Autogynephilia and Autoandrophilia in
Non-Sex and Gender Dysphoric Persons

Paper presented at the World Association for Sexual Health conference, Sydney, 15-21 April, 2007,

By Dr Tracie O'Keefe DCH

Abstract

This paper qualitatively reviews 10 cases of people who presented to the author, over a period of 30 years, with autogynephilia (males who superimpose psycho-imaginary female body images upon themselves during sexual fantasy) and autoandrophilia (females who superimpose psycho-imaginary male body images upon themselves during sexual fantasy) without showing any signs or minimal signs of sex or gender dysphoria. The participants are evenly divided into five females and five males who have both short and long-term cross-sex self-identification during sexual fantasising.

Since the publication of Ray Blanchard's paper (1989) suggesting that transsexual males suffered from a mental illness, namely a misdirected sex drive, Anne Lawrence (1999) and J Michael Bailey (2003) have joined him in this hypothesis. Blanchard's autogynephilia/transsexualism model was based solely in the medical research methodological paradigm that sought pathological etiology as opposed to anthropological, sociological or sexological explorations of wellness. The international sex and gender diverse community, however, hotly contested that transsexualism and transgenderism are necessarily paraphelias or mental aberrations but more likely sex and gender variations in nature and nurture.

In qualitatively profiling and analysing these 10 persons, it clearly demonstrates that the links between primary or secondary sex or gender dysphoria, autogynephilia and autoandrophilia may at times only be incidental rather than causative. These cases further show that such cross-sex body fantasising exists in the general population who do not desire to undergo any form of real-life bodily alteration or engage in any everyday cross-gender social presentation activities. This shows that previous research, based on the observational premise of perceived pathology into the concepts of autogynephilia and autoandrophilia, were likely to have been monoculturally biased research.

Three keywords: auto-gynephilia/androphilia, transsexualism, transgenderism.

Introduction

Autogynephilia and autoandrophilia have become controversial concepts over the past twenty years or so since the publication of Blanchard (1989) and he has published other papers on the subject. Autogynephilia is the psychoimaginary imposition of a vagina upon the self by a male during sexual fantasisation. Autoandrophilia is the self-psychoimaginary imposition of a penis attached to a female's body during sexual fantasiation. Further to this, it is an excitation of the self as the opposite biological sex.

In Anne Lawrence's paper presented at the 1999 Harry Benjamin International Gender Dysphoria Association (HBIGDA (now the World Professional Association For Transgender Health) WPATH) Conference she proposed that many transsexual people experienced autogynephilia prior to a sex and gender transition. Her self-reporting participants for her study were taken from the transsexual community that she accessed via the internet and a magazine article she wrote. Each of those participants had stated that before they had had a sex and gender transition from male to female they had found the idea of having a vagina erotically exciting and stimulating.

In 2003 Bailey published his book The Man Who Would Be Queen and extensively quoted Blanchard as he reported his studies of transsexual people born male but who sought to transition to female. His book was very unpopular in the international gender community because it depicted transitioning transsexual women as being men with an out-of-control sexual fetish which was partly autogynephila.

Many other authors have addressed this subject over the past hundred years, from Hirschfeld to Benjamin but within this paper I will refer to the three more recently published works of Blanchard, Lawrence, and Bailey.

Aims

This study sets out to extend the concepts of autogynephilia and autoandrophilia beyond its outdated exclusive associations with gender dysphoria. The author further seeks to elucidate, by publishing these ten cases, that some earlier studies that considered autogynephilia were largely the result of methodological constructs; and failed to observe the general population and the presence of autogynephilia and autoandrophilia in the general populous.

Method

This qualitative study of ten people was carried out over a period of thirty years. Information was collected in a narrative form directly by the author from the participants themselves with the author making notes during or shortly after the interviews. Some of the participants were psychotherapeutic patients of the author who had sought out the author specifically knowing of her experience in human sexology. Other participants were people who had been made known to the author through special interest groups based around unusual sexual practices; and whom the author had approached for them to grant an interview and discuss their autogynephilia/androphilia. All participants were willing participants in the study, each designated a pseudonym to protect their identity, and were happy to contribute towards the author's ongoing research into human sexual behaviour.

Participants

Robert
Robert consulted me along with his wife in London because they had both been "on a bender" as he called it, having spent several months taking cocaine, ecstasy and partying at the weekends. He felt they needed to get some balance back in their lives. He was fifty one years old and very successful in computers, having amassed a considerable wealth.

He had suffered some secondary impotency due to the over use of cocaine and other drugs. He had been married to his wife for fifteen years had no children and no desire to have children since he felt that it would cramp his lifestyle. Both he and his wife were promiscuous in that they had a long history of being "swingers", having sex with other couples and swopping sex partners. Together both he and his wife used the services of sex workers and had a long history of being into the bondage and the fantasy sex scene.

