Published as:
James A (2006). A defining moment in our history: Examining disease models of gender identity. Gender Medicine. 3. S56. https://doi.org/10.1016/S1550-8579(06)80121-X
Abstract:
Gender identity and expression take on different meanings within different systems of thought. Because medical technologies are available to assist in the somatic expression of these identities, several medicalized disease models of the phenomena have developed. This article examines three disease models as typically applied to those who seek feminization:
Psychosexual pathology (Bailey-Blanchard-Lawrence [BBL] model)
- The BBL model is the least scientific and most stigmatizing, with roots in the eugenics movement of the 19th century.
Psychopathology (âgender identity disorderâ [GID] model)
- The GID model is currently considered legitimate within psychological literature and is a required diagnosis to receive access to trans health services in many places. The author reviews several problems with mental illness models, including âchildhood gender nonconformityâ and âtransvestic fetishism,â two other âmental disordersâ currently considered legitimate diagnoses. The article makes several analogies, asking readers to consider whether âracial nonconformityâ or âreligious identity disorderâ seem legitimate as well.
Pathology (âbirth defectâ model)
- This third metaphor of impairment describes a physical disorder rather than a mental one. The âorderâ implied by positioning these traits and behaviors as diseases reinforces heteronormative hierarchies. These models use scientific-sounding terminology to reinforce the social belief that the âpurposeâ or âfunctionâ of sex and sexuality is procreation. This leads to an examination of historic problems with anatomical thresholds for determining sex. The author then draws parallels with other bioethical debates about technologies that disrupt the ânaturalâ order of procreative sexuality. Interest in feminization is stigmatized in many cultures, and the article concludes with some suggestions for ways to consider it independently from models of sin or disease.
Authorâs note: This personal viewpoint is not intended to be representative of any side or group participating in these discussions.
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Introduction
Interest in feminization, historically revered or feared, has benefited from advances in science that expand possibilities for its physical expression. These advances led to scientific models of gender variance, which were positioned as objective alternatives to the judgmental âsinâ models promoted by some religions. Unfortunately, some allegedly scientific models being used merely replace metaphors of sin with metaphors of disease and impairment, rather than using objective scientific language. The time has come to examine these judgmental models: the assumptions behind their definitions, how they masquerade as science, their roots in eugenics, their impact on our access to health services, and their political implications.
The most insidious disease model appears at first glance to be progressive, even liberal, but on closer examination, it views gender variant behavior in children and adults as a psychosexual pathology (a fancy way of saying itâs a sex-fueled mental illness). Though the idea has been around since the 19th century, new language for this âdisorderâ was proposed by Ray Blanchard (1989) and restated by Anne Lawrence (1997) and J. Michael Bailey (2003). Though the Bailey-Blanchard-Lawrence (BBL) model claims to be non-judgmental in a moral sense, it is undeniably judgmental in suggesting gender variance is a disease.
These old school sexologists still use terminology based on century-old ideas about gender-variant behavior as a sex-fueled disease. Their definitions tangle up several distinct threads about sex and sexuality in our community. Inflammatory language about transwomen like âman who would be queen,â 1 âman without a penis,â 2 or âmen trapped in menâs bodiesâ 3has led to responses in kind about BBL and their apologists, but thankfully, such polemics are now limited to shrill but secluded fringes of discussions about untangling the mess theyâve made.
Definitions and thresholds
Scientific language evolves with understanding, and scientific discussions require that words be used with scientific precision. In short, definitions matter. A definition simultaneously includes and excludes. It affects how people view our community, especially those who expose problems with existing definitions. BBL and their apologists mock the evolution of definitions and ideas as âpolitically correct,â 4, 5, 6, 7 a term used by guardians of convention that signals a lack of intellect and contempt for scientific progress. For instance, Lawrenceâs opening salvo brags of being one of the âtroublesome people who are inclined to doubt the conventional wisdomâ about transgender eroticism, then just ten sentences later defends Blanchardâs use of the inaccurate and offensive term âhomosexual transsexualâ because it is âconventional usage in the psychiatric literature.â 8 [emphasis mine]
Specialized definitions for many words in this debate evolved within separate institutional realms. Though used differently, a term as defined in one field influences another field, especially as we see attempts to merge biology, psychology, law, and medicine into biopolitics. 9 Within the current medico-juridical system, clinical thresholds affect legal thresholds and vice versa.
Imprecise and idiosyncratic definitions plague this debate. The BBL model declares transsexual women are men with one of two sexual desires: âhomosexualâ (males aroused by males) and âautogynephilicâ (males aroused by the thought or image of themselves as women). Both categories efface our identities as women, but âautogynephiliaâ is more problematic in many ways. One major problem is the tendency for some who embrace the term to look at the etymology and think it denotes an innocent and happy form of feminist self-esteem: âI love myself as a woman!â theyâll say. I do too, but thatâs not what this word denotes. When I say, ââAutogynephiliaâ is defined by its creator as a type of paraphilia,â some say, âWell, thatâs not how I use it.â Thatâs like saying someone is a pedophile because she loves children, or that someone is a zoophile because he loves his pets. Those terms are clinical and legal descriptors. Yes, âpedophileâ literally means âlove of childrenâ in Greek, and âautogynephileâ means âlove of self as woman,â but both terms are inexorably linked to their clinical origins as psychosexual pathologies.
