The American-Canadian sexologist Ray Blanchard proposed a psychological typology of gender dysphoria, transsexualism, and fetishistic transvestism in a series of academic papers through the 1980s and 1990s.
[8]: 10 He concluded that asexual, bisexual, and gynephilic transsexuals were motivated by erotic arousal to the thought or image of themself as a woman, and he coined the term autogynephilia to describe this.
[3]: 444 Blanchard and colleagues conducted a study in 1986 using phallometry (a measure of blood flow to the penis), demonstrating arousal in response to cross-dressing audio narratives among trans women.
[13] Blanchard's research and conclusions came to wider attention with the publication of popular science books on transsexualism, including The Man Who Would Be Queen (2003) by sexologist J. Michael Bailey and Men Trapped in Men's Bodies (2013) by sexologist and trans woman Anne Lawrence, both of which based their portrayals of male-to-female transsexuals on Blanchard's taxonomy.
[13] Blanchard states that he intended the term to subsume transvestism, including for sexual ideas in which feminine clothing plays only a small or no role at all.
Blanchard writes that the accuracy of these theories needs further empirical research to resolve,[3]: 445 while others such as the transfeminist Julia Serano characterise them as incorrect.
[31]: 72–73 [8]: 19–20 The exact proposed nature of the relationship between autogynephilia and gender dysphoria is unclear, and the desire to live as a woman often remains as strong or stronger after an initial sexual response to the idea has faded.
[34]: 1729 [35] Some fear that the concept of autogynephilia will make it harder for gynephilic or "non-classical" MtF transsexuals to receive sex reassignment surgery.
[36] Lawrence writes that some transsexual women identify with autogynephilia, some of these feeling positively and some negatively as a result, with a range of opinions reflected as to whether or not this played a motivating role in their decision to transition.
[13] In a 2011 study presenting an alternative to Blanchard's explanation, Larry Nuttbrock and colleagues reported that autogynephilia-like characteristics were strongly associated with a specific generational cohort as well as the ethnicity of the subjects; they hypothesized that autogynephilia may become a "fading phenomenon".
[40]) Blanchard and Lawrence argue that just like more common sexual orientations such as heterosexuality and homosexuality, it is not only reflected by penile responses to erotic stimuli, but also includes the capacity for pair bond formation and romantic love.
[43]: 94 Elke Stefanie Smith and colleagues describe Blanchard's approach as "highly controversial as it could erroneously suggest an erotic background" to transsexualism.
[44]: 262 Serano says the idea is generally disproven within the context of gender transition as trans women who are on feminizing hormone therapy, especially on anti-androgens, experience a severe drop and in some cases complete loss in libido.
[45] Blanchard conjectured that sexual interest patterns could have inwardly instead of outwardly directed forms, which he called erotic target location errors (ETLE).
[47] Lawrence criticized Moser's methodology and conclusions and stated that genuine autogynephilia occurs very rarely, if ever, in cisgender women as their experiences are superficially similar but the erotic responses are ultimately markedly different.
[50] Serano and Veale argue that Bailey and Hsu's results do not support their conclusion, because most "natal females" in their research reported at least some autogynephilic fantasies.
[53] According to Serano, "Blanchard's controversial theory is built upon a number of incorrect and unfounded assumptions, and there are many methodological flaws in the data he offers to support it.
"[54] She argues that flaws in Blanchard's original studies include: being conducted among overlapping populations primarily at the Clarke Institute in Toronto without nontranssexual controls; subtypes not being empirically derived but instead "begging the question that transsexuals fall into subtypes based on their sexual orientation"; and further research finding a non-deterministic correlation between cross-gender arousal and sexual orientation.
[9] She criticised proponents of the typology, claiming that they dismiss non-autogynephilic, non-androphilic transsexuals as misreporting or lying while not questioning androphilic transsexuals, describing it as "tantamount to hand-picking which evidence counts and which does not based upon how well it conforms to the model",[9] either making the typology unscientific due to its unfalsifiability, or invalid due to the nondeterministic correlation that later studies found.
[68] Many authorities, including some supporters, criticize Blanchard's choice of terminology as confusing or degrading because it emphasizes trans women's assigned sex, and disregards their sexual orientation identity.
"[23] In 1987, this terminology was included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) as "transsexual, homosexual subtype".
[71] Anne Lawrence, a proponent of the concept,[16][76] argues that homosexual transsexuals pursue sex reassignment surgery out of a desire for greater social and romantic success.
[14] Blanchard and Zucker state that birth order has some influence over sexual orientation in male-assigned people in general, and androphilic trans women in specific.
[32]: 603–604 [80] In 2000, Meredith L. Chivers and Bailey wrote, "Transsexualism in genetic females has previously been thought to occur predominantly in homosexual (gynephilic) women."
They observed that these individuals were so uncommon that some researchers thought that androphilic trans men did not exist, or misdiagnosed them as homosexual transsexuals, attracted to women.
Smith concluded that female-to-male transsexuals, regardless of sexual orientation, reported more GID symptoms in childhood, and a stronger sense of gender dysphoria.
[84] The paraphilias working group on the DSM-5, chaired by Ray Blanchard, included both with autogynephilia and with autoandrophilia as specifiers to transvestic disorder in an October 2010 draft of the DSM-5.
This proposal was opposed by the World Professional Association for Transgender Health (WPATH), citing a lack of empirical evidence for these specific subtypes.
Blanchard later said he had initially included it to avoid criticism: "I proposed it simply in order not to be accused of sexism [...] I don't think the phenomenon even exists.
[89] The court found in favor of the plaintiff, Rhiannon O'Donnabhain, ruling that she should be allowed to deduct the costs of her treatment, including sex reassignment surgery and hormone therapy.