Gender dysphoria is not one thing

by J. Michael Bailey, Ph.D  and Ray Blanchard, Ph.D

This is the second in a series of articles authored by Drs. Bailey and Blanchard; see here for their first piece.

Many parents who are part of the 4thWaveNow community have daughters who fit the profile of a sudden onset of gender dysphoria in adolescence. This phenomenon is discussed in detail by the authors after the first two types, in the section “Rapid-onset Gender Dysphoria (Mostly Adolescent and Young Adult Females).” Some 4thWave parents will also find the section “Two Rarer Types of Gender Dysphoria” of particular interest (near the end of the article).

We recognize that regular readers and members of 4thWaveNow will not agree with all of what Bailey and Blanchard have to say, but as always, if you wish to challenge the authors, your comments will be more likely to be published if they are delivered respectfully.

As their time permits, Drs. Bailey and Blanchard will be available to interact in the comments section of this post.


Michael Bailey is Professor of Psychology at Northwestern University. His book The Man Who Would Be Queen provides a readable scientific account of two kinds of gender dysphoria among natal males, and is available as a free download here.

 Ray Blanchard received his A.B. in psychology from the University of Pennsylvania in 1967 and his Ph.D. from the University of Illinois in 1973. He was the psychologist in the Adult Gender Identity Clinic of Toronto’s Centre for Addiction and Mental Health (CAMH) from 1980–1995 and the Head of CAMH’s Clinical Sexology Services from 1995–2010.


One problem with the current mainstream narrative regarding gender dysphoria is that it makes no distinctions among apparently very different kinds of persons. For example, Bruce Jenner appeared to be a very masculine man, an Olympic athlete who was married to three different women and had six children with them, before becoming Caitlyn Jenner. In contrast, Jazz Jennings, a natal male, was so feminine that she earned a diagnosis of gender identity disorder at the age of four. She is attracted to males. Jenner and Jennings are so different in their presentation and history that it is surprising to us that anyone thinks they have the same condition. Jenner and Jennings are examples of two very different kinds of gender dysphoria that have been scientifically well studied, and have fundamentally different motivations, clinical presentations, and likely causes.

The failure of so many therapists and activists to acknowledge this distinction is disturbing for at least two reasons. First, it suggests they are either ignorant of relevant scientific evidence or are purposefully ignoring it. Second, failure to make scientifically valid and fundamental distinctions among different kinds of gender dysphoric persons can only prevent progress toward finding the best approach to helping each. Measles, influenza, and strep throat are all associated with fever. But if we had merely lumped them together as “fever,” we would not have effective treatments for them.

 Types of Gender Dysphoria

Gender dysphoria isn’t common. But there are at least three distinct types of gender dysphoria that, presently, regularly occur in children and adolescents. We summarize these at length here. Two other kinds of gender dysphoria are much less common in these age groups, and so we address them less fully near the end of this essay. The main three types differ in their age of onset (childhood, adolescence, or adulthood), their speed of onset (gradual or sudden), their associated sexual orientations (members of the same sex or the fantasy of belonging to the opposite sex), and their sex ratio (equally or unequally likely in males and females).

The first type—childhood-onset gender dysphoria—definitely occurs in both biological boys and girls. It is highly correlated with homosexuality–the sexual preference for one’s own biological sex–especially in natal males. (Sexual orientation is usually not apparent until a child reaches adolescence or adulthood, however.) This is the type that Jazz Jennings had before her gender transition. The second type—autogynephilic gender dysphoria—occurs only in males. It is associated with a tendency to be sexually aroused by the thought or image of oneself as a female. This type of gender dysphoria sometimes starts during adolescence and sometimes during adulthood, and its onset is typically gradual. (Onset may appear sudden to family members, however.) Although Caitlyn Jenner has not discussed her feelings openly, we strongly suspect she is autogynephilic. The third type—rapid-onset gender dysphoria—mostly occurs in adolescent girls. This type is primarily characterized by the age and speed of onset rather than the associated sexual orientation, and it may not be limited to one sex, as the second type is. Our impression is that rapid-onset gender dysphoria is especially common among daughters of parents who read 4thWaveNow as well as those who post on the support board at gendercriticalresources.com.

The first two types (childhood-onset gender dysphoria and autogynephilic gender dysphoria) have been well studied, although autogynephilic gender dysphoria has primarily been studied in adults. The third (rapid-onset gender dysphoria) has only recently been noticed, and it is possible that it didn’t occur much until recently.

How do you know which type of gender dysphoria your child has? If there were clear signs well before puberty that your child was gender dysphoric, s/he has child-onset gender dysphoria. (You would certainly have noticed signs at the time; at the very least you would have coded your child as extremely gender nonconforming.) If your child showed signs of gender dysphoria for the first time during adolescence, s/he has one of the other types. Remember, autogynephilic gender dysphoria occurs only in natal males, and it starts either during adolescence or adulthood. (And to a parent, it usually seems sudden.) We describe the three types more thoroughly below.

Childhood-onset Gender Dysphoria (Boys and Girls)

The most obvious feature that distinguishes childhood-onset gender dysphoria from the other types is early appearance of gender nonconformity. Gender nonconformity is a persistent tendency to behave like the other sex in a variety of ways, including preferences of dress and appearance, play style, playmate preferences, and interests and goals. A very gender nonconforming boy may dress up as a girl, play with dolls, dislike rough play, show indifference to team sports or contact sports, prefer girl playmates, try to be around adult women rather than adult men, and be known by other children as a “sissy” (a term generally used to ridicule and shame feminine boys). A very gender nonconforming girl shows an opposite pattern, with the less derogatory word “tomboy” replacing sissy.

