The Ongoing War: Science vs. Community regarding Transexuality

11270255_1436306063341041_2927062454783514804_oEvery now and then, I enjoy being a little more controversial than usual. This comes often from discussions, either online or in the real world, which trigger my irreverent side. I keep thinking about a certain issue or topic that nags at me, like an itch that doesn’t go away, and then reflect upon the issue. At this stage, my own (scientific) training forces me to adopt some detachment, look from the issue from far, and ask myself, very honestly: why does the issue bother me?

Recently I’ve been discussing, both here and elsewhere, the reasoning behind why there are still people willing to take the Blanchard/Bailey/Lawrence model of transexuality for granted, and persist in discussing the issue based on its theory. It has been debunked so often, both by the scientific community but mostly by the transgender community, and is not used by respectable psychiatrists/psychologists in their diagnosis, so one wonders what is so appealing about it. In a sense, the polarization around this issue seems like a smaller-scale version of the battle of Creationism vs. Evolution or some similar ‘public opinion wars’ that rage the online world.

But for a better understanding one needs to start with the historical context.

Blanchard’s findings

In the 1980s, medical technology had advanced far enough to make gender reassignment surgery a reality for the masses, and not merely an exotic procedure available to a selected few. Of course it was still expensive, but some welfare states already allowed the first surgeries to be performed at public hospitals. The 1980s were also the decade when homosexual rights started really to become not only implemented throughout the Western world, but actively become ‘acceptable’. We were decades away from single-sex marriage and the breakthroughs of the current decade, but the first steps had already been taken: homosexuality and transexuality were not any more considered a ‘mental disease’ or a ‘paraphilia’ but merely a condition, and the rights to the minorities (which weren’t that small!) started to become commonplace. The gay culture started to get more and more widespread; pop bands like Village People became tolerated and accepted, as well as gender-bending artists; TV series depicted drag queens (even though mostly as comic relief); gay bars became open to the public instead of secret places known to only a selected few; and homosexuality, while not necessarily openly accepted and tolerated, was at least not a social taboo any longer. This was the decade when people started to expect — perhaps stereotypically so — that fashion designers and hairdressers were gay (the 1990s added marketing consultants to the list…) and that they would openly admit it.

And transexuals would patiently wait in queues to get their desired surgery.

Some, like the Brazilian Roberta Close, became sex symbols of the decade. Transexuality was not something yet as openly discussed and publicly accepted as homosexuality, but there was already an interesting aspect emerging from the public at large: if a MtF transexual was physically attractive, then they were accepted — as a freak, as an oddity — but people in general (except for the religious fundamentalists) would ‘accept’ such an oddity. In a sense, it was looks — and nothing else — that determined public acceptance.

RayBlanchard3482In his clinic in Toronto, Ray Blanchard was evaluating his patients, and he was seeing a disturbing trend. At that time, the criteria for transition were much more rigid. MtF transexuals had to state clearly and unambiguously that they have always have felt to be in the ‘wrong’ body, feel attracted to males, and look relatively feminine or at least androgynous, and having behaved ‘like women’ all their lives. They would be subject to the real-life test, which would take two years, but most would pass it with flying colours. Many would be separately treated for anxiety or depression, which would be the cause of many suicide attempts, and coming to Blanchard’s clinic would seem to be the last resort, the last hope to live a normal life: getting the desired surgery and progress to get a new identity with a name and gender change. Those patients were usually relatively young, in their 20s or so.

However, Blanchard quickly found out that many of his patients did not fit in this classic model (formerly known as ‘primary transexuals’). Rather, he noticed that he was getting a lot of much older males, most of them married (or just recently divorced), often with kids, and a pretty conventional lifestyle. They admitted that they have tried very hard to live their lives as males for as long as possible, but that they still felt that they were females trapped in male bodies, and simply couldn’t hold out any longer — their lives had been utterly fake until then, a pretense that they had kept up for the sake of their family and friends, but it was enough: it was leading them to utter despair and deep depression, and they wanted to become women instead, and get some happiness in their lives.

More disturbing to Blanchard was that these people never really admitted to feel that they had been women all their lives; it was just a very late development. Most would never pass as women anyway, even with hormones and surgery. Among the ones who were still happily married, they had no intention to break up with their wives — in fact, they felt little or no interest in having sex with anyone else but their wives, much less with males. All they wanted was to get their body to reflect their inner feelings, which were clearly female. Many even had full support of their wives.

Such reports were not unheard of in the past. In fact, requests from this group for transition and surgery were simply rejected. It was assumed that such persons were not ‘true transexuals’, but something entirely different — maybe having developed some form of delusion, due to depression or other mental illnesses, which triggered the desire to change their sex. But they would be referred to therapists to get treated; transition was something that wasn’t allowed to them.

Meanwhile, Blanchard also had to figure out what to do with those ‘perfect’ transexuals that did answer all questions on the reports ‘correctly’, went through transition, but afterwards admitted that it was the worst mistake they had made in their lives. Many were caught while still in transition, and could still de-transition successfully before the final surgery; but for others, it was too late. What went so wrong? Why were some transexuals not happy about the result of their transition?

At that time, Blanchard formulated his theory on transexuality — it wasn’t something created from scratch, and obviously he built upon the research from other specialists in the field — and proposed two models of transexuality to explain what he was observing in his clinic. One type, the ‘homosexual transexuals’ (not his preferred classification, but it was what his colleague Freund labeled them, so he stuck with the same terminology), were truly ‘women in men’s bodies’. They felt strongly attracted to males and wished to physically become females. They would also, in general, already act like females, look relatively like females or at least were androgynous, and had identified with the female gender since very early childhood.

The other type had no name until then, and Blanchard called them ‘autogynephilic transexuals’. Here he invented a new term for a new mental disease that was not known to science until then: the idea that a male would obsessively become attracted to their self-image as female, and utterly desired their physical body to be changed in order to become as close as possible to their self-image. This, Blanchard concluded, might have been present due to child abuse or similar traumatic experiences during childhood, and had developed, over the decades, to the point where the person could not stop obsessing with the idea of fully becoming a woman. Such individuals, Blanchard claimed, would not be really sexually attracted to males; most would be attracted to females, some would claim to be bisexual or at least bi-curious, but, in general, the only form of arousal they got was from their self-image as females. The word autogynephilia was thus created to describe a paraphilia, an aberrant/deviant mental disorder, where the object of attraction, instead of being external to the individual — another person — becomes the person itself, but with a (mental) gender switch.

The issue here, as a sexologist, was what to do with such people. It’s clear that they would suffer from anxiety and depression, just like the so-called ‘homosexual transexuals’. But it was actually forbidden for any other kind to go through transition. The question here was how to ‘treat’ such individuals. Blanchard concluded that so-called ‘autogynephilic transexuals’ could not be treated in any way known to psychiatry and psychology — in fact, apparently, the only possible ‘treatment’ to ease their depression (which often lead to suicide) and anxiety was transition as well.

The works of Blanchard definitely had a huge impact in how we view transexuality today. Nowadays, for instance, a lot of requirements for transition have been dropped. For instance, people don’t need to divorce before transition (which is especially true in countries where same-sex marriages are perfectly legal). In many cases the ‘real life test’ can be shortened, or be much more humane than before (even though Blanchard himself still recommends a more conservative approach). The requirement to ‘look great as a woman’ was most definitely abandoned. The need to go through hormone reassignment therapy or surgery was also dropped. As a consequence, the impact of Blanchard’s work is worthy to be recognized for its importance.

But there were many problems with the classification from the very beginning. For starters, a lot of patients did not fit either type. Blanchard incorrectly assumed that anyone who didn’t fit either case was simply lying. This assumption was not so far-fetched as we might judge; after all, in the 1980s, and well into the 1990s, it was not unusual for the transgender community to get lists of the ‘right’ answers to the psychiatrist’s questions, in order to successfully secure their right to transition. Such cases were well documented, and a major reason for people afterwards regretting their transition. Blanchard was certainly aware of that, so he assumed that either transexuals were ‘homosexual’, ‘autogynephilic’, or simply liars.

What was also clearly ‘wrong’ in the ethical sense (and had little evidence to support it scientifically) was the notion that the so-called ‘homosexual transexuals’ were ‘normal’ people (even if most would come to the doctor with anxiety and depression disorders), while ‘autogynephilic transexuals’ had a serious mental disease, one that could not be cured with therapy.

Needless to say, this seemed to echo views from the beginning of the 20th century, when ‘homosexuality’ was also thought to be a ‘mental disease’. I’m actually shocked to learn that even today there are in the US so-called ‘Christian retraining camps’ where Christian teens and adults who are homosexual are forcefully sent by their parents or familiars in the hope that they can be ‘reconditioned’ to become heterosexual. How such institutions are even permitted to exist is beyond my understanding.

Blanchard, however, re-introduced the idea that some kinds of gender variance are also a mental disease, although at least he didn’t suggest that such people should be ‘re-conditioned’, but rather encouraged to go through transition. At least those that fit Blanchard’s models and theories. The rest, of course, being pathological liars, were excluded and ostracized.

Needless to say, the transgender community was not happy about the concept, and felt especially offended and hurt that most of them had now been classified as suffering from a mental disease and a specific new kind of paraphilia. And they fought back. Very hard.

It’s not all about sex and childhood trauma… sometimes

One of the several issues with Blanchard’s theories, according to my perspective, is that they are still rooted in Freudian/Jungian beliefs, that all human motivation is driven by sex, and that childhood trauma creates all sorts of aberrant or deviant behaviour. To be fair, Jungians today are perfectly able to deal with transexuality in a much more milder and politically correct way, and can often provide great support and encouragement. It’s unfair to say, ‘Freud was wrong’ and completely dismiss the decades of work made by psychoanalysts; Freudian/Jungian methods still work rather well today to deal with many mental diseases.

On the other hand, of course, we also know that a literal way of applying Freudian concepts to everything is very limiting, because so many cases are outside the scope of Freud’s psychoanalysis and require different forms of treatment.

