Rationale for the Narrative Project
The decision to solicit and publish narratives by autogynephilic transsexuals arose from my observation that personal accounts by transsexuals who acknowledged autogynephilic arousal were scarce and my conviction that they needed to be collected and made available to clinicians and other autogynephilic transsexuals. I had searched almost in vain for personal narratives written by MtF transsexuals who acknowledged that autogynephilia had played an important role in their lives. I believed that such narratives needed to be available to professionals, to provide concrete illustrations of the phenomena Blanchard described, and to autogynephilic men who were struggling with gender dysphoria, to reassure them that they were not alone, not crazy, and not ineligible for sex reassignment.
My decision to collect and publish these narratives was also informed by my own history of gender dysphoria and autogynephilic erotic arousal. Beginning in early childhood, I experienced both the wish to be female and erotic arousal in association with cross-dressing and cross-gender fantasy. These feelings intensified in adolescence and continued throughout my adult life. For many years, I imagined I might be unique in both wanting to be female and being erotically aroused by the fantasy of being female. Although my experience of erotic arousal in association with cross-dressing was suggestive of fetishistic transvestism, I didn’t believe that I was simply a transvestite, because I also felt an intense desire to have SRS. That desire led me to suspect that I might be some type of transsexual. But the consensus in the medical literature was that erotic arousal in association with cross-dressing or cross-gender fantasy excluded the diagnosis of transsexualism (see Blanchard & Clemmensen,
1988
) and was a contraindication to SRS (e.g., Dolan,
1987
; Lundström, Pauly, & Wålinder,
1984
; Person & Ovesey,
1974b
).
When I read Blanchard’s writings on autogynephilia in 1994, I discovered a theory that seemed to apply to me. Blanchard’s concept of autogynephilic transsexualism was consistent with my feelings and history and reassured me that there were others like myself. I later wrote:
When I first read [Blanchard’s work] in 1994, I experienced a kind of epiphany. Certainly it spoke to my own experience like nothing I had ever encountered before. It was enlightening and empowering to discover that someone thought feelings of sexual arousal to the idea of having a woman’s body were consistent with genuine transsexualism—and that they provided a logical rationale for seeking sex reassignment. (Lawrence, 1999a )
This discovery still left me feeling isolated, however, because I was unable to locate other clinicians or researchers who accepted Blanchard’s ideas and could independently confirm their validity:
As I discussed Blanchard’s theory with colleagues, I discovered two surprising things. First, his theory was not widely known. Second, many of those who did know about it thought it was not so much wrong as heretical. The intensity of their reactions was astonishing. It was as though thinking about transsexualism as a sexual problem involved such a paradigm shift that it frightened people. (Lawrence, 1999a )
I was also unable to find any detailed histories of persons like myself, either in the form of case reports or personal narratives.
After I underwent SRS in 1996, I began to think of myself as a transsexual activist. I created a website, Transsexual Women’s Resources
(now Dr. Anne Lawrence on Transsexualism and Sexuality
;
http://www.annelawrence.com
) to provide information to other MtF transsexuals. The site became popular, and I decided to use it to solicit narratives by MtF transsexuals who also experienced autogynephilia. My decision to undertake the project was influenced by the ideas of feminist theologian Carol Christ (
1980
), who emphasized the importance of personal narratives in the lives of natal women:
Women’s stories have not been told. And without stories there is no articulation of experience. Without stories a woman is lost when she comes to make the important decisions of her life. Without stories she cannot understand herself. (p. 1)
I felt that Christ’s ideas might also be relevant to gender dysphoric males whose experiences were like mine: A collection of first-person narratives by MtF transsexuals who experienced autogynephilia might help other gender dysphoric males with similar histories make the important decisions of their lives.
Collecting the Narratives
From October 1998 through October 2011, I collected hundreds of narratives written by autogynephilic transsexuals by means of a solicitation posted on the Transsexual Women’s Resources
website. The exact language of the solicitation varied slightly over the years, but this version from 2005 is representative:
Seeking Personal Histories of Sexual Arousal Associated with Sex ReassignmentI am still seeking narratives concerning sexual feelings and fantasies associated with or centered on the sex reassignment experience. If you identify as transsexual and are willing to share your experiences concerning this topic, please read on. I would particularly like to hear from persons who have either been approved for sex reassignment surgery or are postoperative.Some transsexual women report that the process of becoming feminized, either in reality or in fantasy, has been or still is sexually arousing. This phenomenon—sexual excitement at the thought or image of oneself as a woman—is called autogynephilia . Have you experienced feelings like this?Transsexual women have sometimes described sexual arousal in connection with doing or fantasizing the following:
As described above, the solicitation was followed by a text box into which informants could write or paste their narratives. Clicking a “submit” button transmitted the contents of the text box to me anonymously, via a cgi-email script. Roughly one third of informants, however, chose to bypass this method of anonymous transmission and emailed narrative material to me directly, usually because they regarded the anonymous method as too limiting or simply unnecessary. The option of emailing narratives to me directly was explicitly mentioned in later versions of the solicitation. Over the 13-year collection period, I received about 470 narratives addressing or purporting to address the topic of autogynephilia.
In addition to the brief description of autogynephilia provided in the solicitation, informants also had access to one or more essays on my website that explained autogynephilia in greater detail. Originally, the essay was “Men trapped in men’s bodies: An introduction to the concept of autogynephilia” (Lawrence,
1998
). This was replaced in 2000 by “Sexuality and transsexuality: A new introduction to autogynephilia” (Lawrence,
2000
) and in 2004 by “Autogynephilia: A paraphilic model of gender identity disorder” (Lawrence,
2004
). The last essay was supplemented in 2007 by “Becoming what we love: Autogynephilic transsexualism conceptualized as an expression of romantic love” (Lawrence,
2007
). Several informants referenced one or more of these essays in their narratives.