Onset of gender nonconformity is childhood cases is very early, typically about as early as gendered behavior can be noticed.

It is important to understand that not all gender nonconforming children (even very gender nonconforming children) have gender dysphoria. Probably most don’t, in fact. But we know of no cases of childhood-onset gender dysphoria without gender nonconformity.

Gender dysphoria in the childhood cases requires that children are unhappy with their birth sex. Furthermore, they typically yearn to be–or even assert that they are–the other sex.

What do we know about childhood-onset gender dysphoria?

Childhood-onset gender dysphoria has been systematically studied by two high quality international research centers (one in Toronto, which was led by Kenneth Zucker, and one in the Netherlands, which was led by Peggy Cohen-Kettenis). Both centers have assessed and followed representative samples of gender dysphoric children seen at their clinics. Reassuringly, results are fairly similar across the two sites. Furthermore, their results are similar to less representative samples studied earlier in the United States.

The published literature shows that at least in the past, 60-90% of children whose gender dysphoria began before puberty adjusted to their birth sex without requiring gender transition. That may be changing, however, due to changes in clinical practice that encourage gender transition. (See below.)

It is important to realize that childhood-onset gender dysphoria is the only kind of gender dysphoria that has been well-studied in children and adolescents. This means, for example, that the persistence and desistance figures we have provided apply only to that type. We do not know comparable figures about autogynephilic or rapid-onset gender dysphoria. Furthermore, most people, when they think of “transgender children and adolescents” have childhood-onset gender dysphoria in mind. (And they think of happy Jazz more than they think of Jazz’s serious medical surgeries and hormonal treatment for life.) But this association is misleading for all cases of gender dysphoria that are not childhood-onset. Autogynephilic and rapid-onset gender dysphoria have very different causes and presentations than childhood-onset gender dysphoria.

Sexuality

Children with childhood-onset gender dysphoria have a much higher likelihood of non-heterosexual (i.e., homosexual or bisexual) adult outcomes compared with typical children. Childhood-onset gender dysphoric boys who desist usually become nonheterosexual men. A smaller percentage have reported that they are heterosexual at follow up. Those who transition become transwomen attracted to men.

Although most childhood-onset gender dysphoric girls who have been followed identify as heterosexual, those who desist have a much higher rate of nonheterosexuality compared with the general population. Among those who transition, most are attracted to women.

We repeat: there is no evidence that parents can change their children’s eventual sexual orientation, and we don’t think they should try.

Risk Factors for Persistence of Childhood-onset Gender Dysphoria

Which childhood-onset gender dysphoric children will persist, and which will desist? Evidence suggests that we can’t distinguish these two groups with high confidence, although we can distinguish them better than chance.

There is some evidence that the severity of gender dysphoria distinguishes these two groups, although it is far from a perfect predictor. Children who not only say they want to be the other sex but who assert that they are the other sex may be especially likely to persist. The reasons why a child’s expressed belief that s/he is the other sex predicts persistence remain unclear, and this variable does not allow even near-perfect prediction. The idea that it is the essential test of “true trans” is an overstatement.

Other empirically supported risk factors include being of lower socioeconomic status and having autistic traits, both of which predict persistence. Why should these factors matter? Researchers have speculated that socioeconomically disadvantaged families are more likely to have problems that prevent them from providing the consistent supportive social environment that may be most likely to help the gender dysphoric child desist. Autistic traits include perseverative and obsessional thinking, both of which may make desistance more difficult. Furthermore, parents of children with autistic traits may be so concerned about other problems that they are permissive about things likely to foster gender transition.

One powerful predictor of persistence is social transition, or a child’s living as the other sex. Until recently this was practically unheard of. Increasingly, however, it is not only known but encouraged by many gender therapists. (Watch an episode of “I am Jazz.”) In the Netherlands social transition has been common longer than in the United States. A recent study found that social transition was the most powerful predictor of persistence among natal males. That is, gender dysphoric boys allowed to live as girls strongly tended to want to become adult women. (The same trend occurred for natal females, but it was less robust.) This is not surprising. If a gender dysphoric child is allowed to live as the other sex, what will change his/her mind? No one disputes that gender dysphoric children really, really would like to change sex.

What should you do?

The necessary studies have not been conducted to be certain. But based on the overall picture, we suggest:

If you want your childhood-onset gender dysphoric child to desist, and if your child is still well below the age of puberty (which varies, but let’s say, younger than 11 years), you should firmly (but kindly and patiently) insist that your child is a member of his/her birth sex. You should consider finding a therapist if this is difficult for you and your child. You should not allow your child to engage in behaviors such as cross dressing and fantasy play as the other sex. Above all else, you should not let your child socially transition to the other sex.

At the same time, you should recognize that despite your best efforts, your child may ultimately need to transition to be happy. If your child’s gender dysphoria persists well into adolescence (again, the ages vary by child, but let’s say age 14 or so), s/he is much more likely to transition. At that point, in our opinion, parents should consider supporting transition.