Calling oneself or others âautogynephilicâ is participating in oneâs own pathologization, and it legitimizes this fake disease when people claim they donât have it. BBL are engaging in scientific McCarthyism, where they claim a hallmark of âautogynephiliaâ is that those afflicted will deny it. Any refutation becomes proof they are right, a no-win situation like asking âwhen did you stop beating your wife?â
When we say âautogynephiliaâ is a made-up disease, some mistakenly think we are claiming erotic interest in feminization is made-up, too. Obviously, this exists. Many women in our community have been very open and honest about their erotic interest, 10 yet still take issue with labeling it a disease. 11
Sex and sexuality
My response to âsexologyâ is similar to how a person of color might respond to âraceology.â I question anyone who seeks to draw bright lines between nuanced possibilities of sex and sexuality, especially when they claim their attempt is science instead of something arbitrary and subjective. Trying to map a scientific schema onto complex traits and behaviors is like turning an impressionist painting into a paint-by-numbers. Those who fear miscegenation of the sexes or sexualities are just like those racists who use âscienceâ to reinforce socially constructed categories of ethnicity. As Anne Fausto-Sterling notes, âLabeling someone a man or a woman is a social decision. We may use scientific knowledge to help us make the decision, but only our beliefs about genderânot scienceâcan define our sex. Furthermore, our beliefs about gender affect what kinds of knowledge scientists produce about sex in the first place.â 12
What kinds of knowledge about sex are BBL producing? They claim variously that homosexuality appears to be an evolutionary mistake 13 and a âdevelopmental errorâ 14, and gender variance is a âdefect in a manâs sexual learning,â 15 and a âsexual problem.â 16 It makes sense that a doctor would choose a disease metaphor and psychologists would use a mental disorder model to describe their observations and impressions. If we have a disorder, then what is the âorderâ to which they adhere? They imply the âpurposeâ and âfunctionâ of sex and sex organs is procreation. Why, itâs so obviously true that the belief shouldnât even be examined, right? According to people who believe this overly simplified idea, males have evolved (or were designed) to be attracted to females, and vice versa. In their worldviews, anything that deviates from that is, well, deviant.
Well, to borrow a phrase, a few troublesome people are inclined to doubt this conventional wisdom. 17 Many of us question Lawrenceâs claim that sexual desire is âthat which moves us most.â 18 We point to our experiences and feel our identities are what drive us; Wyndzen shows psychology supports our recognition of how powerful a force âidentityâ can be. 19 We even question some passages of Darwin and the Bible (at the same time, no less!). BBL get very upset when highly respected evolutionary biologists like Roughgarden 20 or Gould 21 question their most deeply-held beliefs about sexual selection and human behavior.
Eugenics, genetics, degenerates, gender
The words âeugenics,â âgenetics,â âdegenerates,â and âgenderâ all derive from the same Greek root meaning âto produce or bring forth life.â Some sciences and some religions seek to explain our genesis and control our reproduction of subsequent generations. New reproductive technologies are ushering in a host of bioethical issues and raising the specter of a new wave of eugenics, where the genocide (another related word) will happen before or shortly after conception, after genetic material is screened for âundesirableâ traits. Should people with Down Syndrome or dwarfism be eliminated from the gene pool? How about intersexed people? If Baileyâs colleagues find the âgay gene,â 22 should we wipe out sexual minorities, too? What about gender minorities? Will we see a âtransgenocideâ? Who decides whatâs a disease or a degeneracy?
As evidenced by BBLâs metaphors of disorder and disease, people can only express ideas in the language they have available. Their models of sex and sexuality originated with doctors and criminologists in the late 19th century eugenics movement, and BBLâs ideas havenât evolved much from the influential works that shape their thinking. After Darwinâs Origin of the Species (1859) came Francis Galtonâs Hereditary Genius (1869). Following ideas in that book, Galton coined the term âeugenicsâ in 1883, which melded with the emerging fields of criminology and sexology. Though the term âeugenicsâ is now rightfully associated with Nazism, a few modern adherents hope to usher in an âAge of Galton.â Bailey and Blanchard are charter members of a conservative-run eugenics discussion group devoted to this pursuit. 23
Three physicians who were Galton contemporaries are central to the BBL worldview: Richard Freiherr von Krafft-Ebing, who wrote Psychopathia Sexualis (1886); Havelock Ellis, who wrote The Criminal (1889) and Sexual Inversion (1897); and Magnus Hirschfeld (coiner of both âtransvestiteâ and âtranssexualâ), who in 1897 founded Germanyâs Scientific Humanitarian Committee, whose motto was âjustice through science.â Like BBL, these doctors genuinely believed that social ostracism of sexual minorities would be eliminated through science, but we all know what happened next in Germany. These doctorsâ âscientificâ models were imbued with eugenic paternalism (they believed homosexuals had a pathology and were unfit for procreation), and they claimed those who engaged in non-procreative sex were biologically different. By mid-century, Hirschfeldâs institute had been destroyed, and persecuted minorities had been rounded up and murdered based on âscientificâ models that claimed groups like Jews, gays, and other persecuted minorities were âdegenerate,â biologically distinct, and a threat to âsocial hygiene.â
Lest we think this is an isolated phenomenon that only happened in Nazi Germany, in America, disability and race took center stage in the eugenics movement, 24 which focused on sterilization and birth control for the âunfit.â 25 In Canada during the same period, the focus was immigrants, and the method of control was psychiatry. A physician named Charles Kirk Clarke oversaw the two largest Canadian asylums before accepting Canadaâs top mental-health post. Clarke advocated eugenic policies to limit the immigration and marriage of the âdefective.â He also used psychiatric diagnoses to incarcerate new citizens. Foreign-born patients were 50% of his institutionalized population, including political activists, homosexuals, and other âdefectives.â 26
Clarkeâs sociobiological leanings are still alive and well at the institution named after him, The Clarke Institute in Toronto, where Ray Blanchard works. 27 There, Kurt Freund and Blanchard used Freundâs controversial plethysmograph to delineate deviance. 28 Though the quack device is just a lie detector for the penis (open to manipulation and interpretation by both subject and observer), they used it extensively to separate homosexual from ânon-homosexual,â and later to do sex experiments on âmale gender dysphorics, paedophiles , and fetishists,â which they lumped together, yet divided into homosexual and ânon-homosexual.â 29
In historic diagnoses for sex problems, homosexuality and masturbation were âdiseasesâ that could strike either sex, but other problems were gendered degeneracy: women who had âtoo muchâ interest in straight sex had the now-discredited disease ânymphomania,â while men who had âtoo littleâ interest in it were inverts or perverts, a still legitimate disease category called âparaphilia.â
Dysphoria, disease, disorder, disability, defect
According to my medical records, I am mentally ill. The psychiatry industryâs Diagnostic and Statistical Manual of Mental Disorders (DSM) alleges that I am afflicted with âgender identity disorderâ (GID). Before that, I had âchildhood gender nonconformity,â from their special âkidsâ menuâ of mental disorders. Others with an interest in feminization get diagnosed with the âdisorderâ of âtransvestic fetishism.â 30 For many years, some in our community have relied on mental illness models as a form of validation. I ascribe to the view that âpsychiatric diagnoses are stigmatizing labels, phrased to resemble medical diagnoses and applied to persons whose behavior annoys or offends others. âMental illnessâ is not something a person has, but is something [a person] does or is.â 31
I suppose I had a âdis-ease,â an uneasiness, a dysphoria about the sorts of social and sexual expression I was allowed in the gender roles assigned to me at birth. I did not conform until it became clear in 7th grade that the other option was ever-increasing ostracism and violence, but since when is non-conformity a disease? Imagine a mental illness diagnosis for âracial nonconformityâ or âreligious identity disorder.â
Disease models affect the kinds of knowledge produced by those who use them. Bem called sex researchersâ preoccupation with the causes of homosexuality âscientifically misconceived and politically suspectâ because embedded in their preoccupation with causality is the idea that something went wrong that needs to be diagnosed and fixed. 32 The situation is no different when we look at how sex researchers study transgender persons. BBL are what Ordover calls âbiological apologistsâ who look to the body for absolute truths. A major medicalization of homosexuality occurred in the 1990s, in response to AIDS (a disease which led to renewed interest in a âgay geneâ and later a âgay germâ disease model of homosexuality). 33 While Bailey was drawing federal funds to isolate homosexuality the way others looked for HIV, nobody was looking for the âstraight geneâ or âstraight germ.â Like a good eugenicist who believes biology is destiny and genetics dictate human behavior, Bailey started linking gender roles to genetic discussions: âchildhood gender nonconformity does not appear to be an indicator of genetic loading for homosexuality.â 34 Is gender genetic?
