Blanchard Coins 'Autogynephilia': Non-Androphilic Trans Women Reported More Arousal to Imagining Themselves Female

The concept of autogynephilia and the typology of male gender dysphoria

Authors: Ray Blanchard
Journal: Journal of Nervous and Mental Disease
Year: 1989
Source: https://doi.org/10.1097/00005053-198910000-00004

Summary

In this paper Ray Blanchard introduced the word 'autogynephilia': a male's tendency to be sexually aroused by the thought or image of himself as a woman. He tested the idea on 212 male-to-female transsexual patients at a Toronto gender clinic, grouped by sexual attraction, using a new questionnaire. Patients not attracted to men (those attracted to women, to both sexes or to neither) reported more of this arousal than those attracted to men. Blanchard argued that all gender dysphoria in males not attracted to men is one condition driven by autogynephilia. The idea shaped later research and a label in the main US psychiatric manual (DSM-5), and remains one of the field's most disputed ideas. The evidence is one-time self-reports from one clinic, using a questionnaire built and tested on the same patients. It shows a link, not that arousal causes gender dysphoria.

Key findings

Blanchard coined the word 'autogynephilia' for a male's tendency to be sexually aroused by the thought or image of himself as a woman.
The study included 212 adult male-to-female transsexual patients, aged 17 to 63, at a Toronto psychiatric clinic's gender service.
Patients were split into one group attracted to men and three other groups: attracted to women, attracted to both sexes, and attracted to neither.
Blanchard built a new questionnaire from existing questions to measure arousal at the fantasy of being a woman, and compared the four groups on it.
All three groups not attracted to men were more likely than the group attracted to men to report sexual arousal from imagining themselves as women.
Blanchard concluded that gender dysphoria in males not attracted to men is one condition, 'autogynephilic gender dysphoria', separate from gender dysphoria in males attracted to men.
The idea later fed into a label in the US psychiatric manual DSM-5, attached to the diagnosis of cross-dressing disorder, and remains strongly disputed.

Abstract

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.

Conclusion

As predicted, all three nonhomosexual groups (heterosexual, bisexual and analloerotic) were more likely than the homosexual group to report sexual stimulation by cross-gender fantasy. Blanchard concluded that this supports the hypothesis that the major types of nonhomosexual gender dysphoria are variant forms of one underlying disorder, which may be characterised as autogynephilic gender dysphoria, and proposed the term autogynephilia ('love of oneself as a woman') for a male's propensity to be sexually aroused by the thought or image of himself as a woman.

Methodological limitations

Questionnaire built and tested on the same people: The scale was created in this study and then used to compare the same patients, with no separate testing. This risks making group differences look bigger than they are.
Patients wanted treatment: Answers came from patients being assessed for hormones and surgery, where admitting arousal could affect access. Blanchard's own team (1985) showed gender patients shade their answers to look good.
One clinic, decades ago: All patients came from one Toronto clinic in the 1980s. It is unknown whether results apply to people outside clinics, other countries or today's younger, more often female trans population.
No comparison groups: Without non-dysphoric men and women to compare with, the study cannot show this arousal is special to the groups not attracted to men. Moser (2009) reported high rates of similar answers among women, though his measure has been criticised.
A link treated as a cause: Higher average scores in some groups do not show that autogynephilia causes or drives gender dysphoria. The paper jumps from a group difference to a claim of one 'underlying disorder'.
Group averages, not everyone: The theory says all such patients not attracted to men are autogynephilic, but the data only compare group averages. People who didn't fit, including some with low scores, are explained away rather than counted against the theory.
Groups defined by questionnaire cut-offs: The four groups came from questionnaire scores. The 'attracted to neither' group is defined by reporting no attraction, which may reflect low sex drive, hormone treatment or reluctance to answer.
Disputed in later research: Published critiques (Moser, 2010; Serano, 2010) argue the theory cannot be disproved as used and mixes up sexuality and gender identity. Later studies only partly repeated the link, and found it weaker in younger people (Veale et al., 2008; Nuttbrock et al., 2011). Supporters such as Lawrence say it fits many findings.

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Summary

Key findings

Abstract

Conclusion