So here is the problem. Blanchard and his followers posit that some event in childhood triggered an inner mental state where the usual object of desire — according to them, it should be an external person, preferably of the opposite physical sex — is turned inwards instead. They claim that this happens mostly due to a defense mechanism. Let’s imagine some scenarios: a male child gets physically abused by their parents, who, for some reason, dislike their behaviour. The child feels that somehow externalizing their behaviour is not appropriate — it leads to verbal or physical abuse — and therefore retracts upon himself, imagining a gentle, loving, kind being, an imaginary companion, that accepts themselves fully. When this imagined companion is female, it might trigger autogynephilia at a later stage, as the child becomes attracted to that female image, and, at some level, wants to ‘become’ her. In later years, the child starts believing that everything that is ‘wrong’ with them — namely, the inability to express themselves in front of their parents, family, and friends — is just because they are in the wrong body, and, if they just happened to be that imaginary female person, everything would be all right. As time progresses further, this person starts having difficulty coping with relationships with others: they do not seem to be satisfactory. By contrast, the imagined persona living in their minds becomes more and more desirable over time, to the point of obsession. At this stage, the person has a reduced ability to cope with ‘real’ relationships, since they are much more interested in the attraction to their inner image than to external, living human beings. This progresses further until the person eventually starts desiring to physically ‘become’ that inner image, first perhaps by crossdressing, later through surgery and hormone therapy.

Of course it’s not just the parents that can trigger this ‘mental disease’. Other possibilities might include bullying, for instance: a child is probably weak and slim, and unable to defend himself at school, where he is regularly bullied by the other (male) kids. He sees, however, how the female colleagues — who are also weak and slim, just as him — are respected, protected, cared for, even loved. Therefore he imagines himself as being female, thinking that he was just born in the wrong gender, since girls seem to be able to cope with ‘weakness’ and similar feminine traits and not be victims of bullying and abuse.

Similar scenarios of abuse — which might even include rape — are hypothesized as being the ‘trigger’ for this condition. In some cases, the condition develops so early that the person rejects their gender completely and even develops a physical attraction to members of their own gender (‘homosexuality’). They act and behave like women, and refuse to accept their physical gender. These are Blanchard’s ‘homosexual transexuals’.

In others, there is a constant struggle to cope with their assigned gender at birth. The inner self-image never disappears, and might even become stronger and stronger as time goes by, but the person tries very hard to ‘fit’ to the usual male stereotype — often engaging in ‘tough male’ activities like extreme sports or joining the military — and even get married and start a family. But at some point, the desire and attraction for the inner self-image becomes overbearing and the person cannot deal with it any longer.

Blanchard’s theories do not exclude biological triggers. While at the beginning he only limited himself to male-to-female transexuals, and didn’t analyse intersexed individuals, at later stages he (and his followers) admitted that the ‘trigger’ could have biological origins. In other words, many male children are victims of abuse, but obviously not all develop autogynephilia as a ‘coping mechanism’. So there might be a biological difference that triggers autogynephilia in some cases, but not in most; this is not inconsistent with Blanchard’s theory.

What Blanchard definitely includes as part of the theory is the deep sexual attraction to the inner self-image as female. The inner self-image must always trigger eroticism, arousal, lust, sexual desire, and so forth, or else it’s not ‘real’ autogynephilia but something else. Indeed, one reason for classification under ‘autogynephilic transexuality’ is to provide such individuals with transition with surgery and hormone therapy. Merely having a ‘female self-image’ is not enough; the individual must have a paraphilia, i.e. an aberrant sexual behaviour directed to this self-image.

Anne Lawrence

Anne Lawrence, writing at a later stage, is a bit more condescending: she admits that the ‘love of one’s self-image as a woman’ might also include romantic love and not necessarily just lust and passion — sexual attraction and desire. This is more consistent with a narcissistic disorder — it seems that both kinds of disorders go hand in hand in this case: the male individual, because he has this strong attachment to his female self-image, starts turning inwards more and more, and deeply desires that self-image to ‘become real’ (again, either by crossdressing or by physically altering their bodies). This desire might consume the person obsessively to the point that all they can think about it how to improve themselves so that this inner self-image is manifested in some sort. As a result, other people — social interaction — become secondary in the process, which is consistent with a narcissistic disorder, although it’s a special case (and a different one), progresses differently, and might have been triggered through different reasons than a typical narcissistic disorder.

Even later authors tend to simply label the relationship with one’s inner self-image as a woman as simply ‘attraction’, or, more precisely, ‘attachment’, but always in the context of sexual desire and as a subgroup of narcissistic disorder.

So for the promoters of this theory, there is always an erroneous, deviant, aberrant object of lust and desire, which was triggered through some form of abuse during childhood, and that aberrant behaviour creates this glorified self-image as a female, preventing that person to establish social relationships unless the self-image somehow manifests physically. Such mental disease cannot be treated conventionally. Blanchard’s followers therefore may recommend transition to those individuals, believing that by allowing the individual to actually become the ‘woman in their minds’ they might be able to cope with reality better and lead normal lives.

The theory also excludes all other possibilities. A hallmark of BBL is that there are just two types, and it’s an either/or proposition. Either the person is a homosexual transexual, or an autogynephilic transexual, or they are simply lying to the doctors. There is no third possibility.

Autogynephilia has been further explored outside the scope of transexuality, but still in the context of transgenderism. A few authors (including Lawrence), supporters of the BBL theory, tried to apply the principles of autogynephilia to crossdressers who did not wish to transition. This became a topic of discussion around the label transvestic fetishism, where the individual obsessively crossdresses for sexual reasons (either with a strong fetishist attachment to feminine objects — i.e. clothes and accessories — or to feminine behaviour, which might make them seek for sexual partners willing to engage in sex with a crossdressed individual). In some cases, such fetishists might also be autogynephilic, but still have a strong male identity — autogynephilia, in those cases, is a pure fetishism/fantasy and unrelated to gender identity.

In fact, as you can see from the above descriptions, the BBL theory is notoriously silent about ‘gender identity’. It implies that autogynephiliacs do not really have a ‘female identity’ at all; they remain with a male identity, as assigned by birth, genetics, and biology. But even in some passages, there is a hinted claim that even so-called ‘homosexual MtF transexuals’ remain with a male identity even after transition — thus the label ‘homosexual’. Instead of being ‘females trapped in male bodies’, they become ‘homosexuals who want a female body in order to have sex with males’.

You can imagine how the community reacted to such claims:

Very strongly.

The community utterly rejects the theory

Now we come to the delicate aspect of the theory, and this peaked around the early years of the millennium, as activists such as Lynn Conway and Andrea James rallied the community (thanks to the Internet) to strongly object against the BBL theory and reject it on several accounts. I will just refer to Andrea’s extensive website on the whole debate; she also links to Lynn’s own website as well as to many others. The trigger for the community’s intense response was the publishing in 2003 of Michael Bailey’s own book, The Man Who Would be Queen. I’m not going to do a thorough review of that book; so many people have already commented on it, that there is nothing else I can add. It suffices to say that it sparked an organized movement from the transgendered community against Bailey and his publisher, who ‘passed’ this book as ‘scientifically correct’, to the point where Bailey’s career and reputation were inevitably damaged forever.

As said, the main point of dissension — but by all means not the only one — was the questioning that there is no such thing as a ‘male’ or ‘female’ identity, and that homosexuality and transexuality are linked together, related only to sexual behaviour and preferences, which are somehow triggered by trauma during early childhood. To make matters worse, some forms of transexuality (more on that below) are directly linked to mental diseases. Basically, although his language and methods are contemporary, Bailey throws the whole development of psychology back to the days of Sigmund Freud. And he is aware that he’s doing it deliberately; he says so several times, in fact, anticipating his (future) critics on the subject.

Bailey, at least, has the merit of not being so fundamentalist as Blanchard regarding the two types of MtF transexuals — ‘homosexual’ (or, better, androphilic — i.e. sexually attracted to men) and ‘autogynephilic’. He at least suggests that there might be a certain degree of fluidity between both types — but there are still just two. However, like Blanchard, he rejects further alternatives as merely being people lying about their condition to doctors. At some points in his book, this comes very strongly out; he is almost sure that ‘male bisexuality’ does not even exist, since it doesn’t fit into the BBL theory very well. At least he’s honest enough to claim that he hasn’t studied the issue of FtM transexuality or female homosexuality very thoroughly.

What obviously is very offensive to the community is the way he leads his argument: he considers that sexual preference is biologically determined, and even sustains that argument with evolutionary reasons (i.e. same-sex attraction are evolutionary dead-ends and should have been weeded out by evolution). When sexual preference is not congruent with the genitals, he assumes that there was something that went wrong in the process — but he attributes it mostly to parental neglect, abuse, or ‘wrong’ education (even if well-intended), mixed with the physical attributes that one was lucky to get. ‘Wrong’ is not ‘morally wrong’ but connected with a mental disease which produces aberrant behaviour.

Put it simply (and Bailey is not so simple…), if you have been born with an effeminate male body, and got the ‘wrong’ kind of education, it’s very likely that you’ll develop as a MtF transexual at some point, or, at best, that you will be homosexual (but at a later point he also concludes that the majority of male homosexuals do not really appreciate very effeminate sexual partners). For Bailey, what defines if someone will be a ‘homosexual’ or ‘transexual’ or not are their looks and their sexual appetite.

Therefore, if someone happens to have a very female-looking body from birth, and is attracted to male partners, it’s highly likely that they will become transexual at a later stage. The reasoning behind it is that male homosexuals are attracted to masculinity, not femininity. Therefore, a better strategy for a very effeminate homosexual to attract willing partners is to switch genders — become a woman (since it will be ‘easy’ for them, as they already look feminine) and therefore get male (heterosexual) partners. By contrast, a more masculine homosexual will be far better off remaining in his gender, as they will be attractive to other male homosexuals.

As you can see, Bailey politically incorrectly mixes homosexuality and transexuality in the same type. For him, transexuality is an extension, a special case, of homosexuality. And it is determined by the way you look.

Of course not all transexuals will be attracted to male partners (‘androphilic’). Blanchard, baffled by this, invented ‘autogynephilia’ to explain the second type of transexuals, who are ‘totally different’. Bailey totally endorses this idea, of course. But because they’re different, the ‘excuse’ for this difference is a mental disease — autogynephilia is labeled as being a paraphilia, i.e. an aberrant sexual behaviour, which, however, cannot be ‘cured’ and is mostly harmless (it only harms the person with autogynephilia, not anyone else, unlike other forms of paraphilia such as pedophilia, for instance).

Bailey of course pities ‘autogynephiliacs’. In his book, he tends to depict them as very unfortunate individuals, who have had the bad luck of not looking particularly feminine, and, worse than that, most haven’t even ‘developed’ an attraction for males — so, for most of them, homosexuality is probably not a career choice. Like Blanchard, however, he admits that autogynephiliacs do indeed suffer a lot due to their condition, and that only transition might provide them relief — even if they will never pass as ‘women’ due to their unfortunate very masculine looks (and behaviour).

