As with my post about the Standards of Care, I find myself not wanting to wade into the fray about Bailey/Blanchard/Lawrence or ‘autogynephilia’. It’s petty, it’s the same damn thing everybody’s always talking about, we all go around in circles and fume and we don’t go anywhere.

Part of my reluctance comes from the fact that so much of the response against it has been couched in sex-negative terms that end up as apology for cissexual supremacy and gender coercion. Why the hell should we care *why* people transition? If it makes you happier, *go do it*. Controlling your own body and sex and gender isn’t a privilege granted to the worthy or the people who’ve got the “right reasons”, it’s a fundamental right. Really, if we say that sexual motivations for things aren’t bad or invalid, then why is the two-type theory a problem? (Note: that link? Super problematic.)

I’m also aware that it, as a theory, had a huge negative impact on my mental health for a long time, and that that it is used to justify the Standards of Care, their attendant abuse, and the denial of basic medical care, and insurance coverage of such through the guise of gatekeeping, which is itself through the guise of ‘making the right diagnosis,’ and that Bailey’s two-type theory even contributed to a young woman getting kicked out of her parents’ house at transition. But y’all already know that it’s pernicious.

How do we talk about the two-type theory in a way that doesn’t succumb to its terms? The argument demands we either accept medicalization and gender coercion in this case, or sex-negativity and the validity of gender coercion in other circumstances. We have to challenge the frame–as the sex-positive argument attempts to do. But the sex-positive argument (that sexual motivations are ok) fails to address the underlying misogyny of the theory, which is so fundamental to why it continues to hold power over us–and moreover, how the two-type theory is part of an attack on female sexual subjectivity (trans or cis).

So, let’s define our terms. I’m mostly focusing on “autogynephilia” in this post, rather than the “classic transsexual”/”homosexual transsexual”-by-which-we-mean-straight-trans-women, because in the theory, though straight trans women are pathologized, they are positioned as more ‘real’ and legit than queer ones:

The mantra of some male-to-female transsexuals is that they are simply “women trapped in men’s bodies.” This assertion has some truth for homosexual transsexuals, who are extremely and recognizably feminine (and like most women, attracted to men), but for autogynephilic transsexuals it is not true in any meaningful sense.

J. Michael Bailey

Gross, huh?

It’s important to note that, according to Bailey et al, “male” bisexuality does not exist, and “women” are inherently bisexual. Really, I’m not making this up, you can really be that stupid and get published. Moreover, according to the two-type theory, trans women are men, and thus inherently “gay” or “straight” (see prev. link). (God, the quotation marks hurt my ears, but not using them hurts more) Their contention is that ‘autogynephilic’ transsexuals will have sex/one night stands with men to confirm their identities as women, but not because they’re really attracted to them. The two-type theory depends on this, because otherwise one could do things a different way around–e.g. transition partially out of autogynephilia and partially to have sex with [cis] men. It’s necessary to hold the two concepts apart.

There’s so much I have to come back and critique, but I need to get all my terms out first. Sorry.

Madeline H. Wyndzen has a good essay describing some tensions (‘slippages’ if you’re being a pretentious philosopher) in the definition of “autogynephilia”. On the one hand, Ray Blanchard defines it as “a man’s [sic] paraphilic tendency to be sexually aroused by the thought or image of himself [sic] as a woman.” Wyndzen calls this definition “autogynephilia as a phenomenon,” in contrast to “autogynephilia as a theoretical construct” (a phrase she’s misusing, but whatev):

“Autogynephilia” can be thought of as a “theoretical construct”, which is just a fancy way of saying it’s an “idea that has meaning from its role in an overarching model of how something works.” In this case, the theory is Blanchard’s mis-directed sex-drive model of transsexuality. According to Blanchard there are two ‘legitimate’ sex drives: heterosexuality and homosexuality. A deviance in each causes gender dysphoria, and in extreme cases ultimately causes transsexuality. The deviant form of heterosexuality is called “autogynephilia.”
… J. Michael Bailey not only endorses Ray Blanchard’s theory, but he takes it to an extreme of simplicity. Whereas Blanchard’s model suggests the following three step sequence:

Mis-Directed Heterosexuality (Autogynephilia) -> Gender Dysphoria -> Transsexuality

Bailey suggests only the following two steps:

Mis-Directed Heterosexuality (Autogynephilia) -> Transsexuality

Bailey ignores how uncomfortable we feel being perceived as members of our biological sex (i.e., gender dysphoria). Instead, he turns all of our gendered feelings into something directly caused by (if not simply equivalent to) our sexuality.