In talking about his sex life Robert disclosed that sometimes his wife penetrated him anally with sex toys and he indulged in the fantasy of being the helpless female partner subject to her predatory will. On further investigation it became clear that this fantasy was solely limited to sex acts and he never consciously had the fantasies at other times. Nor had he ever entertained any real-life ideas about becoming, living as or wanting to be female.

At no time did he ever fantasise about his wife being male. His fantasy was about his wife with a penis penetrating him and dominating him as a helpless female.

Clair
Clair was Robert's wife who had a career in which she was very successful in her own right. She was financially independent with her own company. She had met Robert through a business meeting some seventeen years ago. She commented that they had clicked immediately and she considered him her soulmate as well as her husband. Like Robert she had absolutely no interest whatsoever in having children.

In separate interviews Clair talked about her own sexual fantasies of sometimes wanting to play out the role of being a man in bed. She enjoyed having sex as a woman with men but also particularly enjoyed living out her sexual fantasy of being male with a penis. She was a self-declared bisexual who, apart from having sex with Robert and other couples, would also go off to visit female sex workers herself.

She particularly enjoyed the fantasy of raping someone else. This was generally played out with female sex workers who would be accommodating and compliant with the fantasy to her satisfaction. The only male she carried out this sex fantasy with was her husband Robert and at the time of penetrating him she said she clearly envisioned herself as a man with a penis, dominant, powerful and aggressive.

Clair was quite clear that although she might run these fantasies in her mind they were just sexual fantasies. She had never wanted to become a man in any way whatsoever outside of the specific living out of the sexual fantasy. She was a very feminine woman, well coiffed and manicured and very proud of her female body. Any idea of ever becoming a man in life was completely ludicrous and laughable to her and she made it quite plain that she was all woman apart from her sexual fantasy of raping as a man.

Thomas
Thomas was a working-class fifty-eight-year-old man who had been married for twenty seven years and had three grown-up children who had left home. He described his wife as very narrow-minded and although they had no religious convictions he reported they were both typical suburbanites. He had not had sex since his wife went into menopause ten years earlier, after which time she totally refused any of his sexual advances.

He said that he had always cross-dressed since he was a small child with spasmodic intermittent remissions. During masturbation his fantasies turned to being penetrated vaginally by males as he played out the part of a beautiful woman. He confided that he thought in reality he probably looked rather ridiculous dressed as a female.

I was the first person he ever told about his activities. As he had been out of work recently with a lot of time at home his dressing and fantasisation had increased considerably. He always keep a secret stash of female clothes and was afraid because of the recent increase in his activities that his wife might come home and discover him dressed up. He was also very confused because he had been going through the internet and had gained the impression that he might be displaying signs of gender dysphoria and he was absolutely sure that he would never want or could have what he called a sex change.

During therapy I encouraged him to pursue his activities if they gave him so much pleasure but to be very careful that his wife did not become aware of them. He had been adamant that neither his wife nor his family would ever accept or tolerate his activities and at his age he did not want to end up divorced and living alone. He took considerable reassuring that he showed no signs of sex or gender dysphoria but once he accepted that, he was happy to carry on with his activities and fantasise in private.

Adam
Adam had sought help to undergo a sex and gender transition and after several months of counselling and a trial two-month period of oestrogen it became very clear that he was unsure about the whole process of transition. A further complication was that he suffered from a high level of obsessive compulsive disorder (OCD) which had manifested itself for many years as checking tasks several times repetitively. Whilst he held down a teaching job and gave private tuition, much of his time was consumed by his OCD rituals for which he had taken several psychiatric medications over the years.

At twenty seven years old he had been an exclusively gay man who met many other men for sex through small ads in magazines, internet dating and often engaged in casual sex. He was also exceptionally insecure about his physical appearance and greatly prone to high levels of stress. His recent sex history had been that he had only been having sex with men when cross-dressed as a female and remarked that there were a great deal of men who were very eager to have sex with him in those circumstances. For more than two years he had enacted the passive role during sex and played out his fantasy of being a female-bodied person.

As therapy progressed he began to disclose that he had never been very confident as a gay male and never felt attractive. He was, it seemed, using female embodying in order to procure sexual partners who found his female enactment very exciting. He said at some level he believed that perhaps both he and many of his partners were repressed gay men who could not quite deal with having gay identities. Hormones were ceased by mutual agreement and he commenced therapy to try to come to terms with being a gay man.

Claude
This extremely wealthy fifty-nine-year-old man was a highly educated European banker from a privileged background. He was married with two grown-up children and the whole family lived in an exclusive tax haven from which Claude travelled frequently on business to many different parts of the world. Both he and his wife had their own sex lives which were in no way seen as any kind of threat to their long-established and stable marriage.

On business Claude travelled the world and visited many professional sadomasochistic establishments generally run by mature mistresses who were very well experienced dominatrixes. His sexual fantasy was to be treated and dressed up as the suberserviant maid of those mistresses and punished. He had a very clear list of requirements that he should be spanked and caned on the back of the legs, handcuffed and humiliated, and even penetrated anally whilst being told that he was the naughtiest girl in the world and the worst waitress.

