"Autogynephilia": a disputed diagnosis
"Autogynephilia" is a sex-fueled mental illness made up by Ray
Blanchard. Blanchard defines it as "a mans paraphilic tendency
to be sexually aroused by the thought or image of himself as a woman." 
Support for this disease model of gender variance is almost nonexistent, limited to a tiny online "autogynephilia" support group with fewer than 40 contributors out of a worldwide population of transwomen numbering in the millions. This support group was taken down in early 2005. The disease was also prominently featured in The Man Who Would Be Queen by J. Michael Bailey and has been heavily promoted by Anne Lawrence, a former anesthesiologist who has taken up "autogynephile" as a personal identity.
One of the key concepts in this model is the premise that everyone who is gender variant can be categorized based on one of two "male" sexual interests: homosexuality or paraphilia.
Among the few people who identify with this term, a significant number do not
think this is what "autogynephilia" means. These people often interpret
the word's Greek etymology quite literally and think it means an innocent and
happy "love of oneself as a woman," or in apposition to a phobia. This is clearly not how the word
is being used in the context of psychology or sexology, so we can dismiss comments
from these people as irrelevant to the scientific debate.
Many mental health professionals and theorists question if this is a legitimate
or scientifically useful descriptor. See parallels with other discredited illnesses
"Autogynephilia" describes a paraphilia
Blanchard continues to describe this illness as "a distinct paraphilia"
worthy of differential diagnosis, and an improvement in terminology over what
his mentor Kurt Freund labeled "cross-gender fetishism." 
When Blanchard says this is a paraphilia, what does he mean?
"Paraphilia" is the clinical term used by psychologists for problematic
sexual desire or behaviors involving:
the suffering or humiliation of oneself or one's partner
children or other nonconsenting persons. 
Note that "paraphilias" can be diagnosed even if the person has no
subjective distress or impaired function. According to Ray Blanchard, autogynephilia
is a distinct paraphilia, but people with this disease are in the
same clinical class as people who are attracted to animals, children, feces,
In other words, proponents of this diagnosis are claiming that people express
gender variance not only because they are aroused by possessing a certain body
part, but also because they are sexually aroused by humiliating themselves or
their loved ones, and that they get a sexual kick out of appearing in public
as female, because they respond sexually to the responses of nonconsenting persons
like strangers, coworkers and friends, in the same way an exhibitionist gets
off by flashing people.
In fact, one of Blanchard and Bailey's theories is that paraphilias cluster,
so if someone gender-variant is not attracted exclusively to men, they believe
that person is far more likely to be sexually aroused by children, animals,
Blanchard bases this on work he did not with transsexuals who had transitioned,
but with anyone who came to his mental institution by force or choice to discuss
a gender issue.
Blanchard's studies have never been repeated, and his ideas have been widely
ignored until Anne Lawrence latched onto
"autogynephilia" as a political identity. Since that time, Lawrence
has been very busy trying to codify this spurious diagnosis as a legitimate
"Autogynephilia" describes a psychosexual pathology
In the same way that some gay people feel they are mentally ill, some people
interested in transition consider themselves to be mentally ill. Unfortunately,
in both cases, they do not think only they are mentally ill, but that all of
The small number of people who agree with the established scientific denotation
and strongly identify as having this mental illness frequently conflate the
phenomenon with the diagnosis. They seem to think that people concerned about
the term "autogynephilia" are claiming that the observed phenomena
do not exist.
Clearly, some people have sexual fantasies about gender variance. When viewed
as a psychosexual pathology, as Ray Blanchard views it, these fantasies may
be thought of as a "paraphilia."
Parallels with other discredited illnesses
For gender-variant women, "paraphilia" may be the diagnostic equivalent
of historic attempts to pathologize non-transsexual women's sexual behavior
that fell outside of heteronormative expectations. In the way that these made-up
diseases were seen to emanate from the sex organs, Blanchard and colleagues
spend a great deal of time looking for clues about male sexual behavior in their
It is interesting to note that in Blanchard's world, the heteronormative transwomen
need to be separated from those whose erotic interests do not fit the "natural"
model of sexual selection.
As with "autogynephilia" and similar bogus sexual pathologies and
diagnoses, "nymphomania" was created by a clinician. Carol Groneman,
author of Nymphomania: A History (2000) reports that the concept of
"nymphomania" was first laid out by the French physician Bienville
in his 1771 treatise, Nymphomania , or a Dissertation Concerning the Furor
Uterinus. Groneman's book is an excellent overview of how medical ideas
about sexuality can affect the general population and professionals in other
Psychologists like Freud added more crackpot theorizing that remained widely
held beliefs until Kinsey's report on female sexuality in 1953 showed that
"nymphomania" and "hypersexuality" had no scientific basis.
