Autoandrophilia makes it into the DSM-5

Well, what do you know!

After considering all the various comments to the DSM-V proposals, the experts have decided to keep the Transvestic Fetishm category. Autogynephilia (being aroused by the idea of being a woman) remains in the next version of the American psychiatric manual -- at least for the time being.

However, the committee has clearly found that having a diagnosis limited to men only, is politically incorrect. So, lo and behold, the experts are now willing to concede that there are also female to male crossdressers. Autoandrophilia (the love of oneself as a man) has been added to the list of transvestic disorders.

In a sick way, I guess you could call this progress. My dear autoandrophile brothers, you are now also to be considered perverts!

In remission

The experts have also added two more modifiers, where the doctor is to specify whether the condition is in remission or in a controlled environment.

ACH over at the Asexual Explorations Blog argues that "paraphilia in remission" could mean that someone need not actually meet criteria A and B to receive one of these diagnoses:

"I suspect that this specifier will encourage people to ignore the actual diagnostic criteria."

Maybe, but it could also mean that you would include people who have displayed signs of crossdreaming before. You could say that this would mean that you would remain a "pervert" even if you no longer display signs of your "perversion", so you would remain a "pervert" in the eyes of the doctors forever.

However, this does not make much of a difference, as there is no cure for crossdreaming. Sure, crossdressers can stop crossdressing, but he or she cannot stop crossdreaming. Hence, a lack of signs and symptoms mean zip, nada, nothing, unless -- of course -- your goal is to suppress behavior and not to help the client live a better life.

I believe the text "in a controlled environment" points to situation where the individual is an environment where he or she cannot express his or her crossdreaming.

It does not say so in the text, but I found the following reference to the phrase from the DSM-IV.

"In a Controlled Environment: This specifier is used if the individual is in an environment where access to alcohol and controlled substances is restricted, and no criteria for Dependence or Abuse have been met for at least the past month. Examples of these environments are closely supervised and substance‐free jails, therapeutic communities, or locked hospital units."

How a crossdresser or crossdreamer ("autogynephiliac/autoandrophiliac" in this terminology) is to live in a controlled environment is beyond me, unless -- of course -- some of these doctors continue to believe that you can cure crossdressing and crossdreaming with aversion therapy and forced isolation.

Crossdreaming cannot be cured. It is part of the hardware, not the software. Blanchard knows this, so it seems to me that he has been run over in the committee by someone who is more conservative than he is.

Crossdressing as top category

The fact that "transvestic disorder" remains the top category, while fetishism, autogynephilia and autoandrophilia are subcategories also shows us that Blanchard has lost his struggle to make autogynephilia (or whatever the new sex neutral term will be) the top category.

There is even a new tab with a questionnaire helping the doctor to determine the severity of the condition. They are all about crossdressing.

As I have said before, the current text means that people like me -- crossdreamers who do not crossdress -- are not covered by the text. That is plain out silly, and makes no sense scientifically.

I am unhappy about much of what Blanchard has written, but what is really valuable in his research is the fact that he has been able to show that crossdressing is just one of many expressions of an underlying condition. This underlying condition -- which I call crossdreaming -- does not alway lead to crossdressing.

What is clear from all of this is that we have a committee where several members do not understand the complexity of the issue at hand. If they had followed Blanchard's lead the text would at least have been coherent. Now it reflects an insane mix of various view points and approaches.

Even if you do believe that crossdressing and crossdreaming are categories that should be included in such a manual (which I don't) you should at least expect that the experts who write the criteria to be able to deconstruct their own text and make it logical.

What a mess!

Here is the text as it stands now.

A. Over a period of at least six months, recurrent and intense sexual fantasies, sexual urges, or sexual behaviors involving cross‑dressing.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

With Fetishism (Sexually Aroused by Fabrics, Materials, or Garments)

With Autogynephilia (Sexually Aroused by Thought or Image of Self as Female)

With Autoandrophilia (Sexually Aroused by Thought or Image of Self as Male)

Specify if:

In Remission (During the Past Six Months, No Signs or Symptoms of the Disorder Were Present)

In a Controlled Environment

Click here for more posts about the DSM!

