Ray Blanchard, February 2004

 

INTRODUCTION

 

          In 1989 I coined the term autogynephilia from Greek roots meaning “love of oneself as a woman” and defined it as a male’s propensity to be erotically aroused by the thought or image of himself as a woman. My identification of this erotic orientation was not the result of any advance in imaging technologies, laboratory assays, or computationally intensive statistical procedures. It was the result of a perceptual shift—a shift in the way I saw, heard, and understood statements that patients had been making to clinicians for decades. In this essay, I review the perceptions of earlier clinicians and attempt to show how these led to my own formulation.

 

          The study of autogynephilia is, more than anything else, the study of what people say about their experiences. The reader who has never heard or read autogynephiles describe their own feelings in their own words should do so at this point. Two excellent on-line sources are Anne Lawrence’s “28 Narratives About Autogynephilia” and “31 New Narratives About Autogynephilia” . Readers who desire further background on the topic of autogynephilia can access various introductory essays and general discussions on this site and elsewhere:

 

EARLY AND MIDDLE 20TH CENTURY THOUGHT

 

There is ample evidence in the clinical literature that clinical practitioners have been aware of the phenomenon of autogynephilia since early in the last century. Because they had no label or definition for this phenomenon, however, their references to it were oblique or epigrammatic. In some cases, clinicians described patients’ behaviors that clearly struck them as having some special significance, but they did not have the terminology or conceptual tools to identify the underlying motivation as autogynephilic.

 

Epigrammatic allusions to autogynephilia maybe found in the writings of Magnus Hirschfeld (1868–1935). Hirschfeld was the brilliant German physician who coined the term transvestism. He is generally credited with being the first clinician to distinguish homosexuality per se from transvestism and other cross-gender phenomena. He identified the erotic idea of being a woman in a subgroup of cross-dressing males:

 

We are almost tempted to believe that we are here faced with a splitting of the personality in the sense that the masculine component in the psyche of these men is sexually stimulated by the feminine component and that they feel attracted not by the women outside them, but by the woman inside them. (1948, p. 167)

 

Hirschfeld appears to have been, or to have become, aware that autogynephilia does not always completely obliterate erotic interest in (external) women, and in other writings (e.g., 1925, pp. 199–200) he modified his own aphorism to the effect that certain cross-dressers love the woman inside them in addition to the women outside them.

 

          Hirschfeld may have had autogynephilia, among other things, in mind when he made the following comments about his invented term transvestism:

 

We have denoted this impulse as “transvestite,” from “trans,” “across,” and “vestitus,” “clothed,” and readily admit that this name indicates only the most obvious aspect of this phenomenon, less so its inner, purely psychological kernel. (1948, p. 158)

 

It is unlikely that Hirschfeld was referring solely to autogynephilia as the “inner, purely psychological kernel” of transvestism, because, in his later writings, he also applied the term transvestite to homosexual male-to-female transsexuals and to female-to-male transsexuals, neither of which manifests autogynephilia. One thing, however, is for certain. Many later (and lesser) clinicians who wrote about erotically motivated cross-dressing went in precisely the opposite direction to that indicated by Hirschfeld, and focused on the individual’s use of clothing rather than his mental content. This literalist approach is exemplified by the diagnostic criteria for “Transvestic Fetishism” in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, which make no mention of erotic ideation regarding the female persona. The emphasis placed by many writers on the physical properties of clothing used for cross-dressing (silky textures, striking colors) likely militated against the realization that erotic arousal at the thought of being a woman could arise with no ideas or actions involving women’s apparel at all.