Evolving views of nymphomania were reflected in the successive editions of
the American Psychiatric Association's official guide to madness, the Diagnostic
and Statistical Manual of Mental Disorders. Nymphomania was listed as a "sexual
deviation" in the first DSM, published in 1951; by DSM-III (1980) it
had become a "psychosexual disorder," albeit a vaguely defined one.
Sensing the winds of change, or maybe just having watched a few talk shows,
the editors of DSM-III-R (revised third edition, 1987) dropped nymphomania
and its equally quaint male counterpart, Don Juanism, and replaced them with
"distress about a pattern of repeated sexual conquests or other forms
of nonparaphilic [nondeviant] sexual addiction." In DSM-IV (1994) even
sexual addiction was abandoned, perhaps because the non-gender-specific nature
of the term laid bare the speciousness of the whole project
Like "nymphomania," the word "hysteria" is an imprecise
term which is used both clinically and in everyday language. It is applied
in various situations with different meanings. Similar to vague diagnoses
like "autogynephilia," hysteria may describe a lack of self control
over acts and emotions. It may describe morbid self-consciousness, anxiety
or extravagant behavior. It also suggests the simulation of various disorders.
This nebulous description allows nearly any behavior to be describes as "hysterical,"
as J. Michael Bailey has described transsexual women criticizing his book
and his connections to neo-eugenicists.
Acute hysteria - subsumed in DSM IV as conversion (primarily physical) and
dissociative (primarily mental) disorders - is the relatively abrupt appearance
of an artifactual set of signs and symptoms that call attention to themselves.
Chronic hysteria - the form subsumed in DSM IV as somatization disorder or
Briquet's syndrome - are characterized by habitual complaints of symptoms
such as pains, faintness, abdominal cramping, nausea, coughing, shortness
of breath that turn out to be groundless and artifactual.
This is a typical comment from someone who believes in the validity of an
out of fashion diagnosis: "Hysteria is not disappearing but has taken
on less conspicuous guises as people learn what can pass as disease today."
One can expect that proponents of "autogynephilia" will see similar
drift and attempt to shoehorn an ever-widening array of phenomena into an
already nebulous diagnosis (using terms like "partial autogynephilia"
Hysteria has its roots in sexism, being derived etymologically from the Greek
word for uterus. The uterus was also seen as the cause of "nymphomania"
A disease made up by famed neurologist Jean Marie Charcot. A skeptical student,
Joseph Babinski, decided that Charcot had invented rather than discovered
hystero-epilepsy. The patients had come to the hospital with vague complaints
of distress and demoralization. Charcot had persuaded them that they were
victims of hystero-epilepsy and should join the others under his care. Charcot's
interest in their problems, the encouragement of attendants, and the example
of others on the same ward prompted patients to accept Charcot's view of them
and eventually to display the expected symptoms. These symptoms resembled
epilepsy, Babinski believed, because of a municipal decision to house epileptic
and hysterical patients together (both having "episodic" conditions).
The hysterical patients, already vulnerable to suggestion and persuasion,
were continually subjected to life on the ward and to Charcot's neuropsychiatric
examinations. They began to imitate the epileptic attacks they repeatedly
witnessed (Paul McHugh) .
The DSM-III committee and subcommittee charged with drafting the new manual
(1976-78) settled on the diagnosis of ego-dystonic homosexuality , which,
according to Dr. Jon Meyer, "...represented a compromise between those
individuals whose clinical experience, interpretation of the data, and, perhaps,
biases, led them to the conviction that homosexuality was a normal variant
of sexual expression..." By the time DSM-III-R (revised version of DSM-III)
came out in 1987, the tide had shifted again. The category of ego-dystonic
homosexuality was eliminated. As DSM-III-R itself stated, "...the diagnosis...has
rarely been used clinically, and there have been only a few articles in the
scientific literature that use the concept..."
However, one could use the category of sexual disorder not otherwise specified
to include cases that previously would have been called ego-dystonic homosexuality
. Our present DSM-IV does not include homosexuality per se as a disorder,
but still permits the diagnosis of "Sexual Disorder Not Otherwise Specified"
for someone with "...persistent and marked distress about sexual orientation".
