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Annotated Bibliography of Autogynephilia and HSTS Research

by Alex Parkinson

Academic journals cited have links to their abstracts, books have links to either the full text online or where they can be purchased, quotes are included:

Introduction

Citations differentiating homosexual transsexuality and autogynephilia

DSM-IV-TR: American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision. Washington, DC; American Psychiatric Association; 576-582.

Transsexual subtypes : Clinical and theoretical significance Smith Yolanda L. S.; Van Goozen Stephanie H. M.; Kuiper A. J.; Cohen-Kettenis Peggy T.; Psychiatry research (Psychiatry res.) 2005, vol. 137, no3, pp. 151-160

Sex Reassignment: Predictors and Outcomes Of Treatment for Transsexuals Yolanda Louise Susanne Smith – [S.l.] : [s.n.], 2002 – Tekst. – Proefschrift Universiteit Utrecht

Sex reassignment of adolescent transsexuals: a follow-up study. Cohen-Kettenis PT, van Goozen SH. J Am Acad Child Adolesc Psychiatry. 1997 Feb;36(2):263-71.

Sex reassignment: Outcomes and predictors of treatment for adolescent and adult transsexuals. Smith, Y. L. S., van Goozen, S. H. M., Kuiper, A. J., & Cohen-Kettenis, P.T. (2005). Psychological Medicine.

The Transsexual Phenomenon. Harry Benjamin
Full text: http://www.symposion.com/ijt/benjamin/index.htm

The relationship of male transsexual typology to psychosocial adjustment. Johnson SL, Hunt DD. Archives of Sexual Behavior. 1990 Aug;19(4):349-60.

A typology of transsexualism: gender identity theory and data. Bentler PM. Archives of Sexual Behavior. 1976 Nov;5(6):567-84.

Two clinically discrete syndromes of transsexualism. Buhrich N, McConaghy N. British Journal of Psychiatry. 1978 Jul;133:73-6.

Two types of cross-gender identity. Freund K, Steiner BW, Chan S. Archives of Sexual Behavior. 1982 Feb;11(1):49-63.

Abnormal Psychology and Modern Life (11th Edition). by Robert C. Carson, James Neal Butcher, Susan Mineka

Citations on autogynephilia other than those by Dr. Blanchard

Autogynephilia: A paraphilic model of gender identity disorder. Lawrence A. Journal of Gay and Lesbian Psychotherapy. 2004 Vol. 8 Numbers 1/2.

Transgendering, Migrating and Love of Oneself as a Woman: A Contribution to a Sociology of Autogynephilia. Ekins R., King D. (2001) Transgendering, Migrating and Love of Oneself as a Woman: A Contribution to a Sociology of Autogynephilia. International Journal of Transgenderism 5,3

Can fetishism occur in transsexuals? Buhrich N, McConaghy N. Archives of Sexual Behavior. 1977 May;6(3):223-35.

The clinical syndromes of femmiphilic transvestism. Buhrich N, McConaghy N. Archives of Sexual Behavior. 1977 Sep;6(5):397-412.

Papers on homosexual transsexuality alone

Male, Female and Transgender : Stereotypes and Self in Thailand. Sam Winter and Nuttawut Udomsak. International Journal of Transgenderism 6,1

Developmental profile of 200 male and 100 female transsexuals in Singapore. Tsoi WF. Archives of Sexual Behavior. 1990 Dec;19(6):595-605.

Male and female transsexuals: a comparison. Tsoi WF. Singapore Med J. 1992 Apr;33(2):182-5.

Physical attractiveness of boys with gender identity disorder. Zucker KJ, Wild J, Bradley SJ, Lowry CB. Archives of Sexual Behavior. 1993 Feb;22(1):23-36.

Childhood gender non-conformity/sexual orientation

Comments

Sexual orientation and boyhood gender conformity: development of the Boyhood Gender Conformity Scale (BGCS). Hockenberry SL, Billingham RE. Archives of Sexual Behavior 1988 Jun;17(3):287.

Gender in homosexual boys: some developmental and clinical considerations. Isay RA. Psychiatry. 1999 Summer;62(2):187-94.

Psychosocial and erotic development in cross-gender identified children. Zucker KJ. Canadian Journal of Psychiatry. 1990 Aug;35(6):487-95.

Childhood cross-gender behavior and subsequent sexual preference. Green R. American Journal of Psychiatry. 1979 Jan;136(1):106-8.

Gender identity in childhood and later sexual orientation: follow-up of 78 males. Green R. American Journal of Psychiatry. 1985 Mar;142(3):339-41.

Retrospectively measured individual differences in childhood sex-typed behavior among gay men: correspondence between self and maternal reports. Bailey JM, Nothnagel J, Wolfe M. Archives of Sexual Behavior. 1995 Dec;24(6):613-22.

Taxometric analyses of sexual orientation and gender identity. Gangestad SW, Bailey JM, Martin NG. J Pers Soc Psychol. 2000 Jun;78(6):1109-21.

Homosexual sexuality/F2M transsexuality

Gender-related traits in gay men, lesbian women, and heterosexual men and women: the virtual identify of homosexual-heterosexual diagnosticity and gender diagnosticity. Lippa RA. J Pers. 2000 Oct;68(5):899-926.

Butch, femme, or straight acting? Partner preferences of gay men and lesbians. Bailey JM, Kim PY, Hills A, Linsenmeier JA. J Pers Soc Psychol. 1997 Nov;73(5):960-73.

Sexual orientation of female-to-male transsexuals: a comparison of homosexual and nonhomosexual types. Chivers ML, Bailey JM. Archives of Sexual Behavior. 2000 Jun;29(3):259-78.

Citations on specific biology of transsexuality

Sexual differentiation of the bed nucleus of the stria terminalis in humans may extend into adulthood. Chung WC, De Vries GJ, Swaab DF. J Neurosci. 2002 Feb 1;22(3):1027-33.

Gender differences in behaviour: activating effects of cross-sex hormones. Van Goozen SH, Cohen-Kettenis PT, Gooren LJ, Frijda NH, Van de Poll NE. Psychoneuroendocrinology. 1995;20(4):343-63.

Organizing and activating effects of sex hormones in homosexual transsexuals. van Goozen SH, Slabbekoorn D, Gooren LJ, Sanders G, Cohen-Kettenis PT. Behav Neurosci. 2002 Dec;116(6):982-8.

Birth order and sibling sex ratio in two samples of Dutch gender-dysphoric homosexual males. Blanchard R, Zucker KJ, Cohen-Kettenis PT, Gooren LJ, Bailey JM. Archives of Sexual Behavior. 1996 Oct;25(5):495-514.

Neuroendocrine response to estrogen and sexual orientation. Gladue BA, Green R, Hellman RE. Science. 1984 Sep 28;225(4669):1496-9.

On the LH response to oestrogen and LH-RH in transsexual men. Dorner G, Rohde W, Schott G, Schnabl C. (1983) Exp Clin Endocrinol. 1983 Nov;82(3):257-67.

Neuroendocrine response to estrogen and brain differentiation in heterosexuals, homosexuals, and transsexuals. Dorner G. Archives of Sexual Behavior. 1988 Feb;17(1):57-75.

Sexual differentiation of gonadotrophin secretion, sexual orientation and gender role behavior. Dorner G, Docke F, Gotz F, Rohde W, Stahl F, Tonjes R. J Steroid Biochem. 1987;27(4-6):1081-7.

Papers by Ray Blanchard

Typology of male-to-female transsexualism. Blanchard, Ray. Archives of Sexual Behavior. Vol 14(3) Jun 1985, 247-261.

Social desirability response set and systematic distortion in the self-report of adult male gender patients. Blanchard, Ray; Clemmensen, Leonard H; Steiner, Betty W. Archives of Sexual Behavior. Vol 14(6) Dec 1985, 505-516.

Phallometric detection of fetishistic arousal in heterosexual male cross-dressers. Blanchard, Ray; Racansky, I. G; Steiner, Betty W. Journal of Sex Research. Vol 22(4) Nov 1986, 452-462.

Heterosexual and homosexual gender dysphoria. Blanchard, Ray; Clemmensen, Leonard H; Steiner, Betty W. Archives of Sexual Behavior. Vol 16(2) Apr 1987, 139-152.

A test of the DSM-III–R’s implicit assumption that fetishistic arousal and gender dysphoria are mutually exclusive. Blanchard, Ray; Clemmensen, Leonard H. Journal of Sex Research. Vol 25(3) Aug 1988, 426-432.

Nonhomosexual gender dysphoria. Blanchard, Ray. Journal of Sex Research. Vol 24 1988, 188-193.

Prediction of regrets in postoperative transsexuals. Blanchard R, Steiner BW, Clemmensen LH, Dickey R. Can J Psychiatry. 1989 Feb;34(1):43-5.

The classification and labeling of nonhomosexual gender dysphorias. Blanchard, Ray. Archives of Sexual Behavior. Vol 18(4) Aug 1989, 315-334.

The concept of autogynephilia and the typology of male gender dysphoria. Blanchard, Ray. Journal of Nervous & Mental Disease. Vol 177(10) Oct 1989, 616-623.

Clinical observations and systematic studies of autogynephilia. Blanchard, Ray. Journal of Sex & Marital Therapy. Vol 17(4) Win 1991, 235-251.

Sibship size, sibling sex ratio, birth order, and parental age in homosexual and nonhomosexual gender dysphorics. Blanchard R, Sheridan PM. J Nerv Ment Dis. 1992 Jan;180(1):40-7.

Birth order in transgendered males from Polynesia: a quantitative study of Samoan fa’afafine. Poasa KH, Blanchard R, Zucker KJ. J Sex Marital Ther. 2004 Jan-Feb;30(1):13-23

Nonmonotonic relation of autogynephilia and heterosexual attraction. Blanchard R. J Abnorm Psychol. 1992 May;101(2):271-6.

Varieties of autogynephilia and their relationship to gender dysphoria. Blanchard R. Arch Sex Behav. 1993 Jun;22(3):241-51.

Comparison of height and weight in homosexual versus nonhomosexual male gender dysphorics.Blanchard R, Dickey R, Jones CL. Arch Sex Behav. 1995 Oct;24(5):543-54.

Citations discusing the historical, social and political aspects of transsexuality

Deconstructing the feminine essence narrative Blanchard R. Arch Sex Behav 37.3 (June 2008), 434.

