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Blanchard, Bailey, and Lawrence theory (also Blanchard Autogynephilia Theory (BAT) and Blanchard's taxonomy) is a taxonomy of male-to-female transsexualism created by Ray Blanchard, building on the work of his colleague, Kurt Freund. The theory states that male-to-female transsexuals can be broken up into two groups: "homosexual transsexuals", who transition because they are attracted to men, and "non-homosexual transsexuals", who transition because they are "autogynephilic" (sexually attracted to the thought of themselves as a woman). Prominent supporters of the theory include J. Michael Bailey, Anne Lawrence, James Cantor, and others who argue that there are significant differences between the two groups, including sexuality, age of transition, ethnicity, IQ, fetishism, and quality of adjustment. Scientific criticism of the theory includes papers from Veale, Nuttbrock, Moser, and others who argue that the theory is poorly representative of M2F transsexuals, non-instructive, the experiments poorly controlled, or contradicted by other data. Many sources, including some supporters of the theory, criticize Blanchard's choice of wording as confusing or degrading. The theory has created a firestorm of protest in the transsexual community, although it has its supporters.

Origins

The early history of the study of transsexualism is sparse; however, the concept of a categorization of transsexuals can be seen as early as 1923 with the work of Magnus Hirschfeld.^[1]. In 1966, Harry Benjamin wrote that researchers of his day thought that attraction to men, as a woman was the factor that distinguished a transvestite from a transsexual.^[2] In 1980 in the DSM III, a new diagnosis was introduced, that of "302.5 Transsexualism" under "Other Psychosexual Disorders". This was an attempt to provide a diagnostic category for a gender identity disorders.^[3] The diagnostic category, "Transsexualism", was for gender dysphoric individuals who demonstrated at least two years of continuous interest in transforming their physical and social gender status.^[4] The subtypes were 1. asexual, 2. homosexual (same anatomic sex), 3. heterosexual (other anatomic sex) and 0. unspecified.^[3] This was removed in the DSM IV, wherein Gender Identity Disorder replaced transsexualism.

Previous taxonomies, or systems of categorization, used the terms "classic transsexual" or "true transsexual," terms once used in differential diagnoses.^[5] In 1982, Kurt Freund reported evidence that there exist two types of cross-gender identity in male-to-female transsexuals^[6], coined the term "homosexual transsexual" and hypothesized that gender dysphoria in "homosexual males" (male-to-female transsexuals attracted to men) is different from gender dysophoria in heterosexual males. His protege, Ray Blanchard notes that "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."^[7]

Blanchard's observations at the Clarke Institute began with four types of male transsexuals based on their sexual orientation relative to their sex assigned at birth: homosexual, heterosexual, bisexual, and asexual (i.e., transsexuals attracted to men, women, both, or neither, respectively.)^[8] Blanchard conducted a series of studies of biological males with gender dysphoria, including male-to-female transsexuals, concluding that there exist two distinct types.^[9]^[8]^[10] One type of gender dysphoria/transsexualism are those individuals who are exclusively attracted to men, whom Blanchard referred to as homosexual transsexuals, adopting Freund's terminology^[9] The other group includes those who are attracted to females (gynephilic), attracted to both males and females (bisexual), and attracted to neither males nor females (analloerotic or asexual); Blanchard referred to this latter set collectively as the non-homosexual transsexuals.^[11]^[12] Blanchard claims that the non-homosexual transsexuals (but not the homosexual transsexuals) exhibit autogynephilia, a paraphilic interest in having female anatomy.^[13]^[14]^[15]^[16]

Autogynephilia

Autogynephilia (Template:PronEng) (from Greek “αὐτό-” (self), “γυνή” (woman, though the stem is actually “γυναικ-”^[17], so that “autogynephilia” is ill-formed^[18]) and “φιλία” (love) — "love of oneself as a woman") is a term coined in 1989 by Ray Blanchard, to refer to "a man's paraphilic tendency to be sexually aroused by the thought or image of himself as a woman."^[10] The term is recognized by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, where Blanchard has served on the gender dysphoria sub-working group for the DSM-IV and of the paraphilia sub-working group for the DSM-5. . The term is most notable for its use in Blanchard's taxonomy to explain the motivation behind gender dysphoria in "non-homosexual" (gynephilic) male-to-female transsexuals, in contrast to sexuality as the motivating factor in "homosexual" (androphilic) transsexuals. Autogynephilia has also been suggested to pertain to romantic love as well as to sexual arousal patterns.^[19] While Blanchard claims that autogynephilia does not exist in natal (from birth) women, Veale et al (2008)^[20] and Moser (2009)^[21] report that it does exist in natal women at rates close to or equal to that of non-homosexual transsexuals. This is controversial.^[22]^[23]

Blanchard provides case examples to illustrate the autogynephilic sexual fantasies that people reported:^[7]

Philip was a 38-year-old professional man referred to the author's clinic for assessment....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 his life.

According to Blanchard, "An autogynephile does not necessarily become sexually aroused every time he pictures himself as female or engages in feminine behavior, any more than a heterosexual man automatically gets an erection whenever he sees an attractive woman. Thus, the concept of autogynephilia—like that of heterosexuality, homosexuality, or pedophilia—refers to a potential for sexual excitation"^[24] [emphasis in original].

Blanchard classified four subtypes of autogynephilic sexual fantasies, but noted that "All four types of autogynephilia tend to occur in combination with other types rather than alone."^[24]^[25]

Transvestic autogynephilia: arousal to the act or fantasy of wearing women's clothing
Behavioral autogynephilia: arousal to the act or fantasy of doing something regarded as feminine
Physiologic autogynephilia: arousal to fantasies of female-specific body functions
Anatomic autogynephilia: arousal to the fantasy of having a woman's body, or parts of one.

There also exist biological males who report being sexually aroused by the image or idea of having some but not all female anatomy, such as having female breasts but retaining their male genitalia; Blanchard referred to this phenomenon as partial autogynephilia.^[26]^[27]

Non-homosexual transsexuals versus homosexual transsexuals

In Blanchard's taxonomy, non-homosexual biological males with gender identity disorder (Kinsey Scale 0-4)^[28] exhibit autogynephilia and are either attracted to women, both women and men, or are asexual. Homosexual transsexuals are attracted exclusively to men and do not exhibit autogynephilia.^[9]

Support for the theory comes from a wide range of demographic and psychological aspects of the subjects studied Blanchard's practice in the 1980s. Criticism of the theory is generally focused in two categories: the use of the terms "homosexual" and "non-homosexual" to refer to transsexuals by their sex-of-birth^[29]^[30], and the data underlying the theory itself.^[21]^[31]^[20]^[32]

Justification for the two classifications

According to Blanchard (1985, 1987) key characteristics of homosexual transsexuals include conspicuous cross-gender behavior from childhood through adulthood, and a "homosexual" sexual orientation. Blanchard (1987) found in his studies that homosexual transsexuals were younger when applying for sex reassignment^[33]^[34] The average age of the non-homosexual transsexuals in Blanchard's sample is around 39,^[12] whereas the average of the homosexual transsexuals was 23.6.^[9] Moreover, the homosexual transsexuals reported that cross-gender wishes preceded cross-dressing by 3–4 years, whereas the non-homosexual transsexuals reported that their first cross-gender wishes occurred around the time they first cross-dressed. Blanchard also reports that they have a more convincing cross-gender appearance and functioned psychologically better than "non-homosexual" transsexuals.^[35] A lower percentage of the homosexual transsexuals reported being (or having been) married and sexually aroused while cross-dressing.^[12] ^[36] Early studies had variously found that between 10% and 36% of homosexual transsexuals report a history of sexual arousal to cross dressing. Bentler (1976) found 23%, while Freund (1982) reported 31%.^[6]^[28]^[37]^[38] In a follow-up study of post-operative transsexuals, Blanchard found that both types of male-to-female transsexuals respond well to sex reassignment, but that the homosexual transsexuals are less likely to regret doing so.^[39]

Sexologists quantitatively measure sexual orientation using psychological personality test or rely on self reports. Blanchard and Freund used the Masculine Identity in Females (MGI), and the modified androphilia scale.^[40] Homosexual transsexuals averaged a Kinsey Scale measurement of 5-6 or a 9.86±2.37 on the Modified Androphilia Scale.^[41]^[28].

In The Man Who Would Be Queen, J. Michael Bailey (2003) says that the homosexual transsexuals from Chicago gay bars he studied are comfortable with prostitution,^[15] that they have a masculine sexual appetite,but lust after men.^[15] He supports Blanchard's taxonomy of two forms of transsexualism in males -- one that is an extreme type of homosexuality and one that is an expression of autogynephilia. In "The Transsexual Phenomenon", Harry Benjamin (1966) writes that a few dozen transsexuals "find prostitution a useful profession for emotional as well as practical reasons" before surgery.^[2]^: 50–51

Ken Zucker(2002) and Yolanda Smith (2005) independently found that homosexual transsexuals are of lower average IQ^[36], social class, and age. They were on average in their mid-teens to mid-20s when they reported to a gender clinic for sex reassignment.^[36]^[42] The homosexual transsexuals are more likely to have recent immigrant status, non-intact families, non-Caucasian race, and childhood behavior problems).^[43]^[44] Bailey found that most homosexual transsexuals he interviewed from Chicago gay bars learned to live on the streets, resorting to prostitution, or shoplifting.^[15]

Blanchard does not consider sex with males to be a sole defining characteristic of being "homosexual" versus "non-homosexual". Concerning "non-homosexual", autogynephilic transsexuals who sleep with men, Blanchard writes: "The effective erotic stimulus in these interactions, however, is not the male physique of the partner, as it is in true homosexual attraction, but rather the thought of being a woman, which is symbolized in the fantasy of being penetrated by a man. For these persons, the male sexual partner serves...to intensify the fantasy of being a woman."^[10]

Leavitt and Berger also mentioned studies by Blanchard which suggest that heterosexual transsexuals will adjust their life stories to ensure that they get sex reassignment surgery.(Leavitt 1990)^[28] Blanchard considers self-report to be unreliable.^[41]^[28]^[45] Morgan (1978), Blanchard (1985), Lawrence (2005) and other researchers have asserted that many "non-homosexual" transsexuals systematically distort their life stories because "non-homosexuals" were often screened out as candidates for surgery^[46] and because some see "homosexual transsexual" as a more socially desirable diagnosis.

Blanchard (1996) and Zucker (2007) came to the general conclusion that birth order has some influence over sexual orientation in biological males in general, and homosexual male to female transsexuals in specific.^[47]^[48]^[49] This phenomenon is called the "fraternal birth order effect".^[48] In 2000 Richard Green wrote "Homosexual male-to-female transsexuals have a later than expected birth order and more older brothers than other subgroups of male-to-female transsexuals. Each older brother increases the odds that a male transsexual is homosexual by 40%."^[49] Green did not find a higher incidence of homosexuality in the younger brothers of homosexual transsexuals. Zucker and Blanchard wrote that studies have consistently supported the "fraternal birth order effect" that homosexual transsexuals have more brothers than sisters and are born later in birth order. In contrast, in their study using an Asian sample they found that the transsexual men had significantly more sisters than controls.^[48] Zucker attributes this to the preference for males in Korean society causing parents to stop having children once they have a boy.^[48] Therefore all male children are less likely to have older brothers and hence no fraternal birth order effect is observed.^[48] According to Bailey's interpretation of Blanchard's theory the causes of homosexual transsexuality are extreme examples of the causes of homosexuality in males.^[15]

Research by Blanchard, Zucker, and Green argues that the causes of homosexual transsexualism, transsexualism, and homosexuality overlap to a large degree.^[47]^[48]^[49]

Blanchard (1995) also said homosexual transsexuals were comparatively shorter and lighter in proportion to their height than non-homosexuals.^[50] Independent research done by Johnson (1990) and Smith (2005) concur with most of Blanchard's observations.^[51]^[36] Smith did not find a significant difference in height-weight ratio.^[36] Subsequent research has found only partial support of Smith's findings.^[52] Johson's 1990 work used the alternative term "androphilic transsexual", Johson wrote that there was a correlation between social adjustment to the new gender role and androphilia.^[51]

MacFarlane found that in New Zealand that 90% of the transsexual prostitutes were Māori. Of these, 90% had sex with a male as a child and 22% had sex with a female. Every subject in the study considered their sexual activity with men to not be homosexual, as they considered themselves female.^[44] Maoris comprise 9% of the overall population. In The Man Who Would Be Queen J. Michael Bailey says that about 60% of homosexual transsexuals he studied in Chicago gay bars were Latina or black;^[15] in his studies of gay males only 20% were non-white.(Bailey 2003)^[15] Bailey quoted the opinions of two of his subjects who attributed the difference to genetics, or inflexible gender roles in their respective cultures.^[15] MacFarlane similarly concluded that cultural acceptance influenced the number of Māori homosexual transsexuals, but also greater detachment from their culture, a lower standard of education, fewer job opportunities, and cultural confusion due to the abandonment of old customs.