Note that like "ego-dystonic homosexuality," the diagnosis of "autogynephilia"
is rarely used clinically, and there have only been a few articles in the
scientific literature that use the concept.
One of the most laughable examples of the unscientific nature of this diagnosis
is Blanchard's claims that cases of "partial autogynephilia" exist
in order to explain phenomena that need to be shoehorned into the theory.
This is about as valid as diagnosing someone with "partial cancer"
or "partial paraphilia." The fact that this term was even introduced
into the published literature suggests the general lack of rigor in journals
devoted to sexual science.
"Autogynephilia" proponents wish to see a differential diagnosis,
meaning they want to separate gender-variant people into two distinct "illnesses."
Although the axis of sexual preference is the most persistent, it is not the
only one proposed.
Their logic follows a disease model of gender variance. Bailey calls this "lumping
and splitting." As they explain, some disorders have similar symptoms.
The clinician, therefore, in his diagnostic attempt, has to differentiate against
disorders which need to be ruled out to establish a precise diagnosis.
Below are some other diagnoses sometimes suggested for gender-variant people:
Factitious Disorder /Munchausen syndrome by proxy
Somatization disorder Briquet's Syndrome
Pain associated with psychological factors
True medical or psychiatric illness related to presenting complaints
Differential diagnosis is appealing to some gender-variant people and practitioners
who wish to separate people who transition into different groups.
It is my hunch that "autogynephilia" and differential diagnoses are
especially appealing to those with a deep-seated homophobia. It seems rooted
in the same motivations that some cross-dressing social groups use to exclude
gay members. I will be discussing this theory in upcoming revisions.
"Autogynephilia" is quackery
The pathologization of socially unacceptable erotic interests has a long history.
As noted about, recent clinical diagnoses such as "ego-dystonic homosexuality"
and "nymphomania" have fallen into disrepute. Many expect "autogynephilia"
will be similarly discredited as a diagnosis in time.
In fact, the diagnosis is an example of quackery, which is defined as "overpromotion
in the field of health."
Below is an example of how "autogynephilia" proponents like Ray Blanchard
cannot separate the observed phenomena from the diagnosis:
"In the meantime, it is important to distinguish between the truth or
falseness of theories about "autogynephilia", on the one hand, and
the existence or nonexistence of "autogynephilia", on the other.
The latter is also an empirical question, but it appears, at this point, to
be settled." 
This conflation creates a false dilemma. Lets replace "autogynephilia"
with another spurious diagnosis as an example:
"In the meantime, it is important to distinguish between the truth or
falseness of theories about nymphomania, on the one hand, and the existence
or nonexistence of nymphomania, on the other. The latter is also an empirical
question, but it appears, at this point, to be settled."
Quacks like Blanchard used to say exactly this before nymphomania
was discredited as a diagnosis or a scientifically useful descriptor. Nymphomania
is not a legitimate diagnosis or classification simply because there are observable
phenomena that fit the denotation or clinical criteria. Saying that nymphomania
does not exist is not the same as saying women who are extraordinarily sexually
active do not exist. Of course they exist. That doesnt mean that nymphomania
exists, though. This is the primary problem with Blanchard's thinking.
Lets replace "autogynephilia" with another pseudoscientific
concept that could be written by a similar type of quack:
"In the meantime, it is important to distinguish between the truth or
falseness of theories about clairvoyance, on the one hand, and the existence
or nonexistence of clairvoyance, on the other. The latter is also an empirical
question, but it appears, at this point, to be settled."
Just because someone observes something that fits the criteria for clairvoyance
does not settle the empirical question of whether it exists or not. Thats
not how science works. Thats called confirmation bias, or less formally,
"begging the question." Blanchard comes to a questionable conclusion
("autogynephilia" exists) based on an assumed premise ("autogynephilia"
is a scientifically useful term).
"Autogynephilia" is based on interlocking pseudoscientific claims
Real discoveries of phenomena contrary to all previous scientific experience
are very rare, while fraud, fakery, foolishness, and error resulting from
overenthusiasm and delusion are all too common. (Cromer 1993)
There are several established
phenomena common to pseudoscientists and quacks. Empiricists tend to emphasize
the tentative and probabilistic nature of knowledge, while rationalists tend
to be dogmatic and assert they have found a method to discover absolutely certain
Some pseudoscientific theories can't be tested because they are so vague and
malleable that anything relevant can be shoehorned to fit the theory, e.g.,
the the theory of multiple personality disorder,"partial autogynephilia,"
or the Myers-Briggs Type Indicator ®.
