Toronto Clinic Study: Most Non-Androphilic Trans Women Reported Arousal to Cross-Dressing, Versus 15% of Androphilic

Typology of male-to-female transsexualism

Authors: Ray Blanchard
Journal: Archives of Sexual Behavior
Year: 1985
Source: https://doi.org/10.1007/BF01542107

Summary

Psychologist Ray Blanchard tested an idea, drawn from Kurt Freund's work, that male-to-female transsexuals come in two basic types. Using routine questionnaires at a Toronto gender clinic, he grouped 163 patients by attraction to men and women. He asked whether they had ever been sexually aroused while cross-dressing. Two-thirds or more of those attracted to women, to both sexes or to neither said yes, compared with 15% of those attracted to men. Blanchard concluded that the groups not attracted only to men form one family, separate from those attracted to men. The paper became the basis of his later 'autogynephilia' theory and of a label in the main US psychiatric manual (DSM-5). Its evidence is a single self-reported question from one 1980s clinic, with small groups and no comparison group, and critics question whether the types hold up elsewhere.

Key findings

163 male-to-female transsexual patients at a Toronto psychiatric clinic filled in questionnaires about sexual attraction. Their average age was about 30.
A statistical method that sorts people by similar scores, set in advance to find four groups, gave 100 patients attracted to men, 35 attracted to both sexes, 16 attracted to women and 12 attracted to neither.
Sexual arousal while cross-dressing was reported by 14 of 16 attracted to women (88%), 9 of 12 attracted to neither (75%) and 23 of 35 attracted to both (66%), against 15 of 100 attracted to men (15%).
The group attracted to men differed clearly from each of the other groups, while the other three groups did not clearly differ from each other.
Blanchard concluded that those attracted to both sexes or to neither are variants of those attracted to women, giving two basic types: attracted to men, and not (later called 'autogynephilic').
The study was the starting point for Blanchard's types and his 1989 autogynephilia idea, which the US psychiatric manual DSM-5 later used for a label attached to the diagnosis of cross-dressing disorder.

Abstract

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.

Conclusion

The prediction that asexual and bisexual transsexuals would report a history of cross-gender fetishism about as often as heterosexual transsexuals, and much more often than homosexual transsexuals, survived what Blanchard called an objective, 'hands-off' test that could have shown it false. He argued that anyone dissatisfied with his hypothesis must offer an alternative that explains the high rates of cross-gender fetishism in the asexual and bisexual groups and makes a new, testable prediction. He concluded that male transsexuals may be divided into two basic types, heterosexual and homosexual, with the asexual and bisexual forms being variants of the heterosexual type.

Methodological limitations

One yes/no question: Arousal was measured by one question ('Did you ever feel sexually aroused when putting on females' underwear or clothing?'). It says nothing about how often, how strongly, how recently, or whether arousal mattered to the person's gender feelings.
Patients wanted treatment: Patients were being assessed for sex reassignment, and admitting arousal could seem to harm their chances. Blanchard's own team (1985) showed gender patients shade their answers to look good, which could especially affect answers from those attracted to men.
One clinic, decades ago: All patients came from one Toronto clinic in the late 1970s–80s, and many came from an earlier study (Freund et al., 1982). It is unknown whether results apply to other countries, people outside clinics or today's trans population.
Very small groups: Only 16 patients were attracted to women and 12 to neither, so the finding that these groups were 'no different' is weak and uncertain.
Groups shaped by the method: The number of groups (four) was set in advance, and the questionnaires were designed for male gender patients. The groups may reflect the method's assumptions as much as any natural divide.
No comparison groups: There were no non-transsexual men or women to compare with, so the study cannot show this arousal is special to the non-'attracted to men' groups. Moser (2009) reported similar answers among women, though his measure was itself criticised.
A link, not a cause: More arousal in some groups does not show that arousal causes or drives gender dysphoria. That cause-and-effect reading came later and is still disputed (Moser, 2010; Serano, 2010).
Groups overlap: 15% of those attracted to men and a third of those attracted to both sexes did not fit the predicted pattern. The two-type split is a tendency, not a clean divide.
Mixed results elsewhere: Studies in other groups (for example Veale et al., 2008; Nuttbrock et al., 2011) only partly supported the link between attraction and this kind of arousal, and found it weaker in younger people.

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Summary

Key findings

Abstract

Conclusion