Despite these problems, many in our community embrace a disease metaphor. Lawrence intones about âsymptomsâ of transsexualism, its âclinical course,â the benefits of âpalliative treatment.â 35 Lawrence then magnanimously claims that âeveryone has a right to self-define,â yet asserts that those who disagree with Lawrenceâs diagnosis arenât being very honest with themselves or others. A âpalliative treatmentâ helps symptoms while leaving the disease uncured, and the uncured disease can be a personal and political identity. In her important series of scientific criticisms of Blanchard, Wyndzen cites studies on self-verification where people âassimilated their illnesses into their identities.â 36 Almost everyone who is attracted to the concept of âautogynephiliaâ identifies through metaphors of impairment. Many participants in the main ââautogynephiliaâ supportâ newsgroup are on public assistance, which seems related to their fears about removal of gender variance from the DSM. They fear subsidized medical services will be denied if there is no mental illness classification. But what do they think will happen if there is differential diagnosis that claims their subgroup does all this to indulge an autoerotic interest? Should insurance companies give out high heels as âpalliative treatmentâ for shoe fetishists?
As Lawrence notes, âThere are many human behaviors that look like the same thing, but really aren’t.â 37 Previous medical attempts to catalogue behavior like Lawrenceâs were not only pathologizing, but insulting: People like Lawrence were âtransvestitic applicants for sex reassignmentâ 38 who are âagingâ 39 and âdistressed,â 40 suffering from âpseudotranssexualismâ 41 a ânon-transsexualâ variant of âgender identity disorderâ (GIDAANT), 42 and âiatrogenic artifact.â 43 Many notable âborderlineâ cases are doctors: Renee Richards, Anne Lawrence, Gregory/Gloria Hemingway. They may epitomize these published observations. They all self-treated, vacillated, and âdetransitionedâ to varying degrees, and all three challenge existing diagnostic categories. 44 If interest in feminization is an iatrogenic artifact (a disease made up by doctors), wouldnât doctors be the best evidence of that? Further, why would Dr. Marci Bowers transition without incident in the same hospital group that forced Anne Lawrence to resign? Do they really have the same âdiseaseâ? I have never heard Dr. Bowers have to assert sheâs a ârealâ transsexual, as Dr. Lawrence has.
I do not defer to people just because they are clinicians. My work fighting quacks and consumer fraud has put me in touch with countless âexpertsâ who have no business in science or medicine. Some âexpertâ will probably diagnose my questioning âexpertsâ as âauthority nonconformityâ or some other made-up disease to undermine my credibility. After all, my questioning the legitimacy of âautogynephiliaâ is evidence Iâm afflicted with it. To refute that kind of argument, we need to contextualize the term.
âParaphiliaâ and âautogynephiliaâ
The term âparaphiliaâ first appeared in 1923, in a book prepared for doctors and criminologists by physician Wilhelm Stekel. 45 Over eighty years later, BBL collaborator Simon LeVay still calls paraphilias âillnesses that need treatment.â 46 âParaphiliaâ is the psychiatric term for problematic sexual desire or behavior. The current name for this alleged mental disorder first appeared in the DSM in 1980. 47 It describes âparaphiliaâ as ârecurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving
(1) nonhuman objects
(2) the suffering or humiliation of oneself or one’s partner, or
(3) children or other non-consenting personsâŠ.