Scientific criticism of the terminology

Harry Benjamin said in 1966:

....it seems evident that the question "Is the transsexual homosexual?" must be answered "yes" and " no." "Yes," if his anatomy is considered; "no" if his psyche is given preference.
What would be the situation after corrective surgery has been performed and the sex anatomy now resembles that of a woman? Is the "new woman" still a homosexual man? "Yes," if pedantry and technicalities prevail. "No" if reason and common sense are applied and if the respective patient is treated as an individual and not as a rubber stamp.^[53]

Many others agree with what Dr. Benjamin wrote about the use of this term. ^[29] Bagemihl writes "..the point of reference for "heterosexual" or "homosexual" orientation in this nomenclature is solely the individual's genetic sex prior to reassignment (see for example, Blanchard et al. 1987[24], Coleman and Bockting, 1988[25], Blanchard, 1989[26]). These labels thereby ignore the individual’s personal sense of gender identity taking precedence over biological sex, rather than the other way around."^[29] Bagemihl goes on to take issue with the way this terminology makes it easy to claim transsexuals are really homosexual males seeking to escape from stigma.^[29] Leavitt and Berger stated in 1990 that "The homosexual transsexual label is both confusing and controversial among males seeking sex reassignment.^[28]^[46] Critics argue that the term "homosexual transsexual" is "heterosexist",^[29] "archaic",^[54] and demeaning because it labels people by sex assigned at birth instead of their gender identity.^[55] Benjamin, Leavitt, and Berger have all used the term in their own work.^[28]^[2] John Bancroft also recently expressed regret for having used this terminology, which was standard when he used it, to refer to transsexual women.^[56] He says that he now tries to choose his words more sensitively.^[56]^[56] Moser (2010) is likewise critical of the terminology.^[31]

Scientific criticism of the theory

In "Autogynephilia in Women", Charles Moser applies an analogue of Blanchard's autogynephilia criteria for "non-homosexual transsexuals" to to natal (anatomically from birth) women. 93% were classified as autogynephiles. Even using a much more rigorous standard, 28% still fit the classification. Moser concludes that Blanchard's assertion that autogynephilia raises questions that require further study and that what is being probed is not a paraphilia, but rather a normal part of female sexuality no more prevalent among M2F transsexuals in comparison to the general female population.^[21] Lawrence criticized Moser (2009) for not accurately representing Blanchard's autogynephilia questionaire.^[22] Moser, in turn, defended his questions and accused Lawrence of making inaccurate comparisons.^[23]

Veale, Clarke, and Lomax (2008) did a similar, but larger scale test of Blanchard's theories, with a different set of equivalent autogynephilia questions than Moser. Veale found that while both autogynephilic and non-autogynephilic transsexuals averaged higher rates of autogynephilia than natal women in the study, they also showed a stronger incidence of childhood female gender identity (essentially identical for both autogynephilic and non-autogynephilic transsexuals). 52% of biological female subjects scored a six or higher on the Core Autogynephilia scale and 3 or greater on the Autogynephilia Interpersonal Fantasy scale, compared to Blanchard's mean of 6.1 and 2.7 for "autogynephilic" non-homosexual transsexuals. Perhaps the starkest comparison versus Blanchard's data, Veale found no difference between autogynephilic and non-autogynephilic M2F transsexuals in terms of sexual orientation. 68% of those classified as non-autogynephilic scored the highest possible score on the Sexual Attraction to Females scale. Veale's conclusion is that while Blanchard's categorization of two groups of transsexuals may have merit in some cases, it does not completely represent the diversity among M2Fs.^[20]

Nuttbrock et al (2010) attempted to reproduce Blanchard's studies from Toronto in the 1980s in modern times with 571 M2F transsexuals from New York City. For the study, autogynephilia is assumed to be equivalent to transvestism fetish. The study did confirm Blanchard's findings of three times higher rates of transvestic fetish among non-homosexuals versus homosexuals, but the correlation was too weak to be considered deterministic. Blanchard (1992)'s finding of the highest level of transvestism fetich being found with an intermediary level of gynephilia could not be reproduced. Age and ethnicity were found to be correlated with sexual orientation. Being caucasian was found to correlate with transvestism. Transvestism results overall are significantly lower than Blanchard's, prompting the hypothesis that transvestic fetish is a historically fading phenomenon. Nuttbrock concludes that, "These limitations notwithstanding, we nonetheless conclude that a classification of the MTF population, based solely on sexual orientation, is fundamentally limited."^[32]

Moser (2010)^[31] conducts a wide-ranging review of the literature on the subject as a critique of Blanchard's theory over a range of issues. His claims include:

Blanchard's use of "ever" to define autogynephilia, including those who have only had a few incidents of arousal long ago, is akin to classifying someone as homosexual for ever having been aroused by a member of the same sex in their life.
Blanchard (1989)'s claim of clinical importance for autogynephilia because "it interferes with normal interpersonal sexual attraction" is contradicted by his own work in Blanchard, Clemmensen, & Steiner (1987). "Autogynephilias as an orientation" (Blanchard 1993) is criticized in that autogynephilic M2Fs interest in transitioning does not overshadow interest in courtship, love, and cohabitation with a partner of the preferred sex, with most reporting stable partnered relationships after SRS (Lawrence, 2005). No cases were found in the literature of differences between the gender dysphoria of homosexual and non-homosexual M2Fs, or response to anti-androgens, or the clinical utility of distinguishing the two. Data on rates of regret for both groups of transsexuals is contradictory, and is low in either regard (Lawrence (2003) and Olsson & Moller (2006)).
Blanchard's statement, "All gender dysphoric biological males who are not homosexual ... are instead autogynephilic ..." is contrary to Blanchard's own data; examples include Blanchard (1993), Blanchard (1985), Bentler (1976), Leavitt and Berger (1990), Lawrence (2005), and others.
Lawrence (2005, 2006)'s claim that self-identified homosexual transsexuals are misrepresenting themselves (evidenced by a history of marriage to a woman) ignores that 20% of self-identified "white homosexual men" have a history of marriage to a woman, 14% had heterosexual coitus in the last year, and 52% in their lifetime (Bell & Weinberg, 1978). The claim that M2Fs deny their autogynephilia to win favorable SRS recommendations is contradicted by the fact that Blanchard's clinic did not discriminate between the two types, and in some cases autogynephilia could lead to a more favorable diagnosis.
Blanchard et al's reliance on phallometry is noted to be controversial, as per APA (2000) and Marshal & Fernandez (2000). Blanchard, Racansky, & Steiner (2006) is criticized for studying cross-dressers but attributing the results to transsexuals, for omitting any chance for the subject to test positive for a lesbian identity, and for offhand dismissing results that contradict the theory. Moser notes that Blanchard, Lynkins, et al (2009) interprets results in the opposite manner.
The treatment of autogynephilia as a paraphilia is criticized for failing to match with sex drive. That is, paraphilias are rare in natal women (autogynephilia was found in women in Veale et al (2008) and Moser (2009)); decline with age (non-homosexual M2F transsexualism does not); and should correspond with a decreased interest in transition and discomfort under the presence of anti-androgens. This is often the case with transvestites, but non-homosexual transsexuals generally report unabated interest and a feeling of relief from the anti-androgens, even without estrogens. "Autoandrophobia" is suggested as an alternative explanation.
While Blanchard (1991) claims that "autogynephilia ... is the main correlate of transsexual tendancies and also of diminished capacities for heterosexual relationships and pair-bond formation", Lawrence (2005) found that 83% of M2Fs interested in female partners before and after SRS were in a stable, partnered relationship versus 36% of those interested in males. Lawrence (2005)'s claims of transsexuals having trouble finding partners after SRS is criticized for using an older age range than the national baseline she compares to, as age is inversely correlated with sexual partners. Using a similar age range, the rate of sexual partners is similar. Contrary to Blanchard (1989a, 1991)'s claims that male partners of "non-homosexual transsexuals" are "faceless" and not "desirable partners in their own right", Lawrence (2005) shows 71% in stable partnered relationships post-SRS versus 64% for "homosexual" transsexuals, with an average number of post-SRS male partners of 2.8 versus 8.4, respectively.
Bailey (2003)'s claims that "homosexual transsexuals" are extremely feminine gay men, and Lawrence (2004)'s claims that homosexual M2Fs transition because it "seems obvious" for "greater social and romantic satisfaction and success" are criticized for lacking in supporting data and for the notion of amputation of one's genitals being an "obvious" route to sexual success.

Transsexual community reaction

The concept began receiving attention outside of sexology when sexologist Anne Lawrence, a physician and sexologist who self-identifies as autogynephilic, published a series of web articles about the concept in the late 1990s.^[57] Lynn Conway and Andrea James responded to Lawrence's essay. Conway started an investigation into the publication of Bailey's book by the United States National Academy of Sciences. Accusations of misconduct by Bailey were leveled. Northwestern University investigated Bailey, but did not reveal the findings of that investigation and did not comment on whether or not Bailey had been punished.^[58] According to intersex^{[citation needed]} researcher and bioethics specialist Alice Dreger, who is now one of Bailey's supporters, two of the four transwomen who accused Bailey of misusing their stories were not mentioned anywhere in the book.^[59]

According to Leavitt and Berger, "transsexuals, as a group, vehemently oppose the label and its pejorative baggage."^[28] Transwoman Andrea James has called the term "inaccurate and offensive,"^[60] and transman Aaron Devor wrote, "If what we really mean to say is attracted to males, then say 'attracted to males' or androphilic... I see absolutely no reason to continue with language that people find offensive when there is perfectly serviceable, in fact better, language that is not offensive."^[61] Still other transsexuals are opposed to any and all models of diagnosis which allow gatekeeping, and seek their removal from the DSM^[62]

References

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^ ^a ^b Lothstein, Leslie Martin (1983). Female-to-male transsexualism. Routledge. p. 60. ISBN 0710094760. Retrieved 2009-04-24.
^ Meyer, Walter (February 2001). "The Harry Benjamin International Gender Dysphoria Association's Standards Of Care For Gender Identity Disorders, Sixth Version" (PDF). 6th. Harry Benjamin International Gender Dysphoria Association. Retrieved 2009-04-22. {{cite journal}}: Cite journal requires |journal= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
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^ ^a ^b Blanchard, R. (1985). Typology of male-to-female transsexualism. Archives of Sexual Behavior, 14, 247-261.
^ ^a ^b ^c ^d Blanchard, R., Clemmensen, L. J., & Steiner, B. W. (1987). Heterosexual and homosexual gender dysphoria. Archives of Sexual Behavior, 16, 139–152.
^ ^a ^b ^c Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria]. The Journal of Nervous and Mental Disease, 177 616-623. Cite error: The named reference "Blanchard1989" was defined multiple times with different content (see the help page).
^ Blanchard, R. (1989). The classification and labeling of nonhomosexual gender dysphorias. Archives of Sexual Behavior, 18, 315-334.
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^ Blanchard, R. (1991). Clinical observations and systematic studies of autogynephilia. Journal of Sex & Marital Therapy, 17, 235-251.
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^ ^a ^b ^c Moser, Charles (2009). "Autogynephilia in Women". Journal of Homosexuality. 56 (5 ed.): 539–547. doi:10.1080/00918360903005212. {{cite journal}}: Unknown parameter |month= ignored (help)
^ ^a ^b Lawrence, Anne A. (2010). "Something Resembling Autogynephilia in Women: Comment on Moser (2009)". Journal of Homosexuality. 57 (1 ed.): 1–4. doi:10.1080/00918360903445749. {{cite journal}}: Unknown parameter |month= ignored (help)
^ ^a ^b Moser, Charles (2010). "A Rejoinder to Lawrence (2010): It Helps If You Compare the Correct Items". Journal of Homosexuality. 57 (6 ed.): 693–696. doi:10.1080/00918369.2010.485859. {{cite journal}}: Unknown parameter |month= ignored (help)
^ ^a ^b Blanchard, R. (1991). Clinical observations and systematic studies of autogynephilia. Journal of Sex & Marital Therapy, 17, 235-251.
^ Blanchard, R. (1993). Varieties of autogynephilia and their relationship to gender dysphoria. Archives of Sexual Behavior, 22, 241–251.
^ Blanchard, R. (1993). The she-male phenomenon and the concept of partial autogynephilia. Journal of Sex & Marital Therapy, 19, 69–307.
^ Blanchard, R. (1993). Partial versus complete autogynephilia and gender dysphoria. Journal of Sex & Marital Therapy, 19, 301–307.
^ ^a ^b ^c ^d ^e ^f ^g ^h Leavitt, Frank; Berger, Jack C. (October). "Clinical patterns among male transsexual candidates with erotic interest in males". Archives of Sexual Behavior. 19 (5): 491–505. doi:10.1007/BF02442350. PMID 2260914. 1573-2800. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help) Cite error: The named reference "leavitt1990" was defined multiple times with different content (see the help page).
^ ^a ^b ^c ^d ^e Bagemihl B. Surrogate phonology and transsexual faggotry: A linguistic analogy for uncoupling sexual orientation from gender identity. In Queerly Phrased: Language, Gender, and Sexuality. Anna Livia, Kira Hall (eds.) pp. 380 ff. Oxford University Press ISBN 0195104714
^ Benjamin, Harry. The Transsexual Phenomenon. Chapter 2, Paragraph 16.{{cite book}}: CS1 maint: location (link)
^ ^a ^b ^c Moser, Charles (2010). "Blanchard's Autogynephilia Theory: A Critique". Journal of Homosexuality. 57 (6 ed.): 790–809. doi:10.1080/00918369.2010.486241. {{cite journal}}: Unknown parameter |month= ignored (help)
^ ^a ^b Nuttbrock, Larry; Bockting, Walter; Mason, Mona; Hwahng, Sel; Rosenblum, Andrew; Macri, Monica; Becker, Jeffrey (2010). "A Further Assessment of Blanchard's Typology of Homosexual Versus Non-Homosexual or Autogynephilic Gender Dysphoria". Archives of Sexual Behavior. doi:10.1007/s10508-009-9579-2.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Smith, Yolanda L.S. authorlink= (2005-12-15). "Transsexual subtypes: Clinical and theoretical significance" (PDF doi=10.1016/j.psychres.2005.01.008). Psychiatry Research. 137 (3 pages=151–160). Elsevier. PMID 16298429. Retrieved 2007-06-26. {{cite journal}}: Missing pipe in: |first= (help); Missing pipe in: |format= (help); Missing pipe in: |issue= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ Blanchard, R. (1994). A structural equation model for age at clinical presentation in nonhomosexual male gender dysphorics. Archives of Sexual Behavior, 23, 311-320
^ Blanchard R, Clemmensen LH, Steiner BW (1987). Heterosexual and homosexual gender dysphoria. Archives of Sexual Behavior, Volume 16, Number 2 / April, 1987
^ ^a ^b ^c ^d ^e Smith, Yolanda L.S. (2005-12-15). "Transsexual subtypes: Clinical and theoretical significance" (PDF). Psychiatry Research. 137 (3). Elsevier: 151–160. doi:10.1016/j.psychres.2005.01.008. PMID 16298429. Retrieved 2007-06-26. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ Bentler P M (1976). "A typology of transsexualism: Gender identity theory and data." Archives of Sexual Behavior 5: 567-584.
^ Blanchard R (1985). "Typology of male-to-female transsexualism." Archives of Sexual Behavior, 14, 247-261.
^ Blanchard, R., Steiner, B. W., Clemmensen, L. H., & Dickey. R. (1989) Prediction of regrets in postoperative transsexuals. Canadian Journal of Psychiatry, 34, 43–45.
^ Blanchard, Ray (1990). Carole A. Beere (ed.). Gender Roles. Greenwood Publishing Group. p. 35. ISBN 0313262780. Retrieved 2009-04-21. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ ^a ^b Lawrence, Anne; Latty, Elizabeth M; Chivers, ML; Bailey, JM (April). "Measurement of sexual arousal in postoperative male-to-female transsexuals using vaginal photoplethysmography" (^{[dead link]}). Archives of Sexual Behavior. 34 (2): 135–145. doi:10.1007/s10508-005-1792-z. PMID 15803248. 1573-2800. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help)
^ Blanchard, R. (1994). A structural equation model for age at clinical presentation in nonhomosexual male gender dysphorics. Archives of Sexual Behavior, 23, 311-320
^ Cohen-Kettenis, Peggy T. (February 2003). "Gender-Dysphoric Children and Adolescents: A Comparative Analysis of Demographic Characteristics and Behavioral Problems". Journal of Abnormal Child Psychology. 31 (1). Netherlands: Springer Netherlands: 41–53. doi:10.1023/A:1021769215342. PMID 12597698. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ ^a ^b MacFarlane, D. F. (August 1984). "Transsexual prostitution in New Zealand: Predominance of persons of Maori extraction". Archives of Sexual Behavior. 13 (4). Netherlands: Springer: 301–309. doi:10.1007/BF01541903. PMID 6487074. Retrieved 2008-02-26. {{cite journal}}: Cite has empty unknown parameter: |coauthors= (help)
^ Blanchard, Ray (December 1985). "Social desirability response set and systematic distortion in the self-report of adult male gender patients". Archives of Sexual Behavior. 14 (6). Netherlands: Springer. 1573-2800. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ ^a ^b Morgan AJ Jr (1978). Psychotherapy for transsexual candidates screened out of surgery. Archives of Sexual Behavior. 7: 273-282. Cite error: The named reference "morgan1978" was defined multiple times with different content (see the help page).
^ ^a ^b Blanchard, Ray; Zucker, Kenneth J.; Cohen-Kettenis, PT; Gooren, LJ; Bailey, JM (October). "Birth order and sibling sex ratio in two samples of Dutch gender-dysphoric homosexual males". Archives of Sexual Behavior. 25 (5): 495–514. doi:10.1007/BF02437544. PMID 8899142. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help)
^ ^a ^b ^c ^d ^e ^f Zucker, Kenneth J; Blanchard, Ray; Kim, TS; Pae, CU; Lee, C (October). "Birth order and sibling sex ratio in homosexual transsexual South Korean men: Effects of the male-preference stopping rule". Psychiatry and Clinical Neurosciences,. 61 (5): 529–533. doi:10.1111/j.1440-1819.2007.01703.x. PMID 17875032. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help)CS1 maint: extra punctuation (link)
^ ^a ^b ^c Green, Richard (July). "Birth order and ratio of brothers to sisters in transsexuals". Psychological Medicine. 30 (4): 789–795. doi:10.1017/S0033291799001932. PMID 11037086. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help)
^ Blanchard R, Dickey R, Jones CL. Comparison of height and weight in homosexual versus non-homosexual male gender dysphorics. Archives of Sexual Behavior 1995 Oct;24(5):543-54.
^ ^a ^b Johnson SL, Hunt DD (1990). The relationship of male transsexual typology to psychosocial adjustment. Archives of Sexual Behavior, Volume 19, Number 4 / August, 1990 349-360.
^ Kreukels, Baudewijntje (15 January 2008). "Male-to-female transsexual subtypes: Sexual arousal with cross-dressing and physical measurements". Psychiatry Research. 137 (1). Psychiatry Research: 321. Retrieved 2009-04-21. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ Benjamin "Transsexual Phenomena" chapter 2
^ Wahng SJ (2004). Double Cross: Transamasculinity Asian American Gendering in Trappings of Transhood. in Aldama AJ (ed.) Violence and the Body: Race, Gender, and the State. Indiana University Press. ISBN 025334171X
^ Leiblum SR, Rosen RC (2000). Principles and Practice of Sex Therapy, Third Edition. ISBN 1-57230-574-6,Guilford Press of New York, c2000.
^ ^a ^b ^c Bancroft, John (2008). "Lust or Identity?" (PDF). Archives of Sexual Behavior. 37 (3). Springer: 426–428. doi:10.1007/s10508-008-9317-1. PMID 18431640. Retrieved January 2009. {{cite journal}}: Check |authorlink= value (help); Check date values in: |accessdate= (help); Cite has empty unknown parameter: |coauthors= (help); External link in |authorlink= (help)
^ Lawrence AA (1998). "Men Trapped in Men's Bodies:"An Introduction to the Concept of Autogynephilia. originally published at annelwrence.com, October 1998. Retrieved August 21, 2006)
^ Robin Wilson. Northwestern U. Concludes Investigation of Sex Researcher but Keeps Results Secret. Chronicle of Higher Education, 2004.
^ Dreger, A. D. (2008). The controversy surrounding The Man Who Would Be Queen: A case history of the politics of science, identity, and sex in the Internet age. Archives of Sexual Behavior, 37, 366-421.
^ James A (2006). A defining moment in our history: Examining disease models of gender identity. Gender Medicine. 3:56 ISSN:15508579
^ Lane R (2008). Truth, Lies, and Trans Science. Archives of Sexual Behavior 37:3, 453-456
^ Shefer, Tamara; Boonzaier, Floretta (2006). The Gender of Psychology (Illustrated ed.). Juta and Company Limited. ISBN 1919713921, 9781919713922. {{cite book}}: Check |isbn= value: invalid character (help) (see pages 273-274, 282)