Autogynephilic Gender Dysphoria (Adolescent Boys and Men)

From a parent’s perspective, autogynephilic gender dysphoria (which occurs only in natal males) often seems to come out of the blue. This is likely to be true whether the onset is during adolescence or adulthood. A teenage boy may suddenly announce that he is actually a woman trapped in a man’s body, or that he is transgender, or that he wants gender transition. Typically, this revelation follows his intensive internet research and participation in internet transgender forums. Importantly, the adolescent showed no clear, consistent signs of either gender nonconformity or gender dysphoria during childhood (that is, before puberty).

There is an important distinction between rapid-onset gender dysphoria and autogynephilic gender dysphoria that happens to have an adolescent onset. Rapid-onset gender dysphoria is suddenly acquired, whereas autogynephilic gender dysphoria may be suddenly revealed, after having grown in secret for a number of years. We will talk more about this later.

Where does autogynephilic gender dysphoria come from? We know a lot about the motivation of this kind of gender dysphoria. Most of our knowledge comes from studies of adults born male who transitioned during adulthood. Some of these adults had gender dysphoria during adolescence, but all of them had the root cause of their condition: autogynephilia.

(Warning: Autogynephilia is about sex. We understand that it is awkward and uncomfortable for any parent to consider their children’s sexual fantasies. But you can’t understand your son with this kind of gender dysphoria without doing so.)

Autogynephilia is a male’s sexual arousal by the fantasy of being a woman. That is, autogynephilic males are turned on by thinking about themselves as women, or behaving like women. The typical heterosexual adolescent boy has sexual fantasies about attractive girls or women. The autogynephilic adolescent boy’s may also have such fantasies, but in addition he fantasizes that he is an attractive, sexy woman. The most common behavior associated with autogynephilia during adolescence is fetishistic cross dressing. In this behavior, the adolescent male wears female clothing (typically, lingerie) in private, looks at himself in the mirror, and masturbates. Some autogynephilic males are not only sexually aroused by cross dressing, but also by the idea of having female body parts. These body-related fantasies are especially likely to be associated with gender dysphoria.

It is important to distinguish between autogynephilia and autogynephilic gender dysphoria. Autogynephilia is basically a sexual orientation, and once present does not go away, although its intensity may wax and wane. Autogynephilic gender dysphoria sometimes follows autogynephilia, and is the strong wish to transition from male to female. A male must have autogynephilia to have autogynephilic gender dysphoria, but just because he is autogynephilic doesn’t mean he will be gender dysphoric. Many autogynephilic males live their lives contented to remain male. Furthermore, sometimes autogynephilic gender dysphoria remits so that a male who wanted to change sex no longer does so.

In general, adolescent boys are unlikely to divulge their sexual fantasies to their parents. This is likely especially true of boys with autogynephilia. Furthermore, many boys who engage in cross dressing feel ashamed for doing so. The fact that autogynephilic fantasies and behaviors are largely private is one reason why autogynephilic gender dysphoria usually seems to emerge from nowhere. Another reason is that autogynephilic males are not naturally very feminine. An adolescent boy with autogynephilia does not give off obvious signals of gender nonconformity or gender dysphoria.

It is likely that most autogynephilic males do not pursue gender reassignment, but this is difficult to know. (We would need to conduct a representative survey of all persons born male, asking about both autogynephilia and gender transition. This has not been done and won’t be done anytime soon.) Many males with autogynephilia are content to cross dress occasionally. Some get married to women and many also have children. Family formation is no guarantee against later transition, although that may slow it up somewhat. In past decades, when autogynephilic males have transitioned, they have most often done so during the ages 30-50, after having married women and fathered children. It is possible that autogynephilic males have recently been attempting transition at younger ages, including adolescence.

The relationship between autogynephilia and (autogynephilic-type) gender dysphoria is uncertain. One view is that gender dysphoria may arise as a complication of autogynephilia, depending perhaps on chance events or environmental factors. Another view is that autogynephiles who become progressively gender dysphoric were somewhat different from simple autogynephiles from the beginning (for example, more obsessional). Because we do not actually know the causes of autogynephilia, it is quite difficult to sort out these various interpretations at present.

Autogynephilia—the central motivation of autogynephilic gender dysphoria—can be considered an unusual sexual orientation. As with other kinds of male sexual orientation, we do not know how to change it, and we shouldn’t try. The dilemma is how to live with autogynephilia in a way that allows the most happiness. For some with autogynephilia, this will mean staying male. For others, it will mean transitioning to female.

What do we know about autogynephilic gender dysphoria?

Much of what we know about autogynephilic gender dysphoria comes from research conducted on adults. Most of the early research was conducted by the scientist who developed the theory of autogynephilia, Ray Blanchard. This work was subsequently confirmed and extended by other researchers, especially Anne Lawrence, Michael Bailey, and Bailey’s students.

Blanchard’s research identified two distinct subtypes of gender dysphoria among adult male gender patients. One type, which he called “homosexual gender dysphoria” is identical to childhood onset male gender dysphoria. Males with this condition are homosexual, in the sense that they are attracted to other biological males. Blanchard provided persuasive evidence that the other male gender patients were autogynephilic. We currently favor the theory that there are only two well established kinds of gender dysphoria among males, because no convincing evidence for any other types has been offered. This could change­–we are committed to a scientific open-mindedness. In particular, it is possible that some cases of adolescent-onset gender dysphoria among males are essentially the same as Rapid-onset Gender Dysphoria that occurs among natal females. This will require more research to establish, however.