The behavior, sexual urges or fantasies cause clinically significant distress in social, occupational, or other important areas of functioningâ 48
Some people who identify with the diagnosis of âautogynephiliaâ chime in at this point and say, âWell, then I donât have a paraphilia, because I donât think I have a problem.â The most recent version of DSM was revised just for themâit says this illness can be diagnosed even if the person does not experience any subjective distress or impaired functioning. 49 LeVay notes: âThis is quite a significant shift; it emphasizes that psychiatrists may go beyond responding to clients’ complaints and may use their expertise for other purposes, such as protecting society from sex crimes.â 50
âAutogynephiliaâ is not a behavioral model, it describes a sex-fueled mental illness that lumps gender variance in with sex crimes. BBL believe that paraphilias cluster, meaning that they believe that âautogynephilesâ are more likely to be aroused by children, corpses, excrement and other illegal and socially unacceptable things. This diagnosis was widely ignored after Blanchard first suggested it in the Journal of Nervous and Mental Disease in 1989. 51 By the end of his series of papers, Blanchard was shoehorning other behaviors into his model with crackpot variants like âpartial autogynephilia.â 52 However, Blanchard and his colleagues had enough influence in this rarely-studied subspecialty to get âautogynephiliaâ mentioned in the DSM. 53 The work would have remained an obscure intradisciplinary skirmish until Lawrence found Blanchardâs articles in 1997, during a time of great need. A year earlier, Lawrenceâs erotic interest in ritualized genital modification led to indulging that interest. 54 Lawrence had taken âphysician, heal thyselfâ to heart previously, and after yet another failed âcureâ in the form of vaginoplasty, Lawrenceâs fascination did not wane. In 1997, a lack of social acceptance at work (described in one account as âbizarre behaviorâ) 55 and an incident where Lawrence examined an unconscious patient for signs of ritualized genital modification ended a respected career. 56 Discovering Blanchard was clearly revelatory for Lawrence, who now had a diagnosis to explain what happened. Suddenly, this forgotten diagnosis had a vocal and influential champion. I dismantle the pseudoscience behind âautogynephiliaâ in a longer essay elsewhere. 57
A scientific or reasonable discussion of âautogynephiliaâ is like a scientific discussion of horoscopes: thereâs no science to discuss, only pseudoscience. Yes, both concepts exist, but that does not mean either are legitimate science. Some people have a need to create an identity based on a worldview where people are predictable based on vague, unproven categories that arbitrarily assign traits to everyone, imposing order onto an unpredictable and incomprehensibly complex world.
âTranssexualâ defined
BBL have proposed several definitions for âtranssexualâ that include people not previously considered within that definition. Their definitions view gender variance through the lens of disordered sexual desire. Bailey defines âtranssexualâ as anyone who has âthe desire to become a member of the opposite sex.â 58 They do not have to act on this desireââonly serious thoughtsâ are enough to qualify. 59 This model reflects Baileyâs definitions of sexual orientation: someone is a homosexual whether they act on their desire or not. Lawrence believes transsexuality is âfundamentally about changing one’s anatomy, or sex; and that sometimes it may have little to do with gender identity, or with gender role.â 60 Some do this ânot primarily because they have a gender problem, but because they have a sex problem, and indeed a sexual problem⊠the expression of a paraphiliaâ 61Blanchard says heâs reluctant to label children as âtranssexual,â 62 which is reminiscent of the âpre-homosexualâ language used by his homophobic counterparts in âgay cureâ groups like NARTH. 63 Blanchardâs colleague Ken Zucker is a vocal advocate of reparative therapy for gender-variant children, and he considers transsexuality âa bad outcome.â64 In fact, Bailey has noted that unchecked, this disease could spread: a world tolerant of gender-variant children âmight well come with the cost of more transsexual adults.â 65
Echoing Lawrenceâs strict anatomical construction of âtranssexual,â a quaint aphorism claims, âIf you arenât a transsexual before surgery, you are after.â Really? What about David Reimer or others surgically altered as children who do not identify as transsexual? 66 Conflicting definitions occur within any demographic grouping. Extremist separatists from both sides of any constructed binary often create unlikely alliances: for instance, âpeople of colorâ and âAfrican-Americanâ are terms debated by both ethnic separatists and conservatives. 67 In our community, pluralist concepts like âqueerâ or âtransgenderâ are debated in circles where distinctions between gay men and transwomen, or between crossdressing and transsexualism, are very important.
Lawrence insists the few who embrace this diagnosis âdo not declare ourselves sick.â 68 Not morally sick, anyway, but physically sick. Lawrenceâs self-descriptions have remarkable parallels with descriptions of binge-and-purge cycles among crossdressers who hate their behavior, or those âafflictedâ with âunwanted homosexualityâ: âThe loneliness and disconnection from others that typically accompany autogynephilia [sic] are a large part of what makes this condition feel like genuine paraphilia (i.e., a âdisorderâ) to many of us who experience it (and I’m including myself here) and not merely a âbenign variantâ form of human sexuality.â 69 Swap âautogynephiliaâ with the word âhomosexuality,â and Lawrenceâs comment would feel right at home in a NARTH publication. Lawrenceâs âproblemâ is not self-love, but self-hate.
For those of us who view âgenderâ and âsexâ as socially constructed, transsexualism canât be separated from its social component. Phenotype can trump genotype; gender expression can trump anatomy. Those who need to use anatomy as evidence of their identity have failed in gaining acceptance within a social or institutional framework. Everyone has a right to self-identify, but if others donât accept that proclaimed identity, we must either accept their lack of acceptance, or work to change their minds. People can legislate rights, but not acceptance. That has to be earned.
Audre Lorde said âYour silence will not protect you.â 70 I say your anatomy will not protect you, either. Legal and medical models based on anatomical benchmarks for âmaleâ and âfemaleâ will inevitably conflict and fail. Sexists who wish to efface the identities of women like me can always find a physiological or behavioral reason to say I am ââreallyâ a man,â and some of the worst offenders are âhelping professionalsâ and people in our community. They echo the racists who came up with âscientificâ schemes to determine who was ââreallyâ black,â or heterosexists like BBL who create ways to determine who is ââreallyâ gay.â
Gatekeeping versus services on demand
Much of my early activism was informed by sex-positive, pro-choice feminism. We passed out condoms and âJust Say Yesâ sex-ed books at Chicago Public Schools, and we defended clinics from Operation Rescue. One of our major initiatives was family planning services (including abortion) that were âsafe, free and on demand.â I have always seen parallels between family planning and transition-related medical services, both of which were once only available through back alley clinics and black market sources. Women in our community died from this, and still die from illegal and unregulated products and procedures because of our legal status. I believe controlling our bodies is a fundamental human right. If someone wishes to undergo a vasectomy, vaginal rejuvenation, abortion, facial tattoo, piercings, tongue splittings, facial feminization, breast implants, mastectomy etc., I believe these procedures should be available to anyone who is willing to sign a release. I find it quite telling that our surgical procedures and abortion both face similar challenges, since both involve altering oneâs capacity to reproduce.