The whole of his fantasy experience with those dominatrixes was not only about him being treated as female during the domination session but also about them treating his body as female. Claude said that because he daily dealt with millions of dollars and so much responsibility was expected of him in the business world it was a relief for him to play the most subservient of females. Like most aristocrats he considered his sex life to be nothing to do with his wife and family and showed absolutely no desire whatsoever to change anything at all about his life or his body.

James
James was a fourteen-year-old boy who was sexually adventurous far beyond his years. He had secretly started his sex life at eleven years old and explored it with many different partners who, according to his reporting had believed he was above the age of consent. Although he was working-class he had access to funds because he had three part-time jobs, the money from which he regularly used to discreetly visit sex workers.

On one occasion two months before interview he had visited a dominatrix who had dressed him as a female sex slave and made him play the submissive role during sex games. She had made him play out the same role five more times during an eight-week period. He said that he had very much enjoyed being her bitch for the afternoon, making him extremely sexually aroused to the point where he allowed another of her male clients to have anal intercourse with him whilst James was dressed as a female.

James talked about these encounters at a sexual health drop-in centre because he was confused whether it would make him want to become a woman if he continued. He was certain he enjoyed the encounters and even enjoyed sex with the man but came to the conclusion that it was really the intense attention that he had been paid that made him keep going back. He shortly developed an interest in another woman with whom there was no subservient role-playing and his confusion of the encounters seemed to be resolved.

Suzie
A wholly feminine petite women Suzie presented as a typical heterosexual twenty-five-year old professional accountant. There was nothing at all masculine about her. She had been in a relationship with her boyfriend for two and a half years. She had found her fantasies during sex, particularly visualisations and kinesthetic imagination, about her having a penis very distressing. This had never been disclosed to anyone before, least of all her boyfriend.

In looking at Suzie's life it was clear that she had played the role of the good girl, daughter and fianc?e, always following the expected life path set out for her by others. This had built up a considerable amount of internalised anger and frustration inside which she sublimated and felt she was unable to express within her normal environment. She also dreaded her impending marriage which she felt would trap her into a constrained life from which she would not be able to escape.

During psychotherapy Suzie decided to split up with her boyfriend and leave her parents' home to try and explore who she was and what might be available to her from life in a wider world. The penis fantasies that only happened during sex did not diminish but she was quite sure that it had nothing whatsoever to do with her experiencing sex or gender dysphoria or wanting to be a man.

Julia
This highly educated and enormously well read forty-eight-year-old woman "queer identified dyke" (participant's words) lived alone but was in a very rewarding successful two-year relationship with a woman of her own age. She also reported that she had slept with men and very much enjoyed the experience. Julia was overweight, suffered from sleep apnea, sometimes took antidepressants and had a history of long-term depression although at interview she was managing life well. She had undergone long-term therapy with a psychiatrist who she visited from time to time and reported that therapy had been very successful.

Julia talked about how as a child she had one much older sister and two brothers nearer in age. She felt that her mother had been a complex weak person and she described her mother's attitude towards her as ambivalent. She was very much aware that her father treated her as another son and believed that male energy was the most valued identity within the family's psychodynamics.

When Julia was younger she had felt disappointed that she had not been a boy, often passing as a boy and being pleased by that. She had imagined having a penis and said if she had access to male hormones she might have considered taking them. Over the past ten years she had put on considerable weight and grown larger breasts. When asked if she was happy being woman she replied, "I am happy in this body and I am certainly much happier being a woman than I used to be and I suppose that's part of me evolving as a person. There are times when I am uncomfortable with my body but I do not think I would be any happier in a male body."

Julia enjoyed sex games with her female partner where they both fantasised about being males, wearing strap-on dildos. Her description of this was, "It is not that we want to be men. We are enjoying as part of our rich and varied sex lives fantasy games that involved exploring male energy through homoeroticism and I can do that because I am now powerful as a female."

Sheila
Shelia described herself as "a twenty-three-year-old confused bisexual with a big question mark". She was presently in a relationship with a long-term boyfriend and they had lived together for two years. She was also having secret affairs with women without the boyfriend's knowledge. She found the affairs all very exciting but did not want her boyfriend to find out because she feared it would severely damage his confidence.

She described her heterosexual sex life as plain vanilla with the occasional bit of adventure where she was virtually always passive. She found her elicit affairs with women, however, very raunchy and she always played the dominant role, often role-playing herself as having a penis and behaving almost like a man. She commented, however, that, although she imagined having a penis, wearing a strap-on and having sex with women with it, there was still part of her that wanted the sex to be lesbian sex because that was part of what got her excited.

She said, "I am unsure I'm cut out to be a lesbian because I don't really know what it entails. At least this way I'm not really committed because I'm not a woman having sex with a woman but a woman half pretending to be a man having sex with a woman. Because I'm not seeing a man, I don't think I'm cheating on my boyfriend. We have agreed that he should not see other women and I should not see other men - he never said anything about women. I know I'm playing a really complex and dangerous game but that's what turns me on."