External links

[hirschfeld1923-1] Hirschfeld M (1923). Die intersexuelle Konstitution. Jahrbuch fuer sexuelle Zwischenstufen. 1923: 3-27

[benjamin1966-2] Benjamin H (1966). The Transsexual Phenomenon. The Julian Press ASIN: B0007HXA76

[martin-3] Lothstein, Leslie Martin (1983). Female-to-male transsexualism. Routledge. p. 60. ISBN 0710094760. Retrieved 2009-04-24.

[4] Meyer, Walter (February 2001). "The Harry Benjamin International Gender Dysphoria Association's Standards Of Care For Gender Identity Disorders, Sixth Version" (PDF). 6th. Harry Benjamin International Gender Dysphoria Association. Retrieved 2009-04-22. {{cite journal}}: Cite journal requires |journal= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

[benjamin1966types-5] Benjamin H (1966). ""Three different types of transsexual" The Transsexual Phenomenon.". Julian Press ASIN B0007HXA76.

[freund1982-6] Freund, K., Steiner, B. W., Chan, S. (1982). Two types of cross-gender identity. Archives of Sexual Behavior, 11, 49-63. Cite error: The named reference "freund1982" was defined multiple times with different content (see the help page).

[Blanchard2005-7] Blanchard, R. (2005). Early history of the concept of autogynephilia. Archives of Sexual Behavior, 34, 439–446.

[Blanchard1985-8] Blanchard, R. (1985). Typology of male-to-female transsexualism. Archives of Sexual Behavior, 14, 247-261.

[Blanchardetal1987-9] Blanchard, R., Clemmensen, L. J., & Steiner, B. W. (1987). Heterosexual and homosexual gender dysphoria. Archives of Sexual Behavior, 16, 139–152.

[Blanchard1989-10] Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria]. The Journal of Nervous and Mental Disease, 177 616-623. Cite error: The named reference "Blanchard1989" was defined multiple times with different content (see the help page).

[Blanchard1989class-11] Blanchard, R. (1989). The classification and labeling of nonhomosexual gender dysphorias. Archives of Sexual Behavior, 18, 315-334.

[Blanchard1988-12] Blanchard, R. (1988). Nonhomosexual gender dysphoria. Journal of Sex Research, 24, 188-193.

[13] Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria. Journal of Nervous and Mental Disease, 177, 616-623.

[14] Blanchard, R. (1991). Clinical observations and systematic studies of autogynephilia. Journal of Sex & Marital Therapy, 17, 235-251.

[bailey2003-15] ^ ^a ^b ^c ^d ^e ^f ^g ^h Bailey, J. M. (2003). The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism. Joseph Henry Press. Cite error: The named reference "bailey2003" was defined multiple times with different content (see the help page).

[16] Rodkin, Dennis (Dec. 12, 2003). Sex and Transsexuals. The Chicago Reader.

[17] Smyth, Herbert Weir; Greek Grammar §285.

[18] Smyth, Herbert Weir; Greek Grammar §870.

[19] Lawrence, A. A. (2007). Becoming what we love: Autogynephilic transsexualism conceptualized as an expression of romantic love. Perspectives in Biology and Medicine, 50, 506–520.

[veale2008-20] Veale, Jaimie F.; Clarke, Dave E.; Lomax, Terri C. (2008). "Sexuality of male-to-female transsexuals". Archives of Sexual Behavior. 37 (4 ed.): 586–597. doi:10.1007/s10508-007-9306-9. PMID 18299976. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

[moser2009-21] Moser, Charles (2009). "Autogynephilia in Women". Journal of Homosexuality. 56 (5 ed.): 539–547. doi:10.1080/00918360903005212. {{cite journal}}: Unknown parameter |month= ignored (help)

[lawrencereply2010-22] Lawrence, Anne A. (2010). "Something Resembling Autogynephilia in Women: Comment on Moser (2009)". Journal of Homosexuality. 57 (1 ed.): 1–4. doi:10.1080/00918360903445749. {{cite journal}}: Unknown parameter |month= ignored (help)

[moserreply2010-23] Moser, Charles (2010). "A Rejoinder to Lawrence (2010): It Helps If You Compare the Correct Items". Journal of Homosexuality. 57 (6 ed.): 693–696. doi:10.1080/00918369.2010.485859. {{cite journal}}: Unknown parameter |month= ignored (help)

[Blanchard1991-24] Blanchard, R. (1991). Clinical observations and systematic studies of autogynephilia. Journal of Sex & Marital Therapy, 17, 235-251.

[blanchard1993-25] Blanchard, R. (1993). Varieties of autogynephilia and their relationship to gender dysphoria. Archives of Sexual Behavior, 22, 241–251.

[26] Blanchard, R. (1993). The she-male phenomenon and the concept of partial autogynephilia. Journal of Sex & Marital Therapy, 19, 69–307.

[27] Blanchard, R. (1993). Partial versus complete autogynephilia and gender dysphoria. Journal of Sex & Marital Therapy, 19, 301–307.

[leavitt1990-28] ^ ^a ^b ^c ^d ^e ^f ^g ^h Leavitt, Frank; Berger, Jack C. (October). "Clinical patterns among male transsexual candidates with erotic interest in males". Archives of Sexual Behavior. 19 (5): 491–505. doi:10.1007/BF02442350. PMID 2260914. 1573-2800. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help) Cite error: The named reference "leavitt1990" was defined multiple times with different content (see the help page).

[bagemihl-29] Bagemihl B. Surrogate phonology and transsexual faggotry: A linguistic analogy for uncoupling sexual orientation from gender identity. In Queerly Phrased: Language, Gender, and Sexuality. Anna Livia, Kira Hall (eds.) pp. 380 ff. Oxford University Press ISBN 0195104714

[Benjamin-30] Benjamin, Harry. The Transsexual Phenomenon. Chapter 2, Paragraph 16.{{cite book}}: CS1 maint: location (link)

[moser2010-31] Moser, Charles (2010). "Blanchard's Autogynephilia Theory: A Critique". Journal of Homosexuality. 57 (6 ed.): 790–809. doi:10.1080/00918369.2010.486241. {{cite journal}}: Unknown parameter |month= ignored (help)

[nuttbrock2010-32] Nuttbrock, Larry; Bockting, Walter; Mason, Mona; Hwahng, Sel; Rosenblum, Andrew; Macri, Monica; Becker, Jeffrey (2010). "A Further Assessment of Blanchard's Typology of Homosexual Versus Non-Homosexual or Autogynephilic Gender Dysphoria". Archives of Sexual Behavior. doi:10.1007/s10508-009-9579-2.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[Smith2005-33] Smith, Yolanda L.S. authorlink= (2005-12-15). "Transsexual subtypes: Clinical and theoretical significance" (PDF doi=10.1016/j.psychres.2005.01.008). Psychiatry Research. 137 (3 pages=151–160). Elsevier. PMID 16298429. Retrieved 2007-06-26. {{cite journal}}: Missing pipe in: |first= (help); Missing pipe in: |format= (help); Missing pipe in: |issue= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

[Blanchard,_R._1994-34] Blanchard, R. (1994). A structural equation model for age at clinical presentation in nonhomosexual male gender dysphorics. Archives of Sexual Behavior, 23, 311-320

[blanchard1987-35] Blanchard R, Clemmensen LH, Steiner BW (1987). Heterosexual and homosexual gender dysphoria. Archives of Sexual Behavior, Volume 16, Number 2 / April, 1987

[psychology_Research-36] Smith, Yolanda L.S. (2005-12-15). "Transsexual subtypes: Clinical and theoretical significance" (PDF). Psychiatry Research. 137 (3). Elsevier: 151–160. doi:10.1016/j.psychres.2005.01.008. PMID 16298429. Retrieved 2007-06-26. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

[bentler1976-37] Bentler P M (1976). "A typology of transsexualism: Gender identity theory and data." Archives of Sexual Behavior 5: 567-584.

[blanchard1985-38] Blanchard R (1985). "Typology of male-to-female transsexualism." Archives of Sexual Behavior, 14, 247-261.

[BlanchardSteiner1989-39] Blanchard, R., Steiner, B. W., Clemmensen, L. H., & Dickey. R. (1989) Prediction of regrets in postoperative transsexuals. Canadian Journal of Psychiatry, 34, 43–45.

[40] Blanchard, Ray (1990). Carole A. Beere (ed.). Gender Roles. Greenwood Publishing Group. p. 35. ISBN 0313262780. Retrieved 2009-04-21. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

[lawrence2005-41] Lawrence, Anne; Latty, Elizabeth M; Chivers, ML; Bailey, JM (April). "Measurement of sexual arousal in postoperative male-to-female transsexuals using vaginal photoplethysmography" (^{[dead link]}). Archives of Sexual Behavior. 34 (2): 135–145. doi:10.1007/s10508-005-1792-z. PMID 15803248. 1573-2800. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help)

[Blanchardequation-42] Blanchard, R. (1994). A structural equation model for age at clinical presentation in nonhomosexual male gender dysphorics. Archives of Sexual Behavior, 23, 311-320

[zucker22002-43] Cohen-Kettenis, Peggy T. (February 2003). "Gender-Dysphoric Children and Adolescents: A Comparative Analysis of Demographic Characteristics and Behavioral Problems". Journal of Abnormal Child Psychology. 31 (1). Netherlands: Springer Netherlands: 41–53. doi:10.1023/A:1021769215342. PMID 12597698. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

[MacFarlane-44] MacFarlane, D. F. (August 1984). "Transsexual prostitution in New Zealand: Predominance of persons of Maori extraction". Archives of Sexual Behavior. 13 (4). Netherlands: Springer: 301–309. doi:10.1007/BF01541903. PMID 6487074. Retrieved 2008-02-26. {{cite journal}}: Cite has empty unknown parameter: |coauthors= (help)

[classicBlanchard-45] Blanchard, Ray (December 1985). "Social desirability response set and systematic distortion in the self-report of adult male gender patients". Archives of Sexual Behavior. 14 (6). Netherlands: Springer. 1573-2800. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

[morgan1978-46] Morgan AJ Jr (1978). Psychotherapy for transsexual candidates screened out of surgery. Archives of Sexual Behavior. 7: 273-282. Cite error: The named reference "morgan1978" was defined multiple times with different content (see the help page).