 

          Havelock Ellis (1859–1939), another of the great, classic sexologists, had perceptions similar to Hirschfeld’s, although he couched them in somewhat different language.  Ellis used the term Eonism, usually in regard to nonhomosexual males, to designate overt cross-gender behavior as well as subjective feelings; he sometimes used an alternative term, sexo-aesthetic inversion, for the same thing.  In his view:

 

The Eonist is embodying, in an extreme degree, the aesthetic attribute of imitation of, and identification with, the admired object. It is normal for a man to identify himself with the woman he loves. The Eonist carries that identification too far. (1935, p. 244)

 

In other writings, Ellis reiterated his opinion that “Eonism” and normal heterosexual interest have some common point of origin:

 

Psychologically speaking, it seems to me that we must regard sexo-aesthetic inversion as really a modification of normal hetero-sexuality. (1928, p. 103)

 

          Throughout most of the 20th century, psychiatry and psychology were dominated by psychodynamic theories, and simple descriptions of patients’ behavior were less interesting to clinical authors than their theories about this behavior. This propensity can be seen in the next few examples of early clinical commentary on autogynephilic phenomena. The reader should bear in mind when reading these examples (and when studying the old literature generally) that many writers used the term transvestite for persons who would today be called transgendered or transsexual.

 

          Otto Fenichel (1897–1946) was a prominent psychoanalyst and author. Fenichel (1930), writing on transvestism, also noted autogynephilic phenomena in terms not dissimilar from Hirschfeld and Ellis. He did not, however, dwell long at the descriptive level:

 

Love for the subject’s own self—phantasies that the masculine element in his nature can have intercourse with the feminine (i.e. with himself) are not uncommon. Love for the phallic mother is often transformed into love for the ego in which a change has been wrought by identification with her. This is a feature in the psychic picture which has struck even non-analytical writers, who have described a narcissistic type of transvestist. (p. 214)

 

Although Fenichel noted the same fantasies as Hirschfeld and Ellis, he also, in a sense, denied their importance. In Fenichel’s view, the transvestite’s driving fantasy was not the conscious thought of himself as a woman with a vulva but rather the unconscious thought of himself as a woman with a penis.

 

Buckner (1970) advanced an elaborate theory of the developmental events leading to transvestism. In his theory, the future transvestite begins with fetishistic masturbation, but then

 

begins to build in fantasy a more complete masturbation image . . . Through a process of identification and fantastic socialization he takes the gratificatory object into himself . . . [The next step] involves this elaboration of masturbation fantasies into the development of a feminine self (pp. 383–384). . . . [which is] gratifying in both sexual and social ways. When it becomes fixed in his identity, he begins to relate toward himself in some particulars as if he were his own wife. (p. 387)

 

Thus, Buckner also recognized the erotic idea of being a woman, although it is debatable whether he located it correctly in the developmental sequence.

 

The 20th century writers varied considerably in their ability or willingness to differentiate autogynephilia (erotic interest in the idea of being a woman) from homosexuality (erotic interest in men and men’s bodies). The following quote from Karpman (1947) provides a good example of failure to make this distinction:

 

If a married man insists in his relations with his wife in occupying the succubus position and at the same time demands of her that she massage his breasts, this can hardly be interpreted as anything else but an expression of unconscious or latent homosexuality. (p. 293)

 

It was self-evident to Karpman that such behavior betokened a sexual interest in men; he never even considered that the fundamental and irreducible sexual stimulus was the idea of being a woman.

 

          There is evidence that other writers, in contrast, were aware of the difference between true homosexual attraction and autogynephilically mediated attraction—the difference between sexual interest in men for their bodies and sexual interest in men for their symbolic value as accoutrements of femininity. Thus, Henry (1948), writing at almost the same time as Karpman, reported as objective fact the remark of a married cross-dresser concerning one of his homosexual encounters:

 

It was all from the point of vanity of being a woman. I have absolutely no taste for homosexuality itself. (p. 495)

 

In summary, the generations of clinicians following Hirschfeld and Havelock Ellis had, to varying degrees, some awareness of the existence of autogynephilia. In the absence of a label and a definition for this phenomenon, however, they were unable to systematize their observations or to communicate them very effectively to any audience.