In the final paragraph of the solicitation, I sought to make it clear that I only wanted to hear from MtF transsexuals who had personally experienced autogynephilia, not from anyone who had an opinion on the topic. Some opponents of Blanchard’s theory have criticized that paragraph. For example, after I posted on the Internet a few of the earliest narratives I had received (Lawrence,
1999c
,
1999d
), Barnes (
2001
) objected that “all she [Lawrence] really did was solicit responses from those sympathetic with her theory” (p. 24). Roughgarden (
2004
) similarly alleged that “the narratives that Lawrence posted are the ones most likely to be supportive. Lawrence discourages counternarratives” (p. 272). Such criticisms are both misplaced and inaccurate.
My stated intention was to collect narratives from MtF transsexuals who had personally experienced autogynephilia, in order to learn what they had to say about it. It would seem self-evident that MtF transsexuals who had not
experienced autogynephilia would be unable to provide relevant narratives. If my intention had been different—for example, to conduct a survey of MtF transsexuals’ opinions about Blanchard’s transsexual typology—then soliciting narratives from persons who had not experienced autogynephilia would have been appropriate. But I was not conducting such a survey. Because Blanchard’s MtF transsexual typology is controversial, however, some of its opponents seem to believe that every discussion of autogynephilia must include a debate about that typology—a debate in which they are entitled to participate. I disagree.
Moreover, not every MtF transsexual informant who experienced autogynephilia and submitted a narrative agreed with everything Blanchard theorized. Some informants disagreed with Blanchard (and me) about the meaning and significance of autogynephilia; others challenged Blanchard’s transsexual typology or his implicit theory of transsexual motivation. I neither discouraged nor suppressed such dissenting opinions by autogynephilic informants; they are presented in detail in
chap. 10
and occasionally in other chapters as well.
Editing and Analysis
Editing and analysis of the narratives was a multistep process. First, I eliminated any messages that did not describe the informant’s personal experience of autogynephilia. I received a few dozen such messages, most of which either condemned the concept of autogynephilia or disagreed with all or part of the associated theory. I also eliminated a handful of narratives—fewer than a dozen—that I believed were fabrications; I will describe these and the reasons I considered them fabrications later in this chapter. From the remaining narratives, I grouped together those that appeared to have been submitted by the same informant. Most informants sent only one narrative, but some sent two or more, up to a maximum of six. There may have been a few instances in which a single individual submitted more than one narrative and I was unable to recognize this. This process resulted in a collection of one or more narrative submissions from 301 different informants.
Although I had solicited narratives only from persons who identified as transsexual, I received several narratives from autogynephilic persons who either denied being transsexual or who did not appear to be transsexual according to usual definitions. I had wanted to emphasize narratives written by informants who were recognizably transsexual, because such narratives were scarce. Moreover, narratives by informants who were not recognizably transsexual could too easily be dismissed as not truly relevant to understanding the phenomenon of autogynephilic transsexualism. Consequently, I divided the 301 autogynephilic informants into those whom I could classify with some confidence as transsexual and those whom I was unable to classify as transsexual or who appeared to be nontranssexual.
Deciding which informants qualified as transsexual and which did not required some subjective judgments. A few informants did not provide enough unambiguous information about gender dysphoria, cross-gender identification, cross-gender expression, formal diagnoses, or treatment history to permit definitive classification. In general, I considered informants to be transsexual if they expressed the wish to have a female body or to live and be recognized as a woman. More specifically, I considered informants to be transsexual if they (a) identified themselves as such or described the severe gender dysphoria (discomfort with anatomic sex or gender role) or pronounced cross-gender identity (desire to be female, live as a woman, or undergo SRS) that are typical of MtF transsexualism; (b) stated that they were using hormones to feminize their bodies (with one exception noted below), were living full-time in female role, or had been approved for SRS (implying both of the former), or (c) stated that they had completed SRS.
Some informants were especially difficult to classify. The largest subgroup of these consisted of individuals who experienced the most prevalent form of partial autogynephilia
(Blanchard,
1993b
): the desire to have female breasts, and often other female anatomic features as well, but without any strong desire to have female genitalia or undergo SRS. Some of these individuals reported that they were using low doses of feminizing hormones to develop breasts or were considering living full-time as women, factors that further complicated the decision process. For the sake of consistency, I eventually decided to classify informants who described partial autogynephilia and did not
desire to have female genitalia or undergo SRS as nontranssexual, even if they reported that they were using feminizing hormones. Narratives from several informants who conformed to this description are included in
chap. 11
.
Even more difficult to classify were a few informants who expressed a wish to have female genitalia—or who had in some cases undergone SRS to acquire female-appearing genitalia—but who claimed they had no desire to live in a traditional female role or had concluded that it was not feasible to do so. Some of these individuals stated that they only wanted female genitalia, others that they wanted female genitalia and breasts but nothing more, and still others that they wanted complete physical feminization. All, however, either claimed they wanted to live as men or stated that living in a male gender role seemed like the best option available to them. Attempting to classify these individuals begs the question: What is the essential feature of MtF transsexualism? Is it the desire to live as a woman? The desire to have something resembling a female body? If the latter, is the desire to have female-appearing genitalia enough? There are no universally satisfactory answers to these questions. I eventually decided to classify any informant who expressed an unequivocal desire to have female genitalia as transsexual. This was partly for the sake of consistency, but it also reflected my clinical experience with a few patients who had told me they wanted SRS but had no desire to live as women: In every case, it eventually became clear that these clients actually did want to live as women (albeit sometimes as rather androgynous women) but had simply concluded that this was unfeasible and had therefore put the idea out of their minds. I suspect (but obviously cannot prove) that many, if not most, autogynephilic men who claim to want only female genitalia actually want both fully feminized bodies and a female-typical social role but cannot bring themselves to admit this. Narratives from several informants in the group described above are included in
chap. 6
.