Basically, the difference is this: in def’n #1, ‘autogynephilia’ is a bad kind of sexual desire and in #2 it’s the more pathological one of two kinds of sexual desire that cause transsexuality. The problem here is that Bailey et al try to prove #2 simply by asserting the existence of #1–as Wyndzen quotes Bailey:

Even if autogynephilic transsexuals exist, aren’t they rare?

No. Every indication is that autogynephilia is a common motivation for male-to-female transsexualism.

In a recent review by Anne Lawrence of 11 studies with requisite data, the median percentage of transsexuals who acknowledged a history of sexual arousal to cross-dressing (a hallmark sign of autogynephilia) was 37%. In her large survey of SRS patients of Dr. Toby Meltzer, Lawrence found that 86% of respondents had had at least occasional autogynephilic arousal …

[EDIT ADDITION 9:30pm]–Note that there’s no attempt to check and see the rates of such arousal in other gender categories, e.g. cis men, cis women, trans men. He’s not even bothering to argue that “autogynephilia” is more common in trans women than others (or that “autogynephilic” fantasies are distinct from fantasies that cis women have)–only that it exists. I’d respond that correlation doesn’t imply causation, but he doesn’t even establish correlation.

So, according to both Blanchard and Bailey, autogynephilia’s a paraphilia. What’s a paraphilia?

Paraphilias are defined by DSM-IV-TR as sexual disorders characterized by “recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving (1) nonhuman objects, (2) the suffering or humiliation of oneself or one’s partner, or (3) children or other nonconsenting persons that occur over a period of 6 months” (Criterion A), which “cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” (Criterion B). DSM-IV-TR describes 8 specific disorders of this type (exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, voyeurism, and transvestic fetishism) along with a ninth residual category, paraphilia not otherwise specified (NOS). (link)(emphasis mine)

This is where I hit paydirt.

So, getting sexual pleasure out of the idea I’m female. How is this a paraphilia? The nonconsenting/not-of-age criterion is out. So either 1)a woman is a nonhuman object, or 2)being female & sexual = suffering and humiliation. Blanchard defines 4 “types” of autogynephilia (what the hell is it with these people and their categorizations? Numerology?)

but noted that “All four types of autogynephilia tend to occur in combination with other types rather than alone.”[9] [10]

  • Transvestic autogynephilia: arousal to the act or fantasy of wearing women’s clothing
  • Behavioral autogynephilia: arousal to the act or fantasy of doing something regarded as feminine
  • Physiologic autogynephilia: arousal to fantasies of female-specific body functions
  • Anatomic autogynephilia: arousal to the fantasy of having a woman’s body, or parts of one.

The first could go either way–whether you’re talking about the clothing or the wearing of such. The second isn’t about an object, so my only option is to conclude that it’s paraphilic because doing feminine things is suffering and humiliation. The third can *kind of* go either way, but mostly seems like female-body-as-object, and the fourth seems pretty clear: female body parts are non-human objects.

Basically: labeling “autogynephilia” paraphilic and pathological depends on the objectification and subordination of women. There’s really not a way around it.