 

THE PIVOT POINT

 

          The first real advance in this area, after the seminal observations of Hirschfeld, was made by another of the great 20th century sexologists, Kurt Freund (1914–1996). Although he was born and educated in Prague, Freund was, like Hirschfeld, a native German speaker. This is likely more than coincidence. During his formative years as a sexologist, Freund had read and absorbed the works of Hirschfeld (as well as other German sexologists of the pre-World War Two period). A North American-born psychiatrist or psychologist would have been considerably less likely to be familiar with Hirschfeld’s thinking, first, because many of Hirschfeld’s books were destroyed by the Nazis—Hirschfeld was a Jew—and second, because none of Hirschfeld’s major original writings (even the famous Die Transvestiten) was translated into English until 1991.

 

          In the late 1970s, when I first met him, Freund was working on a study which he eventually published in 1982 under the title, “Two Types of Cross-Gender Identity.” Freund was interested in determining whether cross-gender identity in homosexual males is the same clinical entity as cross-gender identity in heterosexual males. His eventual conclusion was captured in the title of the article: There are two distinct types of cross-gender identity. The feminine gender identity that develops in homosexual males is different from the feminine gender identity that develops in heterosexual males. In other words, homosexual and heterosexual men cannot “catch” the same gender identity disorder in the way that homosexual and heterosexual men can both “catch” the identical strain of influenza virus. Each class of men is susceptible to its own type of gender identity disorder and only its own type of gender identity disorder.

 

          The reason that I stress this 1982 article is that in it Freund, perhaps for the first time of any author, employed a term other than “transvestism” to denote erotic arousal in association with cross-gender fantasy. His reasons for doing so are not clear in the article, and I cannot fully trust my recollections of conversations about the manuscript from 25 years ago. I suspect, however, that he wanted to reserve the term “transvestism” for his definition of a particular syndrome:

 

Transvestism is the condition in which a person fantasizes her- or himself as a member of the opposite sex only when sexually aroused. (p. 54)

 

This left Freund with a terminological problem. He now needed a separate term to denote erotic arousal in association with cross-gender fantasy, because this phenomenon could occur in individuals who would not meet his definition of transvestites. He therefore coined the term cross-gender fetishism, which he was very careful to distinguish from “fetishism proper”:

 

cross-gender fetishism is characterized by the subject’s fantasizing, during fetishistic activity, that she or he belongs to the opposite sex . . . the fetish, in such cases always an object characteristic of the opposite sex, is used to induce or enhance cross-gender identity (p. 50)

 

Elsewhere in the article, Freund points out that clothing characteristic of the opposite sex is usually, but not always, the individual’s favorite symbol of his own femininity.

 

          The significance of Freund’s terminological innovation for my own thinking was the following: It freed up, if ever so slightly, the erotic idea of being a woman from the word “transvestism” and from any necessary association with women’s garments. This set the stage for me later to free up the idea completely.

 

THE INTRODUCTION OF THE TERM AUTOGYNEPHILIA

 

          In 1980 I accepted a full-time position in the Gender Identity Clinic at the former Clarke Institute of Psychiatry in Toronto, Ontario, Canada (now officially called the College Street Site of the Centre for Addiction and Mental Health). I shortly thereafter decided, like many investigators before me, that further typological research on gender identity disorders was needed.

 

          The clinical literature at that time included a confusing array of classification schemes for gender identity disorders in biological males. One thing that most authorities did agree on is that gender identity disorders are phenomenologically and probably etiologically heterogeneous. The taxonomic question, therefore, was not whether there is more than one type of transsexualism in males, but rather, how many more than one type, and how these should be characterized.

 

          The research strategy that I used for this question was to start by distinguishing a larger number of groups and then reduce this to a smaller number by combining groups that seem to be merely superficially different variants. Although I was a frequently collaborator of Kurt Freund in those days—and still very much his student and protégé—I did not begin this project with his 1982 typology. Instead, I started this research program by returning to the first taxonomic scheme ever proposed, namely, that advanced by Magnus Hirschfeld.

