The hypothesis that autogynephilia lies at the root of much transexual behaviour has gained prominence in academic psychology, but remains controversial

Despite their prevalence (even at a rate of 0.5%, there would be approximately 300 000 TG folk in the UK alone) and long history, expressions of transgenderism have been the subject of comparatively little serious academic study. As a consequence, there is still a lack of a consensus among medical and mental health professionals concerning the origins of gender dysphoria, and the best ways to help people who are struggling with the inevitable consequences (mental health problems, relationship difficulties, etc). Advances in medical techniques have added further to the complexity, because they have facilitated permanent reconstruction of the genitalia to create permanent sex change, where for most of human history cross-dressing has been the only outward manifestation of gender dysphoria. As a consequence, the development of a comprehensive etiology has become even more challenging.

One of the most basic questions concerns whether gender dysphoria is a mental disorder. Is it a curable condition? The present consensus of the leading professional societies representing psychologists is that it is not a treatable condition. However, there remain some controversies, particularly concerning the treatment of children who present with symptoms of gender dysphoria. One minority school of thought suggests that a high fraction of children who present as transgender will in fact resolve their dysphoria by remaining in their birth gender and identifying as gay. The goal for the therapist is thus to try, wherever possible, to help transgender children accept their birth gender. Some trans activists regard this as a form of “reparative therapy”, such as has been attempted in the attempted “cure” of gay people by religious fundamentalists. This is a large issue that I will not address here.

Perhaps the most fundamental question is whether gender dysphoria is connected with sexuality. Many trans activists have argued that there is no necessary connection between sex and sexuality; being trans is about the gender identity of the individual and not what they are aroused by.

The most articulate voice to the contrary is that of Ray Blanchard, of the University of Toronto, a highly influential academic psychchologist interested in various aspects of human sexuality, including issues associated with transexualism. Blanchard has played a key role in drafting sections of the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) dealing with paraphilias and in particular was associated with the drafting of the sections on transexualism.

Blanchard divides transsexuals into two basic types: androphilic (attracted to men) and gynephilic (attracted to women). The former group, he argues, are sexually aroused by the idea of being penetrated by a man as a woman is; but the latter group are sexually aroused by the idea of themselves as women (hence, autogynephilic). Blanchard has published extensively, and his work has proved to be highly influential. However, it carries with it the assertion that at root, transsexualism is about sexuality: for androphilic transsexuals it is the desire to experience physical union that lies at its root, while for gynephilic transsexuals it is the erotic fantasy of oneself as a woman that is central.

I cannot give here a robust academic response to Blanchard; to do so would require academic scholarship and research in a field in which I have no expertise. But so strong is the dissonance between Blanchard’s conclusions and my own experience, that I feel that I want to provide a critique of some of his ideas. I may not be a professional psychologist but in so far as Blanchard’s work is scientific, it is susceptible to logical analysis.