A total of 249 informants met one or more of the inclusion criteria that permitted me to classify them as transsexual: 130 met criterion (a), 91 met criterion (b), and 28 met criterion (c). The Appendix summarizes the highest inclusion criterion satisfied by each informant whom I categorized as transsexual and the specific element(s) in the informant’s narrative that led me to conclude that the inclusion criterion had been satisfied. I will subsequently refer to these informants as the “autogynephilic transsexual informants” or “transsexual informants”; this denotes only that they reported having experienced autogynephilic arousal, not necessarily that they considered this arousal to have the same meaning or significance that Blanchard theorized.
There were also 52 narratives by informants who did not meet any of these inclusion criteria, but who nevertheless described autogynephilic feelings; some of these informants were probably transsexual but simply did not provide enough information for me to confidently classify them as such. I felt that many of the narratives by these informants contained information that might contribute to a better understanding of autogynephilic transsexualism; consequently, I decided to devote a separate chapter,
chap. 11
, to their accounts. I will subsequently refer to these informants as the “nontranssexual autogynephilic informants” or the “nontranssexual autogynephiles.”
The inclusion criteria I used admittedly leave the study open to criticism that some of the informants I categorized as transsexual might not have been “genuinely” transsexual according to more stringent criteria. Most of the informants I considered transsexual would presumably meet criteria for a diagnosis of transsexualism in the International Classification of Diseases
(ICD-10; WHO,
1992
), which requires only the presence of cross-gender identity, usually accompanied by gender dysphoria. But critics could argue that some of my transsexual informants might not have experienced severe enough gender dysphoria or a sufficiently persistent cross-gender identity to satisfy the definition of transsexualism in the most recent edition of the DSM (APA,
2000
, p. 828). Indeed, a few informants who experienced significant gender dysphoria or cross-gender identity chose not to refer to themselves as “transsexual,” but used alternative terms, such as “transgendered,” to describe themselves. It is important to remember, however, that the symptoms classically associated with transsexualism—gender dysphoria, cross-gender identity, anatomic dysphoria, belief that one’s feelings resemble those of the opposite sex, desire to live as a member of the opposite sex, and wish for hormonal and surgical sex reassignment—are highly correlated (Deogracias et al.,
2007
; Singh et al.,
2010
). Moreover, autogynephilic transsexualism and less severe autogynephilic conditions (e.g., fetishistic transvestism) are more usefully conceptualized as points on a continuum of symptomatology than as distinct disorders (Benjamin,
1966
; Docter,
1988
; Lawrence,
2009a
,
2009b
; Levine,
1993
; Person & Ovesey,
1978
; Whitam,
1987
). Consequently, attempting to draw a definitive line between autogynephilic transsexualism and closely related conditions is probably neither feasible nor crucially important.
I next edited the narratives by the 249 transsexual informants and the 52 nontranssexual informants in the interests of insuring anonymity and improving readability. I redacted any information that might identify the informants and removed material that was peripheral to the topic of autogynephilia (e.g., detailed accounts of family history or educational achievements). I also performed some basic copyediting: correcting misspellings, inserting missing words, expanding abbreviations, reordering some sentences and paragraphs to improve clarity, and condensing excessively prolix passages. The resulting document contained about 128,000 words.
Finally, I conducted a thematic analysis of the narratives. I created a new thematic category for each major theme I identified and placed narrative excerpts pertaining to that theme in the corresponding category. Some of the themes were essentially predetermined and represented fundamental elements or concepts in the theory of autogynephilia (e.g., anatomic autogynephilia); other themes arose directly from the content of the narratives. Whenever I identified a new theme, I reexamined previously analyzed narratives for possible instances of the theme, extracted any relevant narrative excerpts, and placed them in the appropriate category. This process ultimately yielded 30 distinct thematic categories that together contained about 75,000 words of narrative excerpts. All of the narratives by transsexual informants yielded useful excerpts; about two thirds of the narratives by nontranssexual informants did as well. Sometimes I further edited the narrative excerpts for length when I incorporated them into the text of the chapters.
The methodology I employed was similar in many ways to the constant comparative method used in the grounded theory approach to qualitative analysis (Glaser & Strauss,
1967
; Strauss & Corbin,
1998
). This study was not, however, a grounded theory analysis, because my intention was not to generate a new theoretical model of autogynephilia. A serviceable theory of autogynephilia already existed, and all the informants were aware of it, as evidenced by their decisions to submit narratives. Instead, the intention of this study was primarily descriptive: I wanted to document the feelings and opinions of MtF transsexuals who had experienced autogynephilic arousal, including what they had to say about the role autogynephilia had played in their lives.
Validity Issues
How confident am I that the transsexual and nontranssexual informants represented themselves accurately and reported their feelings and experiences truthfully? For most informants, I cannot claim great confidence, although there were a few cases in which I either knew an informant casually or had some corroborating historical information. Concerns about truthfulness and accuracy are potential issues whenever personal narratives are used as data sources, but are especially pertinent in studies like this one, in which the absence of face-to-face contact with informants precludes the use of nonverbal information to assess probable truthfulness.