On transgender embarrassment

Shame and embarrassment

This is a blog that boldly goes where even angels fear to thread. I have decided to cover controversial and "embarrassing" topics, simply because I believe that knowledge sets us free.

I also believe that ethics is not about following rules, regulations and inherited customs. Being a good person is about being able to love others and help them get a good life where they can be whoever Nature or God meant them to be.

This is not about whether women should be allowed to wear miniskirts or burkas or whether it is OK for a grown man to play with model trains. This is also why I believe we have to go into the fantasy life of crossdreamers in order to understand what makes us feel the way we do.

Kinky sex is OK

It is interesting to note that even if we live in a society where psychologists and psychiatrists consider a rich sexual fantasy life healthy and enriching, and where most forms of consensual sex are considered acceptable, crossdreamer fantasies continues to be problematic.

One of the reason the more militant "classical transsexuals" try to distance themselves from crossdressers is partly this: They do not want to be associated with men that get turned on by dressing up as women. They believe the very existence of "the transgendered" stigmatizes them as freaks. In order to avoid that stigmatization they would like crossdressers and crossdreamers to climb back into their closets and suffer in silence.

Stigmatized

This is of course exactly what society has told both gays and transsexual for ages. My old aunt used to say to me that she had nothing against gay people -- after all, uncle "Freddy" was clearly gay, and he was such a nice man who shared her love of orchids -- but why did they have to talk about it! It was embarrassing to talk about men doing unspeakable acts in polite conversations. 60 years of cultural conditioning had made an otherwise tolerant lady homophobic.

The post I wrote about the Norwegian politician Carl I. Hagen attacking his former son-in-law, now a woman, for causing his grandchildren pain by coming out as a transwoman is another example.

I believe Hagen when he says that he accepts that transwomen cannot be blamed for who they are and deserve our respect. But he is not willing to help change a society that makes the children of a transwoman despise "a man" that dresses up as a woman -- even if he acknowledges that this "man" is in fact a woman!

Abstruse Goose

I found this one over at Abstruse Goose. Some of you may like it!

Click on image to see the original!


Thanks to Lilith!

Master thesis on transgender narratives, including autogynephilia

I have found a very interesting paper for you. It is a master thesis called They Need Labels: Contemporary Institutional and Popular Frameworks for Gender Variance, written by Ophelia Bradley.

Ms. Bradley manages to give a very intelligent and insightful analysis of both the socio-cultural aspects of transgender issues, as well as the different types of research done in this area. And she does so without becoming too politicized or partial.

The review of current biological research on sex, gender and transsexuals is very useful, and her handling of the current transgender controversy ("classic transsexuals" vs. "transgender") is interesting.

Here is the abstract:

"This study addresses the complex issues of etiology and conceptualization of gender variance in the modern West. By analyzing medical, psychological, and popular approaches to gender variance, I demonstrate the highly political nature of each of these paradigms and how gender variant individuals engage with these discourses in the elaboration of their own gender identities.

I focus on the role of institutional authority in shaping popular ideas about gender variance and the relationship of gender variant individuals who seek medical intervention towards the systems that regulate their care.

Also relevant are the tensions between those who view gender variance as an expression of an essential cross-sex gender (as in traditional transsexual narrative) and those who believe that gender is socially constructed and non-binary. I finally argue that the standards of treatment for gender variant individuals pertains more to the medical legitimization of their identities than with necessarily improving outcomes."

You can download it here.

On hormones, gender, mice and men

As soon as I posted my second article on Gilmartin's love shy men, up pops new research on the interaction between hormones and gender. This new research does not change the basic narrative of what I have written lately, but it does make it even more interesting and -- I must admit -- complicated.