The two-type theory tries to account for bi/pan/queer trans women by claiming that when we have sex with men, the

“effective erotic stimulus in these interactions, however, is not the male physique of the partner, as it is in true homosexual attraction, but rather the thought of being a woman, which is symbolized in the fantasy of being penetrated by a man. For these persons, the male sexual partner serves…to intensify the fantasy of being a woman.”(link)

I’m a huge Buffy the Vampire Slayer nerd. I fantasize about having sex with Angel, I’m really not ashamed of this fact, he’s fucking hot and his relationship with Buffy, no matter how fucked up, has a lot of emotional/sexual charge. But what I want to know is–why should anyone care about whether I’m fantasizing about Angel fucking me or fantasizing about the sensations my body would experience in that encounter? Isn’t it kind of a duh thing for being-Buffy to be an integral part of a fantasy made hot not only by Angel’s body but by their relationship? (She’s the protagonist–the viewer is supposed to envision hirself as Buffy, and if the person doing the fantasizing isn’t a cis woman, then that envisioning is a ‘fantasy of being a woman’.*) Furthermore, who in the hell decided these were discrete categories, ones that one had either one or the other of, not only within a single fantasy, but over a lifetime? Moreover, what do these categories represent?

Part of what makes BTVS so rad is that it does a good job articulating [white] [able] [cis] [thin] female sexuality/sexual subjectivity–and a sexual fantasy is a fundamentally selfish thing, fundamentally a matter of sexual agency and desire. It exists for your own pleasure, not for anyone else’s (though of course it can be acted upon to bring someone else pleasure). So for true sexual subjectivity, one has to be able to be as self-centered as one pleases in a fantasy. But what the two-type theory does is say that some fantasies–those that cater to [cis] men’s desires and center/glorify cis male bodies–are legit, and other fantasies–those that are irreducibly about female desire and embodiment and sexual subjectivity, those that derive pleasure from one’s own body, those that don’t center cis men–are pathologized. If your fantasy centers deriving pleasure from your cunt–whether or not your bits are currently recognized as such–then it’s fucked up, and if it centers a cis male body deriving pleasure from your cunt, it’s legit.

To be incredibly blunt–according to the two-type theory, female genitals are a hole for a man to stick a dick into, not a source of pleasure. “Real” women aren’t focused on getting off or getting laid, they’re pleasing men and cementing relationships. Have we heard this somewhere before?

‘Autoandrophilia’ isn’t a paraphilia not because it doesn’t happen, but because (according to teh Patriarchy) being male isn’t suffering or humiliation, and a penis isn’t a non-human object–one should derive pleasure from it. If an ‘autoandrophilic transsexual’ were to have sex with a woman to confirm his maleness, rather than out of attraction to her, it would be ok in the medicalized discourse–because using and objectifying women is what he’s supposed to do–his having sex for his own purposes isn’t seen as problematic. Not only is male sexual subjectivity perfectly licit, but it’s still licit when it crosses over into oppressive behavior.

Furthermore, focusing on another woman’s body is insufficient–that desire may or may not be licit, but according to the two-type theory that means your sexual desires as a whole are pathological and bad. Only devoting all your energy to men is acceptable. Erotic attraction to women implies–is synonymous with–self-centered desire (which apparently only men are supposed to have). This categorization/equivalence again positions women as objects to be taken and used, legitimating (actual) men treating female partners as means and not as ends. It assumes that women aren’t even capable of eliciting–let alone worth–service, sexual devotion, or an other-centered desire to please. It’s telling that while Janice Raymond and other cissexualist-feminists (who think of [cis] women as valuable sexual partners that everyone’s trying to get into bed with) assume that queer trans women transition in order to “gain access to women,” the concept of a trans woman transitioning out of desire for dykes (in a non girl-on-girl-pr0n kind of way) never occurs to the authors of this two-type schema. Men–particularly cis straight men–are valuable sexual partners one might transition in order to have access to, whereas lesbians are pretty worthless–my fantasies about Willow and Tara couldn’t possibly have the same motivational force as my fantasies about Angel or Riley or Spike. (We also have a devaluing of homosexuality going on here, such that while someone might transition ‘to be straight’ they’d never transition ‘to be queer’)* And while my assumed motivation for fantasizing about being Willow or Tara and having sex with the other–to confirm my own femaleness–is unremarkable and assumed in the BBL typology (why else would I be fantasizing about them?), ‘using’ men for such confirmation (objectifying them) is unacceptable and pathological. (I’m not endorsing this possibility, just talking about the implications of their blind spot.) A real woman’s purpose is to serve men, subordinate and objectified.