So Bailey somehow tends to imply that if you have been born male, but have a very effeminate body, you will be subject to abuse and bullying all your life; you ought to change sex and become an attractive female, therefore avoiding the abuse and bullying, and raising your chances of successfully establishing a relationship with a male partner. If you happen to be very male-looking, but are still attracted to males, then you ought simply to be gay. If you are male-looking, attracted to females, and have an inner self-image of yourself as female, then you’re mentally diseased, you have a condition called ‘autogynephilia’ which is not curable through psychology and psychiatry or medication, so you should also ‘transition’, even though the result will not be a ‘full life as a woman’, since you will never pass. Instead, you will just feel some relief from getting your body slightly feminized, and this will allow you to lead a ‘better’ life somehow.

Of course the community could not tolerate such claims, especially when a lot of the ‘research’ that Bailey quotes are some surveys he did with his students (Bailey does not explicitly say if such surveys actually became academic papers subject to peer review), as well as some works from earlier psychologists and sociologists that he picks to support his (and Blanchard’) theories. This wishy-washy mix-matching of case studies, anecdotal evidence, tables and charts pulled from who knows where, was labeled as being completely ‘unscientific’ — and hurt the reputation and feelings of dozens of thousands of transexuals, who complained very vigorously against the way Bailey was depicting them.

Unfortunately, Bailey doesn’t stop at this point, but he rather goes on and on with his theories, crossing the border where he is merely provocative (already in a negative way) to becoming rude in his assertions. All shrouded behind the mask of ‘scientific knowledge’. He even idolatrises Blanchard’s attitude, who has stated repeatedly that he couldn’t care less about the subjects he studies — he just wants to describe the ‘truth’ (according to what his views of the truth are, of course), no matter if anyone gets emotionally hurt in the process. Bailey tries to follow in his footsteps.

And he goes further on to explore what kind of people are these transexuals he has found. He states very unambiguously: they are poor, with low IQ, very low education, school dropouts, mostly coloured/Hispanic, with a history of shoplifting (!) and drug abuse. They spend their lives as sex workers and enjoy it utterly. Again, they only live for sex, and he explores the different types of jobs they get as sex workers. To make sure the picture is complete, he posits that they never establish long-lasting relationships, even though all claim that this is their goal in life, but Bailey quotes that ‘no one has ever had such a relationship or heard about anyone who was in such a relationship’.

By contrast, autogynephilic transexuals are even depicted in a worse light. They might be more intelligent, with better education and a family, but they’re hopelessly mentally deranged. Here the narrative is really harsh on the autogynephiliacs. While the ‘homosexual transexuals’ are merely seen as kind of male homosexuals who opted for sex reassignment surgery in order to better attract partners — so it’s a ‘survival strategy’ in order to have more and better sex — the autogynephilics are born with a terrible disorder, called erotic target location error. Not surprisingly, this is another of Blanchard’s inventions, with Bailey and Lawrence very strong supporters of this theory.

Briefly stated, ‘erotic target location error’ (ETLE) is a mental disease that causes people to find the source of their erotic pleasure outside the body of their sexual partners. Autogynephilia is the case of someone being sexually attracted to their own self-image as female, but other examples have been proposed (for instance, Lawrence suggests that things like infantilism and furries are cases of ETLE). This is stronger than a ‘fetish’ — at least Bailey, in his book, suggests that someone with ETLE will never be able to have a normal, fulfilling relationship with a sexual partner, because even if they manage to have one, they will always feel more attracted to their self-image than to the partner. We will explore this disturbing thought further ahead.

Bailey also suggests that autogynephilic transexuals are in a state of perpetual denial, and are compulsive liars towards their doctors (and probably to everybody else, including themselves). He is pointing to some actual cases in the 1980s, when only so-called ‘homosexual transexuals’ were allowed to transition. Therefore, autogynephilic transexuals would usually lie about their sexual preferences in order to get hormones and surgery. Such cases are actually well-established, and the only ‘good thing’ that Blanchard gave to the community was the ability for autogynephilic transexuals to be allowed to transition as well.

Bailey, however, believes that this didn’t make them stop lying. In fact, he thinks that the whole concept of ‘gender identity’ is pure pretense, i.e. autogynephilic transexuals have just invented that concept in order to ‘hide’ their mental disorder — because ETLE is utterly incomprehensible to anyone else but someone who suffers from that disease, autogynephiliacs have come up with this ‘lie’ called ‘gender identity disorder’, which is more politically correct — so Bailey claims — in order to cover up what they really feel. And although Bailey still believes that transition is the best ‘cure’ that can be given to autogynephilic transexuals, they will all develop narcissistic disorders instead, as their bodies finally ‘become’ the self-image they always entertained, and can freely indulge in auto-erotic sexual behaviour with their physical bodies.

Autogynephilia therefore becomes merely a sophisticated form of masturbation — one that is so intense and so obsessive that the individual cannot even feel deep attraction to anybody else. They are in rapture and ecstasy with their own bodies (after transition). Still, he thinks it’s better to be totally self-centered but happy, as opposed to be suffering a lot to be only able to imagine their self-image as females but not have the appropriate physical body to allow constant and continuous sexual arousal.

Thus, for Bailey, transition is something like amputation to save a life by cutting a limb off: it doesn’t mean that the person will somehow become ‘perfect’, but at least they will get on with their lives. Or, in different words: autogynephilic transexuals are so mentally deranged that it’s better that they become self-centered, obsessive narcissists instead of very depressed individuals. A narcissist will still be able to go on with their lives. Chronic depression, by contrast, just leads to suicide, or, at least, to absolute apathy and an impossibility to function normally in society.

You can imagine how such claims have been received…

Because of the uproar in the community, the BBL theory has mostly been abandoned. I understand that the current batch of psychologists, psychiatrists, sexologists, and similar experts in the field, when diagnosing gender dysphoria, simply disregard BBL, and, instead, try to understand exactly how they can relieve the suffering of their patients. Each case is individually analysed, and, depending on its characteristics, a different approach might be suggested. ‘Autogynephilia’ was stricken from the DSM in its latest revision, even though Blanchard still remains an authority in the field.

Post-Blanchardism: two theories (or more?) emerge


When coming across some BBL writings (or of its supporters), many ‘new’ transgendered individuals (‘new’ in the sense that they have finally realized and admitted to themselves that they are, indeed, transgendered) find some appeal with the model that is presented to them, stripped down from its ideology. The concept that one is somehow ‘attracted’ to their self-image as the opposite gender rings some bells in the minds of many transgendered people. It is seen as a primary motivation for their behaviour; it explains a lot of their urges, but also of their insatisfaction when manifesting those urges and desires. So there is something that Blanchard & co. have correctly figured out — the problems are with the consequences of their hypothesis, which are rejected by the community, and, as such, the ‘new’ transgendered individual feels lost. Yes, they might have developed some sort of attraction to their self-image as the opposite gender — now what? The path taken by BBL is clearly wrong, so what is the alternative?

As I’ve repeated so often, I’m no expert whatsoever, but just an avid reader of gender issues, and I came across two post-Blanchardist mechanisms that attempt to explain what is going on. Each has its own merits and limitations; one is far more polemic than the other, mostly because it’s still rooted in some Blanchardian (mis)concepts, but tries to provide for a different, alternative explanation.

The first proposal I read comes from Jack Molay, and is known as crossdreaming. It retains the notion of having a self-image as a different gender, but is a much more open-minded and all-embracing theory. Some people might develop some sort of obsession towards that differently-gendered self-image, but most might not. Some might feel that experience to be deeply sexual and erotic, while others will not. Some will manifest that self-image physically — either by crossdressing or even going through transition — but most will not. Molay does not provide an explanation why some people develop this differently-gendered self-image, while others do not, but he engages in several possible explanations. None might be taken as the ‘definitive’ or ‘ultimate’ one. Rather, Molay prefers to encourage a more open approach: there might be several explanations, just pick the one you feel that applies best to you.

Molay also does not ‘imply’ a ‘career path’ in the sociological sense. It’s tempting to believe that crossdreamers start to generate a differently-gendered self-image of themselves, then the attachment to this self-image becomes erotically arousing, therefore the need to do something ‘physically’ about it prompts the individual first to crossdress, and later, when crossdressing is simply not satisfactory enough, they go through transition and become the differently-gendered person physically (and legally). Certainly this applies to a few, but not many. There are far more crossdressers than transexuals; there are even more crossdreamers who never manifest their inner self-image externally than actual crossdressers. Therefore, while this is just one of the possible career paths, it’s by no means the only one.

Many crossdreamers are perfectly balanced individuals who just happen to have found an equilibrium between their inner self-image and the image they habitually present to others. Others, by contrast, might trigger depression or anxiety or compulsive/obsessive behaviour, as they feel they are at odds with their inner self-image, and might require some therapy to deal with the issues; a few of them might even go through transition. Again, Molay does not imply that crossdreaming leads to any of those conditions. Crossdreaming is not a ‘mental disease’. It’s also not necessarily tied to sexual drive as motivation. As such, it describes the same condition as Blanchard, but strips it from the unnecessary pathologisation and the sexual aspect of it.

Therefore, asexual people can perfectly be crossdreamers; and even people with low libidos might be crossdreamers and have no real sexual motivation behind it.

Molay also implies that crossdreaming is somehow ‘intrinsic’, i.e. it’s not a ‘fad’, a ‘hobby’, something that one day was ‘not there’ and that suddenly, either through influence from others, reading something, watching an image, ‘triggers’ this self-image as a different gender. Instead, he considers that it’s something that crossdreamers are born with. It cannot disappear. It can be repressed, of course, but there is no valid psychological or psychiatric method of ‘removing’ that inner self-image: it will always remain with the crossdreamer. The issue here is how it affects the normal, functional life of the individual; in some cases, it might affect it adversely, and then the individual might be diagnosed with gender dysphoria.

There is also a possibility that some transgendered individuals do not have a differently-gendered self-image. A typical example are gender-fluid individuals — who adopt whatever gender expression they’re more comfortable with, depending on mood. And, of course, crossdreaming does not explain all kinds gender expressions. MtF crossdressing fetishists, for example, as a rule of thumb, do not have an inner self-image as ‘females’: the crossdressing activity is just a pretext to attract the kind of sexual partners they prefer.

Central to the crossdreaming theory is the notion that ‘gender identity’ has little to do with ‘gender manifestation/expression’ and even less with ‘sexual preference’ — and is not tied to the anatomical, biological sex of the individual. As such, this theory is very consistent with the current state-of-the-art descriptions of gender. And, although it’s use is not yet widespread — there is still very little academic work published specifically about crossdreaming — it is a theory very consistent with the way the transgender community thinks about itself, and therefore enjoys some popularity there, especially in those groups which always had an inner self-image as a different gender but all they did about it was to write fiction, draw images, or engage in similar artistic/creative activities, often adopting a nickname or nom de plume from a different gender, but without any physical expression of the gender they identify with. Such group has been, until Molay, pretty much excluded from the transgender discussion.