The story so far is that both sexual orientation, gender identity and gender specific traits are at least partly grounded in biology: genes, hormones and male hormone (androgen) receptors. Variation in prenatal hormone production and the body's ability to react on these hormones (reception), may also lead to variation in the way we feel and act sex and gender wise later in life.

The Economist reports that Dr. Nirao Shah (pictured above) and his colleagues at the University of California, San Francisco, have discovered that both mice and -- presumably -- men seem to lack the expected androgen receptors needed to turn the early prenatal testosterone-surge into action. They could not find these neurons.

The Economist:

"It was reasonable to think, as many people did, that androgen receptors - which respond to male hormones - were mediating the manly transformation. But androgen receptors were found to be nearly non-existent in the brains of newborn animals. Dr Shah could not find them earlier in development either, such as just after the fetal testes first started putting out testosterone in a 13-day-old embryo. Without male hormone receptors to respond to testosterone, the researchers started to suspect androgen receptors were not the players they had been assumed to be. Nor, perhaps, was testosterone."

Still, it is clear that male-typical behaviours develop as the result of this early burst of testosterone. These researchers now believe that the testosterone is being converted into estrogen to carry out the newborn sexual-differentiation.

Interesting! The "female" hormone turns men into men. The plot thickens.

Androgen receptors are not the master regulators for male behaviours, but rather, the researchers say, a "gain control mechanism" which amplifies such behaviours—or, when the receptors are absent, reduces typical masculine behavior.

The last part of the previous paragraph is interesting in relation to crossdreaming (autogynephilia) and the development of love shy "male lesbians". 

The researchers  genetically engineered male mice to lack androgen receptors in their nervous systems. These males still had androgen receptors in their muscles and elsewhere, so they had masculine bodies, and they experienced the testosterone surge and responded to normally circulating testosterone. But their brains were simply not able to detect it:

"The mice were compared with normal males in tests of masculinity. In one, a female was put into the cage. Interestingly, the genetically modified mice still showed the classic male-mating repertoire—mounting, penetration and ejaculation. But the researchers noted that they mounted less often, were less apt to penetrate and did not stick at it for as long as the normal mice. Another test turned up similar results. Typically, a strange male entering another male's cage is met with a fight. Again, the mutant mice behaved appropriately, but they were much less aggressive, spent less time fighting and they took longer breaks between attacks. The same was found for scent-marking. Like normal males, the mutant mice urinated in various spots around their cage (unlike females, who create a single latrine). But they deposited significantly fewer urine marks than the normal males."

Remember that the love shy often resent the pressure to behave aggressively and take part in the rough and tumble play of boys. They identify strongly with the stereotypical female way of behaving because of this. Their bodies appear  masculine, but their minds are something else.

Again: I am not saying that this explains how men become crossdreamers, i.e. that their dreams of being a woman and recurrent non-masculine behaviors and interests are caused by a reduced number of androgen receptors. Men are more complicated than mice. But it could definitely be one of many factors.  

This is yet another example of how modern biology develops models that opens up for new and more flexible interpretations of gender issues. The fact that there is so much research going in this field right now gives me hope that we will get a better understanding of the different transgender conditions.

The Shah Laboratory

The paper: The Androgen Receptor Governs the Execution, but Not Programming, of Male Sexual and Territorial Behaviors. Scott A. Juntti, Jessica Tollkuhn, Melody V. Wu, Eleanor J. Fraser, Taylor Soderborg, Stella Tan, Shin-Ichiro Honda, Nobuhiro Harada, Nirao M. Shah. Neuron 2010; 66(2): 260-272.

Testosterone Amplifies Pre-programmed Male Behaviors (TS-Si)

On Gilmartin's love-shy men and the male lesbian (Part 2)

In this post I take a look at the factors that may be causing love-shyness and the birth of male lesbians.

In my post On Gilmartin's love-shy men and the male lesbians (Part 1) I presented Dr. Brian G. Gilmartin's book from 1987: Shyness & Love: Causes, Consequences, and Treatment.