What Many Transgender Activists Don’t Want You to Know: and why you should know it anyway Bailey M, Triea K, Perspectives in Biology and Medicine – Volume 50, Number 4, Autumn 2007, pp. 521-534

The Controversy Surrounding The Man Who Would Be Queen: A Case History of the Politics of Science, Identity, and Sex in the Internet Age, Dreger A. In Press

Other citations and comments on methodology

Kavanagh v. Attorney General of Canada

Changes in the sexual orientation of six heterosexual male-to-female transsexuals. Daskalos CT. Archives of Sexual Behavior. 1998 Dec;27(6):605-14.

Behavioral differences and emotional conflict among male-to-female transsexuals. Levine EM, Gruenwald D, Shaiova CH. Archives of Sexual Behavior. 1976 Jan;5(1):81-6.

Introduction

We frequently hear claims from the heterosexual mtf community that: 1. Blanchard’s etiological explanation for non-homosexual transsexuality, autogynephilia, has little or no evidence to support it, 2. that the notion that homosexual and non-homosexual transsexuality are different conditions is not widespread, or that it is held only by Blanchard, and has little or no evidence to support it. From the historical and published scientific research, this is simply not true.

There is a great deal of evidence to support the theory that autogynephilia, that is, auto-erotic interest in being or becoming female or feminized, is a distinct feature in non-homosexual transsexuality. This was frequently observed before Blanchard’s studies; he just confirmed it with additional research and offered a convincing highly plausible explanation for its role in non-homosexual transsexuality. These were scientific studies and observations published in peer reviewed journals that would only be categorically dismissed without counter-argument by people who had an ulterior motive to do so.

The typology that Blanchard used distinguishing in homosexual from non-homosexual transsexuals is just a refinement of what has been obvious and documented since the 60s. There have been no serious studies which attempt to consolidate the two types, only those which either do not address typology, or which firmly differentiate the two types. While autogynephilia as the cause of non-homosexual transsexuality is still somewhat controversial, there is no serious academic dispute that transsexuality could be a unified condition. Some of the early writing on transsexuality assumed that all mtf transsexuals were androphilic, but from the point that it became clear that there were in fact, non-homosexual transsexuals, it was also clear that they were fundamentally different.
So, I hope this bibliography will help to correct this confusion as well as detailing our sources and giving sort of a reading list for further interest…with commentary added to explain why and how the works sited here are relevant to us.

DSM-IV-TR: American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision. Washington, DC; American Psychiatric Association; 576-582.
Link to Book on Amazon

From the Text [on GID]:

“For sexually mature individuals, the following specifies may be noted based on the individuals sexual orientation: Sexually Attracted to Males, Sexually attracted to females, Sexually Attracted to Both, and Sexually Attracted to Neither. Males with Gender Identity Disorder include substantial proportions with all four specifiers. Those who are attracted to males usually fist experience the disorder beginning in childhood or early adolescence, while those males attracted to females, both genders, or neither, usually report their gender dysphoria in early to mid-adulthood. Those men attracted to neither gender are often isolated individuals with schizoid traits. Boys with Gender Identity Disorder often show marked feminine mannerisms and speech patterns. Adult males who are sexually attracted to females, to both males and females, or to neither sex usually report a history of erotic arousal associated with the thought or image of oneself as a woman (termed autogynephilia). In most cases, the individual would qualify, at least in the past, for a diagnosis of Transvestic Fetishism. Only a very small number of children with Gender Identity Disorder will continue to have symptoms that meet the criteria for Gender Identity Disorder in adolescence or adulthood. By late adolescence or adulthood, about three-quarters of boys who had a childhood history of Gender Identity Disorder report a homosexual or bisexual orientation, but without concurrent Gender Identity Disorder.”
“In adult males, there are two different courses for the development of Gender Identity Disorder. The first is a continuation of Gender Identity Disorder that had an onset in childhood. These individuals typically present in late adolescence adulthood. In the other course, the more overt signs of cross-gender identification appear later and more gradually, with clinical presentation in early to mid-adulthood usually following, but sometimes concurrent with, Transvestic Fetishism…Males with Gender Identity Disorder who are sexually attracted to males tend to present in adolescence or early adulthood with a lifelong history of gender dysphoria. In contrast, those who are sexually attracted to females, to both males and females, or to neither sex tend to present later and typically have a history of Transvestic Fetishism.

Comments: The fact that the Diagnostic and Statistical Manual of Mental Disorders, the most significant diagnostic handbook accepted in the mental health profession as an agreed upon standard for clinical classification, recognizes the homosexual/non-homosexual typology in mtf, and further recognizes non-homosexual mtfs as suffering from autogynephilia, is a real testimony to how widely and generally this typology is accepted for serious psychological purposes. This typology is not some esoteric fringe theory in psychology but a mainstream typology with the weight of the research and researchers behind it; part of the American Psychiatric Association’s accepted description of GID. This is a very different reality than the one that some non-hsts transsexual activists outside of the mental health community try to portray it as.

The DSM describes two types of Gender Identity Disorder in biological males, one where, patients start treatment starts in adolescence, there cross-gender behavior is obvious and apparent from childhood, and are sexually attraction is to males exclusively, and another group where patients start treatment in early to mid-adulthood, cross-gender “identification” only becomes apparent as adults, they have a history of transvestic fetishism and experience autogynephilic sexuality, and have a sexual orientation other than exclusive attraction to males. Instead of “homosexual” and “non-homosexual” the DSM IV TR describes one early onset/presentation type specified as “attracted to males” and three types that experience autogynephilia specified as “attracted to females” “attracted to both” or “attracted to neither”, the last being the most pathological.
I have certain objections to the conceptual framework assumed in Gender Identity Disorder, not the least being that as the DSM-IV-TR acknowledges, so called “Childhood Gender Identity Disorder” is in most cases a pre-homosexual condition, only rarely leading to homosexual transsexuality in adolescence, and I don’t think the symptoms it describes are caused by an identity disturbance, which I write about here.

Transsexual subtypes : Clinical and theoretical significance Smith Yolanda L. S.; Van Goozen Stephanie H. M.; Kuiper A. J.; Cohen-Kettenis Peggy T.; Psychiatry research (Psychiatry res.) 2005, vol. 137, no3, pp. 151-160

Abstract

From Abstract:

The present study was designed to investigate whether transsexuals can be validly subdivided into subtypes on the basis of sexual orientation, and whether differences between subtypes of transsexuals are similar for male-to-female (MF) and female-to-male transsexuals (FMs). Within a large transsexual sample (n=187), homosexual and nonhomosexual subjects were compared on a number of characteristics before the start of treatment. Differences within MF and FM groups were also investigated. Homosexual transsexuals were found to be younger when applying for sex reassignment, reported a stronger cross-gender identity in childhood, had a more convincing cross-gender appearance, and functioned psychologically better than nonhomosexual transsexuals. Moreover, a lower percentage of the homosexual transsexuals reported being (or having been) married and sexually aroused while cross-dressing. The pattern of findings was different for MFs and FMs. No differences between homosexuals and nonhomosexuals were found in height, weight, or body mass index. A distinction between subtypes of transsexuals on the basis of sexual orientation seems theoretically and clinically meaningful. The results support the notion that in the two groups different factors influence the decision to apply for sex reassignment. The more vulnerable nonhomosexual transsexuals may particularly benefit from additional professional guidance before and/or during treatment.

Comments: This study specifically continues the previous studies by Smith et. al. which found differences in transsexuals on the basis of sexual orientation, homosexual or nonhomosexual. Significant differences were again found based on this typeology and these distinctions were judged to be clinically valuable in the treatment outcomes. This is the latest paper by Smith et. al. to replicate Dr. Blanchard’s original typeology and to further establish the typeology as a valuable clinical tool.

Sex Reassignment : Predictors and Outcomes Of Treatment for Transsexuals / Yolanda Louise Susanne Smith – [S.l.] : [s.n.], 2002 – Tekst. – Proefschrift Universiteit Utrecht

Full Text
Relevant Section

From Abstract:

Prospective research supports the therapeutic effect of sex reassignment (SR) for adolescent and adult transsexuals. Data were used from 345 patients who applied for SR…Follow-up data were gathered one to five years after SR…By far the least explored and most controversial domain with respect to SR is early (hormone) treatment with adolescent transsexuals. Results of the present study support the decision to refer well-functioning adolescents for early (between 16 to 18 years) hormone treatment, considering the positive outcomes of SR on several areas of postoperative functioning of this group…The adolescents also appeared to function quite well socially and psychologically… Eligibility for SR was largely based upon the factors gender dysphoria, psychological stability, and physical appearance. Transsexuals with a nonhomosexual preference, psychological instability, and strong dissatisfaction about their appearance, at assessment, are more at risk for worse postoperative functioning and more dissatisfaction after treatment.
Other findings from this thesis led us to conclude that the distinction between subtypes of transsexuals is theoretically and clinically meaningful. The differences that were found between homosexual and nonhomosexual transsexuals suggest different developmental routes for each of these subtypes. The road along which the nonhomosexual subtype evolves the gender identity conflict is most likely to be accompanied with more obstacles. Taking into account that the nonhomosexuals were found to be psychologically more vulnerable than the homosexuals, especially before treatment, they may require additional guidance during treatment…Finally, we investigated which factors at assessment could predict the course and outcomes of SR. Eligibility for SR was largely based upon the factors gender dysphoria, psychological stability, and physical appearance. Transsexuals with a nonhomosexual preference, psychological instability, and strong dissatisfaction about their appearance, at assessment, are more at risk for worse postoperative functioning and more dissatisfaction after treatment.

From the Text:

“Later, several other authors (Bentler, 1976; Buhrich and McConaghy, 1978; Freund et al., 1982; Hamburger, 1953; Money and Gaskin, 1970-1971; Person and different types of transsexuals and arrived at a similar distinction. Although these authors may have differed in the names and the number of subtypes or in the percentages each of their subtypes consisted of they identified and labeled a homosexual type more consistently than any other category of transsexual (see also Blanchard, 1989a)… .. Taking all the findings into account, we conclude that homosexual and nonhomosexual transsexuals differ from each other in many ways, but that the pattern of differences is not entirely similar for MFs and FMs. An important characteristic the sexes do have in common is that nonhomosexuals function psychologically less favorable. The different manifestations of homosexual and nonhomosexual subtypes of transsexualism found in this study might be reflecting different etiologies knowing that the nonhomosexuals are psychologically more vulnerable than the homosexuals, especially before treatment, they need special attention during the diagnostic procedure.”

