Scientific critique of autogynephilia & psychopathology model of transsexualism

Editor's note: Katherine Heather has a Ph.D. in psychology and has written one of the first scientific critiques in response to the publication of The Man Who Would Be Queen. Katie sent me the following letter on 13 May 2003.

Hi Everyone,

Ray Blanchard's Mis-Directed Sex-Drive model of transsexuality, including the controversial notion of autogynephilia, has received a great deal of attention recently. It has had a remarkable amount of success in pervading both general audience and professional medium: Anne Lawrence and J. Michael Bailey each wrote popular accounts, the DSM [Diagnostic and Statistical Manual of Mental Disorders] and HB-SOC [Harry Benjamin Standards of Care] now include reference to Blanchard's constructs, and I have heard that even textbooks have started to feature it.

I find this trend disconcerting as both a transsexual and a scientific psychologist. I feel the evidence for this theory is weak. Interpreting this theory to say that MtF [male-to-female] transsexuals are 'really' gay men or 'really' crossdressing men is insensitive. Many perspectives on this controversy have been expressed. Typically the scientific perspective has been held by those most supportive of Blanchard's model. I would like to advance a scientific perspective that is skeptical of Blanchard's model and the ability of any Psycho-pathological model to adequately understand transgenderism. Some of you may be interested in the following two new essays found on my web-site (links are below).

The Banality of Insensitivity: Portrayals of Transgenderism in Psychopathology

Though the mental health community intends to help transsexuals, embedded within psychopathology is an insensitivity towards the very people it seeks to help. Removal of the mental illness diagnostic categories "Gender Identity Disorder" and "Transvestic Fetishism" is recommended to allow for objective scientific work and to heal the divisive relationships between the mental health and transgender communities. Included in this essay is a discussion of the idea that we are 'really' our biological sex according to Blanchard's model. Also included is a discussion of the claim that transsexuals who deny a sexual motivation for their gender dysphoria are lying.


"Blanchard's Mis-Directed Sex-Drive Model of Transsexuality"

This essay provides a scientific critique of Blanchard's model. It includes a summary of the model's key points and the evidence supporting those points. It continues to address what may be numerous serious methodological flaws. The essay also addresses the clinical intuition that sexuality may be the only force powerful enough to explain transsexuality by showing how the psychological literature suggests identity is also a remarkably powerful mechanism.


Any feedback about these essays is always appreciated. I would very much appreciate if you would please forward this message to other transgender mailing lists where Blanchard's model has been a significant or recent topic.

Best wishes,

You may contact Katie via her website, "All Mixed Up" (