Female sexual subjectivity? Not allowed. By making a focus on one’s own body & sex illegitimate, the two-type theory seeks to control and subjugate all women’s sexuality. Focusing this pathologizing discourse on trans women–who cis people are very willing to believe are pathological–allows misogynistic social scientists to get these ideas circulating in public discourse without triggering feminist response or critique, allows them to get people to internalize sexist beliefs without necessarily even being aware they’re doing it. We as a community cannot afford to address autogynephilia solely as a transphobic (and sex-negative) theory, because its power and its goals are rooted in misogyny.

ETA: a number of small edits about 9:30pm on 3/31, both content and syntax. Significant additions are marked with a * or an [edit] lead off to a paragraph.

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With respect to my last post, Battybattybats writes:

But it is worth taking this further, because in much of the world to obtain basic rights and essential services as a transgender person that cis folk always enjoy one must be steralised.

It’s all well and good for those who choose to undergo procedures that render them sterile. Its their right to make that decision for themselves and everyone should support their right to do so. But to mandate it in exchange for basic rights and access to essential services is a human-rights abuse plain and simple.

If there is a genetic cause or factor involved in being Transgender then forced sterilisation is clear and direct biological Genocide.

It is Eugenics!

Transgender people do not automatically lose their reproductive rights! They may choose to waive them but should never be forced to waive them.

Those who do go through treatment that renders them sterile should be able to preserve reproductive material where possible and to use that later in life if they so choose. [though fine in the US, it can disqualify one for government document change elsewhere, notably Japan.–me]

Where there are state-based health systems these should provide for this service for those that are covered by them.(link)

In this context, but without the governmental authority, at least one US medical practitioner, Jamie Feldman, has made a hysterectomy a precondition for testosterone treatments for a trans man married to a cis man. (with WPATH’s approval–she operates out of the same building)

(you might also want to read Antiseptic Stings in reference to this whole mess.)

It does something to you, growing up trans in this world, coming out, transitioning. It does something to you, knowing you are worth less.

When you decide, if you decide, to take hormones, to have surgery, to medically transition, you have to accept that your life is worth less because you are trans. You have to accept that in our society, you are not worth a couple weeks of a researcher’s time, an office, and a couple hundred rats.

You have to accept that you will never receive safe medical care again. There are no studies, there is no research. There will be no research. There is a federal ban on funding research. No one knows your risk of cancer, no one knows if there are better options, no one has scientific evidence of jack shit. No one knows the long term effects of trans HRT, let alone how your body reacts with other drugs. Let alone the changes you will experience that aren’t on the map for cis people, that aren’t about them, that are specifically trans. You are not worth even the laxest of FDA approval standards, at least not to the government. Not to medicine. Not even to WPATH. Not even they advocate, protest, denounce, even they are complicit. You are not worth a single class in medical school. You are not worth a single day in medical school. You are not worth any formal training. At all. You are not worth being treated by someone properly trained.

I know, these are false. This is only culture. But you have to accept it nonetheless. You have no choice, if you want to access medicine.

You have to accept not merely the risk, but the certainty of institutional violence against you as a cost of transition. If you want to transition, you must accept abuse. You must accept coercion. These days, you can purchase hormones from overseas, but you still must accept that if the US government finds your purchases it will steal them. You must accept that if it does this you risk health consequences.

If you have surgeries, you have to accept paying thousands of dollars for what cis people have to begin with. You have to accept paying for it all yourself, unfunded by the same cis people who will demand that you take part in funding the same procedures for them. You have to accept that you are shouldering a larger economic burden than those who make twice as much as you do. You have to accept shouldering economic burdens for the very same people who discriminate against you, paying for research you are legally prohibited from benefiting from.

You have to accept that from here on out, you are never safe. You have to accept exchanging internal misery for violence, discrimination, and abuse. You have to accept that the chances you will be murdered go up 16 fold.