Comments: This is a really excellent and significant set of studies in the Netherlands. Yolanda Smith with well known Dutch researchers Stephanie van Goozen and Peggy Cohen-Kettenis, were able to replicate nearly every study Blanchard did at the CAMH demonstrating significant differences between homosexual and non-homosexual transsexuals with a large population. That they were able to replicate Blanchard’s findings reinforces the already well established typology differentiating the two types of transsexuals. Yolanda Smith was able to find additional significant differences in homosexual and non-homosexual transsexuals, finding differences in psychological functioning and physical appearance that had not been examined as directly in earlier studies. She suggests that the difference isn’t just interesting from an academic standpoint but relevant to treatment. Smith also found really positive and consistent results for starting treatment in adolescence.
One thing to note though is that the homosexual and non-homosexual groups were not sorted so well because Smith included mtfs currently self reporting an attraction to men regardless of sexual history in the homosexual group. This ended up including mtfs who had been married to females in the homosexual group based on current sexual orientation, though they certainly would not have been considered homosexual transsexuals in any etiological sense. Given this poor sorting there were probably at least 20% and up to nearly 40% of the “homosexual group” who were in fact not originally homosexual. (assuming that pseudo-androphile non-hsts marry at a similar rate as the other non-hsts mtfs in her study). Despite this, her sample sizes were large enough that they still found the same statistical differences that Blanchard did and confirmed his studies; since even if the homosexual group was only 60% hsts and 40% non-hsts there would still be significant differences with a group that was 100% non-hsts…but I would think if Smith had sorted into groups based on sexual experience (such as asking “have you been sexually active with men, women, both, neither” instead of current sexual orientation she would have found even more striking results.
In any case I think Sex Reassignment: Predictors and Outcomes Of Treatment for Transsexuals is an excellent piece of work. Anyone who is interested in (or wants to dispute) Blanchard’s research but doesn’t have access to a university library with his publications, should read it since some of the experiments done are very similar.

Sex reassignment of adolescent transsexuals: a follow-up study. Cohen-Kettenis PT, van Goozen SH. J Am Acad Child Adolesc Psychiatry. 1997 Feb;36(2):263-71.
Abstract online

From the Abstract:

“OBJECTIVE: To investigate postoperative functioning of the first 22 consecutive adolescent transsexual patients of our gender clinic who underwent sex reassignment surgery… Twelve subjects had started hormone treatment between 16 and 18 years of age. The posttreatment data of each patient were compared with his or her own pretreatment data… Not a single subject expressed feelings of regret concerning the decision to undergo sex reassignment…CONCLUSIONS: Starting the sex reassignment procedure before adulthood results in favorable postoperative functioning, provided that careful diagnosis takes place in a specialized gender team and that the criteria for starting the procedure early are stringent.”

From the Text:

“Part of the adolescents’ better functioning might be due to the fact that they more easily pass in the desired gender role, because of their convincing appearance…the voices of the MFs were not noticeably male sounding, and all MFs had only sparse beard growth at the time of hormonal treatment. The early antiandrogen treatment apparently had acted in a timely way to block the facial hair growth and the lowering of the voice…Another aspect of this relatively positive outcome may be attributable to the criteria for treatment eligibility…those patients selected for early treatment not only are among the best-functioning applicants, but probably they also belong to the subtype of so-called “homosexual transsexuals” (that is, individuals who are, before SRS, sexually attracted to same-sex partners)…”Homosexual transsexuals” have been found, among other things, to present earlier for treatment, to report more childhood cross-gender identification, and to show less postoperative regrets than “nonhomosexual transsexuals” (Blanchard, 1985, 1988; Blanchard et al., 1989, Doorn et al., 1994). It is also possible that the biological factors recently found to be associated with transsexualism are of greater etiological significance in the earlyonset than in the late-onset group (Zhou et al., 1995). Postoperative regrets in the nonhomosexual group (which probably largely coincide with the late-onset group) are more likely because they usually…”

Comments: Any study arguing that hormone intervention and transition in adolescence is safe and helpful for homosexual transsexuals who haven’t developed significant male secondary sexual characteristics is a good thing. Finding useful criteria for eligibility along these lines makes it possible to help the people who will objectively benefit most from early intervention, rather then trying to make broad treatment recommendations for all transsexuals most of whom pose a much greater risk for negative outcomes. This is one example of were a recognition of transsexual typology has clinical implications…if all gender dysphoric biological males were treated in a similar manner there would probably be much more mixed results (objectively if not subjectively) which might call into question adolescent interventions in general even for those who would be the best candidates (similar to what happened to the American gender clinics).

Sex reassignment: Outcomes and predictors of treatment for adolescent and adult transsexuals. Smith, Y. L. S., van Goozen, S. H. M., Kuiper, A. J., & Cohen-Kettenis, P.T. (2005). Psychological Medicine.
Abstract online

From the abstract:

Background. We prospectively studied outcomes of sex reassignment, potential differences between subgroups of transsexuals, and predictors of treatment course and outcome. Method. Altogether 325 consecutive adolescent and adult applicants for sex reassignment participated: 222 started hormone treatment, 103 did not; 188 completed and 34 dropped out of treatment. Only data of the 162 adults were used to evaluate treatment. Results between subgroups were compared to determine post-operative differences. Adults and adolescents were included to study predictors of treatment course and outcome. Results were statistically analysed with logistic regression and multiple linear regression analyses. Results. After treatment the group was no longer gender dysphoric. The vast majority functioned quite well psychologically, socially and sexually. Two non-homosexual male-to-female transsexuals expressed regrets. Post-operatively, female-to-male and homosexual transsexuals functioned better in many respects than male-to-female and non-homosexual transsexuals. Eligibility for treatment was largely based upon gender dysphoria, psychological stability, and physical appearance. Male-to-female transsexuals with more psychopathology and cross-gender symptoms in childhood, yet less gender dysphoria at application, were more likely to drop out prematurely. Non-homosexual applicants with much psychopathology and body dissatisfaction reported the worst post-operative outcomes. Conclusions. The results substantiate previous conclusions that sex reassignment is effective. Still, clinicians need to be alert for non-homosexual male-to-females with unfavourable psychological functioning and physical appearance and inconsistent gender dysphoria reports, as these are risk factors for dropping out and poor post-operative results. If they are considered eligible, they may require additional therapeutic guidance during or even after treatment.

The Transsexual Phenomenon
Harry Benjamin
Full Text

Comments: The Transsexual Phenomenon is an interesting work to be read in a historical context. I think the theoretical understanding of transsexualism in Benjamin’s work is incorrect and his classification system not consistent with empirical findings including his own cases. One of the major problems was that Benjamin did not recognize the existence of non-homosexual transsexuals, that there could be transsexuals attracted to women principally and that their gender dysphoria could be as or more intense then the others he observed. His classification system assumes that sexuality and presentation correlate with intensity of desire to change sex, and this has been shown to be empirically incorrect. All mtfs with a principle interest in women, for instance, would likely be classified by Benjamin as Type III transvestites who he suggests should not have sex reassignment surgery, for instance. It further artificially groups sexually inactive late transitioning transsexuals with early transitioning homosexual transsexuals as “true transsexuals” despite recognizing that they have completely different symptoms in comments like “[a type iv transsexual] Intensely desires relations with normal male as “female,” if young. Later, libido low. May have been married and have children, by using fantasies in intercourse” (not that “using fantasies in intercourse” is an especially credible explanation for someone whose supposedly exclusively homosexual, “kinsey 6”)
However, there are still some interesting things in The Transsexual Phenomenon which are still relevant. Benjamin describes auto-eroticism along lines similar to autogynephilia and recognizes the relationship to transvestism and homosexuality (though he doesn’t approach it in a very empirical way so he doesn’t provide a very useful for it). Benjamin recognizes that transsexuality is heterogeneous and needs to be classified in several types rather then a single condition.
I think the most interesting part of his book is a discussion of different motivations for having sex reassignment surgery. Two of the motives he gives, a “sexual” and “social” motive are found in young transsexuals; the sexual motive being that srs facilitates sex with straight male partners and the social motive being that living as female increases the social status of mtf’s who have “conspicuous feminine physique, appearance, and manners” who would be embarrassments as males. These are motivations that have nothing to do with “internal gender identity” that give homosexual transsexuals a very good reason to want to live as female and have srs. Benjamin also identifies a “gender” motive in “older transsexuals” who feel “imprisoned” in their male bodies, which would appear to be consistent with the internal motive that autogynephilic transsexuals claim.
This section can be found here
When reading The Transsexual Phenomenon it’s important to keep in mind of course that it was written in 1966 and while a significant early contribution, it’s really mostly descriptive using unproven hypothesis to frame a disorder without making a systematic empirical study of it.

The relationship of male transsexual typology to psychosocial adjustment. Johnson SL, Hunt DD. Archives of Sexual Behavior. 1990 Aug;19(4):349-60.
Abstract online

From the Abstract:

“In a search to uncover variables predictive of psychosocial adjustment of male transsexuals, this study examined features which have been empirically linked to characteristics of male transsexual typology Valid and reliable scales measuring the typological variables of erotic partner preference (androphilia and gynephilia), cross-gender fantasy in association with sexual arousal (cross-gender fetishism), and degree of feminine gender identity in childhood were used. Results indicate a significant relationship between social gender reorientation and the feature of androphilia and between work adjustment and gynephilia.”

Comments: This study found a difference in homosexual and non-homosexual types (which it terms androphilic and gynephilic) in terms of adjustment in social life and work. The typology is basically the same as has been discussed, recognizing the associated features of cross-gender fetishism and childhood gender variance which are recognized as features of the non-homosexual and homosexual type respectively.

A typology of transsexualism: gender identity theory and data. Bentler PM. Archives of Sexual Behavior. 1976 Nov;5(6):567-84.
Abstract online

From the Abstract:

An analysis of postoperative data obtained from 42 male-to-female transsexuals showed them to fall into three distinct categories: homosexual transsexuals, asexual transsexuals, and heterosexual transsexuals Additonal data further differentiated these groups and suggest that the categorization is theoretically meaningful and relevant to understanding the causes and course of the transsexual phenomenon. An extensive developmental theory is suggested to account for both differences and commonalities among the different subgroups of transsexuals, as well as among these and related groups, such as effeminate homosexuality and transvestism.”

