Autogynephilia
A New Way of thinking About the Male to Female Experience
by Barbara F. Anderson, Ph. D., LCSW
Anne Lawrence, M.D., an MtoF physician in Seattle, introduced me to the concept of autogynephilia at the August 1999 HBIGDA International Conference and she has informed my thinking on the subject of transgenderism since then.
Autogynephilia, which literally means "love of oneself as a woman," refers to the experience of some MtoFs who are aroused by the thought of themselves as a woman. Ray Blanchard, Ph. D., first wrote of this in 1991 when he suggested that some males who seek sex reassignment also experience sexual arousal when crossdressing or involved in cross-gender fantasy. He raised the possibility that "these individuals have a sexual problem -- a paraphilia -- with or without an associated gender problem." His work on the subject appeared in The Journal of Sex and Marital Therapy, and perhaps because this publication is not widely read by professionals in the gender field, it received little notice.
Dr. Lawrence, motivated in part by her own subjective experience as well as the spirit of scientific inquiry, has revisited this issue and done some preliminary research on the frequency of autogynephilic feelings in self-identified MtoFs seeking or having accomplished sex reassignment treatment and procedures. She concluded that autogynephilia is a significant factor in the above population and that access to hormones and SRS is an appropriate treatment "in both psychopharmacologic and existential terms." But because she sees autogynephilia as a sexual rather than a gender disorder, she does not believe that the Real Life Experience required by the Benjamin Standards of Care is relevant to their treatment. While for some individuals the RLE presents no obstacle as that is their chosen way of life, for others it is an insurmountable impediment due to the inability to pass comfortably, to maintain valued relationships, or to continue successfully in a developed career path. Therefore, she suggests that there be no expectation, let alone requirement, that the autogynephilic individual live in the feminine gender role prior to or following sex reassignment.
As a psychotherapist and Gender Specialist the concept of autogynephilia provides an answer to many questions that have puzzled me about some of the individuals I have counselled. Having been trained to understand that one of the distinctions between the crossdresser and the transsexual was the presence or absence of erotic arousal to crossdressing, what was I to make of the number of individuals seeking counseling or endorsement letters for hormones or SRS who owned up to such experiences?
Since having been exposed to Dr. Lawrence's thinking I have reviewed my case records and identified a significant portion of individuals who have presented with the above clinical picture. Additionally, many clients, who are as well-informed as any therapist with regard to the symptomatology of Gender Identity Disorder and the requirement of HBIGDA's Standards of Care, were probably skillful enough to avoid describing behaviors that they knew would be seen as casting question on the appropriateness of such a recommendation.
In my current work with clients who present with, or even hint at such a clinical picture, I raise the concept of autogynephilia and when appropriate, share with them one of Dr. Lawrence's papers on the subject. I encourage the client to talk of her transgender and sexual experiences over time, their meaning to her, what about them is troublesome and what is satisfying. I share my concerns surrounding the seriousness of SRS to ameliorate the symptoms of a paraphilia before trying medications known to be helpful in treating obsessive-compulsive symptoms. Lastly, I advise them that the Real Life Experience is still required by the Standards of Care.
Although I have not progressed with any client further than the above protocol, should I find myself working with an autogynephile requesting endorsement for SR who has complied in every way with the SOC as well as attempted to address her paraphilia with less extreme treatments, I would support her in her search for relief of symptoms and endorse SR procedures. Until that time. I look forward to more research and clinical writing on this issue as well as the topic being addressed by HBIGDA.
Comments, questions, rebuttals, arguments are welcomed by the author as well as suggestions for future articles. She can be contacted at: Barbara F. Anderson, Ph. D., LCSW. 1537 Franklin St., Suite 104, San Francisco, CA 94109 Phone: (415) 776-0139, FAX: (415) 441-0936