Autogynephilia is a probably rare, although it is difficult to know for certain. Among males who seek gender transition, however, it is common. In fact, in Western countries in recent years, including the United States, autogynephilia has accounted for at least 75% of cases of male-to-female transsexualism.

Given how important autogynephilia is for understanding gender dysphoria, it may surprise you that you had never heard of it. Autogynephilia remains a largely hidden idea because most people–including journalists, families, and many males with autogynephilia–strongly prefer the standard, though false, narrative: “Transsexualism is about having the mind of one sex in the body of the other sex.” Many people find this narrative both easier to understand and less disturbing than the idea that some males want a sex change because they find that idea strongly erotic.

Although many autogynephilic males find discovery of the idea of autogynephilia to be a positive revelation–autogynephilia has been as puzzling to them as it is to you–some others are enraged at the idea. There are two main reasons why some autogynephilic males are in denial. First, they correctly believe that many people find a sexual explanation of gender dysphoria unappealing–discomfort with sexuality is rampant. Second, they find this explanation of their own feelings less satisfying than the standard “woman trapped in man’s body” explanation. This is because autogynephilia is a male trait, and autogynephilia is about wanting to be female.

It is good to be aware of autogynephilia’s controversial status, because transgender activists are often hostile to the idea. You will not learn more about it from the activists. And if your son has frequented internet discussions, he may also resent the idea. We emphasize that autogynephilia is controversial for social reasons, not for scientific ones. No scientific data have seriously challenged it.

Sexuality

Males with autogynephilia can have a variety of autogynephilic fantasies and interests, from cross dressing to fantasizing about having female bodies to enjoying (for erotic reasons) stereotypical female activities such as knitting to fantasizing about being pregnant or menstruating. One study found that autogynephilic males who fantasize about having female genitalia also tended to be those with the greatest gender dysphoria.

Autogynephilic males sometimes identify as heterosexual (i.e., attracted exclusively to women); sometimes as bisexual (attracted to both men and women), and sometimes as asexual (i.e., attracted to no individuals). Blanchard’s work has shown that autogynephilia can be thought of as a type of male heterosexuality, one that is inwardly directed. Autogynephilia often coexists with outward-directed heterosexuality, and so autogynephilic males usually say they are also attracted to women. Some autogynephilic males enjoy the idea that they are attractive, as women, to other men. They may have sexual fantasies about having sex with men (in the female role); some may even act on these fantasies. This accounts for the bisexual identification among some autogynephilic males. In some others, the intensity of the autogynephilia–which is attraction to an imagined “inner woman”–is so great that there are no erotic feelings left for other people. This accounts for asexual identification. (Asexual autogynephilic males have plenty of sexual fantasies, but these fantasies tend not to involve other people.)

When autogynephilic males receive female hormones as part of their gender transition, they typically experience a noticeable decrease in their sex drive. Some have reported that this has diminished their desire for gender transition as well. Others, however, have reported no change in their desire for transition. (In any case, hormonal therapy is a medical intervention with serious potential side effects, and we do not recommend it as a way to treat gender dysphoria, except in cases in which after very careful consideration, gender transition is pursued.)

Autogynephilia is a paraphilia, meaning an unusual sexual interest nearly exclusively found in males.

We repeat: Autogynephilia is a sexual orientation–to be sure, an unusual orientation that is difficult to understand. There is no evidence that parents can change their children’s sexual orientations. And we don’t think they should try.

What should you do?

Consistent with our values, knowledge, and common sense, we believe that males with autogynephilic gender dysphoria should not pursue gender transition right away, as soon as they first have the idea. Transition ultimately requires serious medical procedures with irreversible consequences. But we are unsure what the right approach to autogynephilic gender dysphoria is. In part, this is because there has been too little outcome research conducted by scientists knowledgeable and open about autogynephilia.

First, we recommend that your son be informed about autogynephilia. The best way to do this is up to you. There is probably no non-awkward way. Consider showing them this blog. People should make important life decisions based upon facts, and for males autogynephilic gender dysphoria, autogynephilia is a fact. The standard “female mind/brain in male body” is a fiction.

Some males become less motivated to pursue gender change when they understand their autogynephilia. However, some do not become less motivated. We know far less about patterns of persistence and desistance of autogynephilic gender dysphoria than we do about childhood onset gender dysphoria.

If an autogynephilic male has become familiar with the scientific evidence, has patiently considered the potential consequences of gender transition over a non-trivial time period, and still wishes to transition, we do not oppose this decision. It is possible that many autogynephilic males are happier after gender transition. But there is no rush for any adolescent to decide.

Rapid-onset Gender Dysphoria (Mostly Adolescent and Young Adult Females)

Rapid-onset gender dysphoria (ROGD) seems to come out of the blue. We think this is because ROGD does come out of the blue. This is not to say that all adolescents with ROGD were happy and mentally healthy before their ROGD began. But importantly, they had no sign of gender dysphoria as young children (before puberty).