[Blanchardbrothers-47] Blanchard, Ray; Zucker, Kenneth J.; Cohen-Kettenis, PT; Gooren, LJ; Bailey, JM (October). "Birth order and sibling sex ratio in two samples of Dutch gender-dysphoric homosexual males". Archives of Sexual Behavior. 25 (5): 495–514. doi:10.1007/BF02437544. PMID 8899142. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help)

[Zuckerbrothers-48] ^ ^a ^b ^c ^d ^e ^f Zucker, Kenneth J; Blanchard, Ray; Kim, TS; Pae, CU; Lee, C (October). "Birth order and sibling sex ratio in homosexual transsexual South Korean men: Effects of the male-preference stopping rule". Psychiatry and Clinical Neurosciences,. 61 (5): 529–533. doi:10.1111/j.1440-1819.2007.01703.x. PMID 17875032. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help)CS1 maint: extra punctuation (link)

[Greenbrothers-49] Green, Richard (July). "Birth order and ratio of brothers to sisters in transsexuals". Psychological Medicine. 30 (4): 789–795. doi:10.1017/S0033291799001932. PMID 11037086. {{cite journal}}: Check date values in: |date= and |year= / |date= mismatch (help)

[blanchard1995-50] Blanchard R, Dickey R, Jones CL. Comparison of height and weight in homosexual versus non-homosexual male gender dysphorics. Archives of Sexual Behavior 1995 Oct;24(5):543-54.

[Johnson1990-51] Johnson SL, Hunt DD (1990). The relationship of male transsexual typology to psychosocial adjustment. Archives of Sexual Behavior, Volume 19, Number 4 / August, 1990 349-360.

[52] Kreukels, Baudewijntje (15 January 2008). "Male-to-female transsexual subtypes: Sexual arousal with cross-dressing and physical measurements". Psychiatry Research. 137 (1). Psychiatry Research: 321. Retrieved 2009-04-21. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

[benjamin1966(2)-53] Benjamin "Transsexual Phenomena" chapter 2

[wahng-54] Wahng SJ (2004). Double Cross: Transamasculinity Asian American Gendering in Trappings of Transhood. in Aldama AJ (ed.) Violence and the Body: Race, Gender, and the State. Indiana University Press. ISBN 025334171X

[leiblum2000-55] Leiblum SR, Rosen RC (2000). Principles and Practice of Sex Therapy, Third Edition. ISBN 1-57230-574-6,Guilford Press of New York, c2000.

[Bancroftcomment-56] Bancroft, John (2008). "Lust or Identity?" (PDF). Archives of Sexual Behavior. 37 (3). Springer: 426–428. doi:10.1007/s10508-008-9317-1. PMID 18431640. Retrieved January 2009. {{cite journal}}: Check |authorlink= value (help); Check date values in: |accessdate= (help); Cite has empty unknown parameter: |coauthors= (help); External link in |authorlink= (help)

[lawrence1998-57] Lawrence AA (1998). "Men Trapped in Men's Bodies:"An Introduction to the Concept of Autogynephilia. originally published at annelwrence.com, October 1998. Retrieved August 21, 2006)

[58] Robin Wilson. Northwestern U. Concludes Investigation of Sex Researcher but Keeps Results Secret. Chronicle of Higher Education, 2004.

[Dreger2008-59] Dreger, A. D. (2008). The controversy surrounding The Man Who Would Be Queen: A case history of the politics of science, identity, and sex in the Internet age. Archives of Sexual Behavior, 37, 366-421.

[james2006-60] James A (2006). A defining moment in our history: Examining disease models of gender identity. Gender Medicine. 3:56 ISSN:15508579

[lane2008-61] Lane R (2008). Truth, Lies, and Trans Science. Archives of Sexual Behavior 37:3, 453-456

[shefer-62] Shefer, Tamara; Boonzaier, Floretta (2006). The Gender of Psychology (Illustrated ed.). Juta and Company Limited. ISBN 1919713921, 9781919713922. {{cite book}}: Check |isbn= value: invalid character (help) (see pages 273-274, 282)

