A history of pathologising trans women

Words: Cathy Brennan


There’s a YouTube channel called Ali Bee, in which an older woman (presumably called Ali) uploads videos of herself performing folk songs she has written. So far so wholesome. But the titles are a bit strange: Paedophile Pete, You Walk Like Jeremy Clarkson, and perhaps oddest of all, Never Smile at an Autogynephile. The last song includes lyrics like ‘He wants your place, he’ll take your face / That autogynephile’, and ‘please be rude and always mock / Or he might show you his lady cock’. 

As you might have guessed, this is a song about trans women. The academic-sounding term ‘autogynephile’ is probably unfamiliar if you haven’t had meaningful contact with TERF networks; hopefully, this piece will provide a bit of context.

The term autogynephile was coined by sexologist Ray Blanchard in 1989 as part of a typology to categorise different types of trans women.  Before we get into that, we need to rewind to 1966 and the publication of Harry Benjamin’s book The Transexual Phenomenon. A German-American endocrinologist and sexologist, Benjamin had been meeting and treating trans people since the 1920s. He was sympathetic to the problems trans people faced with regard to their experiences of gender dysphoria.

The Transsexual Phenomenon is considered a ground-breaking publication. In it, Benjamin proposed a model by which to better define gender-variance in individuals. This model took the form of a spectrum which ranged from ‘pseudo’ and ‘fetishistic’ transvestites on one end, to ‘true’ transsexuals on the other. This distinction between ‘true’ and ‘false’ hints at discursive problems later down the line. 

Following Benjamin, other researchers proposed models to define different types of transsexuals. Most of these theories took sexual orientation to be one of the key factors when distinguishing between different types of trans people – which leads us to Blanchard.

Autogynephilia, according to Blanchard, is a paraphilia in which a man is aroused by the thought of himself as a woman. In his 1989 study The Concept of Autogynephilia and the Typology of Male Gender Dysphoria, Blanchard’s hypothesis is that there are two subtypes of trans women. The first type is the autogynephile who is aroused by the thought of being a woman. The second type is the trans woman who is attracted to men, classified by Blanchard as ‘homosexual’.

As tempting as it may be among some to chalk up Blanchard’s increasing irrelevance to political correctness (despite the fact trans activists have been condemning Blanchard’s work for decades), many of Blanchard’s critics simply found his model to be unhelpful when treating and studying trans patients.

This renders trans lesbians non-existent, while presenting straight trans women as deluded gay men. At the heart of this academic theorising is the belief that transness is a human defect to be cured; this belief was given legitimacy by the inclusion of transsexualism in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (1980).

The discourse between Blanchard and his contemporaries was largely confined to psychiatry, and while it affected the medical treatment of trans people, for the most part it did not receive wider public attention. That started to shift in 2003, with the publication of J. Michael Bailey’s salacious book The Man Who Would Be Queen

Bailey, like Blanchard and Benjamin, is a sexologist. However, The Man Who Would Be Queen received a massive public backlash, and is despised by many in the transgender community for numerous reasons. What’s pertinent here is that Bailey adopted a model categorising trans women in a way that was similar to Blanchard. According to biologist and trans activist Julia Serano: ‘Bailey refers to primary-type MTF transsexuals as being ‘homosexual[s]’ […] whose decision to transition to female arises from their desire to be intimate with men. Bailey further claims that secondary-type transsexuals are ‘autogynephilic’ – essentially men who are attracted to women and who seek sex reassignment because they are turned on by the idea of having female bodies themselves.’ 

The distinction between ‘primary’ and ‘secondary’ makes explicit a hierarchy of transness defined by sexuality. This hierarchy can be seen to have its roots in Benjamin’s distinction between ‘true transexuals’ and ‘pseudo transvestites’, wherein lies the implication that certain trans women – those who are not ‘true’ – are untrustworthy deceivers.

Blanchard himself is still interviewed about his research, but his method of defining and categorising trans women is increasingly considered irrelevant in his own field. Dr. Margaret Nichols, a licensed psychotherapist who has worked with trans and non-binary people since 1983, positions Blanchard’s view as part of a wider group of psychiatrists who define transness as a pathology which must be treated, rather than as an identity to be affirmed.

As tempting as it may be among some to chalk up Blanchard’s increasing irrelevance to political correctness (despite the fact trans activists have been condemning Blanchard’s work for decades), many of Blanchard’s critics simply found his model to be unhelpful when treating and studying trans patients. A 2016 meta-analysis looking into the relationship between sexual orientation and gender transition concluded that ‘while the concept of autogynephilia might provide some clinical insight for understanding the transition-related life experiences of a minority of trans people, there is no need to assert it as a universal, or to hierarchize between different experiences.’

Despite that, anti-trans writers still invoke Blanchard’s concept of autogynephilia to define and denigrate trans women. Josephine Bartosch often cites Blanchard in her articles for the right-of-centre magazine The Critic. Responding to news that comedian Eddie Izzard uses she/her pronouns, Bartosch wrote in a December 22nd article that ‘Izzard is a man with a fetish. […] It is not unusual for men who get sexual gratification from cross-dressing to in due course declare themselves ‘transgender women.’ Sexual arousal at the thought of oneself as a woman is what sexologist Professor Ray Blanchard calls ‘autogynephilia’, a term which he coined to describe ‘a male’s propensity to be erotically aroused by the thought or image of himself as a woman’.’

This way of thinking about trans women is not confined to Bartosch. Kathleen Stock is a Professor of Philosophy at the University of Sussex who successfully parlayed her own anti-trans rhetoric into a secondary career as a public figure, with numerous media appearances and writing engagements under her belt. Her invocation of Blanchard can be seen in a tweet from 2018 in which she says ‘contemporary trans activism […] serve[s] the political interests of autogynephilic adult males.’ Stock was appointed an OBE in the 2021 New Years Honours.

This brings us back to Ali Bee’s YouTube channel. ‘Autogynephile’ is now a word used to abuse trans women by online TERFs. In some realms of public discourse, it is used as a universally-applicable scientific term for all trans women who are not exclusively attracted to men. The psychological fallout from the categorising efforts of men like Blanchard leads closeted and newly-out trans women to think of themselves as wrong, lesser than, or ‘not enough’. Such thought patterns can lead to our own self-destruction.

learn more

  • ARTICLE: ‘The pathologization of trans-sexuality: Historical roots and implications for sex counselling with transgender clients’ in Sexologies, Vol. 28 Issue 3, by Antonio Prunas
  • CHAPTER: ‘Pathological Science: Debunking Sexological and Sociological Models of Transgenderism’ in Whipping Girl, 2nd ed., by Julia Serano
  • ARTICLE: ‘Dreger on the Bailey Controversy: Lost in the Drama, Missing the Big Picture’ in Archives of Sexual Behaviour, Vol. 37 Issue 3, by Margaret Nichols

Cathy Brennan is a writer and film critic.