Several clinicians who have worked extensively with MtF transsexuals have reported that their clients tend to consciously or unconsciously distort their histories to conform to the picture of “classic” MtF transsexualism. A classic MtF transsexual is one “who has felt and acted feminine from earliest childhood, has never been sexually aroused by women’s apparel, and is romantically inclined toward males” (Blanchard, Clemmensen, et al.,
1985
, p. 508). For example, Lukianowicz (
1959
) stated that male gender patients often gave inaccurate reports of the early onset of cross-gender wishes:
A wishful falsification of memory takes place, the patients begin to recall and misinterpret various insignificant incidents in their childhood, till they finally firmly believe that “ever since I can remember, I always wanted to be a woman.” (The incessant progress of these emotionally overvalued ideas resembles the relentless development of delusions in paranoia.) (p. 51)
Bancroft (
1972
) argued that one challenge to understanding the developmental history of MtF transsexualism was that
transexuals [sic] distort their past histories to fit in to their transexual identity and are therefore more likely to report early transexual urges to support the idea that they are basically female… [One patient] when first seen reported his transexual feelings to be of recent origin; 9 months later he was reporting them as starting much earlier in his life. (p. 62)
Fisk (
1974
) observed that clients who sought SRS tended to misrepresent their histories—sometimes deliberately but more often unintentionally—to make them conform to accepted ideas about classic transsexualism:
Slowly, there appeared instances in which the seemingly very pat histories revealed inconsistencies, downright fabrications and blatant distortions. The element of conscious fabrication or manipulation seemed quite secondary to the phenomenon of retrospectively “amending” one’s subjective history. Here, the patient quite subtly alters, shades, rationalizes, denies, represses, forgets, etc., in a compelling rush to embrace the diagnosis of transsexualism. (pp. 8–9)
Fisk’s phrase “embrace the diagnosis of transsexualism” suggests that he saw these clients as attempting to convince themselves
as well as others that the diagnosis was applicable to them. Sørensen and Hertoft (
1980
) similarly noted that MtF transsexuals typically displayed “memory distortion with exclusion of earlier masculine traits” (p. 139). Walworth (
1997
) reported that the five most common topics about which MtF transsexuals admitted to having misled their therapists were “sexual arousal in response to women’s clothing[,] sexual attraction to women[,] preferring girls’ games and toys as a child[,] childhood wishes to have been born a girl[, and] identifying with female characters as a child” (p. 359). Taken together, these observations suggest that MtF transsexuals’ histories of childhood femininity, childhood cross-gender wishes, absence of erotic arousal with cross-dressing, and sexual attraction to men should not necessarily be taken at face value.
On the other hand, MtF transsexuals’ histories that contradict the picture of classic transsexualism can be seen as a form of “reluctant testimony” and are likely to be more credible. In particular, self-reported histories of an absence of femininity or cross-gender wishes in childhood, a lack of sexual attraction to men, or the presence of erotic arousal with cross-dressing or cross-gender fantasy should arouse less suspicion, because there is little reason for informants to consciously or unconsciously misreport these things.
I strongly suspected that one or two people who submitted narratives engaged in less-than-truthful reporting. For example, between February 1999 and November 2001, I received eight separate narratives that dealt with the issue of erotic arousal from the idea of feeling regret following sex reassignment (i.e., being a “man trapped in a woman’s body”). These narratives varied in some details (e.g., stated age, whether or not sex reassignment had been completed), but shared certain thematic similarities (e.g., emphasis on the inconvenience of obligatory seated urination), characteristic spelling errors, and unusual syntax. I concluded that these narratives were probably fabrications that had been submitted by a single individual and that described erotic fantasies, not genuine occurrences. Consequently, I decided to exclude these narratives. Even so, many of the thoughts and feelings expressed in them were not terribly different from those found in seemingly more plausible accounts.
Some MtF transsexuals and other persons object to the theory associated with the concept of autogynephilia, and it is possible that a few of them might have attempted to discredit the study or cast doubt on the theory of autogynephilia by submitting false or misleading narratives. What sorts of narratives might advance these goals? A narrative that described bizarre but just barely plausible fantasies or behaviors and was accepted as genuine but subsequently revealed to be a fabrication might discredit the study in the eyes of some. It would be difficult, however, for an individual to prove that he or she was actually the author of any particular narrative, much less that the contents of that narrative were indeed fabricated. In any case, with the exception of the “man trapped in a woman’s body” narratives described above, only one other narrative, which I will describe below, contained material of doubtful plausibility. Alternatively, a fabricated narrative that contradicted some general principle derived from or associated with the theory of autogynephilia, if accepted as genuine, might cast doubt on the theory in the eyes of some. A narrative that described both intense autogynephilic arousal and an exclusively homosexual orientation in a MtF transsexual would fall into this category. A narrative describing the absence of autogynephilic arousal in a nonhomosexual MtF transsexual, however, would neither cast much doubt on the theory nor be eligible for inclusion. As I noted in
chap. 1
, denial of autogynephilic arousal by nonhomosexual MtF transsexuals is a recognized, reasonably well understood, and not especially interesting phenomenon. Moreover, I stated in my solicitation that I had no interest in receiving narratives from persons who had not experienced autogynephilia.
I received only one narrative that was ostensibly from a MtF transsexual who reported both extensive autogynephilic arousal and an exclusively homosexual orientation. I decided to exclude this narrative, because I suspected it was a fabrication: Some of the history it recounted was internally contradictory, and it was submitted a few months after the publication of the controversial book The Man Who Would Be Queen
(Bailey,
2003
) and contained narrative detail that seemed to have been taken directly from two different case descriptions in that book.
Some evidence for the accuracy and truthfulness of the narratives lies in the fact that, in general, they were remarkably consistent with each other, with existing information concerning autogynephilic fantasies and behaviors (e.g., from transgender erotica), with the clinical histories of the MtF transsexual patients I have seen in my practice, and with the theory of autogynephilia generally. The specific detail and emotional frankness that characterized much of the writing conveyed a strong sense of verisimilitude; the informants frequently expressed amazement at their own candor, offering asides like “I can’t believe I’m telling you this” or “This sounds crazy, even to me, but it’s true.”
Previous Publication of Selected Narratives
In 1999, I published 59 of the narratives I had received to date in two separate documents on my website (Lawrence,
1999c
,
1999d
). I included excerpts from these 59 narratives in two papers I presented at the Harry Benjamin International Gender Dysphoria Association XVI Biennial Symposium in London in 1999; the texts of these papers were subsequently published on my website (Lawrence,
1999a
,
1999b
). Selected excerpts from the 59 narratives also appeared in the magazine Transgender Tapestry
in connection with an article I published there (Lawrence,
2000
). Blanchard (
2005
) quoted excerpts from these 59 narratives as well. Because the current analysis employed more rigorous inclusion criteria than I had used in 1999, only 50 of the original 59 narratives were selected for inclusion in the current study.