 

Hirschfeld basically distinguished four main types of “Transvestiten,” according to their erotic interest in men, women, both, or neither. (The last type lacks erotic interest in other people but not necessarily all sexual drive.) Hirschfeld labeled these types the same way that he labeled non-transsexual individuals, that is, according to their biological sex. Thus, in Hirschfeld’s terminology, a male-to-female transsexual who was erotically attracted to men would be labeled a homosexual transsexual. I began my research by defining and labeling the same groups of male-to-female transsexuals identified by Hirschfeld: homosexual, heterosexual, bisexual, and asexual (i.e., transsexuals attracted to men, women, both, or neither, respectively).

 

          The methodology and results of the ensuing taxonomic research are summarized, among other places, in my 2000 conference paper entitled “Autogynephilia and the Taxonomy of Gender Identity Disorders in Biological Males .” That paper is available on this site, so I will not repeat the separate results in the present essay.

 

          My conclusion from this taxonomic research was that heterosexual, asexual, and bisexual transsexuals are more similar to each other—and to transvestism—than any of them is to the homosexual type. Asexual and bisexual transsexualism seemed to be variant forms of heterosexual transsexualism, and transvestism to be a not-too-distant cousin. This left me to answer the question: What is it that transvestites and the three types of non-homosexual transsexuals have in common? It was clear to me, by this point, that the common feature is a history of erotic arousal in association with the thought or image of oneself as a woman.

 

          By the late 1980s, the lack of a word to denote a male’s propensity to be sexually aroused by the idea of himself as a woman was becoming a constant problem in my writing. Freund’s term cross-gender fetishism came closer to describing this phenomenon than the familiar term transvestism, in that the definition of cross-gender fetishism explicitly included the element of cross-gender ideation. Freund’s concept of cross-gender fetishism still, however, implied the presence of a fetish-object, even if it allowed that object to be some symbol of femininity other than clothing. (There exist, for example, men who use sanitary napkins to simulate menstruation during masturbatory rituals.) The term cross-gender fetishism therefore did not seem quite satisfactory for my purposes. I was becoming increasingly convinced that, at least for some men, the idea of being a woman was central to their erotic excitement, and that the specific objects they used to symbolize their femininity were secondary and interchangeable. I was strengthened in this conviction by the following patient, whom I described at length in one report and more briefly as below:

 

Philip was a 38‑year‑old professional man referred to the author’s clinic for assessment. His presenting complaint was chronic gender dysphoria, which had led, on occasion, to episodes of depression severe enough to disrupt his professional life. Philip began masturbating at puberty, which occurred at age 12 or 13. The earliest sexual fantasy he could recall was that of having a woman’s body. When he masturbated, he would imagine that he was a nude woman lying alone in her bed. His mental imagery would focus on his breasts, his vagina, the softness of his skin, and so on—all the characteristic features of the female physique. This remained his favorite sexual fantasy throughout life. Philip cross‑dressed only once in his life, at the age of 6. This consisted of trying on a dress belonging to an older cousin. When questioned why he did not cross‑dress at present—he lived alone and there was nothing to prevent him—he indicated that he simply did not feel strongly impelled to do so. (Blanchard, 1993, p. 70)

 

This patient had not the slightest motivation that I could detect for distorting his self-report in this particular way, and his presentation seemed to me the final evidence that the erotic idea of being a woman could exist in the complete absence of any interest in women’s clothing or any other fetish-object.

 

          I therefore reluctantly concluded that I had no alternative but to invent a new word. My colleagues and I at the Clarke Institute were accustomed—again, under the influence of Kurt Freund—to referring to the erotic preference for adult women as gynephilia rather than heterosexuality, because the former denotes both the gender and the age of an individual’s preferred partners, whereas the latter denotes only the gender. It was thus a small step for me to prefix gynephilia with auto to produce autogynephilia.