Love-shy people are men and women who find it extremely hard to approach the other sex, in spite of the fact that they long for such a relationship more than anything else.

Many of the love-shy men included in Gilmartin's study describe themselves as male lesbians. A male lesbian is a heterosexual man who wishes that he had been born a woman, but who (even if he had been a woman) could only make love to another woman and never to a man.

Although Gilmartin does not cover crossdreaming or autogynephilia, and in spite of the fact that he is adamant about these men not being crossdressers, there are enough similarities to justify a more thorough discussion. I have had many comments and emails for men who identify as love-shy and male lesbians and who are also crossdreamers (autogynephiles) and/or crossdressers.

Note, however, that not all crossdreamers and crossdressers are love-shy men. Far from it. Many of them are outgoing and even promiscuous. But there seem to me there is some correlation between feminization, shyness and crossdreaming.

In this post I am going to look into Gilmartin's ideas about the origins of the love-shy men. The reason I decided to write a post about Genes, hormones, genes and gender identity before publishing this post, is that there are great similarities between Gilmartin's theory from 1987 and current ideas about hormones causing such variation.

In other words: If you have not read that post already, now may be a good time.

Nature and nurture

Gilmartin believes that love-shyness is a learned personality trait that is based on an inborn temperament. In other words: love-shyness is the result of an interaction between biological and psychological drivers.

The love shy is introvert by nature. This is a common trait among homo sapiens, and for most people being introvert does not cause too much trouble. In the case of the love-shy man, however, it stops him from establishing a relationship with a woman.

A love-shy man has also an inborn low anxiety threshold. He experiences anxiety much more frequently, and much more intensely and painfully than a person with a high or normal anxiety threshold.

Gilmartin again:

"(...) there are two inborn components: one is the high emotionality (low anxiety threshold); the second component is inhibition/introversion. When a person is very high on both emotionalityand introversion (...), the chances are exceedingly good within the context of American society that he will develop into a chronically love- shy individual."

Some of the psychological and social problems of the love-shy men could be considered autistic because of the men's trouble in regards to peers, social interactions, and adjustment to change. Years later when asked in an email, Gilmartin felt that 40% of severely love-shy men would have Asperger syndrome.

The causes of love-shyness

Gilmartin suggests there is correlation between and love-shyness and different conditions, including low maternal testosterone during fetal development, nasal polyps, and hypoglycemia. His point is that natal development may lead to the development of an avalanche of different symptoms, many of whom are found among a significant number of love-shys.

Of special interest for crossdreamers is his reflections on the role of pre-natal testosterone (ps 57):

"If the brain of a fetus is left alone, it will develop into a female brain regardless of whether or not it is exposed to feminizing hormones. Inessence, this is one of the myriad reasons why the male is a more delicate organism than the female. Many more things can go wrong in male fetal development than in female fetal development.

As I noted in the gene post this is a common view also today. The female blueprint is the default one. Nature turns you into a male by adding masculinizing and defeminizating hormones.

People like Roughgarden disagrees, and says that both male and female gonad development are caused by a mix of processes that turns female and/or male development on and off. This does not make much of a difference in this context, as the idea that hormones in the womb influences sexual development is the same.

Jogols pointed me to an post on the cause of homosexuality and transgenderism that explains this in more or less the same way as Gilmartin.

Gilmartin again:

"Unless the male fetus is exposed to masculinizing hormones plus the enzymes which permit each of these hormones to work on various sections of the brain, that male fetus will develop a brain that is in at least some ways feminine. The number of ways in which it will be feminine will be determined bythe number of sections of the developing brain that had been deprived of the appropriate masculinizing enzymes. Again, the enzymes permit the male hormones to do their masculinizing job."

So although Gilmartin uses a somewhat different terminology, his story fits well with current biology.