Comments: This study on typology recognizes a distinct homosexual transsexual type and two non-homosexual types. This was in 1976 so, it was before additional research firmly established the non-homosexual types as part of a single underlying condition. It should be noted though that while both heterosexual and asexual mtf transsexuals have autogynephilia there are some distinct features between different autogynephilic groups, as was noted in the DSM IV TR’s comment about asexual transsexuals…so the classification of three types instead of two can be understood in that context. This is similar to the Person and Ovesey classification of an effeminate homosexual type, a heterosexual transvestic type, and an asexual type. This study also notes effeminate homosexuality and transvestism as related groups, as did Blanchard’s.

Two clinically discrete syndromes of transsexualism. Buhrich N, McConaghy N. British Journal of Psychiatry. 1978 Jul;133:73-6.
Abstract online

From the Abstract:

The results of this study indicate that they can be differentiated into two clinically discrete groups. In an investigation of 29 transsexuals who sought a change of sex operation it was found that those who had experienced fetishistic arousal were significantly more likely to be older, to have experienced heterosexual intercourse, to be married and to show penile responses to pictures of men and women indicative of a more heterosexual orientation…The fact that desire for a sex change operation may be associated with experience of fetishistic arousal could be one reason for the higher incidence transsexualism in men than in women.

Comments: The three studies by Buhrich and McConaghy (Link to other two studies by Buhrich et al. describing autogynephilia) are really fascinating because they reach essentially the same conclusions under different terminology that Blanchard would ten years later. As in Blanchard’s typology, Buhrich and McConaghy identified an underlying syndrome shared by both non-homosexual transsexuals and heterosexual transvestites, which they termed femmiphilic transvestism (which Blanchard called autogynphilia)…and as in Blanchard’s typology they recognized fetishistic arousal to oneself as a female to be the unifying feature of non-homosexual transsexuality; and they identified a separate homosexual transsexual syndrome that did not have these features. The fact that they would arrive at exactly the same conclusions as Blanchard did, ten years earlier independently of his research, really speaks to how common sensible these ideas are.

Two types of cross-gender identity. Freund K, Steiner BW, Chan S. Archives of Sexual Behavior. 1982 Feb;11(1):49-63.
Abstract online

From the Abstract:

“The results suggest (1) that there are two discrete types of cross-gender identity, one heterosexual, the other homosexual; (2) that transvestism, and closely related conditions of cross-gender identity, occur exclusively or almost exclusively in heterosexuals; (3) that of the two types of transsexualism distinguished in this study, type A is, in heterosexuals, very rare or completely nonexistent; (4) that (in the course of time) transvestites or borderline transsexuals (defined below) may develop sustained cross-gender identity, as observed by Stoller (1971); (5) that although, according to Hoenig and Kenna (1974), transsexualism by itself is not an anomalous erotic preference, it is (virtually) always either preceded by transvestism or accompanied by homosexuality or cross-gender fetishism.”

Comments: This is yet another presentation of transsexual typology which match’s Blanchard’s conclusions only using a different terms for the non-homosexual group. All of these attempts to examine differences within transsexuals recognize the same homosexual group with very consistent features; the non-homosexual group (or groups) are more complicated but are still seen in a similar way with consistent features, such as autoeroticism or fetishism which would be subsequently termed autogynephilia.

Abnormal Psychology and Modern Life (11th Edition). by Robert C. Carson, James Neal Butcher, Susan Mineka
Link to book on Amazon

Amazon.com Product description: “This book has been providing an introduction to abnormal psychology since 1948 and remains the most authoritative survey of abnormal psychology, known for its comprehensiveness, balance of theory and practice, strong research base, and clinical sensitivity.” From the Text [on transvestic fetishism]:

“Blanchard (1989, 1992) has termed the psychological motivation of transvestites autogynephilia: paraphilic sexual arousal by the thought or fantasy of being women (Blanchard 1991, 1993). The great sexologist Magnus Hirschfeld first identified a class of cross-dressing men who are sexually aroused by the image of themselves as women: “They feel attracted not by the women outside them, but by the woman inside them” (Hirschfeld, 1948, p.167). The vast majority of transvestites are heterosexual (Talamini, 1982). Transvestites may fuse the idea of being a woman with their sexual attractions toward real women in fantasies in which they are engaging in lesbian interactions (Blanchard, 1991). Buckner (1970) formulated adescription of the “ordinary” male transvestite from a survey of 262 transvestites conducted by the magazine Transvestia: He is probably married (about two-thirds are); if he is married he probably has children (about two-thirds do). Almost all of these transvestites said they were exclusively heterosexual – in fact, the rate of “homosexuality” was less than the average for the entire population.” [on transsexualism] “In contrast to female-to-male transsexuals, there are two kinds of male-to-female transsexuals, with very different causes and developmental courses: homosexual and autogynephilic transsexuals (Blanchard, 1989). Homosexual transsexuals might be conceptualized as extremely feminine gay men who also wish to change their sex. In contrast, autogynephilic transsexuals appear to have a paraphilia in which their attraction is to the image of themselves as a woman. This distinction is not currently made in the DSM…is fundamental for understanding the diverse psychology of male-to-female transsexualism…[Homosexual transsexuals] seek a sex change operation in part so that as women they will have the ability to attract heterosexual male partners (Freund al., 1974). Although homosexual transsexuals are attracted to members of their own genetic sex, they resent being labeled gay because they do not feel that they belong to their genetic sex (Adams & McAnulty, 1993). Nevertheless, from an etiological standpoint homosexual transsexualism probably overlaps with ordinary homosexuality…Homosexual transsexuals generally have gender identity disorder from childhood…The difference between homosexual transsexualism and cross-gendered homosexuality (that is, homosexuality accompanied by behavior typical of the opposite sex) is probably more in degree than in kind… ..Autogynephilic transsexualism (Blanchard, 1989, 1992) appears to occur only in genetic males, and its primary clinical feature is autogynephilia, a paraphilia characterized by sexual arousal at the thought or fantasy of being a woman (Blanchard, 1991; 1993). Indeed, autogynephilic transsexuals usually report a history of transvestic fetishism, although it is not uncommon for them to deny such a history… Autogynephilic transsexuals may report sexual attraction either to women, both men and women, or to neither…Research has shown that these subtypes of autogynephilic transsexuals are very similar to each other and differ from homosexual transsexuals in important respects beyond their sexual orientations (R. Blanchard, 1985, 1989, 1991). Unlike homosexual transsexuals, autogynephilic transsexuals do not appear to have been especially feminine in childhood or adulthood. Autogynephilic transsexuals typically seek sex-reassignment surgery much later than homosexual transsexuals (R. Blanchard, 1994). The causes of autogynephilic transsexualism probably overlap etiologically with the causes of other paraphilias but as of yet are not well understood…”

Comments: This text book gives a pretty good description of homosexual transsexualism and autogynephilia. Again, this kind of recognition of Blanchard’s typology as fact in major psychological texts shows how widely accepted and mainstream it is.

Autogynephilia: A paraphilic model of gender identity disorder. Lawrence A. Journal of Gay and Lesbian Psychotherapy. 2004 Vol. 8 Numbers 1/2.

Abstract:

Autogynephila is defined as a male’s propensity to be sexually aroused by the thought or image of himself as a female. Autogynephilia explains the desire for sex reasignment of some male-to-female transsexuals. It can be conceptualized as both a paraphilia and a sexual orientation.

Transgendering, Migrating and Love of Oneself as a Woman: A Contribution to a Sociology of Autogynephilia. Ekins R., King D. (2001) Transgendering, Migrating and Love of Oneself as a Woman: A Contribution to a Sociology of Autogynephilia. International Journal of Transgenderism 5,3,
[Text no longer online] Comments:

Can fetishism occur in transsexuals? Buhrich N, McConaghy N. Archives of Sexual Behavior. 1977 May;6(3):223-35.
Abstract online

The clinical syndromes of femmiphilic transvestism. Buhrich N, McConaghy N. Archives of Sexual Behavior. 1977 Sep;6(5):397-412.
Abstract online

From Abstract:

Thirty-four members of a club established for heterosexual transvestites were interviewed. They were categorized into two groups. Subjects in group I were satisfied with cross-dressing and did not desire additional feminization. Subjects in group II desired to alter their bodily appearance toward female by taking female hormones or by having surgical intervention. All subjects showed a period of fetishistic arousal to women’s clothes during adolescence. With increasing age, fetishistic arousal diminished or disappeared and the frequency of cross-dressing increased. Terms in the literature used to describe the type of transvestism reported in this study are discussed

Developmental profile of 200 male and 100 female transsexuals in Singapore. Tsoi WF. Archives of Sexual Behavior. 1990 Dec;19(6):595-605.
Text online

Male and female transsexuals: a comparison. Tsoi WF. Singapore Med J. 1992 Apr;33(2):182-5.
Abstract online

Comments: These two studies by Tsoi show a consistent homosexual development pattern in Singapore in contrast to the non-homosexual Caucasian transsexuals in the United States.

Physical attractiveness of boys with gender identity disorder. Zucker KJ\, Wild J, Bradley SJ, Lowry CB. Archives of Sexual Behavior. 1993 Feb;22(1):23-36.
Abstract online

Abstract:

University students blind to group status rated boys with gender identity disorder and clinical control boys regarding their physical attractiveness. Ratings were made of the face and upper torso from photographs taken at the time of clinical assessment (mean age, 8.1 years). On all five adjectives (attractive, beautiful, cute, handsome, and pretty), boys with gender identity disorder were judged to be more attractive than were the clinical control boys. Attractiveness correlated with extent of behavioral femininity in the clinical control group, but not in the group of boys with gender identity disorder. The extent to which the group differences in attractiveness were due to objective, structural differences in facial attractiveness vs. socially created, or subjective, processes is discussed.

Sexual orientation and boyhood gender conformity: development of the Boyhood Gender Conformity Scale (BGCS). Hockenberry SL, Billingham RE. Archives of Sexual Behavior 1988 Jun;17(3):287.
Abstract online

Gender in homosexual boys: some developmental and clinical considerations. Isay RA. Psychiatry. 1999 Summer;62(2):187-94.
Abstract online

Psychosocial and erotic development in cross-gender identified children. Zucker KJ. Canadian Journal of Psychiatry. 1990 Aug;35(6):487-95.
Abstract online

Childhood cross-gender behavior and subsequent sexual preference. Green R. American Journal of Psychiatry. 1979 Jan;136(1):106-8.