You have to accept that you are accepting the risks of violence, discrimination, death, and abuse. You have to accept that you are accepting medical risk that would be illegal for any other population. You have to accept that you are accepting the risk that you will not only be killed for who you are, but that that killing will not even be considered murder. You have to accept, when you transition, that you are taking steps that will disqualify you from many of the most basic safety nets our government provides, and that you pay for in taxes. You have to accept, when you transition, that the actions you take may legalize sexually assaulting you, IPV against you, raping you, harassing you, etc etc, and cause you to lose many of the resources available for dealing with them. You have to accept a world in which your life is worth less than a cis woman’s comfort–and you have to accept entering that world on your own two feet. Whether or not it’s a “choice” to be trans, you have to accept that every pill you take, every patch you wear, every shot you inject is a choice to remain in this world of violence and hate.

You have to accept transitioning anyway. You have to accept leaving yourself vulnerable to all of that. You have to accept taking immense risks to gain some of what cis people have from birth, what they have handed to them. You have to accept that you are not turning back, that your own actions expose you to this risk, no matter how little your fault it is–but if you do turn back, you have to accept that you are throwing your emotional health in a wastebasket and lighting it on fire.

You have to accept betraying yourself. One way or another.

No, it is not your fault. No, the violence, discrimination, hate, etc etc is not your fault, you are not “bringing it on yourself,”–the government is, transphobes in the street and in the West Bank University of Minnesota Office Building and in every office building are, transphobic feminists and CLGB folks are. They are solely responsible, and they are reprehensible for it. But you have to accept risk. You have to accept unacceptable risk. You are in a building lit on fire by arson, and you have to accept that there is an exit you are not taking.

There is something that being trans does to you. Something that transitioning does to you.

Today someone asked me–I don’t remember what it was. Why I took some risk. Why I lane split on my bicycle, why I run red lights. And the only thing I could think of is “I’m trans.” Why I bike in bad weather in the winter–my excuse is that public transit is expensive and a site of harassment, but again I can’t get past ‘but I’m trans’. Of course I do that. Someone lectured me about taking herbs that hadn’t had vigorous scientific studies done on them, that no one really knew if they were safe, if they did what they were said to do, if they had unknown terrible side effects. All I could think of is, “but I’m trans.” Someone implored me not to wear my heart on my sleeve, to leave myself vulnerable to people who will attack me and hurt me, and all I can think is “but I’m trans.” People tell me not to get a tattoo unless I’ve meditated on it for a year and been completely certain, since it was permanent, but I think “but I’m trans. What are you talking about?” People lecture me on my BPA water bottle, on this health risk and that health risk, on what we don’t know about food risks, and I think ‘great for you, but I’m trans.’ People wonder why I go out alone at night, when I feel vulnerable to violence, powerless to defend myself, and they chalk it up to trans woman male privilege, but I know that’s not how being trans affects it. People wonder why I bottom intensely with a new person, and I think, are you kidding me? I should be concerned about that when I’m in a community space? Why did you spit at him when he had you trapped against the wall? Why did you kick the car’s bumper?

No, the reason I take risks has nothing to do with male socialization. I take risks because I’m used to it. I take my life into my hands and it’s nothing special, really. I take risks because I know that it’s ok for me to die in my society, and I can’t help internalizing some of that. I take physical risks to preserve my psychological health because it’s all I have. I take risks because I know I don’t matter. I take risks because what’s one more risk given all I already have? I take risks because I really don’t know how long I’m going to live, or what beast is staring at me from thirty years away. I take risks because I know that in ten years my life, my very existence, could be illegal. I take risks because I’m already surviving a risk that others quake at. I take risks because risk has lost its meaning.

Trans folks love to debate about the standards of care, and I feel like there’s a similar dynamic to the male privilege thing happening — the “mature” trans person says, oh, but really it’s ok, you know, it’s not so bad. besides, why does it even matter? It’s not like we should be spending so much time on this. You’re being such a victim and not considering anyone but yourself, you selfish * you.

Without going into the various arguments commonly asserted, there are three that frequently get left out that are hugely important.