The typical case of ROGD involves an adolescent or young adult female whose social world outside the family glorifies transgender phenomena and exaggerates their prevalence. Furthermore, it likely includes a heavy dose of internet involvement. The adolescent female acquires the conviction that she is transgender. (Not uncommonly, others in her peer group acquire the same conviction.) These peer groups encouraged each other to believe that all unhappiness, anxiety, and life problems are likely due to their being transgender, and that gender transition is the only solution. Subsequently, there may be a rush towards gender transition, including hormones. Parental opposition to gender transition often leads to family discord, even estrangement. Suicidal threats are common.*

We believe that ROGD is a socially contagious phenomenon in which a young person–typically a natal female–comes to believe that she has a condition that she does not have. ROGD is not about discovering gender dysphoria that was there all along; rather, it is about falsely coming to believe that one’s problems have been due to gender dysphoria previously hidden (from the self and others). Let us be clear: People with ROGD do have a kind of gender dysphoria, but it is gender dysphoria due to persuasion of those especially vulnerable to a false idea. It is not gender dysphoria due to anything like having the mind/brain of one sex trapped in the body of the other. Those with ROGD do, of course, wish to gender transition, and they often obsess over this prospect.

The subculture that fosters ROGD appears to share aspects with cults. These aspects include expectation of absolute ideological agreement, use of very specific jargon, thinking of the world as “us” versus “them” (even more than typical adolescents do), and encouragement to cut off ties with family and friends who are not “with the program.” It also has uncanny similarities to a very harmful epidemic that occurred a generation ago: the epidemic of false “recovered memories” of childhood sexual abuse and the associated epidemic of multiple personality disorder. We discuss these more below. First, however, we review what little we know about ROGD.

What About Natal Males?

Why do we keep emphasizing natal females versus natal males? There are three reasons. First, the single study that has been conducted on ROGD found substantially higher numbers of females than males (more than 80% female cases). Second, there has been a striking surge in the number of adolescent females identifying as transgender and presenting at gender clinics. Third, there is a different kind of gender dysphoria–Autogynephilic Gender Dysphoria–that likely accounts for most or all of the apparent cases of ROGD in natal males. However, we cannot be completely sure that the smallish number of ROGD cases in natal males are due to autogynephilia. It’s possible, therefore, that what we discuss here applies to some natal males as well.

What Do We Know?

ROGD is such a recent phenomenon that we know little for certain. We have four sources of data. First, an important study of ROGD has been presented by Lisa Littman at the annual meeting of the International Academy of Sex Research. (It has not yet been published, but we suspect it will be soon.) This is the only systematic empirical study to date. Second, we have had numerous conversations with mothers of girls with ROGD. Third, we have read several case studies of the phenomenon. Fourth, we have been in touch with clinicians who work (either as therapists or consultants) with children with ROGD, or their families. Fortunately, the sources have provided convergent findings. We are fairly confident about the following generalizations:

–The large majority of persons with ROGD are female, and the most typical age of onset ranges from high school to college ages.

–Persons with ROGD have a high rate of non-heterosexual identities before the onset of their ROGD.

–Signs of extreme social contagion are typical. For example, this includes multiple peer group members who all began to identify as transgender. Sometimes this occurs after school-sponsored transgender educational programs.

–Persons with ROGD have high rates of certain psychiatric problems, especially aspects related to borderline personality disorder (e.g., non-suicidal self-harm) and mild forms of autism (that used to be called “Asperger Syndrome).

–In general, the mental health and social relationships of children with ROGD get much worse once they adopt transgender identities.

–Parents resisting their children’s ROGD are not “transphobic” or socially intolerant. These are parents who, for example, usually approve of gay marriage and equal rights for transgender persons.

Our Current Take on ROGD

Rapid-onset Gender Dysphoria (ROGD) occurs when a young person (generally an adolescent female) is persuaded that she is transgender, despite strong evidence that the young person had few or no signs associated with established forms of transgender. How and why does this happen?

Despite the very limited available research to date, we have strong intuitions and hunches about what is going on, based on its similarity to similar phenomena in the past: the recovered memories and multiple personality epidemics. We spend considerable effort in this section both explaining these past epidemics and drawing the parallels to the current one that concerns us now: Rapid-onset Gender Dysphoria. We believe that she who forgets (or ignores) the past is doomed to repeat it.

During the 1990s there was an explosion of cases in which women came to believe that they had been sexually molested, usually by their fathers and often repeatedly and brutally. They believed these things even though prior to “recovering” these “memories”–most often during psychotherapy–they did not remember anything like them. They believed in the memories even though the memories were often highly implausible (for example, family members would have noticed). Many women with recovered memories cut off relationships with their families. Some developed symptoms of multiple personality disorder. We know now that the recovered memories were false. And multiple personality disorder doesn’t exist, at least in the way those affected and their therapists believed. We refer to recovered memories and multiple personality disorder, which have similar causes–and also some similar causes to ROGD–as RM/MPD

Here are the main similarities between ROGD and RM/MPD:

  1. Cases consistent with RM/MPD were very rare prior to the 1980s but became an epidemic. The same appears to be happening with ROGD.
  2. Both have primarily affected young females, although RM/MPD began substantially later (on average, age 32) than ROGD (typically during adolescence). (Another destructive epidemic of social contagion–witch accusations in colonial Salem–primarily involved adolescent girls.)
  3. The explanations of both RM/MPD and ROGD by “true believers” are contradicted by past experience, common sense, and science. Memory and personality integration did not work the way that therapists treating RM/MPD believed they did. For example, children and adults who experienced trauma can’t repress them–they remember them despite their best attempts. And gender dysphoria in natal females does not begin after childhood–unless it is the acquired condition that is ROGD.
  4. Both show ample evidence of social contagion of false, harmful beliefs. In RM/MPD, the “infection route” usually went from therapists who strongly believed in RM/MPD to their suggestible patients, who acquired a similar belief, applied it to their own lives, and manufactured false and monstrous accusations against previously loved ones. (A harmful result of therapy or medical treatment is called iatrogenic,) In ROGD, the infection route appears to be primarily directly from youngster to youngster. To be sure, therapists get into the act after the person with ROGD acquires the belief that she is transgender, and then they are complicit in tremendous harm. But it seems rarely to occur (yet) for a youngster to be talked into ROGD by a therapist.
  5. Both are associated with sociopolitical ideologies. (Interestingly, both ideologies still find comfortable homes in Gender Studies programs in many universities.) For RM/MPD, the ideological system was that men’s sexual abuse of children has not only been too common (true), but that it has been rampant, even the rule (false). Couple this ideology with a belief in Freudian theory and methods (like hypnosis), and what could go wrong? Plenty, it turned out. For ROGD, the relevant ideology is less coherent, but includes the seemingly contradictory ideas that gender is “fluid” (here meaning that not everyone fits into a male-female dichotomy); that forcing people into rigid gender categories is a common cause of societal and personal anguish; but that gender transition is an underused way of helping people.
  6. Both RM/MPD and ROGD are associated with mental health issues, generally, and especially a personality profile consistent with borderline personality disorder (BPD). This is not to say that all persons with either RM/MPD or ROGD have BPD; simply that evidence suggests that it is common in these groups. For example, the high rate of non-suicidal self-injury we have noticed from the aforementioned sources is striking. Such behavior is strongly associated with BPD. (For a discussion of BPD among those with RM/MPD, see this article, pages 510ff.)
  7. Adopting the belief that one has either RM/MPD or ROGD has been associated with a marked decline in functioning and mental health.

Some of the factors that seem to be common in ROGD–and some that are similar between ROGD and RM/MPD–likely encourage the adoption of false beliefs and identities. These include a fragile sense of self (BPD), attention seeking (BPD), social difficulties (BPD and autistic traits), social malleability (BPD, and adolescence), social pressure (adolescence), and strongly held (if irrational and poorly supported) beliefs that make embracing false conclusions especially likely (sociopolitical indoctrination). Adolescents with an actual history of gender nonconformity, or whose sexual orientations are non-heterosexual, may be especially vulnerable to believing that these are signs they have always been transgender. Adolescents whose lives have not been going well may be especially looking for an explanation and may be especially receptive to drastic change.

Based on the aforementioned data sources with which we are familiar, and on our informed hunches, we suspect that many persons with ROGD were usually troubled before they decided they were gender dysphoric and many will lead somewhat troubled lives even after their ROGD (hopefully) dissipates. Of course, ROGD can only make things worse, both for the affected person and her family.

What to do

Because ROGD is such a recent phenomenon, there is very little guidance about helping affected persons. Lisa Marchiano has written two excellent essays abounding with good sense, and we recommend starting with those.

Second, set aside, for now, rapid-onset gender dysphoria. Identify your child’s problems that existed before ROGD and that may have contributed to it. Attending to these problems will be useful for everybody, and perhaps your child will even agree.

Third, with respect to ROGD, do what you can to delay any consideration of gender transition. Of the different kinds of gender dysphoria, ROGD is the type for which gender transition is least justifiable and least researched. Remember, ROGD is based on a false belief acquired through social means. None of the aforementioned factors that have caused your child to embrace this false belief will be corrected by allowing her to transition.

Two Rarer Types of Gender Dysphoria

For the sake of completeness, we include two other kinds of gender dysphoria. We suspect that both are rare, even among persons with gender dysphoria. One of us (Blanchard) has seen cases of the first type, autohomoerotic gender dysphoria, which appears to be an erotically motivated gender dysphoria. In this case, sexually mature natal females (i.e., not biologically still children) become sexually preoccupied with the idea of becoming a gay man and interacting with other gay men. Neither of us has seen someone clearly fitting the second type, gender dysphoria resulting from psychosis. (Our inclusion of this type was motivated in large part by the argument of Dr. Anne Lawrence, an important scholar we both respect.) In this type, a person (either male or female by birth) acquires the delusion that s/he is the other sex, because s/he is suffering from gross thinking deficiencies.

Superficially, both of these conditions have some similarities to some other kinds of gender dysphoria. For example, a female with rapid onset gender dysphoria may be sexually attracted to males and thus strive to become a gay man, similar to autohomoerotic gender dysphoria. The important difference is that the female with rapid onset gender dysphoria is not primarily motivated by an erotic desire to be a gay man. Instead, having the prospect of having sex with gay men is a by-product of her condition, not the main point of it. The female with rapid onset gender dysphoria acquires it via social contagion, broadly speaking (i.e., including cultural signals that gender dysphoria is in some crucial ways desirable). With respect to the other rare subtype, we have both known gender dysphoric persons with psychosis. However, in these cases, the psychosis was not the cause of the gender dysphoria. It was simply an additional problem that the gender dysphoric person had. In the case of gender dysphoria resulting from psychosis, the belief that one is transgender (or the other sex) is clearly a delusion resulting from disordered thinking–and not, for example, from social contagion or autogynephilia.