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-{{Merge|Autogynephilia|date=September 2010}}
 {{Sexual orientation}}
+'''Blanchard, Bailey, and Lawrence theory''' (also '''Blanchard Autogynephilia Theory''' ('''BAT''') and '''Blanchard's taxonomy''') is a taxonomy of male-to-female [[transsexualism]] created by [[Ray Blanchard]], building on the work of his colleague, [[Kurt Freund]].  The theory states that male-to-female transsexuals can be broken up into two groups: "homosexual transsexuals", who transition because they are attracted to men, and "non-homosexual transsexuals", who transition because they are "autogynephilic" (sexually attracted to the thought of themselves as a woman).  Prominent supporters of the theory include [[J. Michael Bailey]], Anne Lawrence, James Cantor, and others who argue that there are significant differences between the two groups, including sexuality, age of transition, ethnicity, IQ, fetishism, and quality of adjustment.  Scientific criticism of the theory includes papers from Veale, Nuttbrock, Moser, and others who argue that the theory is poorly representative of M2F transsexuals, non-instructive, the experiments poorly controlled, or contradicted by other data.  Many sources, including some supporters of the theory, criticize Blanchard's choice of wording as confusing or degrading. The theory has created a firestorm of protest in the transsexual community, although it has its supporters.
+==Origins==
-The '''Blanchard, Bailey, and Lawrence theory''' (an informal name) is a highly controversial model and taxonomy of [[gender dysphoria]] in biological males, including male-to-female [[transsexualism|transsexuals]].  It was proposed in the late 1980s by [[Ray Blanchard]], a [[sexologist]] at the [[Centre for Addiction and Mental Health]] (then, the Clarke Institute of Psychiatry) in [[Toronto]]. The acronym "BBL" was coined by critics of the theory and refers to Drs. Ray Blanchard, [[J. Michael Bailey]], and Anne A. Lawrence, the developer and two prominent researchers and proponents of the theory.  The theory says that non-homosexual biological males with [[gender identity disorder]] ([[Kinsey Scale]] 0-4)<ref name="leavitt1990" /> exhibit [[Autogynephilia]].<ref name = Blanchardetal1987>Blanchard, R., Clemmensen, L. J., & Steiner, B. W. (1987). Heterosexual and homosexual gender dysphoria. ''Archives of Sexual Behavior, 16,'' 139–152.</ref>  [[Homosexual transsexual|Homosexual gender dysphorics]] do not exhibit autogynephilia, are younger, have more older brothers, and less post operative regret than their non-homosexual counterparts.
+The early history of the study of transsexualism is sparse; however, the concept of a categorization of transsexuals can be seen as early as 1923 with the work of [[Magnus Hirschfeld]].<ref name="hirschfeld1923">Hirschfeld M (1923). ''Die intersexuelle Konstitution. ''Jahrbuch fuer sexuelle Zwischenstufen''. 1923: 3-27</ref>.  In 1966, [[Harry Benjamin]] wrote that researchers of his day thought that attraction to men, as a woman was the factor that distinguished a transvestite from a transsexual.<ref name="benjamin1966">Benjamin H (1966). ''[http://www.symposion.com/ijt/benjamin/ The Transsexual Phenomenon.]'' The Julian Press ASIN: B0007HXA76</ref>  In 1980 in the DSM III, a  new diagnosis was introduced, that of "302.5 Transsexualism" under "Other Psychosexual Disorders". This was an attempt to provide a diagnostic category for a gender identity disorders.<ref name= "martin">{{cite book|last=Lothstein|first= Leslie Martin |title=Female-to-male transsexualism|publisher=Routledge |year=1983|pages=60|isbn=0710094760|url=http://books.google.com/?id=5HI9AAAAIAAJ&pg=PA61&lpg=PA61&dq=transsexual+%2B+DSM+III|accessdate=2009-04-24}}</ref> The diagnostic category, "Transsexualism", was for [[gender dysphoria|gender dysphoric]] individuals who demonstrated at least two years of continuous interest in transforming their physical and social gender status.<ref>{{cite paper| first = Walter| last =  Meyer| coauthors =Walter O. Bockting, Peggy Cohen-Kettenis et al| title =The Harry Benjamin International Gender Dysphoria Association's Standards Of Care For Gender Identity Disorders, Sixth Version| version = 6th| publisher = Harry Benjamin International Gender Dysphoria Association| date = February 2001| url = http://www.wpath.org/Documents2/socv6.pdf| format = PDF| accessdate =2009-04-22 }}</ref> The subtypes were 1. asexual, 2. homosexual (same anatomic sex), 3. heterosexual (other anatomic sex) and 0. unspecified.<ref name= "martin"/>  This was removed in the DSM IV, wherein [[Gender Identity Disorder]] replaced transsexualism.
-Research comparing homosexual and non-homosexual transsexuals has found several differences between them. Over 80% of non-homosexual transsexuals and less than 10% of homosexual transsexuals report some history of experiencing [[sexual arousal]] while cross-dressing<ref name = Blanchardetal1987/><ref name="Smith2005" />. Homosexual transsexuals reported that cross-gender wishes preceded cross-dressing by 3–4 years<ref name = Blanchardetal1987/>  Homosexual transsexuals seek sex reassignment at younger ages, on average, than do non-homosexual transsexuals.<ref name = Smith2005/><ref name="Blanchard, R. 1994">Blanchard, R. (1994). A structural equation model for age at clinical presentation in nonhomosexual male gender dysphorics. ''Archives of Sexual Behavior, 23,'' 311-320.</ref>  Homosexual transsexuals have an increased number of older brothers, relative to non-homosexual transsexuals.<ref name="Blanchard, R. 1992">Blanchard, R., & Sheridan, P. (1992). Sibship size, sibling sex ratio, birth order, parental age in homosexual and non-homosexual gender dysphorics. ''Journal of Nervous and Mental Disease, 180,'' 40–47.</ref><ref name="Blanchard, R. 1996">Blanchard, R., Zucker, K., Cohen-Kettenis, P., Gooren, L., & Bailey, J. (1996). Birth order and sibling sex ratio in two samples of Dutch gender-dysphoric homosexual males. ''Archives of Sexual Behavior, 25,'' 495–514.</ref><ref name="Green, R. 2000">Green, R. (2000). Birth order and ratio of brothers to sisters in transsexuals. ''Psychological Medicine, 30,'' 789–795.</ref>
+Previous taxonomies, or systems of categorization, used the terms "classic transsexual" or "true transsexual," terms once used in [[differential diagnosis|differential diagnoses]].<ref name="benjamin1966types">{{cite web|author=Benjamin H|year=1966|url=http://www.symposion.com/ijt/benjamin/chap_04.htm#Three%20different%20types%20of%20transsexuals|title="Three different types of transsexual" ''The Transsexual Phenomenon.''|publisher=Julian Press ASIN B0007HXA76}}</ref>  In 1982, Kurt Freund reported evidence that there exist two types of cross-gender identity in male-to-female transsexuals<ref name="freund1982">Freund, K., Steiner, B. W., Chan, S. (1982). Two types of cross-gender identity. ''Archives of Sexual Behavior, 11,'' 49-63.</ref>, coined the term "homosexual transsexual" and hypothesized that gender dysphoria in "homosexual males" (male-to-female transsexuals attracted to men) is different from gender dysophoria in heterosexual males.  His protege, Ray Blanchard notes that "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."<ref name = Blanchard2005>Blanchard, R. (2005). Early history of the concept of autogynephilia. ''Archives of Sexual Behavior, 34,'' 439–446.</ref>
-The sexologist practice of using terminology which labels transsexuals based on their sexual orientation and birth sex instead of their gender identity has been called into question.  Two critical sexologists are Harry Benjamin and Bruce Bagemihl.<ref name ="bagemihl" /><ref name="Benjamin">Benjamin Q, Harry. [http://www.symposion.com/ijt/benjamin/chap_02.htm#Relationship%20to%20homosexuality The Transsexual Phenomenon]. Chapter 2, Paragraph 16.></ref> Benjamin, who first used the term transsexual, commented that male to female transsexuals are homosexual if one considers anatomy and totally disregards their psyche, and called doing so pedantic. Bagemihl wrote that referring to transsexuals using terminology that emphasizes their male biology is a way of asserting [[heteronormativity]].<ref name ="bagemihl" />  John Bancroft wrote that even though he used to use such terms he no longer does so out of consideration for the feelings of his patients and research subjects.<ref name="Bancroftcomment" />
+Blanchard's observations at the Clarke Institute began with four types of male transsexuals based on their sexual orientation relative to their sex assigned at birth: homosexual, heterosexual, bisexual, and asexual (i.e., transsexuals attracted to men, women, both, or neither, respectively.)<ref name= Blanchard1985/>  Blanchard conducted a series of studies of biological males with gender dysphoria, including male-to-female transsexuals, concluding that there exist two distinct types.<ref name="Blanchardetal1987" /><ref name = Blanchard1985>Blanchard, R. (1985). Typology of male-to-female transsexualism. ''Archives of Sexual Behavior, 14,'' 247-261.</ref><ref name="Blanchard1989">Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria]. ''The Journal of Nervous and Mental Disease, 177'' 616-623.</ref> One type of gender dysphoria/transsexualism are those individuals who are exclusively attracted to men, whom Blanchard referred to as ''homosexual transsexuals'', adopting Freund's terminology<ref name=Blanchardetal1987/> The other group includes those who are attracted to females (gynephilic), attracted to both males and females (bisexual), and attracted to neither males nor females (''analloerotic'' or asexual); Blanchard referred to this latter set collectively as the ''non-homosexual transsexuals''.<ref name = Blanchard1989class>Blanchard, R. (1989). The classification and labeling of nonhomosexual gender dysphorias. ''Archives of Sexual Behavior, 18,'' 315-334.</ref><ref name = Blanchard1988>Blanchard, R. (1988). Nonhomosexual gender dysphoria. ''Journal of Sex Research, 24,'' 188-193.</ref> Blanchard claims that the non-homosexual transsexuals (but not the homosexual transsexuals) exhibit [[autogynephilia]], a paraphilic interest in having female anatomy.<ref>Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria. ''Journal of Nervous and Mental Disease, 177,'' 616-623.</ref><ref>Blanchard, R. (1991). Clinical observations and systematic studies of autogynephilia. ''Journal of Sex & Marital Therapy, 17,'' 235-251.</ref><ref name="bailey2003">Bailey, J. M. (2003). ''The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism.'' Joseph Henry Press.</ref><ref>Rodkin, Dennis (Dec. 12, 2003). [http://ai.eecs.umich.edu/people/conway/TS/Bailey/Reader/Chicago%20Reader.12-12-03.html#anchor172929 Sex and Transsexuals]. The Chicago Reader.</ref>
-==Origins==
-Blanchard has recounted how he arrived at this taxonomy of male-to-female transsexualism and coined the term ''autogynephilia''.<ref name = Blanchard2005>Blanchard, R. (2005). Early history of the concept of autogynephilia. ''Archives of Sexual Behavior, 34,'' 439–446.</ref> His concept follows from observations by earlier sexologists such as [[Magnus Hirschfeld]],<ref name="hirschfeld1923">Hirschfeld M (1923). ''Die intersexuelle Konstitution. ''Jahrbuch fuer sexuelle Zwischenstufen''. 1923: 3-27</ref> [[Harry Benjamin]],<ref name="benjamin1966">Benjamin H (1966). ''The Transsexual Phenomenon.'' New York: The Julian Press.</ref> and Blanchard's collaborator [[Kurt Freund]], who had previously reported evidence that there exist two types of cross-gender identity.<ref name="freund1982">Freund, K., Steiner, B. W., Chan, S. (1982). Two types of cross-gender identity. ''Archives of Sexual Behavior, 11,'' 49-63.</ref> Freund hypothesized that gender dysphoria in homosexual males is different from gender dysophoria in heterosexual males. Blanchard notes that "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."<ref name = Blanchard2005/>
+==Autogynephilia==
-Blanchard's observations at the Clarke Institute began with four types of male transsexuals based on their sexual orientation relative to their sex assigned at birth: homosexual, heterosexual, bisexual, and asexual (i.e., transsexuals attracted to men, women, both, or neither, respectively.)<ref name= Blanchard1985/>  Blanchard conducted a series of studies of biological males with gender dysphoria, including male-to-female transsexuals, concluding that there exist two distinct types.<ref name="Blanchardetal1987" /><ref name = Blanchard1985>Blanchard, R. (1985). Typology of male-to-female transsexualism. ''Archives of Sexual Behavior, 14,'' 247-261.</ref><ref name="Blanchard1989">Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria]. ''The Journal of Nervous and Mental Disease, 177'' 616-623.</ref> One type of gender dysphoria/transsexualism are those individuals who are exclusively attracted to men, whom Blanchard referred to as ''homosexual transsexuals.''<ref name=Blanchardetal1987/> The other group includes those who are attracted to females (gynephilic), attracted to both males and females (bisexual), and attracted to neither males nor females (''analloerotic'' or asexual); Blanchard referred to this latter set collectively as the non-homosexual transsexuals.<ref name = Blanchard1989class>Blanchard, R. (1989). The classification and labeling of nonhomosexual gender dysphorias. ''Archives of Sexual Behavior, 18,'' 315-334.</ref><ref name = Blanchard1988>Blanchard, R. (1988). Nonhomosexual gender dysphoria. ''Journal of Sex Research, 24,'' 188-193.</ref> Blanchard has also reported that the non-homosexual transsexuals (but not the homosexual transsexuals) exhibit [[autogynephilia]], a paraphilic interest in having female anatomy.<ref>Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria. ''Journal of Nervous and Mental Disease, 177,'' 616-623.</ref><ref>Blanchard, R. (1991). Clinical observations and systematic studies of autogynephilia. ''Journal of Sex & Marital Therapy, 17,'' 235-251.</ref><ref name="bailey2003">Bailey, J. M. (2003). ''The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism.'' Joseph Henry Press.</ref><ref>Rodkin, Dennis (Dec. 12, 2003). [http://ai.eecs.umich.edu/people/conway/TS/Bailey/Reader/Chicago%20Reader.12-12-03.html#anchor172929 Sex and Transsexuals]. The Chicago Reader.</ref>
+Autogynephilia ({{pronEng|ˌɔːtoʊˌɡaɪnəˈfɪliə}}) (from [[Greek language|Greek]] “αὐτό-” (''self''), “γυνή” (''woman'', though the stem is actually “γυναικ-”<ref>Smyth, Herbert Weir; ''Greek Grammar'' §285.</ref>, so that “autogynephilia” is ill-formed<ref>Smyth, Herbert Weir; ''Greek Grammar'' §870.</ref>) and “φιλία” (''love'') &mdash; "love of oneself as a woman") is a term coined in 1989 by [[Ray Blanchard]], to refer to "a man's paraphilic tendency to be [[Sexual arousal|sexually aroused]] by the thought or image of himself as a woman."<ref name = Blanchard1989/>   The term is recognized by the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' of the [[American Psychiatric Association]], where Blanchard has served on the gender dysphoria sub-working group for the DSM-IV and of the paraphilia sub-working group for the DSM-5.
-In the 2000 revision of the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' (DSM-IV-TR), the section on gender identity disorder specifies [[transvestic fetishism]] is a related [[paraphilia]].<ref name="dsmgid">American Psychiatric Publishing (2000). ''Diagnostic and Statistical Manual of Mental Disorders]'' (4th ed, text revision). Washington, DC: Author.</ref> Although the concept of this paraphilia is mentioned in the DSM, some psychologists object to the pathologizing of gender variance and paraphilia.<ref name="moser">Moser, C., Kleinplatz, P. J. (2002). Transvestic fetishism: psychopathology or iatrogenic artifact? ''New Jersey Psychologist, 52,'' 16-17.</ref>
+.
+The term is most notable for its use in Blanchard's taxonomy to explain the motivation behind [[gender dysphoria]] in "non-homosexual" ([[gynephilia|gynephilic]]) [[male-to-female transsexual]]s, in contrast to sexuality as the motivating factor in "homosexual" ([[androphilia|androphilic]]) transsexuals.  Autogynephilia has also been suggested to pertain to romantic love as well as to sexual arousal patterns.<ref>Lawrence, A. A. (2007). Becoming what we love: Autogynephilic transsexualism conceptualized as an expression of romantic love. ''Perspectives in Biology and Medicine, 50,'' 506–520.</ref>  While Blanchard claims that autogynephilia does not exist in ''natal'' (from birth) women, Veale et al (2008)<ref name="veale2008" /> and Moser (2009)<ref name="moser2009" /> report that it does exist in natal women at rates close to or equal to that of non-homosexual transsexuals.  This is controversial.<ref name="lawrencereply2010" /><ref name="moserreply2010" />
+Blanchard provides case examples to illustrate the autogynephilic sexual fantasies that people reported:<ref name = Blanchard2005/>
-==Descriptions of the types==
+<blockquote>Philip was a 38-year-old professional man referred to the author's clinic for assessment....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 his life.</blockquote>
-===Homosexual transsexuals===
-{{Main|homosexual transsexual}}