Gender identity in childhood and later sexual orientation: follow-up of 78 males. Green R. American Journal of Psychiatry. 1985 Mar;142(3):339-41.
Abstract online

Retrospectively measured individual differences in childhood sex-typed behavior among gay men: correspondence between self and maternal reports. Bailey JM, Nothnagel J, Wolfe M. Archives of Sexual Behavior. 1995 Dec;24(6):613-22.
Abstract online

Comments: These studies are a sampling of the many many studies that establish a very clear relationship between childhood gender non-conformity and homosexuality. The vast majority of boys who could warrant a cGID diagnosis and are otherwise very gender variant do not become transsexuals, they grow up to be normal gay men. Likewise non-homosexual transsexuals did not typically have nearly so pronounced cross-gender behavior as children.

Taxometric analyses of sexual orientation and gender identity. Gangestad SW, Bailey JM, Martin NG. J Pers Soc Psychol. 2000 Jun;78(6):1109-21.
Abstract online

From abstract:

Taxa are nonarbitrary classes whose existence is an empirical question and not a matter of mere semantic convenience. Taxometric procedures detect whether numerical relations between purported indicators of conjectured taxa bear the hallmarks of true taxa. On the basis of theoretical considerations, the current study tested whether taxa underlie sexual orientation and related measures of gender identity… An understanding of the origins of these latent taxa may be important to understanding the development of sexual orientation and gender identity.

Gender-related traits in gay men, lesbian women, and heterosexual men and women: the virtual identify of homosexual-heterosexual diagnosticity and gender diagnosticity. Lippa RA. J Pers. 2000 Oct;68(5):899-926.
Abstract online

From Abstract:

Three studies investigated the relationship between gender-related traits and sexual orientation. Study 1 showed that gay men and lesbians in an unselected sample of 721 college students differed from same-sex heterosexuals most strongly on gender diagnosticity (GD) measures, which assess male- versus female-typicality of interests (effect sizes of 2.70 for men and .96 for women) and least strongly on measures of instrumentality (I) and expressiveness (E)…Using data from Studies 2 and 3, “gay-heterosexual diagnosticity” measures were computed for men and “lesbian-heterosexual diagnosticity” measures for women, based on occupational and hobby preferences. These measures correlated very strongly with GD measures

Sexual orientation of female-to-male transsexuals: a comparison of homosexual and nonhomosexual types. Chivers ML, Bailey JM. Archives of Sexual Behavior. 2000 Jun;29(3):259-78.
Abstract online

From the Abstract:

“Homosexual and nonhomosexual (relative to genetic sex) female-to-male transsexuals (FTMs) were compared on a number of theoretically or empirically derived variables. Compared to nonhomosexual FTMs, homosexual FTMs reported greater childhood gender nonconformity, preferred more feminine partners, experienced greater sexual rather than emotional jealousy, were more sexually assertive, had more sexual partners, had a greater desire for phalloplasty, and had more interest in visual sexual stimuli… These findings indicate that FTMs are not a homogeneous group and vary in ways that may be useful in understanding the relation between sexual orientation and gender identity.”

Comments: A lot of people have asked us about FTM analogues to the MTF typology. I don’t think there is any reason why the homosexual/non-homosexual typology that makes empirical sense in MTF transsexuals should be able to be extended, in any way to FTMs. There is no intuitive reason to think that for instance young butch lesbian’s would have exactly the same things to gain by transitioning that female looking effeminate gay boys would; especially given the sociological differences in gay and lesbian populations and their relationship to the heterosexual population, as well as limitations of FTM surgeries and psychological and sexual differences. There is even less reason to think that non-homosexual FTMs (who are far rarer then non-hsts mtfs) would have some kindof analogous disorder to autogynephilia, like a theoretical “autoandrophilia.” Just because something like “autoandrophilia” might seem conceptually possible doesn’t mean that it nessissarily exists in any real empirical sense the way autogynephilia can be shown to. However it’s interesting to see that in this study there actually were some parallels to MTF typology.

Sexual differentiation of the bed nucleus of the stria terminalis in humans may extend into adulthood. Chung WC, De Vries GJ, Swaab DF. J Neurosci. 2002 Feb 1;22(3):1027-33.
Full text online

From the Abstract:

“A limbic structure of special interest in this regard is the sexually dimorphic central subdivision of the bed nucleus of the stria terminalis (BSTc), because its size has been related to the gender identity disorder transsexuality. To determine at what age the BSTc becomes sexually dimorphic, the BSTc volume in males and females was studied from midgestation into adulthood…we found that the BSTc was larger and contains more neurons in men than in women. However, this difference became significant only in adulthood, showing that sexual differentiation of the human brain may extend into the adulthood.”

Comments: Dick Swaab’s earlier study which found that BSTc volumes in mtf transsexuals were a similar volume to those in females rather then those in males, is widely held by the “transgender community” to be scientific proof that these transsexuals, even late transitioning ones who functioned as males for decades, have “female brains.” This older BSTc study was the only scientific foundation for their argument insisting that they are “really women” on some fundamental level from the beginning and that there is only one etiology of mtf transsexual. Well, as it turns out the same researcher who led the team who did the original study, Dick Swaab, found more recently that BSTc volume is in fact not a pre-natal sex marker at all but a part of the brain that differentiates in adulthood so it would seem like the “female” size of the transsexuals BSTc region was merely the effect of hormone replacement therapy and in no way suggested any irregularities in pre-natal hormones.

Gender differences in behaviour: activating effects of cross-sex hormones. Van Goozen SH, Cohen-Kettenis PT, Gooren LJ, Frijda NH, Van de Poll NE. Psychoneuroendocrinology. 1995;20(4):343-63.
Abstract online

From the Abstract:

“The relative contribution of organizing and activating effects of sex hormones to the establishment of gender differences in behaviour is still unclear. In a group of 35 female-to-male transsexuals and a group of 15 male-to-female transsexuals a large battery of tests on aggression, sexual motivation and cognitive functioning was administered twice: shortly before and three months after the start of cross-sex hormone treatment. The administration of androgens to females was clearly associated with an increase in aggression proneness, sexual arousability and spatial ability performance. In contrast, it had a deteriorating effect on verbal fluency tasks. The effects of cross-sex hormones were just as pronounced in the male-to-female group upon androgen deprivation: anger and aggression proneness, sexual arousability and spatial ability decreased, whereas verbal fluency improved. This study offers evidence that cross-sex hormones directly and quickly affect gender specific behaviours. If sex-specific organising effects of sex hormones do exist in the human, they do not prevent these effects of androgen administration to females and androgen deprivation of males to become manifest.

Comments: This study is sort of odd because when Goozen and Cohen-Kettenis and Gooren did a similar study with only homosexual transsexuals they found evidence of an organizing effect but no activating effects…This might suggest that there are in fact activating effects of hormone therapy in non-homosexual transsexuals and those activating effects were what they saw in this study, since a mixed group of both hsts and non-hsts transsexuals if sufficiently large should show statistical correlations related to either group; but that frankly would seem pretty hard to explain unless it was based on some kindof a placebo effect relevant to non-hs transsexuals (who often think that taking hormones will substantially change their psychology). Non-homosexual transsexuals frequently attribute major personality shifts to hormones and shifts in their sexuality. However, this group of researchers was not able to replicate these results in mtf transsexuals in a later study they did looking at long term hormone effects (though they did replicate their findings in ftm transsexuals) so it’s hard to know what to make of these results…especially with a sample size of only 15.

Organizing and activating effects of sex hormones in homosexual transsexuals. van Goozen SH, Slabbekoorn D, Gooren LJ, Sanders G, Cohen-Kettenis PT. Behav Neurosci. 2002 Dec;116(6):982-8.
Abstract online

From the Abstract:

“The hypothesis that atypical prenatal hormone exposure could be a factor in the development of transsexualism was examined by establishing whether an atypical pattern of cognitive functioning was present in homosexual transsexuals. Possible activating effects of sex hormones as a result of cross-sex hormone treatment were also studied…The data were consistent with an organizing effect, but there was no evidence of an activating effect. Homosexual transsexuals, who prior to hormone treatment scored in the direction of the opposite sex, may have reached a ceiling in performance and therefore do not benefit from activating hormonal effects.”

Comments: Not so much to explain here…it is consistent with the self-reported experience we’ve heard from homosexual transsexuals who say they haven’t experienced noticeable psychological changes from hormones as are often reported by non-homosexual transsexuals. This study is also of note just for treating homosexual transsexuals as a distinct population, when similar studies have often been mixed in regard to type. It would probably be hard to find meaningful results in this type of experiment without differentiating between homosexual and non-homosexual transsexuals (or, as in this case only examining one) given the different etiologies.

Birth order and sibling sex ratio in two samples of Dutch gender-dysphoric homosexual males.Blanchard R, Zucker KJ, Cohen-Kettenis PT, Gooren LJ, Bailey JM. Archives of Sexual Behavior. 1996 Oct;25(5):495-514.
Abstract online

From Abstract:

Subjects in Study 1 were Dutch, adult and adolescent, biological male patients with gender dysphoria (persistent and recurrent desires to belong to the opposite sex), who were undergoing treatment with feminizing hormones. These comprised 83 patients who reported sexual attraction to other males (the homosexual group) and 58 who reported sexual attraction to females or equal attraction to males and females (the non-homosexual group)…The homosexual group consisted of 21 gender-dysphoric homosexual teenagers referred to a gender identity clinic for children and adolescents. The control group were 21 adolescent males referred to the child psychiatry department of the same hospital for reasons other than gender identity disorder, homosexuality, or transvestism…In Study 1, the homosexual group had a significantly elevated sibling sex ratio;..These studies add to the mounting evidence that late birth orders are common to all homosexual samples and that elevated sibling sex ratios are an additional characteristic of extremely feminine ones.

Neuroendocrine response to estrogen and sexual orientation. Gladue BA, Green R, Hellman RE. Science. 1984 Sep 28;225(4669):1496-9.
Full text online

From the Abstract:

A neuroendocrine component, the positive estrogen feedback effect, thought to be related to sexual orientation and, indirectly, to sexual differentiation, was evaluated in healthy, noninstitutionalized research volunteers The secretory pattern of luteinizing hormone in the homosexuals in response to estrogen was intermediate between that of the heterosexual men and that of the women. Furthermore, testosterone was depressed for a significantly longer period in the homosexual men than in the heterosexual men. These findings suggest that biological markers for sexual orientation may exist.”