Yanula
Yanula had little regard for men. Sexually she preferred women but as an upmarket high-priced dominatrix in her forties, who made a great deal of money from fulfilling men's sexual fantasies coming into contact sexually with men every day of her working life. Her working apartment was set into several different fantasy-themed rooms including fully equipped sado/masochistic dungeons and torture rooms. All her contact with men was with her in a dominating role. She had grown up in a small village with her uneducated, unmarried mother experiencing the other children often being cruel to her because she was in a religious culture that saw her as illegitimate.

During sadomasochistic fantasy games with men, when she was the "mistress", she would often tie them up, place them in restraints, blindfolded and gagged them and anally rape them with a strap-on dildo. These were men that had come to her to be dominated and to play out their own fantasies of being subservient.

She commented, "Yes they are my bitches, darling. They want me to take them and if they don't I often take them anyway. I'm the mistress and the master and sometimes the mistress with a dick. I do enjoy taking them and making them my bitches. It's their fantasy and let's be honest I'm playing out a fantasy of mine too. What woman wouldn't want to turn her mans head to the pillow, when she's mad with him, and do to him what he does to her. And no I don't ever want to be a man but I do like having a dick sometimes and using it."

Analysis
In reviewing the ten cases we can see that autogynephilia and autoandrophilia is a different experience for each person. For some people it involves the imaginary superimposition of genitals of another sex in place of their own genitals during sex. For other participants the fantasies extended to other parts of their body in addition to genitalia and involve a temporary personality transformation. In some participants it manifested adjacent to transvestism; in others not, and there are plainly no hard and fast rules.

For some participants this fantasisation was restricted to only some sexual encounters but for others it was a more permanent feature of their sex life. For the majority of participants the fantasisation did not necessarily spill out into the rest of the person's life but for some it could get out of control and be disturbing at times.

In the case of Julia part of her early life experience of autoandrophilia was interlinked with a sense of sex and gender dysphoria but that does not seem to have been the case for the rest of the participants. Later in life, however, when Julia began to accept her female body more wholly, the gender dysphoria diminished and she enjoyed the experience of autoandrophilia as part of sexual fantasisation.

Also for Adam the autogynephilia had gotten out of control and he had associated himself with having sex and gender dysphoria when he was in fact running away from accepting being a gay male. His confusion was further exacerbated by the presence of his OCD traits. At the time of presentation his OCD attachment was connected with sexual fantasies of being a woman during sex. As psychotherapy progressed he began to accept and become more confident with being a gay man and the sex and gender dysphoria reduced.

For the remaining eight participants the experience of autogynephila or androphilia does not seem to have been always part of their everyday life. For some the experience of autogynephila or androphilia could be without doubt undisturbing. In fact the experience proved to offer a great deal of pleasure to many participants, some more frequently than others. For some participants, however, the experience of autogynephilia or androphilia was at times confusing and could even be perceived as unwelcome.

There can be little doubt from the comments and self-descriptions of many participants that autogynephilia/androphilia had a great deal to do with power games and role playing within the sexual context. This would also have been an extension of psychodynamics that carry over from their ordinary everyday lives.

Men, particularly highly successful men with a great deal of responsibility, seem to be able to enjoy sexual subservient role-playing and taking up the fantasisation of female embodiment equalling being submissive; and further equaling having a vagina and being penetrated. They seemed to be giving up the pressures of their ordinary everyday lives, treating the experience as a form of relief or time off from being who they ordinarily are.

In men fulfilling such subservient roles through autogynephilia it may mean giving up total control and being almost natal once again, having someone else make their decisions for them. For other men it may be what could be called reverse domination where the subservient act of autogynephilia is in fact a passive aggressive role-playing.

In the case of Robert and Clair who were married, the autogynephilia and autoandrophilia seemed to be a dance of role reversal and power brokerage that in some ways stabilised a relationship where both partners could be very dynamic and forceful personalities. Neither one of them seemed to be acquiescing to the other's fantasy but were in a conjoint mutually beneficial sex game.

In Thomas's case the autogynephilia coincided with transvestism but that was not the case with many of the other participants. Being secret about his acts of transvestism and thoughts of autogynephilia may have been a large part of the arousal for him. Sexual secrets often increase arousal by seeking to boost the ego and bolster self-image through the feeling of having got away with something that might be forbidden.

Claude, who is a very successful man seemed to seek relief from his huge business and financial responsibly in his autogynephilia fantasies. He also seemed to seek such role-playing as a form of highly detailed titillation designed specifically to fulfill his own needs.

The adverse seemed to have been true for James who sought youthful sexual adventures and was willing to sample a range of sexual experiences that he sought to learn about from his contact with much more sexually experienced people. We can also see with James, at fourteen years old, a very clear juncture where a behaviour might have taken root and become an adult obsession, accept for the fact that his attention was captured elsewhere with what he perceived as a new adventure.