-According to Blanchard,<ref name = Blanchard1990/> "Homosexual gender dysphorics are those who, from the earliest sexual awareness in childhood or puberty, feel attracted only to men. The individual's masturbatory fantasies and romantic daydreams are of males; if he also has sexual encounters or love relationship in real life, these are exclusively or almost exclusively with men....The childhood behavior of homosexual gender dysphorics, unlike that of [non-homosexual] gender dysphorics, closely resembles that DSM-III-R diagnosis of gender identity disorder of childhood....As boys, they are unusually deficient in, or afraid of, physical competitiveness: They avoid rough-and-tumble play, are frightened of fistfights, and strongly dislike team sports. They prefer to play with girls, to play girls' games, and to play with girls' toys, in particular, Barbie-type dolls" (p.&nbsp;69).
+According to Blanchard, "An autogynephile does not necessarily become sexually aroused every time he pictures himself as female or engages in feminine behavior, any more than a heterosexual man automatically gets an erection whenever he sees an attractive woman. Thus, the concept of autogynephilia—like that of heterosexuality, homosexuality, or pedophilia—refers to a ''potential'' for sexual excitation"<ref name = Blanchard1991/> [emphasis in original].
-Richard Docter referred to this as ''primary transsexualism,''<ref>Docter, R. F. (1988). ''Transvestites and transsexuals: Toward a theory of cross-gender behavior.'' New York: Plenum.</ref> but described it the same way: "This category describes individuals who have presented a lifelong history of gender dysphoria, a history of cross-gender identity, and an absence of fetishism associated with cross-dressing. It is imperative that early childhood roots of major gender discontent are revealed. Sexual preference is usually homosexual from an early age. There usually will have been a history of cross dressing. Stoller [believes] the male primary transsexual (whatever he may be called) is an extremely feminine male who never functions in typically masculine roles and who has a feminine 'core gender identity'" (p.&nbsp;25).
+Blanchard classified four subtypes of autogynephilic sexual fantasies, but noted that "All four types of autogynephilia tend to occur in combination with other types rather than alone."<ref name = Blanchard1991>Blanchard, R. (1991). Clinical observations and systematic studies of autogynephilia. ''Journal of Sex & Marital Therapy, 17,'' 235-251.</ref><ref name="blanchard1993">Blanchard, R. (1993). Varieties of autogynephilia and their relationship to gender dysphoria. ''Archives of Sexual Behavior, 22, 241–251.</ref>
-===Non-homosexual transsexuals===
+*Transvestic autogynephilia: arousal to the act or fantasy of wearing women's clothing
-{{Main|Autogynephilia}}
+*Behavioral autogynephilia: arousal to the act or fantasy of doing something regarded as feminine
-{{Wiktionary|autogynephilia}}
+*Physiologic autogynephilia: arousal to fantasies of female-specific body functions
-According to Blanchard,<ref name = Blanchard1990>Blanchard, R. (1990). Gender identity disorders in adult men. In R. Blanchard & B. W. Steiner (Eds.), Clinical management of gender identity disorders in children and adults (pp. 47-76). Washington, DC: American Psychiatric Press.</ref> most non-homosexual transsexuals, "take part in normal boys' activities without outward signs of effeminacy, and most experience sexual arousal when they first begin cross-dressing. [They] tend to work in male-dominated occupations, and the majority get married at least once. When they are not deliberately feminizing their attire, their anatomy, or their presentation, they are unremarkably masculine in demeanor and appearance" <ref name = Blanchard1990/>(p.&nbsp;57).
+*Anatomic autogynephilia: arousal to the fantasy of having a woman's body, or parts of one.
+There also exist biological males who report being sexually aroused by the image or idea of having ''some'' but not ''all'' female anatomy, such as having female breasts but retaining their male genitalia; Blanchard referred to this phenomenon as ''partial autogynephilia.''<ref>Blanchard, R. (1993). The she-male phenomenon and the concept of partial autogynephilia. ''Journal of Sex & Marital Therapy, 19,'' 69–307.</ref><ref>Blanchard, R. (1993). Partial versus complete autogynephilia and gender dysphoria. ''Journal of Sex & Marital Therapy, 19,'' 301–307.</ref>
-Blanchard developed a questionnaire with items such as, "Have you ever become sexually aroused while picturing yourself having ''nude'' [emphasis in original] female body or with certain features of the nude female form?" and "Have you ever been sexually aroused by the thought of being a woman?"<ref name=Blanchard1989/> The homosexual transsexuals were significantly less likely to endorse such items than were the non-homosexual transsexuals. Blanchard concluded that it is the sexual arousal associated with the image of one's self in female form that motivated the non-homosexual (but not the homosexual) transsexuals.<ref name=Blanchard1989/>
+==Non-homosexual transsexuals versus homosexual transsexuals ==
-Blanchard classified autogynephilic sexual fantasies into four subtypes:<ref>Blanchard, R. (1993). Clinical observations and systematic studies of autogynephilia. ''Journal of Sex & Marital Therapy, 17,'' 235-251.</ref>
-:*Transvestic: arousal to the act or fantasy of wearing women's clothing
-:*Behavioral: arousal to the act or fantasy of doing something regarded as feminine
-:*Physiologic: arousal to fantasies of female-specific body functions
-:*Anatomic: arousal to the fantasy of having a female body, or parts of one
+In Blanchard's taxonomy, non-homosexual biological males with [[gender identity disorder]] ([[Kinsey Scale]] 0-4)<ref name="leavitt1990" /> exhibit autogynephilia and are either attracted to women, both women and men, or are asexual.  Homosexual transsexuals are attracted exclusively to men and do not exhibit autogynephilia.<ref name = Blanchardetal1987>Blanchard, R., Clemmensen, L. J., & Steiner, B. W. (1987). Heterosexual and homosexual gender dysphoria. ''Archives of Sexual Behavior, 16,'' 139–152.</ref>
-In another study based on questionnaire responses, Blanchard divided individuals according to whether they reported experiencing the most sexual arousal to the image of themselves as nude women, as fully clothed women, or as women dressed in underwear.<ref>Blanchard, R. (1993). Varieties of autogynephilia and their relationship to gender dysphoria. ''Archives of Sexual Behavior, 22,'' 241-251.</ref>  The group who reported experiencing the greatest arousal to the image of themselves as nude women also reported the greatest desire to undergo surgical sex reassignment.
+Support for the theory comes from a wide range of demographic and psychological aspects of the subjects studied Blanchard's practice in the 1980s.  Criticism of the theory is generally focused in two categories: the use of the terms "homosexual" and "non-homosexual" to refer to transsexuals by their sex-of-birth<ref name="bagemihl">Bagemihl B. Surrogate phonology and transsexual faggotry: A linguistic analogy for uncoupling sexual orientation from gender identity. In ''Queerly Phrased: Language, Gender, and Sexuality''. Anna Livia, Kira Hall (eds.) pp. 380 ff. Oxford University Press ISBN 0195104714</ref><ref name="Benjamin">{{cite book| last = Benjamin| first = Harry| title = The Transsexual Phenomenon| location = Chapter 2, Paragraph 16| url = http://www.symposion.com/ijt/benjamin/chap_02.htm#Relationship%20to%20homosexuality}}</ref>, and the data underlying the theory itself.<ref name="moser2009">{{cite journal|author=Moser, Charles|year=2009|month=July|title=Autogynephilia in Women|journal=Journal of Homosexuality|volume=56|edition=5|pages=539-547|doi=10.1080/00918360903005212|url=http://www.informaworld.com/smpp/content~content=a913016793}}</ref><ref name="moser2010">{{cite journal|author=Moser, Charles|year=2010|month=July|title=Blanchard's Autogynephilia Theory: A Critique|journal=Journal of Homosexuality|volume=57|edition=6|pages=790-809|doi=10.1080/00918369.2010.486241 |url=http://www.informaworld.com/smpp/content~db=all~content=a923357133~tab=content}}</ref><ref name="veale2008">{{cite journal|author=Veale, Jaimie F.; Clarke, Dave E.; Lomax, Terri C.|year=2008|month=August|title=Sexuality of male-to-female transsexuals|journal=Archives of Sexual Behavior|volume=37|edition=4|pages=586-597|doi=10.1007/s10508-007-9306-9|pmid=18299976|url=http://www.ncbi.nlm.nih.gov/pubmed/18299976}}</ref><ref name="nuttbrock2010">{{cite journal|author=Nuttbrock, Larry; Bockting, Walter; Mason, Mona; Hwahng, Sel; Rosenblum, Andrew; Macri, Monica; Becker, Jeffrey|year=2010|title=A Further Assessment of Blanchard’s Typology of Homosexual Versus Non-Homosexual or Autogynephilic Gender Dysphoria|journal=Archives of Sexual Behavior|doi=10.1007/s10508-009-9579-2|url=http://www.springerlink.com/content/b48tkl425217331j/}}</ref>
-A recent psychological study by Charles Moser suggest that natal women report similar rates of autogynephilia to M2F transsexuals. This would contradict one of Blanchard's assumption that Natal women don't experience autogynephilia.  Women were asked questions about becoming aroused while preparing for a date, or anticipating meeting a sex partner.  Moser suggest that what he found is autogynephilia in women.<ref name="moser2009">Moser, Charles (2009).''[http://www.informaworld.com/smpp/content~content=a913016793 Autogynephilia in Women]'' Journal of Homosexuality, Volume 56, Issue 5 July 2009 , pages 539 - 547</ref>
+== Justification for the two classifications ==
-==Research comparing homosexual with non-homosexual transsexuals==
-Homosexual and non-homosexual transsexuals have a number of different characteristics:
+According to Blanchard (1985, 1987) key characteristics of homosexual transsexuals include conspicuous cross-gender behavior from childhood through adulthood, and a "[[homosexual]]" [[sexual orientation]].  Blanchard (1987) found in his studies that homosexual transsexuals were younger when applying for sex reassignment<ref name="Smith2005">{{cite journal |last=Smith |first=Yolanda L.S. authorlink= |coauthors=Stephanie Van Goozen, Aj Kupier, Peggy T. Cohen-Kettenis |title=Transsexual subtypes: Clinical and theoretical significance |journal=Psychiatry Research |volume=137 |issue=3 pages=151–160 |date=2005-12-15 |publisher=Elsevier |url=http://akikos-planet.cocolog-nifty.com/blog/files/psychiatry_research__transsexual_subtypes_clinical_and_theoretical_significance.pdf |format=[[PDF]] doi=10.1016/j.psychres.2005.01.008 |accessdate=2007-06-26 |pmid=16298429}}</ref><ref name="Blanchard, R. 1994">Blanchard, R. (1994). [http://www.springerlink.com/content/w8351l1562t1g836/ A structural equation model for age at clinical presentation in nonhomosexual male gender dysphorics]. ''[[Archives of Sexual Behavior]], 23,'' 311-320</ref> The average age of the non-homosexual transsexuals in Blanchard's sample is around 39,<ref name = Blanchard1988 /> whereas the average of the homosexual transsexuals was 23.6.<ref name = Blanchardetal1987/> Moreover, the homosexual transsexuals reported that cross-gender wishes preceded cross-dressing by 3–4 years, whereas the non-homosexual transsexuals reported that their first cross-gender wishes occurred around the time they first cross-dressed.  Blanchard also reports that they have a more convincing cross-gender appearance and functioned psychologically better than "non-homosexual" transsexuals.<ref name="blanchard1987">Blanchard R, Clemmensen LH, Steiner BW (1987). Heterosexual and homosexual gender dysphoria. ''[[Archives of Sexual Behavior]]'', Volume 16, Number 2 / April, 1987</ref>  A lower percentage of the homosexual transsexuals reported being (or having been) married and sexually aroused while cross-dressing.<ref name=Blanchard1988/> <ref name="psychology Research"/>  Early studies had variously found that between 10% and 36% of homosexual transsexuals report a history of sexual arousal to cross dressing. Bentler (1976) found 23%, while Freund (1982) reported 31%.<ref name="freund1982">Freund K, Steiner BW, Chan S (1982). Two types of cross-gender identity. ''[[Archives of Sexual Behavior]]'' 11: 49-63.</ref><ref name="leavitt1990">{{Cite journal |last=Leavitt |first=Frank | last2 = Berger | first2 = Jack C. |title=Clinical patterns among male transsexual candidates with erotic interest in males |journal=Archives of Sexual Behavior |volume=19 |issue=5 |pages=491–505 |date=October |year=1990 |url=http://www.susans.org/reference/tserotic.html |doi=10.1007/BF02442350 |id=1573-2800 |pmid=2260914 }}</ref><ref name="bentler1976">Bentler P M (1976). "A typology of transsexualism: Gender identity theory and data." ''[[Archives of Sexual Behavior]]'' 5: 567-584.</ref><ref name="blanchard1985">Blanchard R (1985). "Typology of male-to-female transsexualism." ''[[Archives of Sexual Behavior]]'', 14, 247-261.</ref>  In a follow-up study of post-operative transsexuals, Blanchard found that both types of male-to-female transsexuals respond well to sex reassignment, but that the homosexual transsexuals are less likely to regret doing so.<ref name=BlanchardSteiner1989>Blanchard, R., Steiner, B. W., Clemmensen, L. H., & Dickey. R. (1989) Prediction of regrets in postoperative transsexuals. ''Canadian Journal of Psychiatry, 34,'' 43–45.</ref>
-When surveyed about sexual arousal, over 80% of non-homosexual transsexuals report some history of experiencing sexual arousal while cross-dressing, whereas fewer than 10% of homosexual transsexuals report experiencing such arousal.<ref name = Blanchardetal1987/>
+Sexologists quantitatively measure sexual orientation using  [[Psychological_testing#Personality_tests|psychological personality test]] or rely on self reports. Blanchard and Freund used the Masculine Identity in Females (MGI), and the modified androphilia scale.<ref>{{cite book|last=Blanchard|first=Ray|coauthors=Kurt Freund|title=Gender Roles|editor=Carole A. Beere|publisher=Greenwood Publishing Group |year=1990|pages=35|isbn=0313262780|url=http://books.google.com/?id=5X84NFiHXcwC&pg=PA36&lpg=PA36&dq=transsexuals+homosexual|accessdate=2009-04-21}}</ref> Homosexual transsexuals averaged a [[Kinsey Scale]] measurement of 5-6 or a 9.86±2.37 on the [[Modified Androphilia Scale]].<ref name="lawrence2005">{{Cite journal |last=Lawrence |first=Anne | last2 = Latty | first2 = Elizabeth M |title=Measurement of sexual arousal in postoperative male-to-female transsexuals using vaginal photoplethysmography. |journal=Archives of Sexual Behavior |volume=34 |issue=2 |pages=135–145 |date=April |year=2005 |url=http://goliath.ecnext.com/coms2/gi_0199-4169645/Measurement-of-sexual-arousal-in.html |doi=10.1007/s10508-005-1792-z |id=1573-2800 |pmid=15803248 |last3=Chivers |first3=ML |last4=Bailey |first4=JM |format={{Dead link|date=January 2010}} }}</ref><ref name="leavitt1990"/>.
-When surveyed about their recollections of being feminine in childhood, homosexual transsexuals report having been significantly more feminine than do non-homosexual transsexuals.<ref name=Blanchard1988/>
+In ''[[The Man Who Would Be Queen]]'', [[J. Michael Bailey]] (2003) says that the homosexual transsexuals from Chicago gay bars he studied are comfortable with [[prostitution]],<ref name="bailey2003">{{cite book|author=Bailey JM|year=2003|url=|title=The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism|work= }}Joseph Henry Press, ISBN 0-309-08418-0</ref> that they have a masculine sexual appetite,but lust after men.<ref name="bailey2003"/> He supports Blanchard's [[taxonomy]] of two forms of [[transsexualism]] in males -- one that is an extreme type of homosexuality and one that is an expression of autogynephilia. In "[[The Transsexual Phenomenon]]", [[Harry Benjamin]] (1966) writes that a few dozen transsexuals "find prostitution a useful profession for emotional as well as practical reasons" before surgery.<ref name="benjamin1966"/>{{rp|50&ndash;51}}
-In a follow-up study of post-operative transsexuals, Blanchard found that both types of male-to-female transsexuals respond well to sex reassignment, but that the homosexual transsexuals are less likely to regret doing so.<ref name=BlanchardSteiner1989>Blanchard, R., Steiner, B. W., Clemmensen, L. H., & Dickey. R. (1989) Prediction of regrets in postoperative transsexuals. ''Canadian Journal of Psychiatry, 34,'' 43–45.</ref>
+Ken Zucker(2002) and Yolanda Smith (2005) independently found that homosexual transsexuals are of lower average [[IQ]]<ref name="psychology Research"/>, [[social class]], and age. They were on average in their mid-teens to mid-20s when they reported to a gender clinic for sex reassignment.<ref name="psychology Research"/><ref name="Blanchardequation">Blanchard, R. (1994). [http://www.springerlink.com/content/w8351l1562t1g836/ A structural equation model for age at clinical presentation in nonhomosexual male gender dysphorics]. ''[[Archives of Sexual Behavior]], 23,'' 311-320</ref>  The homosexual transsexuals are more likely to have [[immigration|recent immigrant]] status, non-intact families, non-[[Caucasian race]], and childhood [[Anti-social behaviour|behavior problems]]).<ref name="zucker22002">{{cite journal|last=Cohen-Kettenis|first=Peggy T.|authorlink=|coauthors=Owen A., Kaijser V., Bradley S. and Zucker K.|title=Gender-Dysphoric Children and Adolescents: A Comparative Analysis of Demographic Characteristics and Behavioral Problems.|journal=Journal of Abnormal Child Psychology|volume=31|issue=1|pages=41–53|publisher=Springer Netherlands|location=Netherlands|date=February 2003|url=http://www.springerlink.com/content/x6130x8006745471/|doi=10.1023/A:1021769215342|id=|accessdate=|pmid=12597698}}</ref><ref name="MacFarlane">{{cite journal|last=MacFarlane|first=D. F.|authorlink=|coauthors=|title=Transsexual prostitution in New Zealand: Predominance of persons of Maori extraction|journal=Archives of Sexual Behavior|volume=13|issue=4|pages=301–309|publisher=Springer|location=Netherlands|date=August 1984|url=http://www.springerlink.com/content/q72x6l7515m35147/|doi=10.1007/BF01541903|id=|accessdate=2008-02-26|pmid=6487074}}</ref> Bailey found that most homosexual transsexuals he interviewed from Chicago gay bars learned to live on the streets, resorting to prostitution, or shoplifting.<ref name="bailey2003"/>
