IJ TRANSGENDER - London Congress - Abstract - Lessons from Autogynephiles: Eroticism, Motivation, and The Standards of Care

Editors:
Friedemann Pfäfflin,
Ulm University, Germany

Walter O. Bockting,
University of Minnesota, USA

Eli Coleman,
University of Minnesota, USA

Richard Ekins,
University of Ulster at Coleraine, UK

Dave King,
University of Liverpool, UK

Managing Editor:
Noelle N Gray,
University of Minnesota, USA

Editorial Assistant:
Erin Pellett,
University of Minnesota, USA

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ISSN 1434-4599

XVI Harry Benjamin International Gender Dysphoria Association Symposium
17 - 21 August 1999, London

Reflections on "Transsexualism and Sex Reassignment" 1969 -1999

Lessons from Autogynephiles: Eroticism, Motivation, and The Standards of Care

Lawrence, Anne A., M.D. (Private Practice; Seattle, Washington, USA)

Background: Biologic males who seek sex reassignment surgery (SRS) frequently have histories of sexual arousal to feminization or cross-gender fantasy. A few clinicians (e.g., Blanchard) have argued that male-to-female (MtF) transsexuality often reflects a sexual problem -- a paraphilia -- with or without an associated gender problem. However, traditional diagnostic and treatment models have been almost exclusively gender-based. I hypothesized that this has led to diagnostic confusion, treatment delays, and unnecessary suffering.

Methods: MtF transsexuals recruited through the author's medical website were invited to provide personal narratives concerning autogynephilia (Blanchard's term for sexual arousal to the thought or image of oneself as female). These were analyzed for items related to sexuality, diagnosis, treatment, and affect.

Results: Fifty-nine responses met inclusion criteria. Respondents frequently reported paraphilic arousal to feminization; this was often part of their motivation for seeking hormones and SRS. Many had doubted they were "real" transsexuals; often they concealed their autogynephilia from caregivers. Treatment delays and resultant suffering were common, sometimes related to inability to live in role.

Conclusions: Some MtF transsexuals suffer from autogynephilia -- a sexual problem -- with or without an associated gender problem. Treatment with hormones and SRS can control paraphilic symptoms, as well as producing desired feminization. Treatment for sexual problems need not be contingent upon gender-based treatments, such as the Real-Life Experience (RLE). The RLE can have severe social consequences, and may sometimes be unnecessary, or even undesirable. Making the RLE a precondition to either hormone therapy or SRS can create unnecessary suffering.