Illustrative Examples of Narratives
This section presents seven illustrative examples of narratives submitted by the transsexual informants who acknowledged autogynephilia. Most are presented more or less as I received them, with only minor copyediting; the exceptions are the fourth and sixth examples, which were significantly edited for length. Collectively, they illustrate most of the major themes discussed by the informants. In this and subsequent chapters, three-digit numbers in parentheses following the narrative excerpts will be used to identify individual transsexual informants.
The first example is one of the narratives I first published on my website in 1999 (Lawrence,
1999d
):
I am a 42-year-old male-to-female preoperative transsexual. I have been living full time as female for over a year, have completed a legal name change, and have been on hormone therapy for several years. I have just finished reading your article on autogynephilia and can honestly say that, for the first time ever, I have the feeling “this is me!” Previously, when I’ve read the literature on transsexualism, I’ve thought that many, indeed most, of the descriptions applied to me. But there was always something just slightly different from the way I truly felt. It was because of these feelings that I have had doubts about whether I was “really” a transsexual.My sexual fantasies all include myself in female form, either being forced to become female or voluntarily. Frequently they involve a submissive element on my part: I am either forced to be a woman or forced to behave in a particularly submissive manner. If there was a male involved, it was usually a vague or faceless man with extremely strong and powerful physique. From my very earliest masturbatory experiences, I have exclusively used this type of “becoming female” fantasy for arousal.My childhood seemed rather typically male from an outside viewpoint. I can still vividly remember an early experience of becoming aroused at the thought of becoming female when I was approximately 9 or 10 years old. I was overweight and I had begun to develop breasts, solely from my weight. I would soap my breasts in the shower and imagine I was really a woman with a real woman’s breasts, and I would become extremely aroused.I lived fairly successfully as a man for most of my 39 years prior to seeking professional help. I was married for approximately 5 years in my early 30s. My sex life was satisfying to an extent, but I would always use feminization fantasies to achieve orgasm. I thought this was a flaw in my nature, felt guilty because of it, and never discussed this with my wife. I always felt envious of my wife’s body and would invariably fantasize about being like her or trading places whenever we had sex. I also regularly fantasized about becoming any of a variety of beautiful women, such as popular actresses, models, or centerfolds.I did not engage in much cross-dressing at an early age. I did sneak occasionally into my mother’s room and try on a slip, panties, or a bra, but that was the extent of it. Once I graduated from college and was on my own, I began shaving my legs and would invariably achieve extreme states of arousal, culminating in masturbation. It wasn’t until I actually started therapy that I began appearing in public dressed as a female. In the early days, I would become aroused whenever anyone—a sales clerk, a casual stranger—would address me as “Ma’am” or perform some courtesy, such as holding a door for me. This arousal led to a heightened fear of discovery (i.e., that my erection would give me away). After hormone therapy, this became less of a problem and eventually stopped altogether. I thought perhaps it was the initial novelty of the situation that caused my arousal and that this novelty was wearing off as I became accustomed to presenting in the feminine role. But now I realize that I still get that jolt of erotic thrill at being viewed as female, but the hormone treatments have eliminated the erections that embarrassed me.I continue to feel aroused at the thought of feminization. The frequency of my masturbation has greatly decreased since starting hormone therapy, but I still use feminization fantasies during autoerotic activity. To date I have not told anyone else about this aspect of my transgendered nature. I have told my therapist about some of my fantasies but not about the erections when dressed. This is from fear of not being accepted as a true transsexual and being categorized instead as a transvestite or cross-dresser. I have a strong desire for SRS and do not want to jeopardize my chances by appearing in any way skewed from the “classic” transsexual profile. (001)
Most narratives were submitted by middle-aged males, but I received some from informants in their 20s. Here is an example:
I’m a 28-year-old male who has experienced arousal from autogynephilia since the age of 12. I always thought I was weird, because I’ve never been effeminate. When I hit puberty, around age 12, I remember being aroused seeing girls growing boobs and also seeing my stepmother’s bras and panties in the laundry area. I remember being attracted to girls themselves but having extreme arousal over the thought of being a girl and growing boobies. I already fantasized about being a girl and having a vagina before the boob thing started. It’s hard to pinpoint when I realized I was highly aroused by this, but I believe it was when I saw some girls in my class at a play wearing leotards and tights or pantyhose at a school play. I wanted so bad to have a vagina and be free of my penis while being able to express myself in a way not accepted in a man’s world.Since then, I have been through the same thing over and over, hoping that I would somehow grow out of it. I’m an attractive guy; I’ve had sex with at least 20 women, but I have never had an orgasm with one of them. I came close once, when a girlfriend sucked and played with my nipples. I rarely cross-dress anymore, because I get so unbelievably aroused that I shake and tremble and ejaculate much too fast. This is not because of the clothes as much as the more realistic feeling of being an actual woman with female genitalia. I know that I don’t simply have a cross-dressing fetish, because my greatest sexual fantasy is going through puberty again as a girl and experiencing breast development, as well as being in pillow fights and bubble-gum blowing contests with other girls. I’ve only tried makeup on once but got sexually aroused by it. Other things that have aroused me are shaving my legs, sitting with my legs crossed in a feminine way, blowing bubble gum bubbles (something I’ve always associated as being feminine), and sitting with a bunch of women as the only male and listening to “girl talk.”I’m probably more aroused than ever at the thought of being a woman. I’m getting ready to go on hormone therapy, because I’m at my wits’ end as a man. I can’t enjoy sex with women as a man—I’ve lost almost all interest. What I do enjoy with women is snuggling and getting close. As a woman, I could be free to enjoy sex again and be free to cry at a sad part of a movie and free to be chatty and get close with a mate. I have to admit that the thought of growing boobies while on hormone treatment is so arousing that it makes me shake and tremble, literally. This thought just blows me away, and the thought of getting a vagina is just as arousing. (002)
Only a few narratives were submitted by informants in their teens; here is one of the best examples:
After reading about autogynephilia, I suddenly became a lot less apprehensive about my decision to begin to transition. I’m 18 years old and am about to tell my parents. I’m optimistic about their reactions; my mom’s always wanted a daughter. I’m seeing a psychiatrist starting tomorrow. This is not a new thing; I had been in therapy most of my early life.I was worried that the fact that I feel sexually aroused by the idea of being a woman was a reason to doubt my gender dysphoria. I’ve always identified with women more than men but was never extremely effeminate. I am heterosexual, but only because I can’t imagine myself having sex with a man as a man. My first realization of my desire to be feminine was in summer camp, when I was 12 years old. I was making a short video starring myself and I imagined a completely unnecessary scene involving my wearing various beautiful dresses and wigs. I was surprised to be aroused by this and actually ejaculated for the first time after masturbation. After the fantasy had ended, the desire did not retreat and has plagued me ever since. I would guiltily sneak into my mother’s closet when she was away and wear as many combinations of her clothes as possible. I was almost always turned on by it, but I mostly did not masturbate. Instead, I’d condemn my penis for getting in the way. My friends still can’t understand why I hate my penis so much, even after I told them that I am very committed to the idea of becoming a woman.I fantasize about having sex as a woman. I can vividly imagine myself being penetrated. I fantasize about having long, beautiful hair, having it braided, having it on my face, having it short and cute. I try to do these things to my short guy hair and practically cry at feeling so inadequate. Wearing women’s clothing is always something that initially turns me on, but when that damn penis of mine eventually becomes flaccid, I feel very comfortable and natural. I imagine having breasts. I tried taping my chest [to create the appearance of cleavage], but I’m too thin to generate a satisfactory appearance. I had a brief period during which I would only be attracted to women I would want to be.I feel that it is perfectly natural for transgender people to be turned on by sexual situations involving being who they believe they are. Having your biological self in a sexual fantasy can completely ruin it. (003)
Some informants stated that they had rejected the idea of undergoing sex reassignment, even though they intensely wanted it; usually they cited inability to pass as a woman or family obligations as the principal reasons.
I am an autogynephiliac. I want to be female, but I don’t already feel female inside. Rather, I have a deep, hard-wired longing built into me that I can’t shake or get rid of and that I can remember having since I was a child. I feel like I am looking through an unbreakable glass window at a place I want to be and a life I want to have yet am unable to reach. This desire feels hardwired: As much as I don’t want to want it, it is still there, taunting and frustrating me. The thought of being female turns me on so much that it’s my primary sexual attraction mechanism. But my body is such that I could never transition convincingly.This feels way deeper than what I imagine a fetish to be. There are countless days where I experience little in the way of feeling “turned on,” yet I still have this deep aching inside of me to somehow be transformed into the object of my desires. Some days it is just a fleeting feeling on the edge of my peripheral awareness. Other days I feel it so strongly that I want to scream in frustration. I do have a separate, unrelated fetish, and I can feel a significant difference between that fetish and my autogynephilia. With the fetish, I can be turned on very strongly, but I don’t actually want it to be made manifest; it’s just a fantasy. But with the desire to be female, there is nothing I want more, even though it usually doesn’t turn me on quite as much as my fetish.I don’t feel that I am a woman in a man’s body. As a child, riding my bike and playing with robots and guns and blowing up toy cars was more interesting to me than playing with dolls and dress-ups. Clothes and fashion never really interested me. I am attracted to women, not to men; I can remember always wanting a girlfriend. I am competitive and driven to win and achieve. I sometimes feel masculine aggression at thoughts like winning a fight or defending my family. I love logical, analytical activities and write software and web applications professionally.My attraction to women has never involved a desire to have sex; at no point have I ever looked at a woman and had a sexual response to the thought of having sex with her. My desire for a girlfriend, I think, always related to the need for acceptance and companionship. When I am really in the midst of a fantasy, imagining myself as a female, my interest in women decreases, though not completely. My sexual desires and fantasies take on that of a heterosexual woman, including all of the normal acts that would occur in the bedroom. I can even start to fantasize about being pregnant, breast-feeding, getting married, and so forth. When I think of myself in a male body, though, none of that appeals to me, and it even repulses me. (004)
Most informants did not explicitly report their nationality, but I assumed that they were predominantly from the US. Among informants from outside the US, most resided in Australia, Canada, or the UK; here is an example from a Canadian informant:
I am a 50-year-old Canadian male. My first memories of identifying with the opposite gender were in early childhood. By the time I was 12 or 13, I was secretly experimenting with makeup, wearing my mother’s lingerie, and curling and styling my hair as a girl would. I honestly do not recall whether my cross-dressing was erotically motivated, but from my experiences later in life, I would say that my motivation was erotic.In my early teens, I became interested in girls for reasons other than wearing their clothes. In an attempt to purge myself of my longings, I plunged myself into the world of competitive athletics. I was very athletic and not feminine at all. I won seven provincial championships in two different sports. My success in sports did not, however, eradicate my feminine yearnings: They survived and would resurface over and over again.I recall my first erotic fantasies of becoming female in my late teens. In addition to cross-dressing when I could, I would also purchase Playboy and Penthouse magazines and imagined myself as the models in the pictures, with their breasts and genitals. These are my first memories of anatomic autogynephilia. I have never had or wanted a relationship with a male, although I have fantasized about having a male penetrate me as a woman.I met my wife in high school and we were married during my first year of college. I continued to dress en femme when the opportunity presented itself; the motivation was purely erotic. The thought of having breasts and a vagina aroused me. Seeing myself in a mirror appearing like a woman was erotic, but it also made me feel “better.” In 30 years of my marriage, I have been through the cycles of the desire to be female and cross-dress, followed by shame, guilt, purging and the return of my desire to be female. Although I say that my desire returned after purging, I don’t think it ever really went away.About 15 years ago, my desire to dress and be feminine became overwhelming. I would take every opportunity to fulfill my needs, including taking days off work. I often thought of telling my wife but couldn’t bring myself to do it. Then one evening I decided it was time for us both to face the truth. To my surprise, she took it remarkably well. Since my wife found out about my gender dysphoria, I have made great strides in becoming the person I want to be. I have had approximately 125 hours of electrolysis and my facial hair is almost all gone. I started hormone therapy but stopped after my breasts had developed sufficiently to satisfy me.I am still aroused by the thought of having a female body, but the requirement to masturbate has all but disappeared. The dysphoria, however, has not subsided. Although I have small breasts, and virtually no body or facial hair, the longing to be a female in all physical aspects has persisted and grown stronger. I have reached the point where I want SRS and am taking steps towards that end. (005)