-Blanchard found that Homosexual transsexuals are physically shorter, lighter, and lighter in proportion to their height than non-homosexual transsexuals.<ref name="BlanchardDickey">Blanchard, R., Dickey, R., & Jones, C. L. (1995). Comparison of height and weight in homosexual versus nonhomosexual male gender dysphorics. ''Archives of Sexual Behavior, 24,'' 543–554.</ref> Blanchard hypothesized several possible explanations for this difference, including that homosexual transsexuals might begin puberty earlier, like gay men do,<ref>Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). ''Sexual behavior in the human male.'' Philadelphia: W. B. Saunders.</ref> which results in smaller size.<ref>Tanaka, T., Suwa, S., Yokoya, S., & Hibi, I. (1988). Analysis of linear growth during puberty. ''Acta Paediatrica Scandinavica, 77'' (suppl. 347), 25-29.</ref>  Recent research by Yolanda Smith found no difference in height weight or height to weight ratio in its sample.<ref name="Smith2005" />
+Blanchard does not consider sex with males to be a sole defining characteristic of being "homosexual" versus "non-homosexual".  Concerning "non-homosexual", autogynephilic transsexuals who sleep with men, Blanchard writes: "The effective erotic stimulus in these interactions, however, is not the male physique of the partner, as it is in true homosexual attraction, but rather the thought of being a woman, which is symbolized in the fantasy of being penetrated by a man. For these persons, the male sexual partner serves...to intensify the fantasy of being a woman."<ref name = Blanchard1989>Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria. ''The Journal of Nervous and Mental Disease, 177,'' 616-623.</ref>
-Homosexual transsexuals seek sex reassignment at younger ages, on average, than do non-homosexual transsexuals.<ref name = Smith2005/><ref name="Blanchard, R. 1994" /> The average age of the non-homosexual transsexuals in Blanchard's sample is around 39,<ref name = Blanchard1988 /> whereas the average of the homosexual transsexuals was 23.6.<ref name = Blanchardetal1987/> Moreover, the homosexual transsexuals reported that cross-gender wishes preceded cross-dressing by 3–4 years, whereas the non-homosexual transsexuals reported that their first cross-gender wishes occurred around the time they first cross-dressed.
+Leavitt and Berger also mentioned studies by Blanchard which suggest that heterosexual transsexuals will adjust their life stories to ensure that they get sex reassignment surgery.(Leavitt 1990)<ref name="leavitt1990"/>  Blanchard considers self-report to be unreliable.<ref name="lawrence2005"/><ref name="leavitt1990"/><ref name="classicBlanchard">{{cite journal |last=Blanchard |first=Ray |coauthors=Leonard H. Clemmensen, Betty W. Steiner |title=Social desirability response set and systematic distortion in the self-report of adult male gender patients |journal=Archives of Sexual Behavior |volume=14 |issue=6 |pages= |publisher=Springer |location=Netherlands |date=December 1985 |url=http://www.springerlink.com/content/h155l12m870u11n6/ |doi= |id=1573-2800 |accessdate=}}</ref> Morgan (1978), Blanchard (1985), Lawrence (2005) and other researchers have asserted that many "non-homosexual" transsexuals systematically distort their life stories because "non-homosexuals" were often screened out as candidates for surgery<ref name="morgan1978">Morgan AJ Jr (1978). Psychotherapy for transsexual candidates screened out of surgery. ''[[Archives of Sexual Behavior]]''. 7: 273-282.</ref> and because some see "homosexual transsexual" as a more socially desirable diagnosis.
-Homosexual transsexuals have an increased number of older brothers, relative to non-homosexual transsexual.<ref name="Blanchard, R. 1992"/><ref name="Blanchard, R. 1996"/><ref name="Green, R. 2000"/> This difference, called the [[fraternal birth order effect]] also distinguishes gay men from their heterosexual counterparts,<ref>Blanchard, R., & Bogaert, A. F. (1996). Homosexuality in men and number of older brothers. ''American Journal of Psychiatry, 153,'' 27–31.</ref><ref>Blanchard, R. (1997). Birth order and sibling sex ratio in homosexual versus heterosexual males and females. ''Annual Review of Sex Research, 8,'' 27–67.</ref><ref>Blanchard, R., & Bogaert, A. F. (1996). Biodemographic comparisons of homosexual and heterosexual men in the Kinsey interview data. ''Archives of Sexual Behavior, 25,'' 551–579.</ref> from which Blanchard concludes that there exists some relationship between whatever factors produce homosexuality and whatever factors produce the homosexual subtype of transsexualism. No birth order effects have been observed to occur in female-to-male transsexuals.
+Blanchard (1996) and Zucker (2007) came to the general conclusion that birth order has some influence over sexual orientation in biological males in general, and homosexual male to female transsexuals in specific.<ref name="Blanchardbrothers">{{Cite journal | last = Blanchard | first = Ray | author-link = | last2 = Zucker | first2 = Kenneth J. | author2-link = | title = Birth order and sibling sex ratio in two samples of Dutch gender-dysphoric homosexual males | journal =Archives of Sexual Behavior | volume = 25 | issue = 5 | pages = 495–514 | date = October | year = 1996 | url = http://www.springerlink.com/content/l4w1g8u04t85l462/ | doi =10.1007/BF02437544 | id = | pmid = 8899142 | last3 = Cohen-Kettenis | first3 = PT| last4 = Gooren | first4 = LJ | last5 = Bailey | first5 = JM }}</ref><ref name="Zuckerbrothers">{{Cite journal | last = Zucker | first = Kenneth J | author-link = | last2 = Blanchard | first2 = Ray | author2-link = | title = Birth order and sibling sex ratio in homosexual transsexual South Korean men: Effects of the male-preference stopping rule | journal = Psychiatry and Clinical Neurosciences, | volume = 61 | issue = 5 | pages = 529–533 | date = October | year = 2007 | url = http://www.ingentaconnect.com/content/bsc/pcn/2007/00000061/00000005/art00011;jsessionid=26peinjynboxq.alexandra?format=print | doi =10.1111/j.1440-1819.2007.01703.x | id = | pmid = 17875032 | last3 = Kim | first3 = TS | last4 = Pae | first4 = CU | last5 = Lee | first5 = C }}</ref><ref name="Greenbrothers">{{Cite journal| last = Green | first = Richard | author-link = | last2 = | first2 = | author2-link = | title = Birth order and ratio of brothers to sisters in transsexuals | journal = Psychological Medicine | volume = 30 | issue = 4 | pages = 789–795 | date = July | year = 2000 | url =http://journals.cambridge.org/action/displayAbstract?aid=53879 | doi =10.1017/S0033291799001932 | id = | pmid = 11037086 }}</ref> This phenomenon is called the "[[fraternal birth order]] effect".<ref name="Zuckerbrothers"/> In 2000 Richard Green wrote "Homosexual male-to-female transsexuals have a later than expected birth order and more older brothers than other subgroups of male-to-female transsexuals. Each older brother increases the odds that a male transsexual is homosexual by 40%."<ref name="Greenbrothers"/> Green did not find a higher incidence of homosexuality in the younger brothers of homosexual transsexuals.  Zucker and Blanchard wrote that studies have consistently supported the "fraternal birth order effect" that homosexual transsexuals have more brothers than sisters and are born later in birth order. In contrast, in their study using  an Asian sample they found that the transsexual men had significantly more sisters than controls.<ref name="Zuckerbrothers"/> Zucker attributes this to the preference for males in Korean society causing parents to stop having children once they have a boy.<ref name="Zuckerbrothers"/> Therefore all male children are less likely to have older brothers and hence no fraternal birth order effect is observed.<ref name="Zuckerbrothers"/> According to Bailey's interpretation of Blanchard's theory the causes of homosexual transsexuality are extreme examples of the causes of homosexuality in males.<ref name="bailey2003"/>
-Many of the findings from Blanchard's comparisons of these two types have been replicated. Smith (2005) reported, "In this study the two subtypes were indeed found to differ on many characteristics. Replicating some of the previously observed differences, we found that compared with non-homosexual transsexuals, homosexual transsexuals reported more cross-gendered behavior, appearance and preference in childhood, and they reported less sexual arousal while cross-dressing in adolescence, applied for SR [sex reassignment] at a younger age, and fewer were (or had been) married."<ref name="Smith2005">{{cite journal
- |last=Smith
- |first=Yolanda L.S.
- |authorlink=
- |coauthors=Stephanie Van Goozen, Aj Kupier, Peggy T. Cohen-Kettenis
- |title=Transsexual subtypes: Clinical and theoretical significance
- |journal=Psychiatry Research
- |volume=137
- |issue=3
- |pages=151–160
- |date=2005-12-15
- |publisher=Elsevier
- |url=http://akikos-planet.cocolog-nifty.com/blog/files/psychiatry_research__transsexual_subtypes_clinical_and_theoretical_significance.pdf
- |format=[[PDF]]
- |doi=10.1016/j.psychres.2005.01.008
- |accessdate=2007-06-26
- |pmid=16298429}}</ref>
+Research by Blanchard, Zucker, and Green argues that the causes of homosexual transsexualism, transsexualism, and homosexuality overlap to a large degree.<ref name="Blanchardbrothers"/><ref name="Zuckerbrothers"/><ref name="Greenbrothers"/>
-==Clinical implications==
-Formal gender clinics began operating in the 1960s and 1970s, leading to long-term follow-up studies that began appearing in the research literature in the 1980s and 1990s. These studies have examined heterogeneous samples of male-to-female transsexuals who received clinical approval to undergo surgical sex reassignment and proceeded to do so.<ref>Green, R., & Fleming, D. T. (1990). Transsexual surgery follow-up: Status in the 1990s. ''Annual Review of Sex Research, 1,'' 163–174.</ref><ref>Gijs, L., & Brewaeys, A. (2007). Surgical treatment of gender dysphoria in adults and adolescents: Recent developments, effectiveness, and challenges. ''Annual Review of Sex Research, 18,'' 178-224.</ref>
+Blanchard (1995) also said homosexual transsexuals were comparatively shorter and lighter in proportion to their height than non-homosexuals.<ref name="blanchard1995">Blanchard R, Dickey R, Jones CL. Comparison of height and weight in homosexual versus non-homosexual male gender dysphorics. ''[[Archives of Sexual Behavior]]'' 1995 Oct;24(5):543-54.</ref> Independent research done by Johnson (1990) and Smith (2005) concur with most of Blanchard's observations.<ref name="Johnson1990">Johnson SL, Hunt DD (1990). The relationship of male transsexual typology to psychosocial adjustment. ''[[Archives of Sexual Behavior]]'', Volume 19, Number 4 / August, 1990 349-360.</ref><ref name="psychology Research"/>  Smith did not find a significant difference in height-weight ratio.<ref name="psychology Research">{{cite journal  |last=Smith  |first=Yolanda L.S.  |authorlink=  |coauthors=Stephanie Van Goozen, Aj Kupier, Peggy T. Cohen-Kettenis  |title=Transsexual subtypes: Clinical and theoretical significance  |journal=Psychiatry Research  |volume=137  |issue=3  |pages=151–160  |date=2005-12-15  |publisher=Elsevier  |url=http://akikos-planet.cocolog-nifty.com/blog/files/psychiatry_research__transsexual_subtypes_clinical_and_theoretical_significance.pdf  |format=[[PDF]]  |doi=10.1016/j.psychres.2005.01.008  |accessdate=2007-06-26 |pmid=16298429}}</ref>  Subsequent research has found only partial support of Smith's findings.<ref>{{cite journal|last=Kreukels|first=Baudewijntje |coauthors=Peggy Cohen-Kettenis|date=15 January 2008|title=Male-to-female transsexual subtypes: Sexual arousal with cross-dressing and physical measurements|url=http://www.psy-journal.com/article/PIIS0165178107002016/fulltext|journal=Psychiatry Research|publisher=Psychiatry Research|volume=137|issue=1|pages=321|accessdate=2009-04-21}}</ref> Johson's 1990 work used the alternative term "androphilic transsexual", Johson wrote that there was a correlation between social adjustment to the new gender role and androphilia.<ref name="Johnson1990"/>
-In the taxonomy proposed by [[Harry Benjamin]] in the 1960s, sex reassignment surgery was indicated only in transsexuals whom he called "feminine" and had Kinsey scale ratings of 4-6 (more homosexual than not).<ref>Benjamin, H. (1966). ''The transsexual phenomenon.'' New York: Julian Press, page 22.</ref> In contrast, Blanchard wrote that being a non-homosexual transsexual ought not contraindicate surgical sex reassignment, noting instead that non-homosexual transsexuals should be evaluated with caution.<ref name = BlanchardSteiner1989/>
+MacFarlane found that in New Zealand that 90% of the transsexual prostitutes were [[Māori]].  Of these, 90% had sex with a male as a child and 22% had sex with a female<!-- You can't say this study refers to homosexual transsexuals.  By Blanchard's definition, at least 22% are non-homosexual-->.  Every subject in the study considered their sexual activity with men to not be homosexual, as they considered themselves female.<ref name="MacFarlane">{{cite journal|last=MacFarlane|first=D. F.|authorlink=|coauthors=|title=Transsexual prostitution in New Zealand: Predominance of persons of Maori extraction|journal=Archives of Sexual Behavior|volume=13|issue=4|pages=301–309|publisher=Springer|location=Netherlands|date=August 1984|url=http://www.springerlink.com/content/q72x6l7515m35147/|doi=10.1007/BF01541903|id=|accessdate=2008-02-26|pmid=6487074}}</ref> Maoris comprise 9% of the overall population.  In ''[[The Man Who Would Be Queen]]'' [[J. Michael Bailey]] says that about 60% of homosexual transsexuals he studied in Chicago gay bars were [[Latina]] or black;<ref name="bailey2003"/> in his studies of gay males only 20% were non-white.(Bailey 2003)<ref name="bailey2003"/> Bailey quoted the opinions of two of his subjects who attributed the difference to genetics, or inflexible gender roles in their respective cultures.<ref name="bailey2003"/> MacFarlane similarly concluded that cultural acceptance influenced the number of Māori homosexual transsexuals, but also greater detachment from their culture, a lower standard of education, fewer job opportunities, and cultural confusion due to the abandonment of old customs.
-Three studies compared the outcomes of homosexual transsexuals with non-homosexual transsexuals.<ref name = BlanchardSteiner1989/><ref>Lawrence, A. A. (2003). Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. ''Archives of Sexual Behavior, 32,'' 299–315.</ref><ref>Smith, Y. L. S., van Goozen, S. H. M., Kuiper, A. J., & Cohen-Kettenis, P. T. (2005). Sex reassignment: Outcomes and predictors of treatment for adolescent and adults transsexuals. ''Psychological Medicine, 35,'' 89–99.</ref> Each of these reported that the majority of persons of each type benefited from sex reassignment, although both Blanchard and Smith reported that the few cases of regret that did occur all came from the non-homosexual group.
-==Scientific criticism==
+==Scientific criticism of the terminology==
-In "Autogynephilia in Women", Charles Moser applies an analogue of Blanchard's autogynephilia criteria for "non-homosexual transsexuals" to to natal (anatomically from birth) women.  93% were classified as autogynephiles.  Even using a much more rigorous standard, 28% still fit the classification.  Moser concludes that Blanchard's assertion that autogynephilia raises questions that require further study and that what is being probed is not a paraphilia, but rather a normal part of female sexuality no more prevalent among M2F transsexuals in comparison to the general female population.<ref name="moser2009" />
-==Questionable scientific use of terminology==
 Harry Benjamin said in 1966:
 <blockquote>....it seems evident that the question "Is the transsexual homosexual?" must be answered "yes" and " no." "Yes," if his anatomy is considered; "no" if his psyche is given preference.
@@ Line 90: / Line 65: @@
 </blockquote>