Emasculation trauma

An alternative explanation is something I have just recently read about. The theory has no name (yet) but it builds upon Blanchard’s work. It has a different purpose than Molay’s crossdreaming: it tries to postulate a reason for crossdreaming, and, by analysing some different reasons and possible outcomes, proposes different solutions for the issue.

A summarization of the overall theory can be found on OOCities and has been submitted anonymously. The theory continues to be discussed and extended by ThirdWayTrans and others. ThirdWayTrans (TWT for short) has an interesting life story. He transitioned to female when he was 19, and transitioned back to male at 39 — something which definitely shows that Blanchard’s theory could not be entirely correct. The hypothesis is that correctly diagnosed ‘homosexual transexuality’ or ‘autogynephilic transexuality’ ought to produce perfectly balanced individuals, without gender dysphoria, and leading happy, normal lives. The few ‘mistakes’ of people that have transitioned and regretted it immediately afterwards were considered to be the result of a misdiagnosis, improper counselling, a much harder-than-expected difficulty in coping with the new gender role, and so forth. TWT, by contrast, had lived more years in his preferred gender role than in the one he was assigned at birth. He still felt gender dysphoria and ‘came back’ to his original gender — after two decades of living as the opposite gender. Clearly Blanchard’s model didn’t provide an explanation for such an outcome. Something else must have been at work in this (and many other) case(s).

Briefly, this theory makes a few assumptions, some of which are controversial and probably also not popular with the transgender community. It proposes, like Blanchard, that autogynephilia exists, and that it is a form of fetishism/ETLE, where the object of sexual desire is (incorrectly) drawn inwards (the female self-image) instead of outwards (a physical woman). However, it discards the binary concept of ‘homosexual’/’autogynephilic’. It proposes instead that there is a continuum, and that many transgendered people are, to a degree, autogynephilic. Some are much more than others, which creates dysphoria and associated mental diseases like depression and anxiety. Others cope successfully with the fetish (I’m using their definitions, not agreeing with them!) and incorporate it in their daily lives. In the more extreme cases, transition is the only ‘cure’. Others, still, are not autogynephilic at all, but still have valid reasons for transition. Here there is a clear departure from the BBL theory, since it admits that there are not just ‘two’ possible reasons for transition, but rather a large group of valid reasons, of which autogynephilia is just one.

The important point in this theory is that transition is not adequate for all cases. And here the authors (remember, is not a peer-reviewed scientific article) introduce the mechanism that ‘produces’ autogynephilia: emasculation trauma. More precisely, the authors consider that male children that were victims to humiliation (and this form of humiliation is related to male characteristics) will often develop autogynephilia. However, they are very precise on the following point: it doesn’t really matter if the humiliation was intended, or not. It doesn’t even matter if anything happened that would be considered humiliating. All that matters was what the child thought — what their perceptions were, and what they reasoned at the time.

Let’s see a typical example. A young male child is frail and dislikes sports or rough-and-tumble activities because of that. Their parents and teachers, however, convinced that it is in the best interests of the child to participate in those activities, deliberately ‘coerce’ them to join. During a game, however, the child gets hit by a much larger and heavier kid, and is hurt, not only physically, but emotionally. The large kid might not even be a bully, nor engage in scorning or similar demeaning behaviour. He was just playing the game. However, the frail kid is deeply traumatized by that situation. He starts believing that, because he is frail and unable to enjoy sports with other male kids, that he is somehow ‘different’. He starts preferring much softer activities — like the ones that girls engage in. Slowly, with such traumatic experiences, this kid starts believing that he wasn’t really ‘cut out’ to be a man, and would much rather prefer to have been a girl and not be subject to activities that he positively dislikes.

The authors, once again, are clever enough to allow for variation in the narrative. The stereotypical scenario of a very effeminate and frail kid, which enjoys feminine activities, and later on becomes either homosexual or even transexual, is just one possibility — the one that Blanchard and Bailey focused on. But this is not the only possibility. Some effeminate and frail children never have a traumatic experience and as a consequence develop as perfectly heterosexual males without any gender dysphoria. And, by contrast, perfectly normal, non-feminine kids, were for some reason bullied or ostracized (for instance, because they had good grades), and while they might never have ‘feared’ sports or rough-and-tumble activities, the way they were ‘set aside’ by the other boys might have influenced the development of autogynephilia. They try for a long time to act the male role, but always feel somehow inadequate — even though they might have no reason to think otherwise, they always feel ‘lesser men’: at work, at family, with friends. This would explain ‘late transexuality’ and the notion that they have lived all their lives as a farce.

What are the coping mechanisms with trauma? The authors postulate that in many cases the individual will try to over-compensate. Remember, in many cases (and this was certainly the case before the Internet existed), they had no way to talk about what they felt with anyone else. They felt isolated, strange, unique, and different from everybody else. So they often attempt to engage in ultra-macho activities, like joining the military, in an attempt to ‘hide’ their dislike of male activity, because they feel they have to achieve an impossible degree of ‘masculinity’ (by aiming at irrealistic macho role models) to overcome their internal issues. This is an attempt to ‘control’ the trauma: by creating some sort of ‘internal defense’ against it.

The reverse is also a possibility: they might simply give up, early on, to ‘try’ to be men. Instead, they embrace crossdressing or at least crossdreaming. In either case, these are attempts to cope with trauma by controlling it.

An interesting consequence of this theory is that it aligns with Blanchard & Bailey by explaining why hyper-feminine males do not tend to develop autogynephilia, but instead become what BBL call ‘homosexual transexuals’: it’s because they ‘give up’ very early in trying to become men, because they clearly lack the required attributes. By contrast, ‘normal-looking’ kids who went through emasculation trauma, because they are aware they might never ‘pass’ as females, develop autogynephilia instead.

BBL are very heavy on the sexual theme, and the authors of this document follow in their steps. They postulate that there is no such thing as a ‘gender identity’, but merely ‘gender expression’. Instead, they draw a link between trauma and sexuality. They consider that both drive the mind to very extreme emotions, and that sometimes a border between two is crossed. Such assertions are derived from the observation that trauma-induced psychopathy and similar mental diseases are almost always linked to sexual activity, ritualized or physical. They therefore postulate that the same happens in this case: sexuality is used as another mechanism to cope with the emasculation trauma.

Once again, the authors explain that this coping mechanism can be present in different degrees. Unlike Bailey, who revels in dozens of pages explaining why homosexual males have way more sex than heterosexual ones (and one almost feels a hint of jealousy when he writes about it), the authors of the emasculation trauma theory correctly identify and explain that ‘sexual arousal’ is just one type of sexual experience. There are many more, and all are valid mechanisms to cope with trauma. But there are also some good reasons for keeping sexual arousal at bay: the environment might be adverse (e.g. ostracism of crossdressers) or the individual might simply have a low libido.

So, finally, having identified the mechanism that produces autogynephilia, and, like BBL, considering it to be ‘curable’, they propose some methods of ‘curing’ the patient [quoted verbatim from the text]:

  • Covert crossdressing
  • Overt crossdressing
  • Transgenderism (part-time cross-living)
  • Androgyny / “genderfuck”
  • Non-surgical transsexualism
  • Surgical transsexualism

They add to this list more possibilities: each of those can have a different choice of sexual partners (homo, hetero, bi…) and, of course, there are several kinds of surgery available, hormone therapy, and so forth.

Remember, for these authors, the reason for suggesting this approach is to help psychologists and psychiatrists to evaluate their patients and make recommendations — exactly the same motivation that Blanchard and his followers had. However, BBL tends just to recognise two different types (‘homosexual’ and ‘autogynephilic’ transexuals) and proposes the same ‘cure’ for both: transition. All other possibilities are rejected.

These authors, by contrast, suggest that emasculation trauma has many forms and degrees, and that each case is distinct, since each person will find a way to cope with the trauma differently. As a result, autogynephilia is not black/white, i. e. either you have it or you don’t; but rather, it is a continuum of experiences, with different intensities, and different strategies of coping with it. As such, just proposing to such a patient transition as the only choice is very limiting. The authors therefore suggest a few more alternatives, as we have seen.

One would think, from casual browsing the ’emasculation trauma’ theory, that it provides a much more detailed, clinical analysis of the vast variety of transgender people, and that it is far more solid in describing it and proposing the adequate ‘cure’. It certainly goes way further than BBL, and discards lots of stereotyping and bias present in those authors, by embracing a much vaster variety of transgendered people. Because it links autogynephilia to childhood trauma, it allows psychiatrists and psychologists to focus on that instead of on ‘transgenderity’. Trauma, after all, can often be coped with successful strategies — it’s a well-researched field. Even if the individual rejects the particular strategy, nevertheless the vast literature on trauma can help doctors to treat their patients. It seems to be the hope of the authors of this document that in many cases doctors might deal with trauma first, and therefore reduce depression and anxiety to the point that the gender dysphoria is ‘bearable’ or controllable at least, instead of ‘pushing’ the patient straight into transition. And, finally, edge cases where trauma is not recognized by the patient, and who don’t have obvious links to sexuality (as in the case of patients with low libido), can also be successfully evaluated by doctors using this model: trauma can be subtle, it can be denied by the patient (but a good psychologist will nevertheless be able to identify it), but this is differently dealt with, compared to BBL, who simply assume that the patient is lying and disregards their feelings.

However, the theory has its negative points as well, and these I believe are linked to the personal past of at least one of the proponents, who very likely was a victim of the ‘trauma’ of a failed transition, and therefore. Note that Blanchard, Bailey, and Lawrence also have their strong bias due to their own past behaviour (much of with might have also been induced by trauma), as Andrea James has so well documented — so these authors of the emasculation trauma theory should not be so harshly judged!

The first thing that stands out in the document is the utter rejection of the notion of ‘gender identity’. I’ve addressed this on a comment on another article, but it’s worth discussing it again.

Fundamental level vs. conventional level

TWT admits having been in touch with Hindu meditation techniques, which question identity. I’m not familiar with Hindu techniques, but as some of my readers know, I’m no stranger to Buddhist practice, as well to its philosophy.

In Mahayana Buddhism, reality is seen at two separate levels: fundamental (or ultimate, if you prefer) and conventional. In lay terms, you can say that the fundamental level is how things really are, and the conventional level is how we perceive them. This is similar to some Western thought as well, but there are a few differences.