Psychiatric gatekeeping only works for those who are unwilling or unable to find easier and faster ways. Before the internet, most young people got what they needed through extralegal networks (many poor people still do), and anyone who had the means would skip gatekeeping altogether and jet off to an exotic locale, as it had been done for many years before the gender clinics began imposing controls. At the apex of the gender clinic system, only those willing to endure a process akin to criminals at a parole hearing took that routeâpeople who would say whatever the gatekeeper wanted to hear in order to get what they desired. 71 Ironically, many who tried to get around gatekeeping during their own involvement now insist it remain in place. 72 Lawrence, who is fond of quoting Audre Lorde, 73 must have missed âThe masterâs tools will never dismantle the masterâs house.â 74 Gatekeeping also appeals to those who donât get much validation except from gatekeepers. The acceptance letter becomes about the only acceptance they get. Not only is getting a vagina a status symbol and evidence of identity for this tiny group, but âbeating the systemâ is a status symbol, too (which might also explain the correlation between online ââautogynephiliaâ supportâ and welfare support).
I should note that I had a great therapist who helped me immensely. I probably would have gone even without being required. Therapy and support should be encouraged, but voluntary, and without the stigma of disease, in the way that someone questioning their spiritual beliefs might find therapy helpful without needing their spiritual journey labeled as a âreligious identity disorder.â With gatekeeping, we end up with people like BBL controlling access to services in exchange for money or sex. âSexologyâ is an unregulated activity in most states, meaning anyone could set up shop as a sexologist or sex therapist. Bailey, Lawrence, and others have all used their âsexologistâ credentials to gain easier access to sex partners. Some dismiss this as OK because they sign our little permission slips so we can get medical services. Call me old-fashioned, but I donât feel itâs ethical or scientific for gatekeepers and sex researchers to have sex with clients and research subjects. I also donât want my tax dollars federally subsidizing the sex life of a self-hating [trans]-chaser like Bailey, so he can meet women like me and later claim we âhave the brains of men but the genitals of womenâ 75 or are prone to criminal activity and sexual promiscuity.
Hereâs my question: why not cut out these middlemen and simply request and receive services? If people go to their physician and say they are depressed or anxious, the doctor believes their self-report and suggests options. Why canât it be that simple for us?
Replacing GID as the principal diagnostic means for obtaining medical service is considered a top health priority in our community. Citing a progressive San Francisco program, the National Coalition for LGBT Health states: âThere is a great need for more such programs that avoid GID as a requirement for access⊠this [requirement] results in many transgender people avoiding the psychiatric diagnosis process altogether, and not accessing medically regulated Trans Health Services.â 76 The interest itself isnât the problem, itâs the anxiety and depression caused by depriving its expression. 77 If in some cases hormones and surgery help relieve anxiety and depression, they should be available as an effective, time-tested option.
Roughgarden notes: âTheir bogus categories and made-up diseases are intended to subordinate, not to describe.â 78 Until we get away from this childlike dependence and deference to so-called âexpertsâ simply because they take our money or donât kick us out of their offices, our accommodation in healthcare and law will not be fully realized.
Beyond BBL
People like BBL rarely admit they are wrong, because they are very concerned about their academic legacy (which mirrors their beliefs about offspring). They will spend the rest of their lives fighting tooth and nail to defend their words and actions, but in the end BBL will be regarded as an interesting curiosity from the waning years when our community was considered disordered and diseased because of our interest in feminization, in whatever form that interest might take. Luckily, we donât have to convince them they are wrong; we just have to convince everyone else.
We need to embrace judgment-free models to describe these phenomena. I hereby suggest the phrase that leads off this article: interest in feminization (IF) and the subset erotic interest in feminization (EIF) as umbrella terms without the stigma of disease. It encompasses not only our community, but anyone regardless of motivation, affectional orientation, or gender assigned at birth. Change âFâ to âMâ in the acronym for the F to M folks. I can think of a laundry list of problems with this proposed terminology, but this article is part of an ongoing evolution of ideas. Iâll leave the definitive statements to those who fancy themselves âexpertsâ who claim they know âthe truth.â My thoughts here wonât be the end of old ways of thinking, but with luck, it will spark some new ones, where we describe ourselves and our identities without the stigma of sin and disease.
From the day in April 2003 when Professor Lynn Conway began an investigation into Baileyâs book, 79 it was clear that this was a defining moment for our community. We mobilized all around the world as never before. 80 We made sure this book did not become another Transsexual Empire. 81 BBL underestimated everything about us, from our numbers, 82 to our intelligence, 83 to our ever-strengthening network, to the direct contact we have with our youngest and most vulnerable, to our influential positions in every career and profession, to our ability to effect positive change. 84 This isnât just evolution, itâs revolution. Weâre replacing sin and disease with pride and strength, and this is only the beginning.
Los Angeles
September 2004
Acknowledgments
The author would like to thank Drs. Madeline Wyndzen and Nancy Ordover for key insights and research that informed this article.
References and notes
Please note: Anne Lawrence is notorious for removing website materials as soon as comments in them become difficult to defend. While every effort has been made to keep up-to-date links, some materials may no longer be available online.
1. Bailey JM (2003). The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism. Joseph Henry Press.
http://www.nap.edu/books/0309084180/html/ https://www.nap.edu/catalog/10530/the-man-who-would-be-queen-the-science-of-gender
2. Blanchard R (2004), cited in Armstrong J. The body within, the body without. Globe and Mail, 12 June 2004, p. F1.
http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20040612/COVER12/TPComment/TopStories https://www.theglobeandmail.com/incoming/the-body-within-the-body-without/article1000111/
3. Lawrence AA (1998). Men trapped in menâs bodies: An introduction to the concept of autogynephilia [sic].
http://www.annelawrence.com/autogynephiliaoriginal.html https://web.archive.org/web/19990128221339/http://www.mindspring.com/~alawrence/autogynephilia.html
http://home.swipnet.se/~w-13968/autogynephilia.html [archive]
4. Lawrence AA (2000). Sexuality and transsexuality: A new introduction to autogynephilia [sic]
http://www.annelawrence.com/autogynephilia.htmlÂ
5. Pinnel R (2003). Gay, straight, or lying? Science has the answer. Joseph Henry Press sales materials for The Man Who Would Be Queen.