The sometimes included one:

1)Economics. The SOC impose a substantial financial barrier to trans people getting routine health care access. If you assume that, without insurance, therapy costs ~$100/session (at the cheap end), and that, without insurance, hormones cost ~$150/mo through inhouse pharmacy or the like (bodybuilder testosterone substantially less), three months of weekly therapy incurs an additional ~$1300 of expenses–an up front cost almost 9 times as large as the ensuing monthly cost. A year of biweekly therapy incurs $2600 of additional charges on top of that for a hysto, metiodioplasty, or orchiectomy– all of which are relatively inexpensive otherwise–one can obtain an orchiectomy for $1500-2000, a 130-173% increase in price– for a population suffering dramatic economic marginalization–economic marginalization potentially lessened by having said procedures, and, additionally, reducing the monthly cost of hormones. The economic issue is less pressing for phalloplasty/vaginoplasty, (FFS isn’t regulated) but for the cheaper surgeries it’s a huge deal.

The two I haven’t heard others say:

2)Procedures, not transition, not identity. There’s an almost universal assumption that these standards of care are in case a patient decides to “change hir mind” about transitioning. Putting aside of the implications of protecting trans people from themselves for a moment, transition regret is a red herring. No medical procedure can force you to live in a particular gender permanently. If I’ve been on estrogen for 10 years, have bottom surgery, facial surgery, the works, and decide I want to live as a man again? I start taking T, bind my tits, pack, and it’s no big deal. Yeah, it kinda sucks for me, but I’m not really any worse off than a female assigned at birth transsexual man (and, in fact, my situation would be remarkably similar to his).

–The point is, your informed consent is *not* about “being” a man or a woman (which no one can really truly understand in advance), it’s about the effects on your body (which, while variable, are fairly predictable). If I want an orchi, I need to be willing to take estrogen or testosterone for the rest of my life or be willing to live with the consequences of taking neither, and be willing to either store sperm or not have (more) biological kids–and what gender I plan on living as in the future is fairly irrelevant.

This point is particularly salient if, like me, you transitioned before having any medical intervention. A doctor cannot prevent you from living as a particular sex by not providing treatment–a doctor can only increase the risks associated with doing so. Which is to say, if a doctor refuses medical therapies it’s not a matter of “correct diagnosis” as it is so commonly framed by SOC apologists, it’s not a matter of refusing transition but a matter of refusing treatment known to reduce associated health risks such as discrimination, murder, and harassment (not to mention body dysphoria). Trans people who don’t transition when refused medical treatments are managing their health risks as best they can in the absence of basic medical care, something no one should have to do.

3)Boundaries, mental health, abuse, and control–

The SOC are damaging to trans people’s mental health1 and growth, particularly in the setting of boundaries. Normally, one can say ‘what you just did to me was fucked up, you can’t do that or I just won’t be in a relationship with you; I have other options,’ but through the SOC therapists and doctors create a unified front through which to drastically reduce your options. They create a power relationship with you where you can’t say ‘no’, where you can’t keep the most fundamental control of your body and person to yourself. Medical professionals have the power to protect you from violence, and by withholding it until certain standards are met they use the threat of violence to maintain immense power to determine what you can and can’t do with your life, your body, and your appearance; they also take advantage of the intense emotional pain of body dysphoria to do the same thing. Even if individual professionals do not intend to impose rigorous standards on a person’s gendered actions, the fact remains that the institutional power arrangement concentrates power in the professional’s hands, power over things so basic to one’s body sovereignty and self-determination that one cannot afford to risk the potential consequences of rocking the boat. By creating a unified front, the SOC effectively force trans people to do what their provider wants them to do, without much hope that they could be held accountable. How are we preparing trans people to resist emotionally and physically abusive partners? Aren’t we telling trans folks that it’s ok for another person to control you, financially for instance telling someone that if they don’t have sex with you then you’ll kick them out of the house / they won’t get any spending money next month / etc? The SOC constitute direct abuse, a mix of sexual, emotional, physical, and financial or something separate but equally abusive…

1: I’m tabling important arguments about how it screws with your ability to access (actual) mental health treatment and therapy.