Autohomoerotic Gender Dysphoria

This rare type of gender dysphoria is limited to females. Published cases have consisted of women whose gender dysphoria began in late adolescence or adulthood. (It is conceivable that it might begin earlier in some cases.) It occurs in (heterosexual) females who are sexually attracted to men, but who wish to undergo sex reassignment so that they can have “homosexual” relations with other men. These females appear to be sexually aroused by the thought or image of themselves as gay men. We have created the label autohomoerotic gender dysphoria to denote this sexual orientation. There are little systematic data on this type of gender dysphoria, although clinical mentions of heterosexual women with strong masculine traits, who say that they feel as if they were homosexual men, and who feel strongly attracted to effeminate men go back over 100 years.

It is well documented that at least a few autohomoerotic gender dysphorics have undergone surgical sex reassignment and were satisfied with their decision to do so. There is no compelling reason to question such self-reports of postoperative satisfaction, although current surgical techniques do not produce fully convincing or functional artificial penises, and it is difficult to imagine that autohomoerotics find it easy to attract gay male partners who can overlook this.

This type of gender dysphoria does not appear to be the female counterpart of autogynephilic gender dysphoria, although the differences might appear subtle. Autogynephilic (male) gender dysphorics are attracted to the idea of having a woman’s body; autohomoerotic (female) gender dysphorics are attracted to the idea of participating in gay male sex. For autogynephiles, becoming a lesbian woman is a secondary goal—the logical consequence of being attracted to women and wanting to become a woman. For autohomoerotics, becoming a gay man appears to be the primary goal or very close to it.

The few available case reports suggest that autohomoerotic gender dysphoria may have ideational or behavioral antecedents in childhood. However, these females are not as conspicuously masculine as girls with (pre-homosexual) Childhood Onset Gender Dysphoria. For this reason, and because it is rare to start with, it is unlikely that many parents will detect this syndrome in daughters. It is conceivable, however, that when they occur, cases of autohomoerotic gender dysphoria may be perceived by others as Rapid Onset Gender Dysphoria. This is not because their gender dysphoria arose suddenly, but rather because their early, atypical erotic fantasies were invisible to their parents.

Gender Dysphoria Caused by Psychotic Delusions

The idea that gender dysphoria can sometimes reflect psychotic delusions is certainly plausible. Delusions in schizophrenia, for example, are often bizarre but compelling to the person who has them. Unfortunately, neither of us (Ray Blanchard or Michael Bailey) has had direct contact with a person clearly meeting this profile, and so we have less confidence in this gender dysphoria category than in the others. Our lack of direct familiarity doesn’t necessarily mean that much. Even if gender dysphoria due to psychosis were fairly common (compared with other forms of gender dysphoria), we wouldn’t have expected to come across it. Persons with severe mental illness have generally been treated for their mental illness and not for gender dysphoria. Until recently, clinics treating persons with gender dysphoria would have screened out patients with severe mental illness, because of concerns that their diagnosis and treatment might be compromised. But we are hesitant to embrace this kind of gender dysphoria as “definitely existing,” because we worry that psychiatrists who have claimed to see it may have been insufficiently trained to notice other kinds of gender dysphoria, such as autogynephilia. Thus, they may have concluded that psychosis caused the gender dysphoria, when in fact, psychosis may have simply occurred with autogynephilia within the same person. One of us (Bailey) has recently been in touch with a mother of a young man who appears to have the profile we would expect for gender dysphoria due to psychotic delusions, and there was no evidence that this young man was autogynephilic. Still, we are least sure about the existence–much less the prevalence–of this kind of gender dysphoria.

Not Just One Type of Gender Dysphoria: Some Implications

It should be clear by now that “gender dysphoria” is not a precise enough term. Parents of gender dysphoric children should know which type of gender dysphoria their child has. To do so it is necessary to learn about all three of the most common types. That is, in order to understand why one’s child is Type X, it is necessary to know why s/he is not Type Y or Type Z. This is not simply academic. There are essential differences between the different types of gender dysphoria.

If knowledge is power, then lack of knowledge is malpractice. The ignorance of some leading gender clinicians regarding all scientific aspects of gender dysphoria is scandalous. To do better, they should start here. We recommend against hiring gender clinicians who are hostile to our typology. Ideally, they would agree with it.

Knowing there are very distinct kinds of gender dysphoria also raises questions–and concerns–about transgender persons of one type using their own experiences to make recommendations for children/adolescents of other types. Nothing in Caitlyn Jenner’s experience allows her to understand what it was like to be Jazz Jennings–and vice versa. Yet a number of vocal transgender activists who have histories typical of autogynephilic gender dysphorics do not hesitate to pressure parents, legislators, and clinicians for acquiescence, laws, and therapies that do not distinguish among types of gender dysphoric children. Moreover, they not infrequently claim inside knowledge based on their own experiences. Yet their experiences are irrelevant to the two types of gender dysphoria that they don’t have. And even with respect to autogynephilia, these transgender activists are nearly all in denial. This means that their public recollections of their experiences are either distorted or outright lies. A notable exception is Dr. Anne Lawrence, who has become an important researcher of gender dysphoria, and who has been honest and open about her autogynephilia. Dr. Lawrence has taken the time to learn the scientific literature regarding different types of gender dysphoria and does not insist that her personal experiences apply to non-autogynephilic gender dysphorics. The biggest victims in the attempts by autogynephiles-in-denial to steer the narrative towards sameness are, in fact, other persons with autogynephilia. These include honest autogynephiles, who frequently contact us but are fearful of public attacks by those in denial. Most relevant to this blog as potential victims are autogynephilic youngsters, who are at risk of being swayed toward decisions they would not otherwise make, on the basis of inaccurate fantasies embraced by those who cannot face the truth of their own condition.