Basically, the conventional level is the level at which we interact with others and ‘pretend’ there is a common reality which everybody can perceive in pretty much the same way. To give an example: we know that at the microcosmic level, our body is just a bunch of particles. The whole universe is just that, but possibly the particles that make up ‘our’ body are located at a point in the spacetime continuum that is just slightly ‘denser’. So, quantum physicists ‘know’ that there is no such thing as a ‘human being’ that can be ‘defined’ at the microcosmic level. All we can say is, ‘hey, you slightly-denser cloud of particles over there, how are you today?’

But such artificial constructs, even though they describe what a ‘human being’ is at the fundamental level, is not functional. It’s far more easy for us to interact with ‘human beings’ if we simply ‘pretend’ that this particular slightly-denser group of particles is called ‘Sandra’ and say, ‘hi Sandra, how are you?’

11267136_1433934046911576_1039835245_nNow when doing that, at the conventional level, we can all agree that ‘Sandra’ truly exists. We have named her, we see her, and we can list her attributes — and will probably agree on most of them as well. However, at the fundamental level, there is no ‘Sandra’. There are just particles whirring around, probably slightly closer to each other than to the rest of the universe. There is no intrinsic ‘Sandra-ness’ on those particles. It’s the observer that calls those particles ‘Sandra’, and perhaps the next group of particles chair. At the fundamental level, particles from ‘Sandra’ are interchanging their location with particles from ‘chair’; there are forces like gravity that pull some of them in one direction, and others in another; electromagnetic forces make the particles from ‘Sandra’ not interpenetrate those from ‘chair’, but some will eventually be exchanged — some particles of ‘Sandra’ will remain in the ‘chair’, some from ‘chair’ will move over to ‘Sandra’. This is reality as it is. But describing it all mathematically is an incredible task. On everyday conversation, therefore, we simply use conventions: we say ‘Sandra sits on the chair’ (haven’t you guessed it? 🙂 ) to describe this immensely complex exchange of particles between two slightly denser clouds.

So the conventional level — where things are named because of conventions, not because they truly are like that — allows us to establish meaningful conversations and interactions. It’s far easier to explain to others that ‘Sandra is sitting on the chair’ than to teach them quantum mechanics and write the equations that explain what really is happening at the fundamental level. If you wish, the ‘conventional level’ is an abstraction of the fundamental level, grossly simplifying its interactions, so that we are able to function effectively at a level that our minds can process.

According to Buddhist thought, however, it’s precisely because we fail to realize that the conventional level is just that — a convention — and ignore the fundamental level that we tend to create hopes, expectations, attachments, and all sorts of things that create insatisfaction, and, ultimately, make us suffer in some way. In other words: the conventional level allows us to interact functionally with others, but we should not take it to be the ‘reality’ as it is (but only as we perceive it), or we will suffer from disappointment.

Regardless of that point, Mahayana Buddhism is very clear on separating those two levels, and teaches students not to mix them up — but also not to reject either (other Buddhist schools, like those of Vajrayana Buddhism, have a slightly different approach, which I will skip at this point). The typical example is given by the student that asks the teacher: ‘If at the fundamental level, no such thing as “suffering” exists — because it’s nothing more than an arbitrary mental construct — why bother to follow the Buddha’s training to ease suffering?’ To which a teacher will say: ‘Because people work at the conventional level, not at the fundamental level, and, for them, suffering truly exists. Do not mix up both levels. Suffering is truly existing at the conventional level.’

This would be the same thing as having a transgendered person coming to a psychologist and saying: ‘I think I’m gender dysphoric. I feel that I’m a woman trapped in a man’s body. Can you help me?’ and the answer would be: ‘At the ultimate level, there is no such thing as “male” or “female”. We’re just particles, and particles have no “gender”. So you cannot be gender dysphoric, since gender does not truly exist. Once you realize the intrinsic non-existence of gender, you will stop feeling that you’re in the wrong body.’

This is ultimately correct. However, in order to realize that, it doesn’t merely require an intellectual understanding. Buddhist doctrine is very precise on that: realization is not merely knowledge. We ‘know’ that we are just a bunch of particles, but that doesn’t mean that we still believe that we have a body and an identity. That’s because we’re working at the conventional level, and at the conventional level, we ‘believe’ that we really have a body and an identity (a ‘self’).

Skeptically questioning the intrinsic existence of that body and the ‘self’ that inhabits it is what Buddhist practice is all about. But it takes years, decades, or eventually even several lifetimes, until such a thing can be fully realized, and not merely intellectually understood. And all this time requires a very diligent practice. Now, most people who enter the psychologist’s office have not gone through those decades of diligent practice; instead, they are suffering from a condition that is real for them at the conventional level. High-brow intellectual answers that refer to the fundamental level of reality are of little help!

That’s what nags me at those who claim that ‘gender identity’ does not truly exist. Of course it doesn’t, at the fundamental level. But at the conventional level, we have a gender identity (even if we reject ‘gender’, we still have a ‘gender-rejection identity’). It’s pointless to claim that ‘gender identity’ does not intrinsically exist — even if it’s true at the fundamental level — if that provides no help to the patient afflicted with gender dysphoria. He or she wants treatment, not philosophy. And s/he wants a treatment that provides some relief at short term, not an intellectual treatise and a meditation technique that — maybe — will give some results after years or decades of practice. In fact, some qualified Buddhist teachers even refuse to teach students that are already clinically depressed. Instead, they suggest that the students get some treatment for their depression first, and, once it is cured, then they can start applying Buddhist techniques and methods to figure out how to avoid depression the next time it occurs — given time and diligent application of the techniques, of course. I have certainly met quite a few highly qualified Buddhist teachers who had to deal with depression and anxiety at some point in their career as well. They might have gone over it, and after decades and decades of constant practice have finally been able to be completely free from such negative states of the mind — but that requires a lot of work first.

So, to recap: discarding ‘gender identity’ through philosophy is not going to help anyone. Let’s stick to the conventional level, which is where the vast majority of people with gender dysphoria will be. If they are at a level where they consider that their gender identity is intrinsic to their being, then the role of the psychologist is to help them to deal and cope with their gender identity, not to explain to them philosophically why it doesn’t really exist intrinsically, and why therefore there is ‘nothing to treat’. That’s simply not helpful and not functional.

Why has everything to be about sex?

The authors of the emasculation trauma theory also seem to be worried to make sure they included ‘sex’ in their description of the theory, by linking trauma coping mechanisms to sexual activity. They were careful enough to explain that there are a lot of ways for such sexual activity to be manifested, and several degrees of intensity for the way it is experienced. But, ultimately, they still root their theory in sex.

Why is that so?

In a recent discussion with a supporter of this theory, the issue here is that ‘autogynephilia’ was originally labeled as a disorder (namely, erotic target location error), and this association stuck — getting rid of it and let it go, somehow, seems to be hard for the authors.

Molay, by contrast, has no problem in dropping the sexual element from crossdreaming. He certainly considers that the inner self-image of a different gender is ‘attractive’, in the sense that crossdreamers are ‘attracted’ to it. Such attraction might include lust, i.e. it might be erotic, and lead to some sort of narcissistic behaviour. But that’s just one possibility. It can merely be an attraction without the sexual component; such things obviously exist, at least in this post-Freudian era.

The authors of the proposed emasculation trauma theory disagree. If I understand their reasoning correctly, they imply that the coping mechanism for emasculation trauma is almost always sexual in nature (even though they recognize that the sexuality can be expressed in an incredible variety of ways, some of which might not even be labeled as ‘sexual’ by external observers). One consequence of such an assumption is that there is no need to posit the existence of ‘gender identity’ to explain the distress felt by gender dysphoric individuals. Instead, they relate the distress merely to trauma and the sexual coping mechanisms. In science, it’s usual to apply Occam’s Razor to prefer a simpler explanation over an explanation that requires several external entities; therefore, the reasoning of these authors is pretty much aligned with the scientific method.

Of course, it also introduces a new concept as the driving mechanism — emasculation trauma — and another concept to deal with it — sexuality.

The authors go further to explore this model. They suggest that the sexual attraction (no matter how it is actually realized; that varies from individual to individual, and, for some, it might not even feel sexual at all) towards the inner self-image creates a form of distress which is similar to what narcissistic individuals experience — pretty much what Bailey and Lawrence also describe. As a result, such individuals might have some difficulty in establishing long-lasting partnerships with others. The authors suggest that such ‘self-relationship’ has gone on for so long, and has become a habit for such a long time, that no other form of relationship can be more lasting. They even go further to say that transition will not help in this case: the self-relationship — they use the expression ‘being married to one’s self-image as a different gender’ — will remain forever the strongest bond, and even further relationships established after transition cannot be long-lasting. They will always make their partner feel that they’re not ‘giving their all’ in the relationship; the partner will always feel a bit like an outsider, that the transgendered person’s needs in their self-relationship will be more important than the needs of their physical partner.

This is probably even more so for crossdressers than for post-transition transexuals, but the authors don’t make the difference. They just claim that the person who has dealt with trauma by engaging in a strong self-relationship with their inner self-image as the different gender will have ‘crippled’ relationships with any partner. Again, they are just restating Bailey’s suggestions.

Now this is a bold claim — and of course, since this is not an academic study, there is no data to validate or refute such a claim. Bailey was also purely speculative in his analysis. The interesting thing is that Bailey was aware of many autogynephilic transexuals who had normal families (at some point he even expresses his belief that almost all autogynephilic transexuals create families with kids), but then dismisses those relationships as being unimportant, since after transition, almost all autogynephilic transexuals that Bailey has met have divorced their wives and distanced themselves from their children.

So while the authors of this document are much more careful in expressing their views — much more liberal and open-minded in accepting that there are continuums and not binary ‘poles’, and very different degrees of coping with autogynephilia — they still tend to side with BBL and view autogynephilia as a traumatic mental disease, one that renders the person ‘diminished’, at least in terms of establishing normal relationships with others.

That’s one of the reasons that they wish that doctors focus on dealing with the trauma first, and worry about the progression of the transition (if needed) or other mechanisms later.

This, of course, makes a lot of sense for those who have de-transitioned. Many of those allegedly have regretted their transition because the consequences of the traumatic episodes in their youth have not been resolved by the transition. They still remained, and still caused distress, even after transition. Some might have been lucky enough to get in touch with different doctors, who tried to cure them of the consequences of trauma. Once they managed to do that, suddenly these people noted that they didn’t have to transition at all. They could simply use the new coping mechanisms for trauma and revert back to their original gender.