It was clear that all the women in this study saw autoandrophilia not only as the fulfillment of a sexual fantasy but also as a form of empowerment that they felt they were unable to achieve as ordinary women. For Yanula there also seemed to be an element of revenge in her attitude towards men in that she had been deserted by her father as a child and since that time saw all men as a form of currency. In her acting out her always dominant role with men she appeared to seek security through domination.

For Clair the acquisition of male energy and a part-time penis seemed to be part of her acquired power tools in a business world were men generally dominated. The psychoimaginary penis and its use was almost on an equal with a company car, expense account and corner office with a view.

In Sheila's case the psychoimaginary creation of the penis appeared to be a way for her to deal with her adventures into sexuality with women without having to deal with the concepts of sexual betrayal of her boyfriend. She was not ready to accept her bisexuality so the creation of the penis allowed her to pretend that sex with women was not really lesbian sex at all.

With Suzie the creation of her penis appeared almost like the creation of a mechanism that stopped her from being drowned in a world of mediocrity to which she felt she had been born into by default. It seemed a construct that prevented her from being consumed by her perceived preordained normality.

Julia's early life rejection of her female self, through her therapy with her analyst over the years, had come to be seen in later life as the result of being brought up in male-dominated culture. Further than that she had learnt to embrace both her female and male self concepts and play with those concepts safely within her sexual fantasies with a partner who was fully accepting of that kind of exploration

To say that all the people in this study had never had sex or gender dysphoria would be inaccurate. What can be seen, however, is that autogynephila or androphilia can be experienced without an overbearing sense of those dysphorias and sometimes in the total absence of such dysphorias. Of the participants that had experienced previous sex and gender dysphoria one continued to experience and even enjoy the autoandrophila after such dysphorias had partly or wholly subsided. The other had ceased to experience high levels of autogynephilia after his sex and gender dysphoria had disappeared.

Discussion
It seems likely in light of this study that autogynephilia/androphilia is far more common than current literature depicts. Far from being solely a psychopathology or paraphilia it is likely that many people experience autogynephilia/androphilia as part of their ordinary everyday sexual fantasy lives. For some of those people the experience gave them great pleasure, for some it was confusing and for others it is even disturbing; but what is clear is that each case is bound up with the person's own individual psychodynamics. Those psychodynamics are undoubtedly, as with every person, the results of the person as a whole self and should not be viewed purely in isolation.

Past research and considerations of autogynephilia or androphilia have certainly viewed it as only or mainly a psycopathological defect. This is typical of monocultural research that fails to take into account the qualitative perspectives of each individual and how they might view themselves and their own experiences. Certainly previous research in autogynephilia or androphilia has failed to show the experiences of people who were positive about those experiences free from sex, gender, or even sexuality dysphoria.

Where Blanchard went wrong
Blanchard's (1989) much quoted research can be viewed in the light that it was carried out in a gender identity clinic and that sample of participants were drawn from that client group. The questionnaire he quoted was only administered to patients complaining of sex and gender dysphoria or unwanted transvestism. We can only assume that the transvestism was unwanted because why else would they have been in a gender identity clinic otherwise? He, as a psychological clinician and researcher, was it seems seeking to sort, sift and identify pathologies that, as he saw it, may be contributory or concomitant factors towards sex and gender and sexuality dysphoria. It is clear that he sought to reduce all transsexualism is to homogenised reductionist concepts, one of which was autogynephilia.

It is well known that many patients presenting themselves to gender identity clinics often do not tell the clinicians their true experiences for fear that those truths may prevent them going forward for sex and gender realignment (O'Keefe 1999). Since the emergence of gender identity clinics, often attached to universities' research faculties, many people who applied for sex and gender transition have been refused treatment. That has become a pattern within the past forty years that drives many clients presenting at such clinics to tell the clinicians and researchers what they think they want to hear and in Blanchard's research that may have been compliance to his modus operandi of simplifying pathologisation.

Blanchard undoubtedly started his research with the very underlying philosophy that autogynephilia/androphilia was a psychological and sexological defect, namely a pathological narcissism that interfered with normal heterosexual functions. In Canada where he operated people were unable to get the government-funded help of any kind for sex and gender transition unless it was viewed as pathology. Both clinicians and clients probably joined in a folie ? deux that saw sex, gender and any sexuality diversity, and any associated experiences as pathological. In order to secure funding, people often avoid open, honest self-exploration of sexuality and patients purposefully and repeatedly tell clinicians and researchers what they think they want to hear.

Blanchard's study was based on a strictly bipolar male/female paradigm to examine and explain human experience. To see the human condition and behaviour as only heterosexual, homosexual bisexual or asexual is unenlightened. People are sexual and clusters of sexual stimuli can be triggered by all manner of fantasies that would not be pathological except for narrow monocultural interpretations. In the case of Canada, to a large extent, it would have included a Judeo/Christian element that historically saw only heterosexual males as healthy men.