Gimartin continues:

"...There are different sections of the fetal brain that need to be masculinized. And each of these sections calls for the propitious operation of a different enzyme. Some sections of the brain have to do with sexual/romantic directionality. When these brain sections are inadequately masculinized, the person stands a good chance of becoming a pre-homosexual or a pre-bisexual little boy. "

Two influential contemporary researchers on gender and biology, Aliicia Garcia-Falgueras and Dick F. Swaab, argue that the fetal brain develops during the intrauterine period in the male direction through a direct action of testosterone on the developing nerve cells, or in the female direction through the absence of this hormone surge.

They say:

" In this way, our gender identity (the conviction of belonging to the male or female gender) and sexual orientation are programmed or organized into our brain structures when we are still in the womb. However, since sexual differentiation of the genitals takes place in the first two months of pregnancy and sexual differentiation of the brain starts in the second half of pregnancy, these two processes can be influenced independently, which may result in extreme cases in trans-sexuality.

"This also means that in the event of ambiguous sex at birth, the degree of masculinization of the genitals may not reflect the degree of masculinization of the brain. There is no indication that social environment after birth has an effect on gender identity or sexual orientation."

("Sexual Hormones and the Brain: An Essential Alliance for Sexual Identity and Sexual Orientation", Pediatric Neuroendocrinology. Endocr Dev. Basel, Karger, 2010, vol 17, pp 22–35)

They are talking about gender identity here, not love-shyness, but it is not hard to see the relationship between the various forms of "feminine" or "non-masculine" men.

Gynephiles and androphiles

Gilmartin does differentiate between gynephilic (woman-loving) and androphilic (man-loving) non-masculine boys. He divides the gynephilic (heterosexual) boys into two sub-categories: Some of them are effeminate, some of them are not.

One of the major differences between Gimartin's love-shy men and Blanchard and Bailey's autogynephiliacs is that Blanchard and Bailey make a point out of the autogynephiliacs not being effeminate. For Bailey all effeminate men are "homosexual transsexuals". Woman-loving autogynephiliacs look and act in a masculine manner.

Gilmartin, on the other hand, argues that gynephilic (heterosexual) boys may very well be effeminate:

"Other brain sections have to do with effeminacy. When these are not masculinized, the person becomes an effeminate little boy. And contrary to popular impression, most effeminate men are NOT homosexual. Because of a specific enzyme deficiency during their prenatal period, they become effeminate heterosexuals. And most of them, like heterosexuals generally, will marry and become fathers. But because of rigid and often uncompromising gender role expectations for males, they will suffer much teasing and hazing throughout their formative years as a result of their effeminacy."

Different types of femininity

There can be several reasons for the difference between Gimartin's postition regarding gynephilic effeminate boys and the one of Blanchard and Bailey.

It could be that Blanchard's and particularly Bailey's discussion of effeminate gays and masculine woman-loving autogynephiliacs is based on a projection of their own prejudices. In other words: they see what they want to see. It is certainly true that this part of the autogynephilia theory is the least scientific one.

Blanchard and Bailey base their theory on the observation of transwomen and M2F transgendered seeking surgery. I suspect their impression is caused by the fact that gynephilic transsexuals -- on average -- transition much later than the androphilic ones. Older women look less feminine than younger ones. Moreover, late transitioners have spent a life time trying to live as men, picking up their mannerisms in the process.

But it could also be that Gilmartin has a view of being feminine that is much broader that Blanchard and Bailey's. For Gilmartin this is more than effeminate looks and mannerism. It is also a matter of stereotypical female interests and a lack of male typical assertiveness.

Gilmartin elaborates on this:

"(p. 58) Now, another section of the brain has to do with social assertiveness, competitiveness and drive—the opposite of 'feminine' passivity. And this is the brain section which has a very strong bearing upon shyness generally, and especially upon love-shyness and the behavioral inertia that typically accompanies it.