 

THE PHENOMENON OF AUTOGYNEPHILIA VERSUS THEORIES INVOLVING AUTOGYNEPHILIA

 

          It is important to distinguish between the phenomenon of autogynephilia and theoretical statements involving autogynephilia. The existence of autogynephilia as a distinguishable form of sexual behavior is scarcely in doubt. During the past 15 years, numerous individuals have come forward, outside of clinical contexts, to say that, yes, indeed, the published descriptions of autogynephilic behavior and feelings closely match their own histories. Their testimonials are sometimes accompanied by expressions of comfort and relief at learning of the existence of fellow travelers, sometimes by expressions of grief and anger at the confirmation that their feelings represent a distinct paraphilia and by moving requests for help. Unless all these individuals have been motivated by obscure and perverse desires to claim emotions they have never really felt, their statements constitute further evidence that autogynephilia exists and that it is not extraordinarily rare.

         

Theoretical statements involving autogynephilia are a rather different matter. I have, at one time or another, advanced several of these, for example:

1. All gender-dysphoric biological males who are not homosexual (erotically aroused by other males) are instead autogynephilic (erotically aroused by the thought or image of themselves as females).

          2. Autogynephilia does not occur in women, that is, biological females are not sexually aroused by the simple thought of possessing breasts or vulvas.

          3. The desire of some autogynephilic males for sex reassignment surgery represents a form of bonding to the love-object and is analogous to the desire of heterosexual men to marry wives and the desire of homosexual men to establish permanent relationships with male partners.

          4. Autogynephilia is a misdirected type of heterosexual impulse, which arises in association with normal heterosexuality but also competes with it.

          5. Autogynephilia is simply one example of a larger class of sexual variations that result from developmental errors of erotic target localization.

         

         All or none of the foregoing propositions may be true, false, or something in between. Their accuracy is an empirical question that can be resolved only by further research. In the meantime, it is important to distinguish between the truth or falseness of theories about autogynephilia, on the one hand, and the existence or nonexistence of autogynephilia, on the other. The latter is also an empirical question, but it appears, at this point, to be settled. The primary evidence that autogynephilia exists is the self-report of biological males who say “I am sexually excited by the idea of having breasts,” “I am sexually excited by the idea of having a vagina,” “I am sexually excited by the idea of being a woman.” There is no particular reason to believe that these individuals are merely distorting the familiar transvestitic narrative to make it more acceptable to others. How is it more socially desirable for a man to admit that he is sexually excited by the idea of having breasts than to admit that he is sexually excited by wearing a brassiere? How does a man’s behavior sound more normal if he admits to pretending that his anus is a vagina while he inserts dildos into it than if he admits to a predilection for wearing panties? Thus, even a skeptical view of the data provides little reason for doubting that autogynephilia exists as a discriminable erotic interest—either a superordinate category including transvestism or a correlate of it.

 

REFERENCES

 

Blanchard, R. (1993). The she-male phenomenon and the concept of partial autogynephilia. Journal of Sex & Marital Therapy, 19, 69–76.

 

Buckner, H. T. (1970). The transvestic career path. Psychiatry, 33, 381–389.

 

Ellis, H. (1928). Studies in the psychology of sex (Vol. 7). Philadelphia: F. A. Davis.

 

Ellis, H. (1935). Psychology of sex: A manual for students. New York: Emerson Books.

 

Fenichel, O. (1930). The psychology of transvestism. International Journal of Psycho-Analysis, 11, 211–227.

 

Freund, K., Steiner, B. W., & Chan, S. (1982). Two types of cross-gender identity. Archives of Sexual Behavior, 11, 49–63.

 

Henry, G. W. (1948). Sex variants: A study of homosexual patterns. New York: Hoeber.

 

Hirschfeld, M. (1925). Die Transvestiten [Transvestites] (2nd ed.). Leipzig: Ferdinand Spohr.

 

Hirschfeld, M. (1948). Sexual anomalies. New York: Emerson Books.

 

Karpman, B. (1947). Dream life in a case of transvestism with particular attention to the problem of latent homosexuality. Journal of Nervous and Mental Disease, 106, 292–337.

 

6/6/04