Therefore, the authors of this proposed theory are mostly saying that doctors are looking at the wrong issue. Neither BBL’s theories — that autogynephilia somehow ’emerges’ at some late stage due to a series of reasons which remain unknown — nor the mainstream approach (that transgenderity is a mix of nature and nurture which somehow ‘creates’ an inner self-image of the opposite gender) are treating the right problem. The problem is trauma. Deal with trauma first, teach those people how to deal with it and replace their coping mechanisms (which are usually sexual in nature) with different ones, and ‘gender dysphoria’ ceases to be a problem.

There is some appeal in this theory, looking at it from a detached point of view. In a sense, it claims that gender dysphoria can be treated and cured without requiring any sort of transition. Such a viewpoint is starkly in contrast with the mainstream thought around transexuality. The implications are enormous. In fact, if one links the authors of this theory with Bailey — who sees a closeness between male homosexuality and MtF transexuality — one might even suggest that even homosexuality might be triggered by trauma. That would also mean that homosexuality, and not only transexuality, could be treated and eventually cured.

Such claims are anathema!

What will the community say this time?

Very likely, nothing. The proponent or proponents of this theory have not published a book sold on airports and malls, so it means that the public-at-large does not know them. On the other hand, it was never published as an academic article. It doesn’t quote any academic references, and does not point to any studies postulating that emasculating trauma ’causes’ autogynephilia — therefore, the academic community is very likely not aware of the existence of this document and its intriguing (and polemic) proposals. Even though people like ThirdWayTrans are doing their best to promote this view, their reach is considerably limited — it hasn’t attracted honest academic discussion, but it hasn’t attracted the transgendered community, either (except for Joanna and a handful of others).

Therefore, it is of little consequence. Nevertheless, such things may change. For instance, Blanchard, Bailey or Lawrence (and others) might actually like the suggestion of ’emasculation trauma’ as the motive behind autogynephilia. Because they are so keen in defining transexuality as a consequence of ‘unusual’ sexual drives, they will possibly love the idea of connecting trauma with sexuality. The authors of this document are actually surprised that nobody had made the connection before. It’s plausible to admit that BBL would not make such a connection unless they can devise some kind of study — nevermind how much biased or flawed it might be — to link both together and establish a measurable correlation that can be presented on a scientific conference. If that happens, we’ll have BBL back on the limelight. It’s already very visible that the cases that Bailey lists in his book are almost all connected to some sort of childhood trauma. The link is not hard to make.

However, this theory does depart in significant ways from BBL’s standard model. Bailey is very keen to explain how psychology progresses by either ‘splitting’ or ‘clumping’ mental diseases. ‘Splitting’ happens when one overall description with several symptoms is actually better explained by postulating different mental diseases. A typical case: in the 19th century, women were routinely diagnosed with ‘hysteria’. Today we know that many of those cases were probably some sort of depression (of which there are officially five different kinds) but several others would be better diagnosed under different categories. ‘Clumping’ happens when a plethora of different mental diseases all have the same origin, and are merely manifestations of the same disease. Bailey claims that the biggest contribution of Blanchard to the study of transexuality was to ‘clump’ all possible manifestations of transexuality under two types — and to dismiss anything that did not fit those two types as merely patients lying to their doctors!

The authors of this document, by contrast, still view those two types as ‘useful’, but they consider them to be two extremes of a continuum. As a consequence, postulating that ‘transition’ is the only solution to ‘cure’ transexuality is incorrect — they suggest instead that there are several ways to deal with transexuality, and this depends on identifying the origins of the emasculation trauma, see how it can be treated, and suggest several possibilities for a ‘cure’, of which full transition is just one, appropriate for a few cases, but not all. This is, of course, a major departure from BBL’s theories.

Still, it might be embraced by BBL followers.

If that happens, then I believe that the transgender community will, once again, cry out against such a theory. Even though it departs from the BBL concepts that transexuals are mentally deranged to extreme perversion, it still implies that transexuals are merely concerned about sex as a way to deal with a mental condition (i.e. trauma).

It totally ignores that some people simply did not experience trauma at all, and are absolutely not interested in anything sexual, but they nevertheless still are transexuals.

I believe that the kernel of the discussion will go back to the issue of ‘gender identity’ vs. ‘trauma-induced sexuality’.

Does ‘gender identity’ truly exist… or not?

At this point, it’s worth being skeptical towards everything. Let’s question ‘gender identity’ and see where it leads.

The main issue that BBL and the authors of the ‘Transsexual Analysis’ document raise against ‘gender identity’ is that it’s something hard to measure. How can a male individual know what it means to be female?

It’s very easy to argue that males can only create an image of what they think it is to be female. Bailey actually lists a long series of ‘impossibilities’ for males: for example, a male individual cannot know what ‘maternity’ means, or giving birth, or even the possibility of giving birth. They can imagine it, of course, but they cannot experience it. Therefore, their idea of ‘femaleness’ will always be incomplete, and, to a degree, wrong.

Even if we look at ‘gender identity’ as merely a social role (which is pretty much what the mainstream thinks it is), Bailey argues that a male individual cannot fully apprehend what this role entails. There will be always something missing, something incomplete. For the sake of conversation, let’s just call it a pseudo-female identity: a projection of what a male person thinks that a female person ought to be.

BBL & the authors of ‘Transsexual Analysis’ therefore think that there will always be essentially something missing from this self-image as female. It will be necessarily incomplete. It’s not just the physical body that makes a difference. BBL, for instance, are quite eager to label post-op MtF transexuals as merely ‘males with an apparently female body and female hormones’. But they are still ‘male’ somewhere in their minds, because hormones and surgery can give the appearance of ‘femaleness’, but they cannot ‘give’ real ‘femaleness’ to someone who was born male.

To give a different example: we might resort to extreme surgery to make a cat look like a dog, and train it like a dog, even subject it to a strict company with dogs, maybe even rearing them as dogs since birth, but they will ultimately still be felines, even if from the exterior we will think of them as dogs. Even if we could read its mind, the transformed cat will still be a feline trying to think as a canine. But they are different species. There will always be something missing.

Thus BBL & co. are profoundly convinced that there is an intrinsic ‘maleness’ or ‘femaleness’ that is genetically and biologically determined. They obviously allow — in the face of evidence — that there might have been some embryological processes that can have gone wrong when wiring up the brain (Bailey wrote his book a decade before we understood some of the non-hormonal sexual differentiation of the brain; these days, we’re still a long way to be able to explain how it all works, but it’s clear that a lot of brain areas are sexually differentiated without gonadic hormones; such processes had not even been discovered when BBL proposed their theories). In spite of all that, they still believe that a brain in a male body cannot ‘think’ like a female brain.

What they think it happens is that this ‘damaged’ brain will attempt to cope with its ‘damage’ by essentially ‘lying’ to its owner, pretending that it ‘feels’ to belong to the opposite gender as the body. But all this is claimed by them to be self-delusion. In reality, it’s still, say, a male brain projecting this desire to be female, and creating a false, pseudo-female image, which, however, does not correspond to what females really are.

Let’s step back for a minute and try to understand where the whole issue comes from.

In behaviourist theory, one assumes that the mind of a person (or an animal…) cannot be accessed directly, but it can be induced by its behaviour. I have talked about the pitfalls of induction on a previous article — it never produces absolutely correct results, although it can point to the right direction.

When we talk about ‘identity’ we can also not read people’s minds. And assuming that one is not an advanced Buddhist, Hinduist, Jainist, or Taoist practitioner, we will automatically extrapolate one’s identity from what we observe their behaviour to be. For a pet owner, for instance, all their pets will have different personalities. Someone who cares little about animals might shrug it off, believing that ‘all cats are the same’ or ‘all dogs are the same’. But a pet owner will know that this is not the case: each pet is quite different and exhibits a quite complex personality. Some, of course, will be similar; we can group kinds and types together; but, ultimately, they will all be different. This is just because a pet owner will be spending much time together with their pets and know how to ‘read their minds’: essentially, closely observing their behaviour and understanding what produces that behaviour, and inferring — inducing — what their ‘personality’ is like.

Obviously we humans do that all the time towards our own species as well, and that’s why we group people together according to social labels — the lazy do-nothing, the workoholic, the social butterfly, the egocentrist, and so on, and so forth. We certainly don’t know if these personalities are really what those people are, we can only observe how they act and label them accordingly.

In fact, the more we observe someone — like our own spouses or children — the more detailed our picture of their minds is. This is known as having a theory of mind: the ability to predict behaviour in others, assuming that it is different from our own. Humans are particularly good at this, but some animal species are able to do it as well — very likely the higher primates (hominids), but possibly cats and dogs and some birds, too.

We use such cognitive abilities to attribute mindsets to others. This is how we know, for instance, when someone is angry (even if we’re not angry ourselves); but we are even able to infer so much more from simple hints. We call it commonly ’empathy’ or sometimes ‘intuition’ but it’s actually so much more complex than that: we can tell by small signs — face expressions, body language, the kind of expressions we use when speaking, and so forth — what other people are thinking. There is nothing uncanny or magical about this; it’s a skill that we humans have developed through evolutionary means to be able to cope with very complex societies with wildly differing individuals.

Such skills probably have allowed us to recognize the tribe or clan we belong to as opposed to our enemies’ tribes, and to understand their intentions towards us. It also allows us to label or classify individuals according to certain characteristics we ‘read’ in their faces and expressions: this person is peaceful, this one is dangerous, this person belongs to a certain group, this belongs to a different group.

Due to social conditioning, we also learned and acquired certain behaviours, which probably originally were typical of our tribe — culture and language give us a sense of belonging — but it also allowed us to figure out who were the ‘strangers’ (they didn’t behave or speak in the same way we did). This complex interplay of group identification and attributing intention to what other people are thinking led us to be especially well adapted to recognize patterns of behaviour and label them accordingly — even when these patterns are beyond our direct sphere of knowledge.

It is believed that such skills are a mix of ‘nature and nurture’. On one hand, we have a brain which seems particularly good at pattern recognition — we were hunter-gatherers, and being good at identifying patterns (observing the world around us and figuring out where animals were hidden, or spotting roots and berries on the ground based on a knowledge on how they grow and were they are located). So this was a biological evolution which, these days, we use for things like reading and writing.

But on the other hand, we also learn to identify social behaviour, from our parents and peers, and learn to classify those behaviours under specific labels. These are socially conditioned and obviously change from culture to culture and are dependent on the epoch. So there is a learning process involved, but, once we have learned the hallmarks of our culture, we are able to classify people according to those — and, by the same token, ostracize others who don’t ‘fit’ in our culture, because they have the ‘wrong’ characteristics. And we do that by observing people’s behaviour — because we cannot read minds, but are pretty good at inducing personalities based on behaviour (pattern matching again!).