http://www.jhpress.org/press_release/10530.pdf [archive]
6. Petersen M (2003). Resignation letter to HBIGDA, 4 November 2003.
http://www.tsroadmap.com/info/maxine-petersen.html
7. Cantor J (2003). Book review: The Man Who Would Be Queen. APA Division 44 Newsletter, Summer, 2003.
http://www.apa.org/divisions/div44/vol19nu2.pdf (requires reader)
8. Lawrence AA (1998). Men trapped in menâs bodies.
http://home.swipnet.se/~w-13968/autogynephilia.html
9 Foucault M (1976). Il faut défendre la société [Society must be defended]. Gallimard/Seuil, Paris, 1987, p. 215-216., Chapter 11 (17 March 1976 lecture).
http://www.amazon.com/exec/obidos/tg/detail/-/0679724699/002-8778638-7938457?v=glance
10. McCloskey D (2000). Crossing: A Memoir. University of Chicago Press.
http://www.amazon.com/exec/obidos/tg/detail/-/0226556697/qid=1094414215/sr=1-1/ref=sr_1_1/002-8778638-7938457?v=glance&s=books
11. McCloskey D (2003). Queer Science [review of Baileyâs Man Who Would Be Queen]. Reason, November 2003.
http://www.findarticles.com/p/articles/mi_m1568/is_6_35/ai_109085443
12 Fausto-Sterling A (2000). Sexing the Body: Gender Politics and the Construction of Sexuality. Basic Books.
http://www.amazon.com/exec/obidos/tg/detail/-/0465077145/002-8778638-7938457?v=glance
http://www.symposion.com/ijt/gilbert/sterling.htm (excerpts)
13 Bailey JM (2003). KOOP radio interview.
http://www.donnarose.com/JMBInterview.html (transcription)
14 Bailey JM (1999). Homosexuality and mental illness. Archives of General Psychiatry. 1999 Oct;56(10):883-4.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10530627
15 Blanchard R (1991). Clinical observations and systematic studies of autogynephilia [sic]. Journal of Sex and Marital Therapy, 17(4) , 235-251.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1815090
16 Lawrence AA (1999). Lessons from autogynephiles [sic]: eroticism, motivation, and the Standards of Care.
http://www.annelawrence.com/1999hbigda1.html
17 The medical ideas of function, cause (etiology), and teleology conflict at times with evolutionary theory. See Wyndzen at:
http://www.genderpsychology.org/gender_queer/teleology.html
18 Lawrence AA (2000). Sexuality and transsexuality.
http://www.annelawrence.com/autogynephilia.htmlÂ
19 Wyndzen, MH (2003). Autogynephilia & Ray Blanchardâs mis-directed sex-drive model of transsexuality:
http://www.genderpsychology.org/autogynephilia/ray_blanchard
From Psychology of Gender Identity & Transgenderism:
http://www.genderpsychology.org/autogynephilia/ray_blanchard/anne_lawrence_identity.html
20 Roughgarden J (2004). Evolutionâs Rainbow: Diversity, Gender, and Sexuality in Nature and People. University of California Press.
http://www.amazon.com/exec/obidos/tg/detail/-/0520240731/qid=1094414737/sr=8-1/ref=pd_ka_1/002-8778638-7938457?v=glance&s=books&n=507846
21 Gould SJ (1996). The Mismeasure of Man. W. W. Norton & Company.
http://www.amazon.com/exec/obidos/ASIN/0393314251/qid=1094414821/sr=ka-1/ref=pd_ka_1/002-8778638-7938457
22 Dawood K, Pillard RC, Horvath C, Revelle W, Bailey JM (2000). Familial aspects of male homosexuality. Archives of Sexual Behavior. 2000 Apr;29(2):155-63.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10842723
23 Bierich H, Moser B (2003). Queer science: An âeliteâ cadre of scientists and journalists tries to turn back the clock on sex, gender and race. SPLC Intelligence Report, Winter 2003.
http://www.splcenter.org/intel/intelreport/article.jsp?sid=96
Sailer founded the group on 3 March 1999; Bailey and Blanchard both joined on 4 March. Like early eugenicists, this group advocates what they believe is a âbenignâ form of eugenics called positive eugenics, where âgoodâ traits are encouraged, but this inevitably leads to negative eugenics, where âbadâ traits are eliminated. For a Whoâs Who of the modern eugenics movement, see the full list at: http://www.tsroadmap.com/info/human-biodiversity.html
24 Black E (2003). War Against the Weak: Eugenics and America’s Campaign to Create a Master Race. Four Walls Eight Windows.
http://www.amazon.com/exec/obidos/tg/detail/-/1568582587/qid=1094414996/sr=8-1/ref=pd_ka_1/002-8778638-7938457?v=glance&s=books&n=507846
25 Buck v. Bell, 274 U.S., 200, 207 [1927]: Associate Justice Holmes: âIt is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes.â
http://www.dnalc.org/resources/buckvbell.html (click “Court’s decision” and see page 3 for full text)
26 Dowbiggin IR (1997). Keeping America Sane: Psychiatry and Eugenics in the United States and Canada, 1880-1940. Cornell University Press.
http://www.amazon.com/exec/obidos/tg/detail/-/0801433568/qid=1094415314/sr=8-1/ref=sr_8_xs_ap_i1_xgl14/002-8778638-7938457?v=glance&s=books&n=507846
27 Though they have renamed themselves the Centre for Addiction and Mental Health (CAMH), Blanchard still works at the institution they call the Clarke Site.
http://www.camh.net/about_camh/Guide_CYGenderIdentitySvc.html
28 James AJ (2004). Plethysmograph: a disputed device.
http://www.tsroadmap.com/info/plethysmograph.html
29 Freund K, Blanchard R (1993). Erotic target location errors in male gender dysphorics, paedophiles, and fetishists. British Journal of Psychiatry 1993 Apr;162:558-63.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8481752
30 Zucker K, Blanchard R (1997). Transvestic fetishism: Psychopathology and theory. Sexual Deviance: Theory, Assessment, and Treatment, Guilford Press, New York.