On the LH response to oestrogen and LH-RH in transsexual men. Dorner G, Rohde W, Schott G, Schnabl C. (1983) Exp Clin Endocrinol. 1983 Nov;82(3):257-67. PMID: 6317420
Abstract online

From the Abstract:

“In male rats, androgen deficiency during a critical period of sexual brain differentiation was shown to give rise to a predominantly female-differentiated brain… In addition, they exhibited a sex-specific evocability of a positive oestrogen feedback effect…in homosexual transsexual men, an intravenous injection of 20 mg Presomen (Premarin) produced a significant decrease of serum LH levels followed by a significant increase above the initial LH values. In hetero- or bisexual transsexual men, by contrast, intravenous oestrogen administration, while producing a significant decrease of serum LH levels, was not followed by an increase above the initial LH values.”

Neuroendocrine response to estrogen and brain differentiation in heterosexuals, homosexuals, and transsexuals. Dorner G. Archives of Sexual Behavior. 1988 Feb;17(1):57-75.
Abstract online

From the Abstract:

“Since 1964, we have found positive estrogen feedback to be a relatively sex-specific reaction of the hypothalamo-hypophyseal system in rats as well as in human beings. It is dependent on the estrogen-convertible androgen level during sexual brain differentiation and also on estrogen priming in adulthood…the evocability of a positive estrogen feedback was also demonstrable in most homosexual male-to-female transsexuals in significant contrast to hetero-or bisexual male-to-female transsexuals, The following relations have been found between sex hormone levels during brain differentiation and sex-specific responses in adulthood: (i) Estrogens, which are mostly converted from androgens, are responsible for the sex-specific organization of gonadotropin secretion and hence the evocability of a positive estrogen feedback in later life; (ii) both estrogens and androgens, occurring during brain differentiation, predetermine sexual orientation, and (iii) androgens, without conversion to estrogens, are responsible for the sex-specific organization of gender role behavior.”

Sexual differentiation of gonadotrophin secretion, sexual orientation and gender role behavior. Dorner G, Docke F, Gotz F, Rohde W, Stahl F, Tonjes R. J Steroid Biochem. 1987;27(4-6):1081-7.
Abstract online

Comments: These study suggest a physiological difference between homosexual and non-homosexual transsexuals…the difference of course being because homosexual transsexuals are biologically speaking homosexual males and homosexual males appear to have a different response to estrogen then heterosexuals…though there are other studies that appear to confirm these findings (in homosexual men) there are also studies which have found other variables responsible for the effect (though that doesn’t exactly account for statistical differences between groups) so in any case it’s hard to know what to make of it. It is good to note though that these studies assume the homosexual/non-homosexual typology.

Typology of male-to-female transsexualism. Blanchard, Ray. Archives of Sexual Behavior. Vol 14(3) Jun 1985, 247-261.
Abstract online

From the Abstract:

“This study tested a prediction derived from the hypothesis that asexual and bisexual transsexualism are actually subtypes of heterosexual transsexualism. Two questionnaires measuring erotic attraction to males and females were administered to 163 male-to-female transsexuals. A cluster analysis of their scores divided the Ss into 4 groups: heterosexual, homosexual, bisexual, and asexual. Fisher Exact tests were used to compare the frequency with which Ss in the 4 clusters reported a history of erotic arousal in association with cross-dressing. As predicted, there were no differences among the asexual, bisexual, and heterosexual transsexuals, and all 3 groups included a much higher proportion of fetishistic cases than the homosexual group. Findings support the view that male transsexuals may be divided into 2 basic types: heterosexual and homosexual.”

Comments: This study was quite significant because it showed empirically that bisexual asexual and heterosexual transsexuals were likely part of the same clinical phenomenon as their test scores cluster together and apart from the homosexual transsexuals. The non-homosexual transsexuals further have a history of erotic arousal while cross dressed in a much higher proportion then the homosexual group; findings that would be confirmed and replicated many times as a reliable difference between the two clinical clusters with implications for non-homosexual transsexual etiology: specifically the underlying condition of autogynephilia.

Social desirability response set and systematic distortion in the self-report of adult male gender patients. Blanchard, Ray; Clemmensen, Leonard H; Steiner, Betty W. Archives of Sexual Behavior. Vol 14(6) Dec 1985, 505-516.
Abstract online

From the Abstract:

“Subjects were administered the Marlowe-Crowne Social Desirability Scale and 8 measures that tapped various features of the clinical history commonly given great weight in differential diagnosis. Results indicate that the tendency for a heterosexual S to describe himself in terms of moral excellence or admirable personal qualities was significantly correlated with scores in the transsexual direction on all 8 sexological measures. For the homosexual subjects, only 1 correlation was significant. Because, in this population, the socially desirable presentation is feminine, it is suggested that the differences in the histories produced by transvestites and heterosexual transsexuals are exaggerated to an unknown degree by the motivation of the latter to obtain approval for this operation. The need for caution in interpreting the self-report data among these groups is stressed.”

Comments: This study demonstrates that heterosexual transsexuals systematically distort their histories, making them appear more ‘feminine’ than they were from an objective perspective. These types of results are a good reason to question the accuracy of some of the convictions about their past as well as self-report data that’s impossible to verify. Blanchard Clemmensen and Steiner interpret this as being motivated by fear that they’d be denied surgery approval for surgery, and that could certainly be part of it but I think there are clearly other factors at work as well. Transvestic fetishism is no longer considered an indicator against surgery for transsexuals and, moreover it’s no secret among clinical psychologists that their non-homosexual transsexual patients experience it…but they still tend to represent themselves as being much more “classically transsexual” then they actually are and deny or desperately attempt to explain features of themselves or their past which contradict this image.

Michael Bailey offered this explanation:

“There is one more reason why many autogynephiles provide misleading information about themselves that is different than outright lying. It has to do with obsession. Something about autogynephilia creates a need not only to enact a feminine self, but also to actually believe in her. It seems important to them to emphasize the permanence of the feminine self as well as her primacy: “I was always feminine, I just managed to hide it. I became a green beret as a defensive response to my femininity”(2001, pg 175)

I think this is one of the best explanations for how autogynephilia causes transsexuals distort things. It’s not a deliberate lie but something they feel like they have to believe in order to be true to themselves, or rather to be true to the imaginary aspect of themselves that they’re erotically interested in developing.

Phallometric detection of fetishistic arousal in heterosexual male cross-dressers. Blanchard, Ray; Racansky, I. G; Steiner, Betty W.Journal of Sex Research. Vol 22(4) Nov 1986, 452-462.

From the Abstract:

“We examined whether an erotic response to cross-dressing fantasies could be detected in heterosexual male cross-dressers (HCDs) who verbally denied any erotic arousal in association with cross-dressing for at least the past year. Subjects were 37 HCD patients (mean age range 29.1-36.2 yrs) and 10 heterosexual controls (mean age 23 yrs). Penile blood volume was monitored while subjects listened to descriptions of cross-dressing and sexually neutral activities. All HCD groups responded significantly more to cross-dressing than to neutral narratives, controls did not.

Comments: This study shows that even heterosexual transsexuals who deny autogynephilia still experience autogynephilic arousal that can still be demonstrated. It also shows that autoeroticism from autogynephilic fantasies is not arousing to heterosexual male controls (I know that seems obvious but I’ve actually heard people argue that it is), that the detection method they used works.

Heterosexual and homosexual gender dysphoria. Blanchard, Ray; Clemmensen, Leonard H; Steiner, Betty W. Archives of Sexual Behavior. Vol 16(2) Apr 1987, 139-152.
Abstract online

From the Abstract:

“New referrals to a university gender identity clinic were dichotomously classified as heterosexual or homosexual. The heterosexual males reported that their first cross-gender wishes occurred around the time they first cross-dressed, whereas the homosexual groups reported that cross-gender wishes preceded cross-dressing by 3-4 yrs. Some history of fetishistic arousal was acknowledged by over 80% of the heterosexual males, compared to fewer than 10% of homosexual males and no homosexual females. Results suggest that males are not differentially susceptible to gender dysphoria per se, but they are differentially susceptible to one of the predisposing conditions, namely, fetishistic transvestism.”

Comments: This study repeated Blanchard’s 1985 results finding that transvestic arousal (later termed autogynephilia) correlates very strongly with sexual orientation, that it is a feature of non-homosexual transsexualism (called heterosexual here).
It should also be pointed out that the 10% of “homosexual” males who reported fetishistic arousal does not mean that some etiologically homosexual transsexuals experience autogynephilia or that autogynephilia and exclusive homosexuality can co-exist. Any study that sorts on the basis of self-identification will always have a portion of etiologically autogynephilic transsexuals included in the ‘homosexual’ group. This is because pseudo-androphilia, interest in males as part of an autogynephilic fantasy, rather then homosexual physical attraction to males, is a fourth apparent “sexual orientation” for autogynephilic transsexuals in addition to heterosexual (to women), bisexual and asexual self-identified orientations. The fact of ‘bisexual’ and ‘asexual’ variants of autogynephilia predicts a variant that is apparently homosexual (though in arousal patterns heterosexual) variant as well; some autogynephilic transsexuals use men in sexual fantasies not as the principle erotic object but to complete a sexual fantasy of themselves as female, and when they’re also interested in other women they’re apparently ‘bisexual’, whereas autogynephilic transsexuals who are entirely focused on their own inner feeling of ‘femaleness’ and no other partners are ‘asexual’ (this was later established in another study by Blanchard, The concept of autogynephilia and the typology of male gender dysphoria in 1989) It would seem very plausible that an autogynephilic transsexual with symptoms of both, the pseudo-androphilia of the bisexuals and the lack of interest in other women in the asexuals, would be apparently ‘homosexual’ though etiologically an autogynephilic transsexual and not a homosexual one.

In a study in 1992 called Nonmonotonic relation of autoygnephilia and heterosexual attraction Blanchard found very compelling evidence that autogynephiila is a self directed form of male heterosexuality; so exclusive homosexuals would not be able to experience it because it requires a physical attraction to females, femininity, and the female body which they lack. It also makes sense that no female to male transsexuals would report fetishistic arousal because there is not a document female equivalent of autogynephilia in males. Still, given that the heterosexual group can be presumed to be entirely autogynephilic and the homosexual group would be assumed to have a relatively small minority of etiologically autogynephilic transsexuals, the results can still be statistically significant so as to demonstrate the reality of the difference; just not absolute as they might have been with a different sorting method.