Fewer than a dozen narratives were submitted by informants who resided in non-English speaking countries in Europe; below is one unusually detailed account:
I am a 28-year-old male from Greece and a PhD student in engineering. I think Blanchard’s theory describes me 100%. I was not one of those boys who were feminine in childhood. Around the age of 6 or 7 years, I had my first crush on a girl. I loved her in the way a young boy feels love. I never felt attraction for a boy, only for girls.At the age of 4, I had my first autogynephilic experience. It was so intense that I still recall the smallest details. My mother kept some of her lipsticks in the bathroom. One day I went inside, climbed the tub, reached the lipsticks, and immediately tried one. My heart was pounding and my hands were trembling. I felt a strange mixture of anxiety, happiness, tranquility, and fulfillment. I admired myself in the mirror. I remember saying exactly these words to myself: “I can be a great woman!” When I was 7 or 8 years old, I remember looking at my mother’s panties and feeling a compulsion to try them on. The laundry basket became my magic box; I tried on all the panties I found inside. I hadn’t discovered sexual pleasure yet; it just felt nice wearing female underwear.I had seen my younger sister naked, and I felt the urge to change my genitals. I wanted to make my penis disappear and have a vagina; I wanted to be forced to sit to pee. I created a method of tucking my penis using sticky tape. Every time I was alone in the house, I transformed my genitals. I don’t remember my first orgasm in detail, but it was certainly after genital transformation with the tape. During that period, I could never achieve an orgasm if I hadn’t first transformed my genitals. After a time, I found that I could just fantasize that I was a girl; then I could achieve orgasm easily. All my fantasies had one common thing, my becoming a girl; I usually had to do some feminine thing, like sitting to pee, or having to wear a dress to go outside.During the same period, I felt a great need to use sanitary napkins. The thought of menstruating turned me on, and the first time I used a pad I had a feeling as intense as the first time I tried the lipstick. I started using pads regularly. Every time I changed my body to become more feminine or did something that only girls do, I got that same feeling. I started wearing my mother’s high heels at home and tried on her pantyhose. My usual ritual when left alone in the house was transforming my genitalia, wearing female underwear, a pad, clothes, shoes and jewelry. Every such session ended with masturbation and my fantasizing that I was a woman having sex with a man. The moment after I ejaculated, I got a very negative feeling, a mixture of remorse, sadness, disgust, disappointment, and humiliation.At about age 12, I discovered the ultimate genital transformation: instant glue. I applied a large amount of glue to my genitals, in order to have a firm tuck and be able to go to the bathroom like a girl. The result was quite good: My genitals were hidden perfectly, giving me a smooth crotch. If I wanted to go to the bathroom, I had to go in the feminine way: No other way was possible. Even if I wanted to get free, it would be impossible to do it easily. This feeling of inevitability triggered an explosion of autogynephilic feelings, from the inevitability of being female. I admired my body in the mirror. The price for all this pleasure was two painful hours of sitting with a mirror between my legs, taking off millimeter-by-millimeter the glue that had covered the scrotal and perineal area. Many times the skin was damaged and there was bleeding, and I had to clinch my teeth to stand the pain. Every time I swore that I wouldn’t do it again, but not only could I not keep my vow, at times I tried again after only a few hours. I also experienced the urge to have breasts and be obliged to wear a bra. I enjoyed wearing my mother’s bras and I loved the marks they left in my skin after taking them off.At the age of 17–18, I had my first relationship with a girl. It lasted for almost 6 months. The frequency with which I had transformation sessions decreased. I was functioning more like a normal guy, but there were times that autogynephilic feelings occurred, even with my girlfriend. When she was dressed in very feminine clothes, like a miniskirt and pantyhose, I envied her. Whenever I saw a beautiful woman, I couldn’t tell whether I was attracted to her as a man or whether I envied her for being a woman. Any arousal that I might feel looking at her was only because I was imagining myself in her position. At the age of 19, I went to University. I plucked up the courage and bought my own female underwear, pantyhose, pads, etc., and built a small wardrobe. I spend whole days locked in my apartment, dressed like a woman.I was surprised by the abrupt alternation of my feelings that occurred in fractions of seconds when an “en femme” session ended with an ejaculation (and most of the time I ended by masturbating). Before orgasm, I was ready to sacrifice everything to become a woman. And suddenly, after having an orgasm, the feeling was totally reversed! I was flooded with powerful remorseful feeling, which made me unhappy and miserable.I knew that as soon as an orgasm was achieved, the desire to be female would disappear for a time. For that reason, I often tried to delay orgasm or avoided orgasm at all. Whole weeks sometimes passed before I masturbated. All this time, I went out wearing female underwear under my clothes and generally tried to do normal female activities, avoiding masturbation and orgasm. I also noticed a considerable reduction in the orgasmic aim I used to have; it did not matter too much if I hadn’t had an orgasm. It was more important to experience the everyday aspects of a woman’s life. I found enjoyment in reading women’s magazines, shopping, and grooming my nails and eyebrows. Of course, the sexual urges never stopped, but the remorseful feelings were greatly reduced. Autogynephilic feelings may at first depend on sexual drive in order to be expressed; after a while, though, one associates them with general pleasure and a good feeling.I occasionally met girls with whom I had sexual intercourse. Kissing and cuddling was nice, but when it came to intercourse, I could only have an orgasm by fantasizing that I was female. At age 24, I met my present girlfriend. She has a sweet face and looks tiny and fragile, which triggers my male protective instincts. I promised myself a new beginning and threw all my female clothes away; I wanted to live a normal life as a man. From the beginning, I had a big problem having sex with her. First I couldn’t achieve an erection, and then when I achieved it, I couldn’t have an orgasm unless I fantasized that I was a female. After 8 months, I could no longer resist and tried on her underwear. After that, I again started building a new female wardrobe.Every day is a constant fight between the things that I have to do and the autogynephilia that creates disruptive thoughts. It is not easy to study when your mind pops up thoughts of being a girl. It is impossible to concentrate at your job when you envy the pantyhose that a stranger outside wore. It is hard to maintain a healthy relationship with your girlfriend when you envy her for being female. (006)