http://www.amazon.com/exec/obidos/tg/detail/-/1572302410/qid=1094415488/sr=8-1/ref=sr_8_xs_ap_i1_xgl14/002-8778638-7938457?v=glance&s=books&n=507846
31 Szasz TS (1974). The Myth of Mental Illness. Perennial/HarperCollins p. 267.
http://www.amazon.com/exec/obidos/tg/detail/-/0060911514/qid=1094415537/sr=8-1/ref=sr_8_xs_ap_i1_xgl14/002-8778638-7938457?v=glance&s=books&n=507846
32 Bem D (1996). Exotic becomes erotic: A developmental theory of sexual orientation. Psychological Review 1996. Vol. 103, No. 2, 320-335.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11100261
33 Ordover N (2003). American Eugenics: Race, Queer Anatomy, and the Science of Nationalism. University of Minnesota Press, 2003.
http://www.amazon.com/exec/obidos/tg/detail/-/0816635595/qid=1094415622/sr=8-4/ref=sr_8_xs_ap_i4_xgl14/002-8778638-7938457?v=glance&s=books&n=507846
34 Bailey JM, Pillard RC (1991). A genetic study of male sexual orientation. Archives of General Psychiatry. 1991 Dec;48(12):1089-96.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1845227
35 Lawrence AA (1999). Autogynephilia [sic]: Frequently-asked questions.
http://www.annelawrence.com/agfaqs.htmlÂ
36 Wyndzen MH (2003). Everything you never wanted to know about autogynephilia [sic] * but were afraid you had to ask.
http://www.genderpsychology.org/autogynephilia/index.html
37 Lawrence AA (1999). Autogynephilia [sic]: Frequently-Asked Questions
http://www.annelawrence.com/agfaqs.html
38 Wise TN, Meyer JK (1980). The border area between transvestism and gender dysphoria: transvestic applicants for sex reassignment. Archives of Sexual Behavior. 1980 Aug;9(4):327-42.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7416946
39 Lothstein LM (1979). Psychological treatment of transsexualism and sexual identity disorders: some recent attempts. Archives of Sexual Behavior. 1979 Sep;8(5):431-44
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=496624
40 Wise TN, Dupkin C, Meyer JK (1981). Partners of distressed transvestites. American Journal of Psychiatry. 1981 Sep;138(9):1221-4.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7270729
41 Wise TN, Lucas J (1981). Pseudotranssexualism: iatrogenic gender dysphoria. Journal of Homosexuality. 1981 Spring;6(3):61-6.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7341667
42 American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (DSM III-R).
http://www.amazon.com/exec/obidos/tg/detail/-/0871400499/qid=1094416834/sr=1-1/ref=sr_1_1/002-8778638-7938457?v=glance&s=books
43 Moser C, Kleinplatz PJ (2002). Transvestic fetishism: psychopathology or iatrogenic artifact? New Jersey Psychologist, 52 (2) 16-17.
http://home.netcom.com/~docx2/tf.html
44 Richards (see Second Serve, Madison Books, 1984) and Lawrence both went off hormones, married, and fathered children.Â
http://www.amazon.com/exec/obidos/tg/detail/-/0812880757/qid=1094417020/sr=8-1/ref=sr_8_xs_ap_i1_xgl14/002-8778638-7938457?v=glance&s=books&n=507846
Lawrence writes: âI tried to put aside my cross-gender leanings and to function as a normal male.âÂ
http://www.annelawrence.com/mytrans.html
Hemingway continued to appear at public events as a male years after vaginoplasty.
http://ai.eecs.umich.edu/people/conway/TS/GregoryHemingway.htmlÂ
45 Stekel W (1923). Der Fetischismus dargestellt fĂŒr Ărzte und Kriminalogen. Störungen des Trieb- und Affektlebens (die parapathischen Erkrankungen) 7. [Volume 7: The fetishes, prepared for doctors and criminologists. Disorders of the Instincts and the Emotions (the parapathic illnesses)] Berlin/Wien: Urban & Schwarzenberg, 1923. First English translation by S. Parker as Sexual Aberrations. 1930 Liveright Publishing, New York.
http://www.amazon.com/exec/obidos/tg/detail/-/0871400499/qid=1094416834/sr=1-1/ref=sr_1_1/002-8778638-7938457?v=glance&s=books
46 LeVay S (2003). Human Sexuality. Sinauer, p. 454. Bailey teaches undergraduates from LeVayâs book, and LeVay calls Baileyâs book âabsolutely splendidâ on the front cover.
http://www.amazon.com/exec/obidos/ASIN/0878934545/qid=1094416806/sr=ka-2/ref=pd_ka_2/002-8778638-7938457
47 American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (DSM-III).
http://www.amazon.com/exec/obidos/ASIN/0890420181/ref=pd_ecc_rvi_2/002-8778638-7938457
48 American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
http://www.amazon.com/exec/obidos/tg/detail/-/0890420629/qid=1094416501/sr=1-13/ref=sr_1_13/002-8778638-7938457?v=glance&s=books
49 American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).
http://www.amazon.com/exec/obidos/tg/detail/-/0890420254/qid=1094416419/sr=8-1/ref=pd_ka_1/002-8778638-7938457?v=glance&s=books&n=507846
50 LeVay S (2003). Human Sexuality, p. 454.
http://www.amazon.com/exec/obidos/ASIN/0878934545/qid=1094416806/sr=ka-2/ref=pd_ka_2/002-8778638-7938457
51 Blanchard R (1989). The concept of autogynephilia [sic] and the typology of male gender dysphoria. Journal of Nervous and Mental Disease. 1989 Oct;177(10):616-23.