"The nonassertive, unaggressive little boy will commonly develop non-masculine interest patterns. In essence, he violates traditional gender role expectations in terms of interests and preferences rather than in terms of either effeminacy or in terms of homosexuality or erotic orientation. For example, he will prefer quiet, non-physical forms of play; working with arts and crafts, music and theatre arts, dolls and figurines, etc., all of which relate in different ways to violation of gender role expectation.

Friends, family and foes expect effeminate boys to be homosexual, and classify them as such.

"The shy, passive boy is very often mislabeled 'homosexual' just as the effeminate boy is perhaps even more often mislabeled 'homosexual'. Conservative and rigid people tend to apply the label 'homosexual' to any young boy who violates traditional gender role expectations, just as these same people commonly affix such labels as 'communist' and 'unAmerican' to any person who espouses a political, social or religious attitude or belief with which they happen to disagree."

The sliders of gender development

Like Natalie and me Gilmartin ends up with a model consisting of a large number of variables that may lead to the development of non-typical behavior and interests:

"To be sure, occasionally a number of different enzymes will malfunction while a child is intra utero. And in that case the child (if male) will develop a number of different problems. For example, he may develop BOTH effeminacy AND homosexuality. Or he may develop BOTH effeminacy and chronic shyness. Or he may develop chronic shyness and homosexuality. And in a few rare cases he may develop all three of these separate problems."

Trying to reduce gender identification to one or two variables is therefore impossible. There are not two types of non-masculine born men in this narrative (gynephilic vs. androphilic), but rather a large number of possible combinations of traits. Trying to force them all into a model based on on only one of these variables -- sexual orientation in the case of Blanchard and Bailey -- is to oversimplify the matter.

An explanation for the development of love-shyness

Gilmartin has no final explanation for the variation of hormone and enzyme levels. He does point to some East German research of the time that indicated that there is a strong relationship between a pregnant woman's state of mind, and her male fetus' blood testosterone level. Certain personality traits of a pregnant woman had the effect of neutralizing either the testosterone that is released into the bloodstream of the fetus, or the enzymes which metabolize the testosterone to the point of permitting it to do its job on the various parts of the male. (p. 145).

As far as I know, this theory has not been completely abandoned by modern biologists. There are those that argue that the emotional or physical state of the mother can influence the development of the fetus.

Alicia Garcia-Falgueras and Dick F. Swaab point to several possible factors that may explain variation in gender identity and sexual orientation. Contemporary research indicates that the chance that a boy will be homosexual increases with the number of older

brothers he has:

"This phenomenon is known as the fraternal birth order effect and is putatively explained by an immunological response by the mother to a product of the Y chromosome of her sons. The chance of such an immune response to male factors would increase with every pregnancy resulting in the birth of a son."

Like Gilmartin they consider the emotional state of the mother:

"A stressed pregnant woman has a greater chance of giving birth to a homosexual son. An interesting hypothesis is that the changes in androgen concentration during pregnancy as a result of environmental stress factors may influence the fetal central nervous system as an adaptive adjustment to the environment"

Needless to say, this may also have consequences for the development of other traits linked to our understanding of gender role: introversion/extroversion and level of aggressiveness included.

Resources:

Download Dr. Gilmartin's Shyness and Love: Causes, Consequences, and Treatment

The Love Shy Survival Project

Love-shyness on Wikipedia

Love-shy.com

Love shyness: the 'condition' crippling men (Times Online)

Evolution's Rainbow: Diversity, Gender, and Sexuality in Nature and People by Joan Roughgarden

Sex Differences: Developmental and Evolutionary Strategies by Linda Mealey
Male lesbian - it happens Examiner.com

A Male Lesbian Whose Appeal Is Mainly Cerebral (on British Comedian Eddie Izzard identifying as a male lesbian)

Chastity Tube on Male Lesbians

Aven discussion on male lesbians

T-shirt from zazzle

Dr. Brian G. Gilmartin: Shyness & Love: Causes, Consequences, and Treatment, chapter om male lesbians
Lesbian Trapped In A Man's Body (Fine Art America)