Likewise, the fact that 20% of the heterosexual transsexuals did not report fetishistic arousal does not mean that these transsexuals did not experience autogynephilic arousal. As was shown in the 1986 study Phallometric detection of fetishistic arousal in heterosexual male cross-dressers and the 1985 study Social desirability response set and systematic distortion in the self-report of adult male gender patients heterosexual transsexuals do not always accurately report their erotic interests so one would not expect them to all acknowledge fetishistic arousal even if they all experienced it.

A test of the DSM-III–R’s implicit assumption that fetishistic arousal and gender dysphoria are mutually exclusive. Blanchard, Ray; Clemmensen, Leonard H. Journal of Sex Research. Vol 25(3) Aug 1988, 426-432.
From the Abstract:

This study sought to determine the proportion of adult, of adult, male, heterosexual cross-dressers who acknowledge both gender dysphoria and at least occasional fetishistic response to cross-dressing. Subjects were 193 outpatients of the gender identity clinic or behavioral sexology department of a psychiatric teaching hospital who were surveyed on current level of gender dysphoria and their recent history of sexual response to cross-dressing…About half of even the most strongly gender dysphoric Subjects reported becoming sexually aroused or masturbating at least occasionally when cross-dressing. These findings indicate a need for revision in the DSM III-R’s diagnostic criteria for transvestism and gender identity disorders, which presuppose that gender dysphoria and fetishistic, reactions are mutually exclusive.

Comments: This study helped to demonstrate that transvestic fetishism and ‘gender dysphoria’ in heterosexual biological males are not mutually exclusive conditions as the DSM-III-R implied. The current DSM currently has this positioned revised and now includes transvestic fetishism with specifies of gender dysphoria and states that non-homosexual’s with what it calls Gender Identity Disorder likely have transvestic fetishism or have had it in the past.

Nonhomosexual gender dysphoria. Blanchard, Ray. Journal of Sex Research. Vol 24 1988, 188-193.
Abstract online

Full Abstract:

Tested the hypothesis that asexual, bisexual, and heterosexual transsexualism are akin to one another and to transvestism, whereas homosexual transsexualism has a different etiology. 16 men of each type were compared as to age at which they first presented for assessment and self-reported degree of childhood femininity. Data support the hypothesis.

Comments: This was another study showed that non-homosexual (heterosexual, bisexual, and asexual) transsexuals reported more gender conforming childhoods, and presented for treatment older then homosexual transsexuals, but had no statistical differences between them.
A presentation covering this study and Blanchard’s 1985 “Typology of male-to-female transsexualism” and his 1989 study The concept of autogynephilia and the typology of male gender dysphoria

Prediction of regrets in postoperative transsexuals. Blanchard R, Steiner BW, Clemmensen LH, Dickey R. Can J Psychiatry. 1989 Feb;34(1):43-5.
Abstract online

From the Abstract:

This study investigated whether heterosexual males are more likely to regret sex reassignment surgery than homosexual males or females… Subjects’ feelings about surgery were assessed with self-administered questionnaires. None of the 61 homosexual females or 36 homosexual males consciously regretted surgery, compared to 4 of the 14 heterosexual males: a significant difference. This finding suggests that heterosexual applicants for sex reassignment should be evaluated with particular caution, although a heterosexual preference is not an absolute contraindication for surgery.

Comments: This study shows that non-homosexual transsexuals are significantly more likely to regret having surgery than homosexual transsexuals.

The classification and labeling of nonhomosexual gender dysphorias. Blanchard, Ray. Archives of Sexual Behavior. Vol 18(4) Aug 1989, 315-334.
Abstract online

From the Abstract:

This report suggests systematic strategies for the descriptive classification of nonhomosexual gender identity disorders, based on clinical observations and research findings…A review of cross-gender taxonomies shows that previous observers have identified and labeled a homosexual type far more consistently than any other category of male gender dysphoric. It is suggested that the apparent difficulty in differentiating reliably among the nonhomosexual types results from the sharing of many overlapping characteristics by the various groups. This is supported by a review of informal, mostly clinical, observations and by the findings of three studies designed to test the hypothesis that the nonhomosexual gender dysphorias, together with transvestism, constitute a family of related disorders in men. Two recommendations. are offered for the classification of male gender dysphorics in research studies. When the number of subjects is small, they may be classified simply as homosexual or nonhomosexual. When the number is larger, the nonhomosexual cases may be classified as heterosexual, bisexual, or analloerotic (unattracted to male or female partners, but not necessarily devoid of sexual drive or activities).

Comments: This report by Blanchard argues that non-homosexual transsexuals can be grouped together for research purposes, that they are related disorders unrelated to homosexual transsexualism. This grouping seems to have been adopted by a good deal of research studies.

The concept of autogynephilia and the typology of male gender dysphoria. Blanchard, Ray. Journal of Nervous & Mental Disease. Vol 177(10) Oct 1989, 616-623.
Abstract online

From the Abstract:

This study tested the hypothesis that all gender-dysphoric males who are not sexually aroused by men (homosexual) are instead sexually aroused by the thought or image of themselves as women (autogynephilic). Subjects were 212 adult male-to-female transsexuals. These were divided into four groups; one homosexual and three nonhomosexual. l. The three nonhomosexual groups were heterosexual, bisexual, and analloerotic (unattracted to male or female partners, but not necessarily devoid of all erotic behavior). A Core Autogynephilia Scale was developed to assess a subject’s propensity to be sexually aroused by the fantasy of being a woman…As predicted, all three nonhomosexual groups were more likely than the homosexual group to report sexual stimulation by cross-gender fantasy. This finding supports the hypothesis that the major types of nonhomosexual gender dysphoria constitute variant forms of one underlying disorder, which may be characterized as autogynephilic gender dysphoria.

Comments: This is really one of Blanchard’s most important studies. While Blanchard had shown in the past that transvestic arousal correlates to sexual orientation this study was able to identify the significance of those findings and demonstrates the existence of a more general sexual interest in oneself as female in non-homosexual transsexuals beyond transvestic fetishism. This study introduces the term ‘autogynephilia’ as the underlying sexual disorder common to transvestites and non-homosexual transsexuals, whether heterosexual or apparently bisexual or asexual.

Clinical observations and systematic studies of autogynephilia. Blanchard, Ray. Journal of Sex & Marital Therapy. Vol 17(4) Win 1991, 235-251.
Abstract online

From the Abstract:

“The term autogynephilia denotes a male’s paraphilic tendency to be sexually aroused by the thought or image of himself as a woman. This term subsumes transvestism as well as erotic ideas or situations in which women’s garments per se play a small role or none at all. This review article presents clinical examples of the lesser known types of autogynephilia (i.e., those in which the element of cross-dressing is secondary or entirely absent), sketches earlier attempts to label and conceptualize these phenomena, summarizes recent quantitative studies exploring the relationships between autogynephilia and other psychosexual variables (e.g., heterosexual attraction), and speculates on the etiology of autogynephilia and its relationship to transsexualism.”

Comments: This case report discusses types of autogynephilia other than transvestic fetishism. Men with autogynephilia more interested in possessing a female body rather then wearing female clothes for instance, are more likely to have gender dysphoria then those who are only interested in the transvestic aspects (though men interested in having female physicality are typically also transvestic). There is also a type of autogynephilia with an interest in being in a female behavior including social behavior, not to facilitate other goals and as a perceived social advantage as in homosexual transsexuals, but as something desirable in of itself as part of an erotic interest in being female.

Sibship size, sibling sex ratio, birth order, and parental age in homosexual and nonhomosexual gender dysphorics. Blanchard R, Sheridan PM. J Nerv Ment Dis. 1992 Jan;180(1):40-7.
Abstract online

From the Abstract:

This study investigated whether demographic variables previously reported to differentiate ordinary homosexuals from heterosexuals also differentiate gender-dysphoric homosexuals from gender-dysphoric persons with other sexual orientations. Subjects were outpatients aged 16 and older who were referred by physicians to a specialty clinic for the assessment of gender identity disorders. The subjects were divided into three groups: 204 homosexual women, 193 homosexual men, and 273 nonhomosexual men; the last category included men sexually attracted to females, to both sexes, and to neither sex… A multiple-range test at the .05 level showed that the homosexual men had significantly more siblings than the homosexual women, who, in turn, had significantly more siblings than the nonhomosexual men. The sibling sex ratio of the homosexual men, 131 brothers per 100 sisters, was significantly higher than the sex ratio of live births for the population as a whole (106 men per 100 women; p = .01); the sibling sex ratios of the other groups did not differ from the expected value. he homosexual men had a significantly later birth order than the nonhomosexual men (p = .004);.. The results concerning sibling sex ratio and birth order are consistent with previous findings for homosexual men.

Comments: This study tests Blanchard’s results concerning sibling ratios in homosexual men with homosexual transsexuals. As in similar studies homosexual transsexuals can be differentiated along the same variables that other homosexual biological males can.

Birth order in transgendered males from Polynesia: a quantitative study of Samoan fa’afafine. Poasa KH, Blanchard R, Zucker KJ. J Sex Marital Ther. 2004 Jan-Feb;30(1):13-23
Abstract online

From the Abstract:

In previous research, a late birth order has been shown to be a characteristic of Western homosexual transsexual men. To date, however, it is not clear if a late birth order is specific to Western transsexuals or may be a characteristic of non-Western transgendered males as well. We quantified birth order in a sample of 13 transgendered males known as fa’afafine from Samoa. On average, the fa’afafine were late born, both with regard to number of older brothers and number of older sisters, although the effect appeared to be somewhat stronger with regard to number of older brothers.

Nonmonotonic relation of autogynephilia and heterosexual attraction. Blanchard R. J Abnorm Psychol. 1992 May;101(2):271-6.
Abstract online

From the Abstract:

In this study I investigated the relation between normal heterosexual attraction and autogynephilia (a man’s propensity to be sexually aroused by the thought or image of himself as a woman)…The data were questionnaire measures of autogynephilia, heterosexual interest, and other psychosexual variables. As predicted, the highest levels of autogynephilia were observed at intermediate rather than high levels of heterosexual interest; that is, the function relating these variables took the form of an inverted U. This finding supports the hypothesis that autogynephilia is a misdirected type of heterosexual impulse, which arises in association with normal heterosexuality but also competes with it.

Comments: This is a really fascinating study. It confirms the hypothesis that Blanchard suggested in earlier papers that autogynephilia is a misdirected, a self directed, form of normal male heterosexual attraction towards women. This makes sense because autogynephilic transsexuals, apart from their unusual sexuality and gender dysphoria, otherwise resemble other heterosexual men. Knowing that autogynephilia is a type heterosexual impulse and not a fetish or another sort of pathology also has tremendous implications in terms of understanding the precise way that autogynephilia works.