http://www.genderpsychology.org/autogynephilia/male_gender_dysphoria/ (full text)
52 Blanchard R (1993). Partial versus complete autogynephilia [sic] and gender dysphoria. Journal of Sex & Marital Therapy. 1993 Winter;19(4):301-7.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8308916
53 Bradley SJ, Blanchard R, Coates S, Green R, Levine SB, Meyer-Bahlburg HFL, Pauly IB, Zucker KJ. Interim report of the DSM-IV subcommittee on gender identity. Archives of Sexual Behavior, Vol. 20, 1991, No. 4, pp. 333-343.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1953325
54 Lawrence AA (1996). Taking Portlandiaâs hand: sex reassignment surgery in Portland.
http://www.annelawrence.com/portlandia.html https://web.archive.org/web/19981206232218/http://www.mindspring.com/~alawrence/portland2.html
55 State of Washington Department of Health (1997). Appendix G: Incident Activity Report.
http://www.tsroadmap.com/info/lawrence/anne-lawrence-report.html https://www.transgendermap.com/wp-content/uploads/sites/7/2019/10/anne-a-lawrence.pdf
56 State of Washington Department of Health (1997). Initial Review Panel Case Presentation.
http://www.tsroadmap.com/info/lawrence/anne-lawrence-case.html https://www.transgendermap.com/wp-content/uploads/sites/7/2019/10/anne-a-lawrence.pdf
57 James AJ (2004). âAutogynephiliaâ: a disputed diagnosis.
http://www.tsroadmap.com/info/autogynephilia.html
58 Bailey JM (2003). The Man Who Would Be Queen, p. 144.
http://books.nap.edu/books/0309084180/html/144.html
59 Ibid.
http://books.nap.edu/books/0309084180/html/144.html
60 Lawrence AA (1999). Lessons from autogynephiles [sic].
http://www.annelawrence.com/1999hbigda1.html
61 Ibid.
http://www.annelawrence.com/1999hbigda1.html
62 Federoff JP, Blanchard R (2000). The case for and against publicly funded transsexual surgery. Psychiatry Rounds, April 2000.
http://www.tsroadmap.com/info/psychiatry_rounds.pdf
63 Byrd AD (2004). Book review: The Man Who Would Be Queen. via NARTH (National Association for Research and Therapy of Homosexuality) e.g. âBailey’s focus on femininity among pre-homosexual boys and homosexual men…â
http://www.narth.com/docs/queen.html
64 Bailey JM (2003). The Man Who Would Be Queen, p. 31.
http://books.nap.edu/books/0309084180/html/31.html
65 Ibid. p. 33.
http://books.nap.edu/books/0309084180/html/33.html
66 Colapinto J (2001). As Nature Made Him: The Boy Who Was Raised as a Girl. Perennial.
As I discuss in my essay âWannabes?â, transsexual women seek medical options to confirm their identities as women; others seek them to confirm their identities as transsexuals. Differential diagnosis appeals to some people who wish to be distinguished from or included with a group of people. Some people who seek bodily feminization base their evidence of inclusion on these procedures and use the disparaging term âjust a crossdresser,â as if that is a less legitimate interest or identity.
http://www.tsroadmap.com/info/wannabes.html
67 Swarns RL (2004). âAfrican-Americanâ becomes a term for debate. New York Times, 29 August 2004.
http://query.nytimes.com/gst/abstract.html?res=F60614FA345A0C7A8EDDA10894DC404482
68 Lawrence AA (2000). Sexuality and transsexuality: A new introduction to autogynephilia [sic].
http://www.annelawrence.com/autogynephilia.html
69 Lawrence AA (2004). Posted as âautogynephile1,â 25 August 2004.
http://groups.yahoo.com/group/autogynephiliasupport/message/3682
70 Lorde A (1984). The transformation of silence into language and action. Sister Outsider. The Crossing Press. p. 41.
http://www.amazon.com/exec/obidos/tg/detail/-/0895941414/qid=1094418917/sr=8-1/ref=pd_ka_1/002-8778638-7938457?v=glance&s=books&n=507846
71 Bornstein K (1995). Gender Outlaw: On Men, Women, and the Rest of Us. New York: Vintage Books. e.g.: âTranssexuality is the only condition in Western culture for which the therapy is to lie.â
http://www.amazon.com/exec/obidos/ASIN/0679757015/qid=1094418971/sr=ka-1/ref=pd_ka_1/002-8778638-7938457
72 Lawrence AA (1998). Absence of regrets after a âshort real-life test.â
http://www.annelawrence.com/shortrlt.htmlÂ
73 Lawrence AA (1999). Autogynephilia [sic]: Frequently-asked questions.Â
http://www.annelawrence.com/agfaqs.html
74 Lorde A (1984). The masterâs tools will never dismantle the masterâs house. Sister Outsider. The Crossing Press. p. 110.
http://www.amazon.com/exec/obidos/tg/detail/-/0895941414/qid=1094418917/sr=8-1/ref=pd_ka_1/002-8778638-7938457?v=glance&s=books&n=507846
75 Tremmel PV (2003). Study suggests difference between female and male sexuality. Northwestern University press release, 12 June 2003.
http://www.eurekalert.org/pub_releases/2003-06/nu-ssd061203.php
76 National Coalition for LGBT Health (2004). An overview of U.S. Trans Health Priorities. August 2004 update.
http://www.lgbthealth.net/TransHealthPriorities.pdf (requires reader)
77 Vitale A (1997). Gender dysphoria: Treatment limits and options.
http://www.avitale.com/treatmentoptions.htm
78 Roughgarden J (2004). The Bailey affair: Psychology perverted.
http://ai.eecs.umich.edu/people/conway/TS/Reviews/Psychology%20Perverted%20-%20by%20Joan%20Roughgarden.htm
79 Conway L (2003-2004). An investigation into the publication of J. Michael Bailey’s book on transsexualism by the National Academies.
http://ai.eecs.umich.edu/people/conway/TS/LynnsReviewOfBaileysBook.html
80 Burns C and 1,460 signatories (2004). J. Michael Bailey book petition.
http://www.petitiononline.com/bailey/petition.html
81 Allison R (1998). Janice Raymond and autogynephilia [sic].
http://www.drbecky.com/raymond.html
Reviewing Raymond JG. The Transsexual Empire: The Making of the She-Male. Beacon Press, 1979.
http://www.amazon.com/exec/obidos/tg/detail/-/0807021644/qid=1094430439/sr=8-4/ref=sr_8_xs_ap_i4_xgl14/002-8778638-7938457?v=glance&s=books&n=507846
82 Conway L (2002). How frequently does transsexualism occur?
http://ai.eecs.umich.edu/people/conway/TS/TSprevalence.html
83. Bailey JM (2003). The Man Who Would Be Queen, p. 179.
http://books.nap.edu/books/0309084180/html/179.html
84 Letellier P (2004). Group rescinds honor for disputed book. PlanetOut.com Network, 16 March 2004.
http://www.gay.com/news/article.html?2004/03/16/3
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