-Many others agree with what Dr. Benjamin wrote about the use of this term one of which is Bruce Bagemihl.<ref name="bagemihl" />  Bagemihl writes "..the point of reference for "heterosexual" or "homosexual" orientation in this nomenclature is solely the individual's genetic sex prior to reassignment (see for example, Blanchard et al. 1987[24], Coleman and Bockting, 1988[25], Blanchard, 1989[26]).  These labels thereby ignore the individual’s personal sense of gender identity taking precedence over biological sex, rather than the other way around."<ref name="bagemihl">Bagemihl B. Surrogate phonology and transsexual faggotry: A linguistic analogy for uncoupling sexual orientation from gender identity. In ''Queerly Phrased: Language, Gender, and Sexuality''. Anna Livia, Kira Hall (eds.) pp. 380 ff. Oxford University Press ISBN 0195104714</ref> Bagemihl goes on to take issue with the way this terminology makes it easy to claim transsexuals are really homosexual males seeking to escape from stigma.<ref name="bagemihl" /> Leavitt and Berger stated in 1990 that "The homosexual transsexual label is both confusing and controversial among males seeking sex reassignment.<ref name="leavitt1990">Leavitt F, Berger JC (1990). Clinical patterns among male transsexual candidates with erotic interest in males. ''[[Archives of Sexual Behavior]], [http://www.susans.org/reference/tserotic.html full text]'' Volume 19, Number 5 / October, 1990</ref><ref name="morgan1978">Morgan AJ Jr (1978). Psychotherapy for transsexual candidates screened out of surgery. ''[[Archives of Sexual Behavior]]''. 7: 273-282.|</ref> Critics argue that the term "homosexual transsexual" is "[[heterosexism|heterosexist]]",<ref name="bagemihl" /> "archaic",<ref name="wahng">Wahng SJ (2004). Double Cross: Transamasculinity Asian American Gendering in ''Trappings of Transhood''. in Aldama AJ (ed.) ''Violence and the Body: Race, Gender, and the State''. Indiana University Press. ISBN 025334171X</ref> and demeaning because it labels people by sex assigned at birth instead of their [[gender identity]].<ref name="leiblum2000">Leiblum SR, Rosen RC (2000). ''Principles and Practice of Sex Therapy'', Third Edition. ISBN 1-57230-574-6,Guilford Press of New York, c2000.</ref> Benjamin, Leavitt, and Berger have all used the term in their own work.<ref name="leavitt1990" /><ref name="benjamin1966" />  John Bancroft also recently expressed regret for having used this terminology, which was standard when he used it, to refer to transsexual women.<ref name="Bancroftcomment" /> He says that he now tries to choose his words more sensitively.<ref name="Bancroftcomment">{{cite journal
+Many others agree with what Dr. Benjamin wrote about the use of this term.  <ref name="bagemihl" />  Bagemihl writes "..the point of reference for "heterosexual" or "homosexual" orientation in this nomenclature is solely the individual's genetic sex prior to reassignment (see for example, Blanchard et al. 1987[24], Coleman and Bockting, 1988[25], Blanchard, 1989[26]).  These labels thereby ignore the individual’s personal sense of gender identity taking precedence over biological sex, rather than the other way around."<ref name="bagemihl">Bagemihl B. Surrogate phonology and transsexual faggotry: A linguistic analogy for uncoupling sexual orientation from gender identity. In ''Queerly Phrased: Language, Gender, and Sexuality''. Anna Livia, Kira Hall (eds.) pp. 380 ff. Oxford University Press ISBN 0195104714</ref> Bagemihl goes on to take issue with the way this terminology makes it easy to claim transsexuals are really homosexual males seeking to escape from stigma.<ref name="bagemihl" /> Leavitt and Berger stated in 1990 that "The homosexual transsexual label is both confusing and controversial among males seeking sex reassignment.<ref name="leavitt1990">Leavitt F, Berger JC (1990). Clinical patterns among male transsexual candidates with erotic interest in males. ''[[Archives of Sexual Behavior]], [http://www.susans.org/reference/tserotic.html full text]'' Volume 19, Number 5 / October, 1990</ref><ref name="morgan1978">Morgan AJ Jr (1978). Psychotherapy for transsexual candidates screened out of surgery. ''[[Archives of Sexual Behavior]]''. 7: 273-282.|</ref> Critics argue that the term "homosexual transsexual" is "[[heterosexism|heterosexist]]",<ref name="bagemihl" /> "archaic",<ref name="wahng">Wahng SJ (2004). Double Cross: Transamasculinity Asian American Gendering in ''Trappings of Transhood''. in Aldama AJ (ed.) ''Violence and the Body: Race, Gender, and the State''. Indiana University Press. ISBN 025334171X</ref> and demeaning because it labels people by sex assigned at birth instead of their [[gender identity]].<ref name="leiblum2000">Leiblum SR, Rosen RC (2000). ''Principles and Practice of Sex Therapy'', Third Edition. ISBN 1-57230-574-6,Guilford Press of New York, c2000.</ref> Benjamin, Leavitt, and Berger have all used the term in their own work.<ref name="leavitt1990" /><ref name="benjamin1966" />  John Bancroft also recently expressed regret for having used this terminology, which was standard when he used it, to refer to transsexual women.<ref name="Bancroftcomment" /> He says that he now tries to choose his words more sensitively.<ref name="Bancroftcomment">{{cite journal | last = Bancroft | first = John | authorlink = http://www.kinseyinstitute.org/about/bancroft-cv.html | coauthors = | title = Lust or Identity? | journal = Archives of Sexual Behavior | volume = 37 | issue = 3 | pages = 426–428 | publisher = Springer | location = | date = 2008 | url = http://www.springerlink.com/content/y8842382k001006q/fulltext.pdf?page=1 | doi = 10.1007/s10508-008-9317-1 | id = | accessdate = January 2009 | pmid = 18431640}}</ref><ref name="Bancroftcomment" />  Moser (2010) is likewise critical of the terminology.<ref name="moser2010"/>
-| last = Bancroft
+==Scientific criticism of the theory==
-| first = John
-| authorlink = http://www.kinseyinstitute.org/about/bancroft-cv.html
+In "Autogynephilia in Women", Charles Moser applies an analogue of Blanchard's autogynephilia criteria for "non-homosexual transsexuals" to to natal (anatomically from birth) women.  93% were classified as autogynephiles.  Even using a much more rigorous standard, 28% still fit the classification.  Moser concludes that Blanchard's assertion that autogynephilia raises questions that require further study and that what is being probed is not a paraphilia, but rather a normal part of female sexuality no more prevalent among M2F transsexuals in comparison to the general female population.<ref name="moser2009" />  Lawrence criticized Moser (2009) for not accurately representing Blanchard's autogynephilia questionaire.<ref name="lawrencereply2010">{{cite journal|author=Lawrence, Anne A.|year=2010|month=January|title=Something Resembling Autogynephilia in Women: Comment on Moser (2009)|journal=Journal of Homosexuality|volume=57|edition=1|pages=1-4|doi=10.1080/00918360903445749|url=http://www.informaworld.com/smpp/content~db=all~content=a918509038}}</ref>  Moser, in turn, defended his questions and accused Lawrence of making inaccurate comparisons.<ref name="moserreply2010">{{cite journal|author=Moser, Charles|year=2010|month=July|title=A Rejoinder to Lawrence (2010): It Helps If You Compare the Correct Items|journal=Journal of Homosexuality|volume=57|edition=6|pages=693-696|doi=10.1080/00918369.2010.485859 |url=http://www.informaworld.com/smpp/content~db=all~content=a923362867}}</ref>
-| coauthors =
-| title = Lust or Identity?
+Veale, Clarke, and Lomax (2008) did a similar, but larger scale test of Blanchard's theories, with a different set of equivalent autogynephilia questions than Moser.  Veale found that while both autogynephilic and non-autogynephilic transsexuals averaged higher rates of autogynephilia than natal women in the study, they also showed a stronger incidence of childhood female gender identity (essentially identical for both autogynephilic and non-autogynephilic transsexuals).  52% of biological female subjects scored a six or higher on the Core Autogynephilia scale and 3 or greater on the Autogynephilia Interpersonal Fantasy scale, compared to Blanchard's mean of 6.1 and 2.7 for "autogynephilic" non-homosexual transsexuals.  Perhaps the starkest comparison versus Blanchard's data, Veale found no difference between autogynephilic and non-autogynephilic M2F transsexuals in terms of sexual orientation.  68% of those classified as non-autogynephilic scored the highest possible score on the Sexual Attraction to Females scale.  Veale's conclusion is that while Blanchard's categorization of two groups of transsexuals may have merit in some cases, it does not completely represent the diversity among M2Fs.<ref name="veale2008"/>
-| journal = Archives of Sexual Behavior
-| volume = 37
+Nuttbrock et al (2010) attempted to reproduce Blanchard's studies from Toronto in the 1980s in modern times with 571 M2F transsexuals from New York City.  For the study, autogynephilia is assumed to be equivalent to transvestism fetish.  The study did confirm Blanchard's findings of three times higher rates of transvestic fetish among non-homosexuals versus homosexuals, but the correlation was too weak to be considered deterministic.  Blanchard (1992)'s finding of the highest level of transvestism fetich being found with an intermediary level of gynephilia could not be reproduced.  Age and ethnicity were found to be correlated with sexual orientation.  Being caucasian was found to correlate with transvestism.  Transvestism results overall are significantly lower than Blanchard's, prompting the hypothesis that transvestic fetish is a historically fading phenomenon.  Nuttbrock concludes that, "These limitations notwithstanding, we nonetheless conclude that a classification of the MTF population, based solely on sexual orientation, is fundamentally limited."<ref name="nuttbrock2010"/>
-| issue = 3
-| pages = 426–428
+Moser (2010)<ref name="moser2010"/> conducts a wide-ranging review of the literature on the subject as a critique of Blanchard's theory over a range of issues.  His claims include:
-| publisher = Springer
+* Blanchard's use of "ever" to define autogynephilia, including those who have only had a few incidents of arousal long ago, is akin to classifying someone as homosexual for ever having been aroused by a member of the same sex in their life.
-| location =
+* Blanchard (1989)'s claim of clinical importance for autogynephilia because "it interferes with normal interpersonal sexual attraction" is contradicted by his own work in Blanchard, Clemmensen, & Steiner (1987).  "Autogynephilias as an orientation" (Blanchard 1993) is criticized in that autogynephilic M2Fs interest in transitioning does not overshadow interest in courtship, love, and cohabitation with a partner of the preferred sex, with most reporting stable partnered relationships after SRS (Lawrence, 2005).  No cases were found in the literature of differences between the gender dysphoria of homosexual and non-homosexual M2Fs, or response to anti-androgens, or the clinical utility of distinguishing the two.  Data on rates of regret for both groups of transsexuals is contradictory, and is low in either regard (Lawrence (2003) and Olsson & Moller (2006)).
-| date = 2008
+* Blanchard's statement, "All gender dysphoric biological males who are not homosexual ... are instead autogynephilic ..." is contrary to Blanchard's own data; examples include Blanchard (1993), Blanchard (1985), Bentler (1976), Leavitt and Berger (1990), Lawrence (2005), and others.
-| url = http://www.springerlink.com/content/y8842382k001006q/fulltext.pdf?page=1
+* Lawrence (2005, 2006)'s claim that self-identified homosexual transsexuals are misrepresenting themselves (evidenced by a history of marriage to a woman) ignores that 20% of self-identified "white homosexual men" have a history of marriage to a woman, 14% had heterosexual coitus in the last year, and 52% in their lifetime (Bell & Weinberg, 1978).  The claim that M2Fs deny their autogynephilia to win favorable SRS recommendations is contradicted by the fact that Blanchard's clinic did not discriminate between the two types, and in some cases autogynephilia could lead to a more favorable diagnosis.
-| doi = 10.1007/s10508-008-9317-1
+* Blanchard et al's reliance on phallometry is noted to be controversial, as per APA (2000) and Marshal & Fernandez (2000).  Blanchard, Racansky, & Steiner (2006) is criticized for studying cross-dressers but attributing the results to transsexuals, for omitting any chance for the subject to test positive for a lesbian identity, and for offhand dismissing results that contradict the theory.  Moser notes that Blanchard, Lynkins, et al (2009) interprets results in the opposite manner.
-| id =
+* The treatment of autogynephilia as a paraphilia is criticized for failing to match with sex drive.  That is, paraphilias are rare in natal women (autogynephilia was found in women in Veale et al (2008) and Moser (2009)); decline with age (non-homosexual M2F transsexualism does not); and should correspond with a decreased interest in transition and discomfort under the presence of anti-androgens.  This is often the case with transvestites, but non-homosexual transsexuals generally report unabated interest and a feeling of relief from the anti-androgens, even without estrogens.  "Autoandrophobia" is suggested as an alternative explanation.
-| accessdate = January 2009
+* While Blanchard (1991) claims that "autogynephilia ... is the main correlate of transsexual tendancies and also of diminished capacities for heterosexual relationships and pair-bond formation", Lawrence (2005) found that 83% of M2Fs interested in female partners before and after SRS were in a stable, partnered relationship versus 36% of those interested in males. Lawrence (2005)'s claims of transsexuals having trouble finding partners after SRS is criticized for using an older age range than the national baseline she compares to, as age is inversely correlated with sexual partners.  Using a similar age range, the rate of sexual partners is similar.  Contrary to Blanchard (1989a, 1991)'s claims that male partners of "non-homosexual transsexuals" are "faceless" and not "desirable partners in their own right", Lawrence (2005) shows 71% in stable partnered relationships post-SRS versus 64% for "homosexual" transsexuals, with an average number of post-SRS male partners of 2.8 versus 8.4, respectively.
-| pmid = 18431640}}</ref><ref name="Bancroftcomment" />
+* Bailey (2003)'s claims that "homosexual transsexuals" are extremely feminine gay men, and Lawrence (2004)'s claims that homosexual M2Fs transition because it "seems obvious" for "greater social and romantic satisfaction and success" are criticized for lacking in supporting data and for the notion of amputation of one's genitals being an "obvious" route to sexual success.
+===Transsexual community reaction===
-==Popular Controversy==
 The concept began receiving attention outside of [[sexology]] when sexologist Anne Lawrence, a physician and [[sexologist]] who self-identifies as autogynephilic, published a series of web articles about the concept in the late 1990s.<ref name="lawrence1998">Lawrence AA (1998). [http://home.swipnet.se/~w-13968/autogynephilia.html "Men Trapped in Men's Bodies:"An Introduction to the Concept of Autogynephilia.] originally published at annelwrence.com, October 1998. Retrieved August 21, 2006)</ref> [[Lynn Conway]] and [[Andrea James]] responded to Lawrence's essay. Conway started an investigation into the publication of Bailey's book by the [[United States National Academy of Sciences]]. Accusations of misconduct by Bailey were leveled. [[Northwestern University]] investigated Bailey, but did not reveal the findings of that investigation and did not comment on whether or not Bailey had been punished.<ref>Robin Wilson. [http://chronicle.com/subscribe/login?url=/daily/2004/12/2004120103n.htm Northwestern U. Concludes Investigation of Sex Researcher but Keeps Results Secret]. Chronicle of Higher Education, 2004.</ref> According to [[intersex]]{{Citation needed|date=April 2010}} researcher and bioethics specialist Alice Dreger, who is now one of Bailey's supporters, two of the four transwomen who accused Bailey of misusing their stories were not mentioned anywhere in the book.<ref name=Dreger2008>Dreger, A. D. (2008). The controversy surrounding ''The Man Who Would Be Queen:'' A case history of the politics of science, identity, and sex in the Internet age. ''Archives of Sexual Behavior, 37,'' 366-421.</ref>
+According to Leavitt and Berger, "transsexuals, as a group, vehemently oppose the label and its pejorative baggage."<ref name="leavitt1990">Leavitt, Frank; Berger, Jack C. (October), "Clinical patterns among male transsexual candidates with erotic interest in males", Archives of Sexual Behavior 19 (5): 491-505, doi:10.1007/BF02442350, 1573-2800</ref> Transwoman [[Andrea James]] has called the term "inaccurate and offensive,"<ref name="james2006">James A (2006). A defining moment in our history: Examining disease models of gender identity. ''Gender Medicine''. 3:56 ISSN:15508579</ref> and transman [[Aaron Devor]] wrote, "If what we really mean to say is attracted to males, then say 'attracted to males' or androphilic... I see absolutely no reason to continue with language that people find offensive when there is perfectly serviceable, in fact better, language that is not offensive."<ref name="lane2008">Lane R (2008). Truth, Lies, and Trans Science. ''[[Archives of Sexual Behavior]]'' 37:3, 453-456</ref> Still other transsexuals are opposed to any and all models of diagnosis which allow gatekeeping, and seek their removal from the DSM<ref name="shefer">{{Cite book| last = Shefer| first = Tamara| author-link =| last2 = Boonzaier| first2 = Floretta| author2-link =| title = The Gender of Psychology| place =| publisher = Juta and Company Limited| year = 2006| volume =| edition = Illustrated| url = http://books.google.com/?id=jtiUvdDlTboC| doi =| id =| isbn = 1919713921, 9781919713922}} (see pages 273-274, 282)</ref>
+==See also==
+*[[Autoeroticism]]
+*[[Transsexual sexuality]]
+*[[List of transgender-related topics]]
 ==References==
-{{Reflist|2}}
+{{Reflist|3}}
+== External links ==
+{{Wiktionary|autogynephilia}}
+{{Transgender|state=collapsed}}
+[[Category:Transgender and medicine]]
-{{DEFAULTSORT:Blanchard, Bailey, And Lawrence Theory}}
 [[Category:Gender]]
 [[Category:Gender transitioning]]