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 myntade ordet ‘autogynefili’ för en mans tendens att bli sexuellt upphetsad av tanken på eller bilden av sig själv som kvinna.
• Studien omfattade 212 vuxna transsexuella patienter från man till kvinna, 17 till 63 år, vid en psykiatrisk klinik i Torontos könsmottagning.
• Patienterna delades in i en grupp attraherad av män och tre andra grupper: attraherade av kvinnor, attraherade av båda könen och attraherade av ingendera.
• Blanchard byggde ett nytt frågeformulär av befintliga frågor för att mäta upphetsning vid fantasin om att vara kvinna, och jämförde de fyra grupperna på det.
• Alla tre grupperna som inte var attraherade av män var mer benägna än gruppen attraherad av män att rapportera sexuell upphetsning av att föreställa sig själva som kvinnor.
• Blanchard drog slutsatsen att könsdysfori hos män som inte är attraherade av män är ett tillstånd, ‘autogynefil könsdysfori’, skilt från könsdysfori hos män som är attraherade av män.
• Idén bidrog senare till en beteckning i den amerikanska psykiatriska manualen DSM-5, kopplad till diagnosen cross-dressing-störning, och är fortfarande starkt omstridd.

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.