However, our inductive capabilities are not perfect. I love to give the following example: imagine homo sapiens in the African savannah, waiting patiently for some animals to appear in order to hunt them. Suddenly they see some bushes moving, although there is no wind. There is a rustling sound. Birds start flying out of the top of the trees. Small, furry animals run like crazy out of the forest, apparently panicking. What do we think? Danger. Maybe it’s a large predator — possibly a lion! So we have to react fast: although we don’t see the lion (he is too clever to show himself so clearly), we induce from all those tell-tale signs that a lion might be present, and we don’t hesitate: we run away!

Most of the time we would have been right; it was indeed a large predator. But sometimes we might be completely wrong. It might have been just a series of coincidences happening in the correct sequence, and there was no lion present. But a survival strategy, in this case, is to capture partial data and induce a possible reason that explains everything — and do it very quickly. Those who remained around to think ‘Hmm maybe it’s not a lion after all, just a coincidence…’ would very likely have been eaten before they left any descendants 🙂 Evolution doesn’t quite work like that, of course, but it seems reasonable to admit that those that were best at detecting eventual lions (even if they were wrong a few times) and ran away, would be more likely to pass their genes to their descendants. On the other hand, those who would always wrong in assuming a lion was present and ran away without reason would be labeled as ‘idiots’ and probably lessen their chances of getting a good mate. So, over the generations, we would become rather good at detecting lions, even though we would fail a few times — that’s the evolutionary advantage of becoming very good at induction with partial data, even though often we would be plain wrong.

Now we turn back to the issue of ‘gender identity’.

Unlike what BBL & co. claim, we cannot know for sure if there is such a thing as ‘gender identity’ hard-wired in the brain. What we can know is how people behave— and we certainly see them behaving as if gender identity truly exists, and is a separate issue from sexual preferences. It is also clearly something that cannot be ‘conditioned’, as the David Reimer case has proven. But because it cannot be ‘conditioned’, it’s not a reason to discard it as being inexistent. In fact, almost all people behave as if they have a gender identity and believe to have one. Most will also consider that gender identity to be ‘inborn’ and linked to their physical bodies. A few — the transgendered crowd — will reject that link, or at least skeptically question that there is a link at all. They will, however, link gender identity to the way their mind works.

Now BBL tend to claim that a male transgendered person does not really have a female personality, but rather develop their idea of a female personality (what I amusingly called a ‘pseudo-female identity’). They try to support their theory by presenting MtF transexuals with a list of questions and see if they answer them differently than biological females. Some typical cases where there will be a difference is how they feel about maternity, for instance. MtF transexuals may regret never to be able to go through that experience, but they certainly cannot recreate an experience they have never felt and describe it. BBL therefore claim that MtF transgendered individuals do not ‘think’ like females, even discounting the case of infertile women who know very well in advance that they will never bear children and become mothers — they still claim that a barren woman will think differently than a MtF transgendered individual.

The problem I have with this ‘scientific’ approach is that it’s hard to know if the surveyed sample is representative or not. For instance, I’ve been surrounded all my life by relatively unfeminine, genetic women — almost all have been atypical in expressing their femininity, independently of their physical bodies and social conditioning. One of the most violent and aggressive persons I have ever met was an extraordinary good-looking blonde with whom I worked for a while, and we became close friends; she was gorgeous and used her looks for her advantage, but was definitely not very ‘feminine’ in the way she thought (she exhibited a lot of typical male characteristics, from aggressivity to logical reasoning, to taking unnecessary risks and so forth). She could, however, act feminine when she wanted to ‘lure’ some unwary males to do her bidding; this, however, was just an act, and she couldn’t keep it for very long. On the other hand, she would definitely score incredibly high on a survey related to maternity issues, because it was one of her obsessions (when I met her, she was unable to bear children due to a lot of health conditions; much later, she was able to be treated in order to get pregnant, and finally became a mother. The rest of her unfeminine personality did not change in the least, however).

This was an extreme example, but I happen to have quite a lot more! My own mother was a ‘tomboy’ during her youth, and wanted to become a professional hockey player — she loved sports, rough-and-tumble activities, profoundly despised playing with dolls, and so forth. When she started working at an office, she was proud of beating men at arm wrestling and at those machines where you hit with a hammer to measure your strength; but she would dress in conventional female clothing and styled her hair according to the decade and had absolutely no interest in women, just men. By the time she was married with my father she definitely knew how to play the ‘mother’ role, and dressed and behaved accordingly. She was really not very feminine, but merely slightly extravagant in her behaviour.

My brother’s wife shares his love for very tough sports (she used to be an international handball player), rarely ‘dresses up’ (I just remember her dressing up for her wedding, and she really looked like a man in drag when she did that…), and has few recognizable feminine traits. But, like my mother, she has no problem whatsoever with the ‘mother’ role as well, and there is no question that she is 100% heterosexual, loves my brother with whom she has been living together for two decades, and nobody would ‘confuse’ her with a man, even though, out of context, she could theoretically been mistaken for a very butch lesbian — which she isn’t.

So if I wished to elaborate a theory of femininity based on the women I have met, I would come up with an astonishing picture, which would have surprised BBL. As said, almost all the women I have known (and this includes my wife as well) would have exhibited many more ‘male’ traits than ‘female’ ones — at least according to the questionnaires published by Bailey in his book. None of those women were lesbians, bisexual, or transgendered. In fact, I know a few MtF crossdressers and transgendered people who are far more ‘feminine’ than the women I’ve known, even though almost everybody would look at them and have no doubt they were men in drag.

My point here is that taking random samples of people out of the blue and trying to nail down what exactly ‘gender identity’ is or isn’t can lead to wrong results — mostly because of this inductive ability we have. Because all the women I’ve known clearly presented themselves as women, and socially behaved as such, nobody would think that they were anything but female, and none of them would have any doubts in self-labeling themselves as ‘female’. But most of them, if subjected to the kind of tests and questionnaires that BBL had submitted to transexuals and homosexuals, would very likely be seen as strong deviations from the norm. BBL would just shrug away those results, babble something like ‘femininity is a broad spectrum of behaviours, and we can really just compare averages and should drop all edge cases’ or simply assume that all these women I know are compulsive liars. Note that Bailey, in his book, claims to have done a few questionnaires but gave up on interpreting them because he assumed that everybody was lying.

It’s very easy to propose theories that don’t fit the data (the facts) if all you do is to reject the data and consider that everybody is lying!

So back to ‘gender identity’. BBL and their followers really believe that people are just making up ‘gender identity’ as a way to hide their sexuality. They also base their assumptions on the way transgendered people talk about themselves. On Internet websites about crossdressing, from serious organisations (like Tri-Ess or the Beaumont Society), the sexual aspects of transgenderism are played down or even completely absent. Sexuality is not rejected, or forgotten, but it comes at a distant second place — it gets mentioned for the sake of completeness, but it never gets the strong emphasis placed by BBL.

BBL, by contrast, think that homosexuality and transexuality are all about sex. They believe it to be the only driving force. The ‘Transsexual Analysis’ authors explain that sexuality is the coping mechanism used by transgendered people to deal with their emasculation trauma. The difference between both is that the former believe that transgendered people are only lying about their sexuality, while the latter are more clever and suggest that there are many possible forms of sexuality, and not all of them happen in bed with much sweating and exchange of bodily fluids. Instead, they presume that ‘sexuality’ can be a wide range of behaviours which include a lot of paraphilias, namely, narcissistic disorder as expressed by autogynephilia.

While Bailey is keen of picturing ‘homosexual transexuals’ as sex workers, or at least as people totally obsessed with sex, he is also absolutely convinced that ‘autogynephilic transexuals’ are unable to create successful relationships. He even mentions that it’s inevitable that they will divorce their wives (because most of them are not lesbians or bisexual and will not be willing to share their homes with another woman…) and actually gives professional help to autogynephiliacs to deal with the pains of separation and exclusion from their former families. But he says that autogynephiliacs will not worry too much about it, because they are ‘in love with themselves’ anyway, and this will prevent them to extend their love to other partners.

Now it’s obvious that we cannot discard sex as one of the major motivations for human beings; it also seems to be quite well established that sexuality is a good coping mechanism with some sorts of trauma. As such, and taking into account that BBL did interview many transexuals for whom it was all a question of getting a better and more successful sex life, it’s obvious that sexuality does play a fundamental part of the whole issue, and it cannot (and should not) be excluded from the overall picture.

What is offensive for the transgendered community is to assume that because sex is such a huge motivation for transition (or transgendered behaviour in general, with or without transition), it excludes the possibility for ‘gender identity’ to exist. BBL and their followers think that beyond the sexual motivation, there is nothing more, and that ‘gender identity’ is an artificial construct by those politically correct transgender activists who wish to have the sexual component downplayed, but by doing so, according to BBL & co., they are just lying.

This is obviously going to be always offensive. Leaving the small minority of transgendered people and looking at people at large — are they only motivated by sex? Does Pope Francis or the 14th Dalai Lama act and behave as they do, contributing to world peace, just as an expression of their sexuality? Or are they asexual freaks? (Bailey at least seems to also question that ‘asexual’ individuals do not truly exist, or at least he cannot fit them into his theories — like bisexual males). Do presidential candidates run for power just because the are motivated by sex? (As president of a country, will they be able to use their influence to enhance their sex life?)

It’s obvious that sex is the major driving force behind many people. But surely it’s not the only one; people are motivated by power/money, or by a desire to have some security and stability in their lives, or they’re motivated by fame, glory, and earning respect from their peers. Sex obviously is also one of the items in the list. However, it’s not the only one, and for many, it just comes on second or third place.

It’s hard to claim that all human beings are motivated only by sex, and, therefore, they really have no ‘identity’ — instead, they just have powerful sexual urges, but can express their sexuality in very different ways. Well, I’m sorry to say that this is really throwing the whole study of sociology and psychology back to the Freudian days. We have for decades known that sex is not the only motivator for human beings. Why do BBL and their followers persist in it?

I believe that the main reason is that they want to establish the concept that homosexuality and transexuality are really ‘deviant behaviours’ taken to extremes. They don’t want to pathologize such behaviours, because they admit that they cannot be ‘cured’, and, as such, shouldn’t be pathologized. However, they still wish to strongly label a significant part of the human population as sexually aberrant. This, of course, is something that the community — both the homosexual and the transgendered community — are really not very happy to hear. BBL’s stance is that they have no reason to ‘please’ the community (that they are supposedly treating as their patients), but rather they prefer to show the ‘facts’. But what we get instead is anecdotal evidence and interesting sociological case studies, with a theory that applies perhaps to a few cases, but is hardly universal.