The whole structural problem with Blanchard's study is that he attempts to quantitatively analyse the psychodynamic drivers of sexual fantasisation for 302 participants. This kind of reporting suffers from all the quantitative methodological complexities and deficits of sieving soup through the kind of net used in the goalmouths of a football pitch. The apertures are plainly far too wide and ineffectual. Had this study included women and autoandrophilia been qualitatively explored it is likely that the effect of feminism would have rendered the study quantatively ineffectual. Blanchard's constant references to all the transsexual females as their registered birth sex shows how he has failed to get to grips with even the very basic psychological tenets of transsexual or transexed psychodynamics.

It is well known that many women in the lesbian culture have been male embodying via sexual fantasy since time immemorial. Had Blanchard considered the act of playing "butch" and the frequent acts of autoandrophilia that are often part of lesbian sex play, he might have had to reconsider his approach to the study of autogynephilia and seen it more as a part of natural sexual fantasisation and less of a psychological pathologisation to be catalogued in a far too reductionist way to explain the phenomenon.

The photographer Del La Grace Volcano (1999) has been well known for his work of capturing images of biological females who play on the borders of sex and gender differentiation. Part of those acts are about gender challenging but part are sexually autoandrophilia. To be fair to Blanchard he was very much a statistician being trained in laboratory work and at the time of his research probably had very little awareness of the intellectual and monocultural isolation he was constructing into his study.

His tentative links of autogynephilia exclusively to types of transsexualism or transvestism furthermore show a far too reductionist perspective towards the overwhelming richness of people's sexual fantasy lives. It is psychology by numbers, unscientific and dismissive that human nature as well as nurture can not be reduced to a simple statistical binary coding.

So did Blanchard prove what he set out to prove? According to his results he claimed that transwomen who were attracted to men were generally focused on the erotic experience of being interactive with their partner's male body. He also proposed that transwomen who were attracted to women were really sexually aroused by focusing on fantasising about their own bodies as female.

It obviously never occurred to Blanchard that women who have sex with women might be more in touch with their own sexual pleasures derived from their own bodies. The fact that those lesbians might be transsexual was far beyond his abilities to comprehend because he was still thinking of those people as men. Lesbians and bisexual women may be more sexually narcissistic because they are less likely to be waiting for a man to complete them.

Blanchard seemed unaware that as human beings we are all sexually narcissistic and if we were not then we would not be able to be sexually aroused because there would be no self to interact sexually. Ego determines that during sex we assume an identity and play out our internal fantasies. Those fantasies are sexual drivers, not necessarily pathological sexual interrupters or inhibitors as Blanchard proposed. Therefore for transwomen being autogynephilic would be them simply embracing their identities.

Blanchard also further ignored that a considerable amount of women are analerotics or lesbians who are "butching", and he seemed totally oblivious, as the author's study shows, to non-sex and gender dysphoric people who can experience autogynephilia/androphilia.

Anne Lawrence on a Mission and Misunderstood
When Lawrence presented her paper (Lawrence, 1999)) at the HBIGDA 1999 conference in London it was not well received by members of the gender community. The author can verify that because the author was present at the paper's delivery. The core premise of her research was that some transsexual people (her research was exclusively autogynephilia) transition because of excited sexual fantasies about themselves as another sex. For many years sex and gender rights campaigners had fervently fought against the popular notion that transsexualism was primarily about sexual motivation. Many campaigners at that time were trying to reclassify transsexualism as an intersex condition. At the time Lawrence's paper was seen as threatening that progress and she received short thrift by many members of the gender community. Those campaigners specifically did not want their fight for social and legal recognition to be sabotaged by transsexualism once again being categorised as a matter of sexual perversion when they were trying to have it reclassified as an intersex condition.

Transsexuals, transsexed, and sex and gender diverse people over the past fifty-plus years have suffered horrendous discrimination leading to violence, and economic and social ostracisation because transsexualism was classified by psychiatry as a sexual perversion (Diagnostic Manual of Mental Disorders (DSM III & IV). Transsexualism's presence in the DSM has generally caused more problems for the trans community than it ever solved by using medicalisation as a social get-out-of-jail-free card but trapping it into pyschopathology.

Lawrence, however, was very candid that her research had been motivated by the fact that when she transitioned from male to female she herself experienced autogynephilia. Consequently she sought out others who had made the same journey to see if they had also had the same experience. During Lawrence's explorations on the internet, and in response to a magazine article she wrote, she did find such people but many people misinterpreted the results of her study. They believed that she was trying to say that this sexual fantasisation was the cause of transsexualism: all she was really trying to say was that some transsexuals experienced cross-sex embodiment which was sexually exciting to them. Of that group she also found men who wanted to change their bodies to female because it was sexually exciting but did not want to change gender roles.

In many aspects Lawrence's study was one of the first times such transsexuals had been recorded as openly talking about their sexual fantasisation of pre-transition cross-sexed excitation for their own bodies. Up until then the sexual lives and sexual fantasisation of such transsexuals had rarely been reported academically except in psychoanalytical terms that saw such fantasies as pathological. Lawrence's downfall, however, was that she angered the gender community because her revelations, when made public, were seen as playing into the hands of right-wing fascists who wanted to pigeonhole all transsexuals as mentally ill sexual perverts.