As a proud member of QuackWatch, I have helped debunk a number of pseudoscientific
claims that affect the transgender community. In the case of Blanchard, the
primary quackery involves:
As Dr. Madeline Wyndzen points out in a psychology
trade newsletter  , Blanchard's key empirical findings:
1. have never been replicated
2. failed to include control groups of typically-gendered women
3. failed to covary the acknowledged age-difference from ANOVA
4. drew conclusions about causality from entirely observational data
A plethysmograph is a primitive "lie detector" attached to the
genitals. It is also one of Ray Blanchard's "scientific" tools,
since it was invented by his mentor Kurt Freund.
I have found over my years of exposing medical fraud and quackery that inventors
are frequently the most tenacious quacks. Not only do they want to herald
their invention, they are also most likely to make scientific errors when
fitting the device or concept to use. Because they see their reputation as
tied closely with the reception of their device or their writings, and because
many inventors have a certain eccentricity and sense of individualism, they
will rarely back down from a position, even when they have proven to be frauds.
Fortunately, we don't have to convince the quack he is wrong (which is frequently
impossible); we only have to convince everyone else the quack is wrong.
For more on this, please see Plethysmograph:
a disputed device.
Testimonials and anecdotal evidence
This is classic advertising trick: watch any informercial, and you will see
all sorts of glowing testimonials and anecdotes supporting the promotional
claims being made. Testimonials are always unscientific and are of little
value in establishing the legitimacy of the claims they are put forth to support.
Bailey's book and Lawrence's essays are primarily supported by anecdotal
evidence (or "narratives" as Anne Lawrence calls them). Quacks typically
use testimonials which only back their side of the story. Lawrence and Bailey
only present anecdotal evidence that supports their point. See the discussion
of bias below. This pseudoscientific evidence is further aided by communal
reinforcement: the process by which a claim becomes a strong belief through
repeated assertion by members of a community.
One of the most insidious problems with the science proposed by proponents
of "autogynephilia" is the profound bias inherent in their unproven
These types of bias are also sometimes called hidden persuaders:
"Technically these hidden persuaders can be described as statistical
artifacts and inferential biases (Dean and Kelly 2003: 180)." Dean
and Kelly argue that hidden persuaders explain why many astrologers continue
to believe in the validity of astrology despite overwhelming evidence that
astrology is bunk.
Psychologist Terence Hines, who has explored many varieties of hidden persuaders
(Hines 2003), blames them for the continued use by psychologists of such instruments
as the Rorschach test, despite overwhelming evidence that the test is invalid
"Psychologists continue to believe in the Rorschach for the same reasons
that Tarot card readers believe in Tarot cards, that palm readers believe
in palm reading, and that astrologers believe in astrology: the well-known
cognitive illusions that foster false belief. These include reliance on
anecdotal evidence, selective memory for seeming successes, and reinforcement
This bias takes many forms, and the major problems are outlined below:
Research has demonstrated that the expectations and biases of an experimenter
can be communicated to experimental subjects in subtle, unintentional ways,
and that these cues can significantly affect the outcome of the experiment
( Rosenthal 1998 ). i.e., people who wanted free treatment presented to
Ray and told him what he wanted. People who think Anne Lawrence is a dangerously
disturbed psychotic did not fill out a questionnaire.
Ad hoc hypothesis
Bailey, Blanchard and Lawrence explain away facts that refute the hypothesis:
i.e., those who disagree are lying, and those whose stories match the model
are open and honest.
This theory of human motivation that asserts that it is psychologically
uncomfortable to hold contradictory cognitions. Particularly confusing for
Bailey and Lawrence are people who are clearly quite open about their erotic
interests (like Deirdre McCloskey) but do not consider "autogynephilia"
to be a valid diagnosis. This is clearly incomprehensible to them; Bailey
notes that Deirdre shows "all the hallmarks of autogynephilia"
and Anne Lawrence asks (apparently rhetorically) can someone explain how
this isn't autogynephilia?
This is equivalent to someone who believe "nymphomania" is a
valid diagnosis. Because they cannot comprehend the possibility that the
condition does not exist, their inability colors every observation they
This refers to a type of selective thinking, where favorable evidence
is selected for remembrance and focus, while unfavorable evidence for a
belief is ignored.
A pseudoscientist tends to notice and to look for what confirms one's beliefs
(supportive data), and to ignore, not look for, or undervalue the relevance
of what contradicts one's beliefs. Bailey, Blanchard and Lawrence do this
by claiming those who disagree are lying, or by presenting only evidence
that supports their arguments.