There are also flaws in the argument which are unexplainable according to their own theories. For instance, if transexuals were only motivated by sex, they would have a tough time adapting to hormonal treatment — which in many cases will drastically reduce the libido. Transexuals are aware of the risks, but they still wish to go ahead with them. If they were only concerned about sex, it would make no sense whatsoever to risk losing all libido and ability to have successful sex with potential partners — after all, surgery can go terribly wrong, even if these days it’s so much better than it was in the 1970s or 1980s. What we see instead is that there is a much stronger drive than the purely sexual one that motivates transexuals to change their bodies and become people of the gender they identify with. Bailey — and he quotes Blanchard too — is even keen to show how most MtF transexuals, after transition, do not establish permanent, long-lasting relationships, and many do not even get many sexual partners after transition. Bailey admits that they are not less happy because of it. But since transexuals are so well informed — as Bailey shows — then this does not make much sense, if we assume BBL’s theories to be correct. One would expect that transexuals, knowing that there is a high risk of not having further sexual relationships after transition, would abandon the idea completely — if sex were the only motivator. And on the other hand, those that would still go ahead would be completely depressed about the lack of sex. Even Bailey admits that this is not the case, and that almost all transexuals — ‘homosexual’ and ‘autogynephilic’ — are much more happier after transition. Even if they don’t get as much sex as before. So how can their theories be correct?

Molay’s proposed theory of crossdreaming might not identify exactly what ’causes’ crossdreaming, but at least it explains all those cases which are clearly not sexually motivated. Instead of assuming that everybody who is not interested in sex is lying, the crossdreaming proponents just prefer to postulate that it’s all about gender identity. It’s of little importance if gender identity ‘exists’ or not; what matters is that people behave and react as if gender identity is truly existing, and this ought to be enough for us. From their behaviour, we can only induce that they do, indeed, act as if they have a gender identity. We can admit that induction often produces wrong results, and, as a consequence, we cannot establish with 100% certainty that gender identity is ‘truly existent’. But the truth is that we cannot establish anything to be ‘truly existent’ anyway! The best we can aim for is to establish that there is a conventional existence — one that helps us to identify and label things as we perceive them, even if they are not truly like that.

Therefore, ‘gender identity’ is not a lie to ‘cover up’ sexual drives. Instead, it’s conventional reality. It may or not exist, but we all behave and react as if it exists. We can postulate one’s gender identity through objective questioning — and their presentation according to their assumed gender identity — and, as a result, most of us can recognize a male and a female gender identity. We will even be right 90% of the time — induction really can’t get much better than that.

Gender identity as a human right?

Because of people like BBL, who, even if debunked, still influence a lot of doctors and experts in the field, the activists in the transgendered community are pushing for the next step: recognizing gender identity as a fundamental human right.

The idea is that doctors ought not to decide on behalf of their patients about what ‘gender identity’ they have. This should be the right of every person to decide for themselves, and part of the constitution of every country, therefore abolishing the need to have doctors diagnosing a ‘condition’ so that someone is allowed to legally assume the gender identity they wish.

Doctors, of course, will not be completely out of the picture. One thing is to assume the legal right to assume one gender (or none, if desired). The other thing is to take hormones or go through surgery. The activists want to separate both things, i.e. obviously a transexual that wants to take hormones and go through surgery will need to have a doctor’s evaluation (because of possible complications). But that doctor should not have the right to decide what gender that person is assigned to. That ought to be a separate issue, outside the scope of medical science, but restricted to the legal rights of an individual citizen.

BBL followers will obviously feel very uncomfortable about the idea, since they believe that ‘gender identity’ does not exist, therefore it doesn’t make any sense to give people the right to decide what gender they belong to (or none, if so wished).

But consider some examples: we already have the Universal Declaration of Human Rights guaranteeing us the ‘right to a nationality’ (Art. 15). What exactly is a ‘nationality’? It’s an abstract concept that ties us to a community of citizens in a specific jurisdiction restricted to a geographic location. We can say that ‘nationality’ does not really ‘exist’ — we haven’t been evolutionarily wired-up to be members of a certain country or not, but it just happened by coincidence. If we dissect the brain, there is nothing there that says that a person is ‘born’ being an American or a Portuguese. ‘Nationality’ is a typical social construct which only exists through social conditioning, habit, and laws.

We can still distinguish people based on their nationalities. No matter how they physically look like, an American and a Chinese will think, act, and behave differently. This is not genetically conditioned, or the offspring of Chinese immigrants in the US would still think and act like Chinese — but they don’t. They think and act as Americans (assuming their parents raise them as Americans, of course, instead of isolating their kids in a ghetto), and will be recognized as such, no matter what they look like.

And obviously ‘nationality’ has nothing to do with sex, either. We nevertheless still need it to function in our current societies.

The activists proposing the right to a gender identity are pretty much doing the same. It’s rather irrelevant if ‘gender identity’ truly exists or not. In order to function in our societies, we need to adopt a gender identity, just like we adopt a nationality. Both might be just conventions, abstractions that we invent in order to be functional. Nationality is for sure not wired-in in the brain; gender identity might be or not, but that should be completely irrelevant for the discussion.

Therefore, when BBL followers claim that transgendered people saying ‘I’m a woman in a man’s body’ are blatantly lying, we should simply say that such a ‘lie’ is the same kind of lie as if someone said ‘I’ve been born an American and I think like an American’. It doesn’t matter what the reality at the fundamental level is. If someone thinks and feels that their gender identity is female, they should have the legal right to affirm that, and their right to identify with that gender identity ought to be recognized legally, and protected against discrimination — no matter how they look like. This is not different from what we already have regarding ‘nationality’.

Of course the issue is controversial (but not much more controversial than the discussion, decades and centuries ago, if citizenship should be bestowed upon people who were not the right colour or the right gender). Personally, for instance, I do not totally agree with the activists, for one reason only: functionality. It might not be functional for someone who presents as a male to change their gender identity to female, but still continue to present themselves as male. Because our societies are still polarized with two genders, such an individual would be strongly rejected (or humiliated), and they really ought to have good reasons for going ahead with the gender change in this case. Such reasons will almost invariably be psychological, and those require an evaluation by experts.

The fear of those transgendered activists is that doctors might be biased, or simply not properly educated in transgender issues, and therefore unable to diagnose properly a transgendered condition — so they ought to be able to at least get the right to their gender identity, in spite of what the doctors say.

I would recommend caution. For instance, the Universal Declaration of Human Rights also gives anyone the right to claim a nationality, and the right to leave or enter one’s country. However, if you immigrate to a different country, you don’t get their nationality immediately (at least, not in most countries of the world). Instead, there is a ‘test period’, which lasts several years, where you have to prove to your fellow citizens that you really want to be part of them. Each country has different requirements, of course, but as a rule of thumb, one requirement is almost always the ability to successfully get a job (and sustain one’s family) and stick to it. To do that job, it’s almost always necessary to understand at least a bit of the culture and language of the country. So, after a few years in that job, most countries believe that the person is sufficiently proficient in behaving as a member of that country, and after a few tests, they might be granted nationality. This is not a ‘restriction’ on the right to a nationality, but just a functionalist/utilitarian approach to establishing that right — prove that you’re one of us, and we’ll register that proof by granting you nationality.

I think that something similar ought to be done regarding gender identity. The right to claim a gender identity ought to be inalienable; but the actual process of doing so ought to be a little more conservative. Perhaps the person has to prove to their peers that they are really able to successfully present themselves as members of the gender they wish to be registered with. This might be the work of sociologists, but very likely of psychologists as well. So there is a parallel to applying for nationality, which takes years and possibly requires some evaluation from social workers. For applying to a specific gender identity, instead of a social worker, it would make more sense to have a psychologist/sociologist team doing the evaluation.

The principle would still be there, i.e. the right to a gender identity. It’s the actual procedure that would follow through some rules and duties. The fundamental aspect would be to make sure that doctors are not seen as ‘gatekeepers’ in this process. They should mostly be experts in treating a condition, and offering advice — and eventually therapy — to help people to adapt to their chosen gender identity.


In this ‘ongoing war’, we are mostly fighting ideologies. Science is not void of politics and ideologies, although, among all human endeavours, it probably is the one where politics and ideologies have the least effect. Still, there is some effect.

The BBL crowd have a strong bias and adhere to their theories mostly for ideological reasons: they wish to picture transexuals, especially autogynephilic transexuals, as mentally aberrant individuals suffering from a paraphilia, for which there is no treatment, except for transition, which provides some relief.

But the transgender activists obviously also have their own ideology. Because they reject being classified by ‘scientists’ as aberrant (and even non-functional) members of the society, especially those ‘scientists’ who wish to push them into ghettos of sex workers, they reacted with vehemence. This lead them to create a certain degree of mistrust towards doctors, since it will be hard for a patient of gender dysphoria, especially in a frail state (suffering from depression and anxiety), to be lucid enough to understand the ideological bias of their doctors. As a result, the activists prefer that the recognition of gender identity becomes something separate from the medical aspects of transition.

Mainstream doctors, fortunately, have mostly rejected BBL, and most are free from ideologies and personal bias — at least the serious ones. Nevertheless, Blanchard is definitely a reference in the field, and at the very least they will have some knowledge of their theories, even if they reject them. As said, the basic statements of the BBL theory are very compelling for both patients and doctors. The ‘woman trapped in a men’s body’ is a very convincing narrative that seems to provide a good explanation and even some comfort to the transgendered individual. Such narrative is not necessarily rooted in reality, but it is the reality perceived by the transgendered person. The role of doctors should not be an attempt to push their patients to accept that they have an incurable paraphilia, but deal with each case to alleviate suffering by proposing what seems to be best for them.

BBL continue to publish scientific, peer-reviewed articles about autogynephilia. This means that their theory, even if debunked, is still being promoted and widespread, in spite of the activists’ efforts to suppress and eradicate it.

Therefore, for the forthcoming years, the issue will be to further explore alternative explanations to BBL and give them the required scientific recognition. This is where both the scientific community and the transgendered community should collaborate with each other — a process that is often no easy (compared to other fields of research) because most transgendered people need to hide their condition and avoid speaking publicly about it… in order to avoid transphobic rejection and ostracism.

It’s not easy to find a solution that pleases everybody!