Varieties of autogynephilia and their relationship to gender dysphoria. Blanchard R. Arch Sex Behav. 1993 Jun;22(3):241-51.
Abstract online

From the Abstract:

The relationship between gender dysphoria and autogynephilia (erotic arousal in men associated with the thought or image of themselves as women) was investigated. Subjects were 238 nonhomosexual male outpatients divided into three groups: 94 reporting they were most aroused sexually by images of themselves as nude women, 67 most aroused by images of themselves as women in underwear, and 77 most aroused by images of themselves as fully clothed women. The Nude group was significantly more gender dysphoric than the Clothed group, which, in turn, was significantly more gender dysphoric than the Underwear group. These results support the hypothesis that those nonhomosexual men most aroused sexually by the thought of having a woman’s body are also those most interested in acquiring a woman’s body through some permanent, physical transformation.

Comments: This study shows how autogynephilia can motivate non-homosexual men to have sex changes. The fact that the group with fantasies focused on having their full bodies female (rather then just dressed or in underwear) would also be the most unhappy with their gender and most want to change sex shows that non-homosexual men can see transitioning as a way of fulfilling their autogynephilic sexual desires. If autogynephilia was instead a ‘symptom’ of something broader such as ‘gender identity disorder’ as is often argued by non-homosexual transsexuals uncomfortable with the idea of it as the prime if not sole motivation for transition, one would not expect to find differences in the gender dysphoria of the three groups based on their fantasies. That’s to say, if gender dysphoria caused autogynephilia (mysteriously in non-homosexual but not homosexual bio-males) one would expect the type of preferred autogynephilic fantasy to have no relation to the intensity of the dysphoria; but if it were the other way around and autogynephilia caused gender dysphoria one would expect the types of autogynephilic fantasies hardest to complete in a male body nessessitating transsexualism to have a significant correlation with the degree of gender dysphoria, as is the case. So, these findings by Blanchard point to autogynephilia not only as a correlated variable to non-homosexual transsexuality but as a cause of non-homosexual transsexuality. These findings are consistent with Blanchards 1991 paper Clinical observations and systematic studies of autogynephilia.

Comparison of height and weight in homosexual versus nonhomosexual male gender dysphorics. Blanchard R, Dickey R, Jones CL. Arch Sex Behav. 1995 Oct;24(5):543-54.
Abstract online

From the Abstract:

The authors’ clinical impression that homosexual gender-dysphoric males are physically smaller than nonhomosexual gender-dysphoric males was tested. Subjects were 176 homosexual and 246 nonhomosexual male outpatients, ages 16 to 65, who complained of discontent with their biological sex. Compared with the nonhomosexual male gender dysphorics, the homosexual gender dysphorics were shorter, lighter, and lighter in proportion to their height. The homosexual gender dysphorics were also shorter than men in the general population, whereas the nonhomosexual gender dysphorics were not.

Comments: Homosexual and non-homosexual transsexuals look very different physically. This can probably be accounted for by homosexual transsexual’s self selection for passability as females, that they’re unlikely to attempt it if they don’t think they’d be more socially acceptable and romantically desirable to men as female then male, which is an example of the major etiological and motivational differences between homosexual and non-homosexual transsexuals. Since non-homosexual transsexuals will transition despite a mannish appearance as their motivation is internal and their sexuality values being approximately female more then having a partner, they do not do this same self selection so they have a typical male appearance.

Kavanagh v. Attorney General of Canada

This is a court case, obviously, not a journal publication or a book, but I decided to include it anyways because it involved experts in the field and a discussion of typology.
Text online

From the Text:

“[18] Male heterosexual transsexuals tend to be masculine in appearance, and do not ordinarily have a history of early feminisation. These individuals develop an attraction to female anatomy, specifically female anatomy on themselves. Heterosexual transsexuals or “autogynephiles” are attracted to women, and become lesbians after sex reassignment surgery. In contrast, homosexual male transsexuals tend to be more highly feminized than heterosexual transsexuals, and manifest feminine characteristics and symptoms of Gender Identity Disorder earlier in life. Male homosexual transsexuals remain “androphilic”, or attracted to men, after sex reassignment surgery.” “A. Physical Risk to Other Prisoners [100] Dr. Watson’s suggestion that pre-operative male to female transsexuals would pose little physical risk to female prisoners was addressed by several of CSC’s witnesses. Dr. Dickey, Dr. Hucker and Ms. Petersen all disagree with Dr. Watson’s statement that most male to female transsexual inmates are attracted to men: To the contrary, they say, the majority of transsexuals in federal prisons are actually attracted to women. It takes serious criminal activity to qualify a person for a federal prison sentence in Canada. According to Dr. Dickey and Ms. Petersen, homosexual transsexuals do not generally have the degree of aggressiveness or psychopathy necessary to get them into a Canadian federal prison. The transsexuals that Dr. Hucker has encountered in the correctional setting tend, he says, to be “more ambiguous” in their sexual orientation… Dr. Dickey, Dr. Hucker and Ms. Petersen all say that they would be very concerned about putting a pre-operative male to female heterosexual transsexual inmate in a women’s prison, given the risk that the inmate would prey on female prisoners.”

Changes in the sexual orientation of six heterosexual male-to-female transsexuals. Daskalos CT. Archives of Sexual Behavior. 1998 Dec;27(6):605-14.
Abstract online

From the Abstract:

“Researchers traditionally have assumed that sex reassignment procedures do not change sexual orientation. Of 20 transsexuals of various types that were interviewed 6 heterosexual male-to-female transsexual respondents reported that their sexual orientation had changed since transitioning from male to female… The respondents explained the changes in their sexual orientation as part of their emerging female gender identities… It did not appear that the respondents’ post-transitional sexual attractions towards males were similar to autogynephilic images and fantasies described by Blanchard (1991).”

From the Text: “Sexual orientation is recognized as an important demarcation among transsexuals, implying fundamental behavioral and developmental differences among them (Blanchard et al., 1987)…The respondents were assigned to two groups, homosexual and nonhomosexual, based upon their original sexual orientation as suggested by Blanchard (1989) and their biological sex (e.g. homosexual male-to-female transsexual). The nonhomosexual group contained 13 subjects, 12 heterosexual male-to-female respondents and 1 heterosexual female-to-male respondent. The homosexual group contained 7 subjects, 4 homosexual male-to-female respondents and 3 homosexual female-to-male respondents 6 respondents reported that their sexual orientation had changed during this time. These 6 respondents were heterosexual male-to-female transsexuals; 4 were postoperative and 2 were preoperative at the time of the study. Before their transitions from male to female, these subjects remembered having been sexually oriented towards females. (…) Five of the 6 had been married to heterosexual women.
” “Jane, a postoperative transsexual, had been married to Richard for about 6 years at the time she was interviewed. They had met at a meeting of a social support group for heterosexual cross-dressers (…) One postoperative respondent named Sherri had met Scott at a meeting of a social support group for heterosexual cross-dressers. Sherri and Scott became romantically involved after Sherri began to live as a woman full time (…) One postoperative heterosexual male-to-female respondent whose sexual orientation changed from woman to man reported that she had not been involved in any sexual activities with men since transitioning (…)” “Five of the 6 respondents, whose sexual orientation had changed, reported that their pretransitional sexual orientation towards females was an attempt to conform to traditional masculine gender role expectations. Sherri’s explanation for her previous sexual orientation went as follows: “No, I was always attracted to women [before transitioning]. This is where you can make the mind fit the situation. The mind is a wonderful thing, you can make it work or not work.”
The 6 respondents explained that their posttransitional sexual orientation to males represented an aspect of their female gender identities which they could not express or did not know existed before transitioning.”
“As Sherri related: They [the hormones] gave me the emotions to go with the feelings and let the true emotions come out because before [the transition] I wasn’t attracted to guys but then again how much of this was society? I couldn’t be attracted to a guy when I was a guy because that would make me gay. The way that I look at myself now is that I am a normal heterosexual female with slight lesbian tendencies.
” “Luann recalled having sexual thoughts involving males before transitioning: There were times before I transitioned when I thought I was maybe gay because I was actually having some thoughts of other guys like in high school and that. Until I realized I wasn’t having gay thoughts, I was having male to female thoughts but I was thinking of being with the guys as a female.” “Some heterosexual male-to-female transsexuals reported a decrease in their sexual desire [in response to hormones] but no such decrease was reported by any of the homosexual male-to-female respondents.”

Comments: Despite the author’s claim that these non-homosexual transsexual’s sexual orientation did not appear to be from autogynephilia, the actual descriptions given by his subjects in the paper are entirely consistent with the autogynephilic pseudo-androphilic orientation described by Blanchard. All six of the non-hsts in his study who changed self reported orientation, said that the attraction was as part of their female gender identity; in other words, their interest in males depended on them being female. This is consistent with a type of sexuality were the males are accessories to their autogynephilia and not an independent sexual interest (otherwise why would that interest depend on being female?). Luann for instance, realized she wasn’t gay when she recognized that her sexual thoughts about men were only about being a female with a man and not the man himself…which is a perfect example of the pseudo-androphilic aspect often found in autogynephilia that Blanchard described.

The five of the six who reported that their pre-transition sexual orientation was a result of trying to conform to expected gender role is not at all consistent with closeted homosexuals trying to conform to their gender role because they are aware of their sexuality, they simply try to hide it. They never claim to have been genuinely heterosexual even if they were married, often having affairs with men on the side.

It’s also interesting to note that some of their descriptions of their sexuality are not directly sexual but rather talk about things like “true emotions.” Further, looking at the six subjects who supposedly changed sexual orientation, one of them has never had any sexual activity, another two were in relationships with other transgendered men, two had never gotten physical or had any sort of relationship with a man, and only one seemed to be living in something resembling a heterosexual partnership (with a man from church…who didn’t want sex). Considering that five of the six were married to women, this wouldn’t seem to be the best showing for post-transition “heterosexuality”, in fact it would be hard to believe that their sexual orientation to men was as conventionally significant as their sexual orientation to women.

So, despite the author’s claim, this study actually shows a pattern of sexual development consistent with autogynephilia and similar to the bisexual population Blanchard studied. One of the good things about this study though is that it made its homosexual and non-homosexual groupings based on original sexual orientation rather then self-reported orientation at the time of the study, which is important because as this study indicates, non-homosexual transsexual’s perceived sexual orientations can shift including pseudo-androphilic types.