This type of biased thinking can be quite subtle. Some pseudoscientists
seriously consider data contrary to their beliefs, but are much more critical
of such data than they are of supportive data.
Nobel Prize winner Irving Langmuir described pathological science as "the
science of things that arent so", using as examples the Davis-Barnes
Effect, N-rays, mitogenetic rays, the Allison Effect, extrasensory perception,
and flying saucers (Langmuir 1968).
Langmuir offered six characteristics of pathological science :
The magnitude of the effect is substantially independent of the intensity
of the causative agent.
The effect is of a magnitude that remains close to the limits of detectability;
or, many measurements are necessary because of the very low statistical
significance of the results.
It makes claims of great accuracy.
It puts forth fantastic theories contrary to experience.
Criticisms are met by ad hoc excuses.
The ratio of supporters to critics rises up to somewhere near 50 percent
and then falls gradually to oblivion.
The problem of induction
This gets into heady philosophy of science type stuff that's lost and Bailey
and friends. For a brief formulation of the problem of induction we can
turn to Born, who writes: '. . . no observation or experiment, however extended,
can give more than a finite number of repetitions'; therefore, 'the statement
of a law - B depends on A - always transcends experience. Yet this kind
of statement is made everywhere and all the time, and sometimes from scanty
material. ' 1
In other words, the logical problem of induction arises from (1) Hume's
discovery (so well expressed by Born) that it is impossible to justify a
law by observation or experiment, since it 'transcends experience'; (2)
the fact that science proposes and uses laws 'everywhere and all the time'.
(Like Hume, Born is struck by the 'scanty material', i.e. the few observed
instances upon which the law may be based.) To this we have to add (3) the
principle of empiricism which asserts that in science only observation and
experiment may decide upon the acceptance or rejection of scientific statements,
including laws and theories.
These three principles, (1), (2), and (3), appear at first sight to clash;
and this apparent clash constitutes the logical problem of induction.
See my earlier discussion of McSynchronicity for this problem described
in lay terms.
Dr. Martina Belz-Merk notes "There is currently a controversial debate
concerning whether unusual experiences are symptoms of a mental disorder,
if mental disorders are a consequence of such experiences, or if people
with mental disorders are especially susceptible to or even looking for
Forer effect (also called subjective validation)
Forer found that people tend to accept vague and general personality descriptions
as uniquely applicable to themselves without realizing that the same description
could be applied to just about anyone. The "symptoms" and "hallmarks"
of "autogynephilia" continue to spread to explain away inconsistencies.
Argument to ignorance
This is a logical fallacy of irrelevance occurring when someone claims
that something is true only because it hasn't been proven false. Bailey
is especially fond of this one.
For more information
Below are some additional resources on this topic. Please see my essay A
defining moment in our history for more on disease
models of gender identity in historical context.
Draft version of 20 May 2004.
1. In J. M. Bailey (Chair), Phenomenology and classification of male-to-female
transsexualism. Symposium conducted at the meeting of the International Academy
of Sex Research , Paris. June, 2000. Slide 38.
2. Blanchard R. Origins of the concept of autogynephilia. Published online
February 2004 via http://www.autogynephilia.org/origins.htm
3. "Paraphilia." Diagnostic and Statistical Manual of Mental Disorders,
4. Wyndzen MH. A personal and scientific look at a mental illness model of
transgenderism. APA Division 44 Newsletter,
Spring 2004, p. 3.
New Medical Thinking or Old Stereotype? by Dr. Katherine Wilson
Blanchard, Lawrence and the fallacy of "autogynephilia" by Jed
You Never Wanted to Know About "Autogynephilia" but Were Afraid You
had to Ask by Dr. Madeline Wyndzen
& Ray Blanchard's Mis-Directed Sex-Drive Model of Transsexuality by
Dr. Madeline Wyndzen
personal and scientific look at a mental illness model of transgenderism by Madeline H. Wyndzen, Ph.D. (PDF: requires reader)
links compiled by Dr. Madeline Wyndzen
Views of one non-transitioner
on Gender: "Autogynephilia" by BC Holmes
LINK: Men Trapped
In Men's Bodies: an Introduction to the Concept of "Autogynephilia" by Dr. Anne Lawrence (taken offline in
and Transsexuality: A New Introduction to "Autogynephilia" by Dr. Anne Lawrence
LINK: The "Autogynephilia"
Resource (autogynephilia.org) by Lisanne
Raymond and "Autogynephilia" by Dr. Rebecca Allison