By using words like paraphelia in her paper, Lawrence angered many transsexual people and there is little doubt she could have communicated her meanings far more clearly to the gender community. She, however, was scientifically astute in her observations but politically na?ve since she had at the time limited experience of mixing in the wider international gender community. There can be little doubt that she was correct that some people make cross-sex alterations to their body for sexual gratification but that perspective was far too facile. The real ramification of altering one's sex or gender is far more complex than sexual gratification and certainly not the only possible accommodation of autogynephilia.

Bailey's Bias
In his book titled The Man Who Would Be Queen (2003) Bailey proposed that the transsexual women he had studied (male to female) were really deluded male homosexuals or autogynephiles. Not only were the autogynephiles excited by their own bodies as females but also he saw that this was a form of self-delusion. It very quickly became clear to the international gender community that Bailey had not done his research and that he was going out on a limb using Blanchard's studies, in an unquestioning and almost adoration-like way, as one of the cornerstone philosophies for his book.

His research received profound criticism internationally that he had started with the premise that transsexual and transexed females were deluded males. He failed to be scientifically objective; had posed to the participants as a registered clinical psychologist when he was not; often sourced his participants from bar workers and street prostitutes, failing to sample an ample social cross-section for the study group. He had promised some of the participants referral letters for surgery when he was not registered to do so. After an extensive enquiry at his university he was demoted and his research has been widely discredited (Conway 2003-2005).

In transsexuals, transexed and intersex people who cross sex identify it would be a normal part of their mental processing to cross-sex fantasise about their genitals if they are transitioning. What is so surprising is that Blanchard, Lawrence, and Bailey found this pathological in the first place.

We do not really know why this happens in all those individuals because we do not truly scientifically know the reasons that such people have the desire to transition because each case is variable and cannot be distilled to the rigour of quantitative analysis. It is generally accepted that sex and gender dysphoric people experience a series of sex, gender and sexuality dysphorias and the vast majority do not simply want to change their identity to satisfy their sexual needs.

One of the major misunderstandings about autogynephilia/androphilia is that clinicians often misinterpret it as evidence of sex or gender dysphoria. In my practice I have observed that some people who experience sex and gender dypshoria do experience autogynephilia/androphilia, but not all. Also some people who experience autogynephilia/androphilia do exhibit sex and gender dypshoria but neither are exclusively linked to the other. As I believe this study discloses it therefore follows that autogynephilia/androphilia is far more common in the general populous than has previously been recorded. Its manifestations should not be necessarily considered a paraphelia unless that behaviour is disturbing to the person themselves or unwanted; but should be embraced as an enriching sexual fantasy.

What this study did not show
This study was not able to show standardised reasons for autogynephilia/androphilia and those may be too complicated to make generalised predictions about because each case needs to be examined on its own merits.

The study did not use standardised mechanisms of observation as some of the participants disclosed their self reporting histories in a couple of interviews. Others observations were derived by the author from psychotherapeutic clients in therapy.

In this study there has been no long-term follow up of participants. The author cannot therefore categorically state that autogynephilia/androphilia might not necessarily convert into transsexual, transexed or sex and gender diverse identities at a later date for the participants but the author found it very unlikely.

Since this was an observational study the author can not predict any future effectiveness of any standardised behavioural modification techniques on the experience of autogynephilia/androphilia.

The author acknowledges that there were participants whose autogynephilia or androphilia was linked to sex and gender dysphoria in this study but felt it was important to include the cases. These cases in themselves, however, show how unreliable autogynephilia/androphilia can be as an indicator of the need to transition sex and gender.

Conclusions
In conclusion this study reviewed the experiences of ten people who experienced autogynephilia/androphilia without an overwhelming sense of sex or gender dysphoria. Many participants had never experienced any form of sex and gender dysphoria, but experienced autogynephila/androphilia, and had no anticipation of ever experiencing sex and gender dysphoria in the future. Although not all participants welcomed the experience of autogynephilia/androphilia, many found the experience undisturbing and even welcomed and took pleasure from those fantasies. The two participants who had experienced sex and gender dysphoria reduced that level of disturbance during some kind of psychotherapeutic or counselling encounters.

Some participants experienced autogynephilia/androphilia as cross-sex genital substitutions during sexual fantasies. Others included the whole body in cross-sex fantasies of themselves as their opposite biological sex. Still further others included role-playing as an innate part of their experience. This study clearly shows that some people experience autogynephila/androphilia as part of their everyday sexual fantasies, whether that be a brief experience or part of a lifelong fixation.