Only a few narratives were received from informants living in Asia; here is one of the best examples:
I am a 20-year-old Chinese Singaporean. I’ve always had thoughts of being female since I was 10 or 11. I would always dream of becoming a lady. But, due to social expectations, I’ve always shelved my desires. As I went through puberty, I started wearing lingerie, since I was 14. I felt extremely aroused when I wore a brassiere and imagined myself having breasts. These sessions always ended with me stimulating my anal cavity, imagining it was a vagina. I was also very fascinated with menstruation and wished I could have that also. I proceeded to try that; the first time I wore a sanitary pad was when I was 10. It was so arousing I had an erection. I always had more girlfriends than guy friends. I find it so fascinating just observing them. At times I just wished so much I could be one of them. I tried cross-dressing once when I was 15. It was such a wonderful experience and I felt so sexually charged when I used the ladies room for the first time. I get rid of the hair on my legs, and I’ve tried all sorts of stuff: wax, creams, etc. It just gave me such a feeling of sexual arousal when I lay there, waiting for the treatment to work, enduring the pain and smell. I used female deodorant and sweet-smelling shower gel. I would just get aroused anywhere when I fantasized about being feminine.I’m now engaged in a romantic relationship with an 18-year-old girl, and I’m trying to tell myself that I am male and I should remain that way. I’m just so afraid to hurt the girl that has been my best friend for 16 months. But I still have the tendency to cross-dress, albeit not in public. And I still can’t suppress my feminization thoughts. I have also questioned myself on whether I’m gay. But I just don’t think so, as I have never really thought of having sex with a guy when I’m physically male. At the same time, I have also fantasized myself being a woman and being gang raped. I’m just so confused with all these feelings. I have never confided in anyone before and I feel embarrassed about expressing myself so explicitly, due to the social mindset that was inculcated in me since childhood. (007)
Major Themes in the Narratives
The examples above illustrate most of the major themes found in the narratives collectively. Some men who experience gender dysphoria, desire sex reassignment, or have begun or completed sex reassignment feel that the concept of autogynephilia accurately describes them. Furthermore, these autogynephilic transsexuals:
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Often express relief and gratitude at having found a description of their condition that seems accurate.
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Often state that their autogynephilic feelings caused them to doubt whether they were “really” transsexual.
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Often report that they hesitated or refused to disclose their autogynephilic feelings to helping professionals and significant others.
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Often report that their autogynephilic fantasies or behaviors began in childhood, usually well before puberty, and sometimes were associated with overt erotic arousal.
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Usually concede that they were not overtly effeminate during childhood but instead displayed many male-typical interests and behaviors.
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Often report that autogynephilic erotic arousal has continued throughout their lives, including after sex reassignment.
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Usually give a history of erotic arousal associated with the fantasy or act of wearing particular items of women’s clothing.
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Almost always report a history of erotic arousal associated with the fantasy or reality of having female breasts or genitalia.
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Sometimes give a history of erotic arousal associated with fantasies of menstruating, breast-feeding, or being pregnant.
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Often report a history of erotic arousal associated with the fantasy or act of engaging in behaviors considered typical or characteristic of females.
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Often describe a history of erotic arousal associated with the fantasy or act of having sex with a man as a woman, even though they are not otherwise sexually attracted to men.
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Typically state that most or all of their sexual partners have been women or that they are primarily attracted to and tend to fall in love with women.
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Often experience autogynephilia and heterosexual attraction as competing with each other, in that autogynephilic feelings decline when a new heterosexual relationship begins and re-intensify when the novelty of a heterosexual relationship wanes.
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Sometimes describe autogynephilia as feeling like a variant, misdirected, or self-directed form of heterosexuality.
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Occasionally experience little or no sexual attraction toward other persons.
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Often report that autogynephilic fantasies or behaviors are obligatory to achieve orgasm during partnered sex and masturbation.
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Sometimes observe that their desire to be a woman temporarily disappears following orgasm and is replaced by feelings of disgust or remorse.
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Sometimes describe other co-occurring paraphilic sexual interests.
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Sometimes experience autogynephilic erotic arousal or associated penile erections as unwanted or unpleasant.
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Typically report that feminizing hormone therapy reduces, but rarely eliminates, autogynephilic arousal.
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Sometimes state that autogynephilic feelings were an important motivation for their seeking sex reassignment, in that sex reassignment enabled them to actualize or manage their autogynephilic feelings.
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Sometimes believe that autogynephilia is an effect, not a cause, of their cross-gender wishes and behaviors.
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