting that response competition from bondage may limit
asphyxiators' involvement in a third paraphilia like transvestism.