Considering the participants it appears easy to understand the behavioural or psychosocial derivations of those autogynephila/androphilia experiences. This group of people, however, appeared to be different from those who experience long-term extremely severe sex and gender dysphoria and persistently seek to alter their sex and gender characteristics. Without doubt, as the study shows, there are people in the general populous who experience autogynephila/androphilia as part of their normal everyday fantasies, who should not be unnecessarily pathologised.

Recommendations
The reason this researcher decided to publish this study was because so many people over the years, who have experienced autogynephilia or androphilia, have contacted her believing they may well be sex and gender dysphoric, and possibly transsexual. On further interview it often transpired that many of those people were not but simply experienced a cross-sex identification during sexual fantasisation of their own bodies.

At the time of writing this paper there are now some people speaking out publicly who have undergone sex and gender transitions who have regretted their decision after hormone therapy and surgery (Ansley, 28.10.2004). It is imperative for clinicians dealing with transsexual, transexed, androgynous and sex and gender diverse people not to jump to the conclusion that the presence of autogynephilia/androphilia automatically necessitates a sex and gender transition.

There have, however, been cases where autogynephilia/androphilia have been a psychobiological marker of an as yet undetected intersex condition. It would be wise of clinicians to investigate the person's physical and genetic presentation to ensure that there is not an intersex condition present before pursuing any form of intensive psychotherapy.

In cases where autogynephilia/androphilia presents adjacent to sex and gender dysphoria leading to sex and gender transition, clinicians should respect the right of the individual to their experiences. The aim of medicine or psychotherapy should never be to make the client fit the model but to assist the person in creating their own model of wellness.

Unless the person themselves views the experiences of autogynephilia or androphilia as a psychological or behavioural fault or defect, then it would be injudicious and unscientific for the rest of us as clinicians and society to foist detrimental and devaluing judgments upon such experiences.

Many people seem to experience autogynephilia/androphilia as a positive experience and healthcare professionals need to embrace that concept, not detract from what positive experience that may add to that person's life. It is not necessary for us as healthcare professionals to understand all of our clients' experiences, like an over-enthusiastic analyst, but simply to support their good experiences and intervene only when that experience may be disturbing to them and they wish that to change.

For some people autogynephilia/androphilia will be a recurring long-term experience that may not change with therapy. It is advisable in those circumstances to help the client to embrace that part of themselves which may be a natural expression of the psychodynamics of their personality.

Future researchers may like to investigate levels of occurrences of autogynephilia/androphilia, the affects of cultural influences on those figures, long term follow up of persons with those experiences and long term follow up of people who ceased to have such experiences.

Bibliography

ANSLEY, GREG, Man to Sue Over Sex-change Operation. Jerry Leach Counselling, LLC and Reality Resources Publications, 28.10.2004.
http://www.realityresources.com/sue.htm

Bailey, Michael J., The Man Who would Be Queen: The Science of Gender Bending and Transsexualism. Jesph Henry Press, Washington, 2003.

Blanchard, Ray, The Concepts of Autogynophilia and The Typology of Male Gender Dsyphoria. Clarke Institute of Psychiatry, 1989.

Conway, Lyn, An Investigation Into The Publication of J. Michael Bailey's Book on Transsexualism by the National Academies. Copyright @ 2003-2006 by Lynn Conway
http://ai.eecs.umich.edu/people/conway/TS/LynnsReviewOfBaileysBook.html

La Grace Volcano, Del & Halberstam, Judith "Jack", The Drag King Book. Serpent's Tail Publishing, London, 1999.

Lawrence, Anne A., Lessons From Autogynophiles: Eroticism, Motivation, and the Standards of Care. Presented at the 16th HBIGDA Symposium, London, UK August 18, 1999.

O'Keefe, Tracie, Sex, Gender & Sexuality: 21st Century Transformations. Extraordinary People Press, London, 1999.

Diagnostic and Statistical Manual of Mental Disorders. Edition III & IV American Psychiatric Association.

Glossary

Crossdresser - A male who may wear female clothes or a female who may wear male cloths. This is a more liberalised term for transvestism.

Gender Dysphoria - To be unhappy with one's social gender presentation.

Intersex - Someone who is born with the biological markers of more than one sex and may include physical or genetic cross-sex indicators.

Transgender - A person who lives as and may change some parts of their body to represent their opposite biological sex but does not undergo genital sex realignment surgery. Part of their identity is still their original biological sex. This term is also used by the Americans to represent the whole of the trans identity spectrum.

Transsexual - Someone who shows many of the characteristics of one sex but seeks to change their body to represent the opposite biological sex, often including genital sex realignment surgery.

Transsexed - Someone who is transsexual but believes that their identity is partly due to an intersex condition although no obvious biological markers can be found.

Sex Dysphoria - To be unhappy with one's physical primary and secondary sex characteristics.

Sexuality Dysphoria - To be unhappy with one's sexuality.

To watch a video of this presentation, visit the WAS Visual website by clicking on the following link text: Autogynephilia & Autoandrophilia in non-sex & gender dysphoric people

BACK TO MAIN PAPERS & ARTICLES PAGE

©O'Keefe & Fox Industries 2007