To us, the most tragic group, along with their families, includes those who have acquired rapid-onset gender dysphoria. That condition appears to be the tragic interaction of the current transgender zeitgeist (“It’s everywhere, and it’s great!”) and social media with the vulnerability of troubled adolescents, especially adolescent girls. They are at risk for unnecessary, disfiguring, and unhealthy medical interventions.


*Note. Suicide is tragic and awful, and because of this, we recommend taking seriously your child’s suicidal ideas, threats, and gestures. We have written elsewhere about the risk of suicide among gender dysphoric persons, and we think that this risk is elevated compared with non-gender-dysphoric persons, but still unlikely.


 

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236 thoughts on “Gender dysphoria is not one thing

  1. Reidentified woman. I think it is very negligent and telling that a psychiatrist would feel you were such an “obvious case”. It shows that our society has a very difficult time separating femininity from female. If we were honestly able to separate the two I don’t think ROGD would be spreading as rapidly as it is. I know everyone who affirms feel that they are being kind but as I have pointed out to different “supportive” people maybe someone should ask why? Why do you feel that your clothing choices and hair style and behaviors make you any less of a female than a girl who checks all the boxes for femininity? Women and men come in all different varieties and femininity and masculinity are choices. We don’t have to perform these to be a real woman or man. I get how a young person could be made to feel very badly about not wanting to be feminine or masculine. I get how trans identity could be such a tempting lifestyle for so many ….. especially if a butch girl or sissy boy is bullied by peers or made to feel bad about themselves by loved ones or even just having the constant feeling of not fitting in. I’m so happy that you stopped listening to all the harmful messages and started listening to your gut. You are very grave and now have a deeper appreciation for what the word woman truly means. Therapists need to WAKE UP!!!!! You can’t label but he’s and femme boys and girls as classic or obvious cases!! It’s cruel and harmful. I have known lovely women in my lifetime who are butch (both lesbian and heterosexual). They are just as much a woman as any of us. This shouldn’t even have to be discussed in 2017!!!! This is why I feel trans ideology is so regressive. It is reinforcing gender stereotypes. Anyway… I wish you much happiness and health and happiness. I hope my own lovely daughter can come to understand herself one day as you have done.

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    • It sure is. I have informed them about me detransitioning and we’re going to have a meeting about it. I’ll take the opportunity to make them better understand what’ makes you trans and not…
      I agree with you, all of this is absurd 2017. But sometimes I think that’s part of the problem. “There are no gender differences…” so it’s not such a big deal to not identify as you sex socially. And after you have made that statement you can’t really go back… and then it’s the slippery slope and bam, you’re alone, depressed and feel like you have no other option than transitioning.
      No we’re not equal yet. No, you can’t escape societal norms by identifying and transforming to another gender. It’s just to accept that it’s way tougher for a GNC person. Understanding that transition is not really an alternative would make us find strategies around this.

      I hope you daughter will get the right information and make peace with herself too some day.

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  2. Don’t know if this comment section is still being read, but I realized I wanted to edit/add some things in my text.
    I write a lot “It is not a choice”. What I mean by that is that you can’t chose weather you will get strong feelings watching a youtube transformation video and feel like that could have been you. That, I think you can’t control.

    However, I do think it is a choice, especially in the beginning (I believe it’s more difficult the longer the time goes by)
    – To watch those videos and read all the blogs (if it’s triggering you).
    – To Not look up (non-angled) information from statistics and research, and to chose to Not listen to the skeptical side at all.
    – To take hasty steps. One might feel like doing it, most do. But there is no one saying it’s a good idea to rush it, not even more serious gender pro people. It’s just common sense to not (In fact I might have that to thank that I don’t pass as a guy today).
    – To not listen to any detransition/reidentified person, instead decide that they are all “TERFS” or fake trans.
    – To not find other distractions/identities (as I wrote a little about). One should try to build a strong identity around something else rather than gender and identity, that might help you realize that there are environments /contexts were gender is not that big of a deal and you could stand being seen as just any gender. (This is something that helped me a lot when I finally found the right education for me. It was very technical and I realized that it occupied me / made me feel so good and competent that gender didn’t feel very relevant anymore.)
    – An maybe most importantly: To think that you have to feel like a woman / man in order to be a part of that social group. This is probably more difficult to go against than what we think, cause this is very much how we talk about gender today… what you feel is what you is. Not what’s the safest for you, or what social group you have actually been raised in and learnt to understand, and what will give you the necessary tools/(cis-privileges) to get through life. (Some radfem theories might be helpful here, they base gender on social groups. – Without saying that they are experts on gender in other regards, but I do think they have a point here.)

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    • People are still reading this thread. Thank you so much for your information. If we could get therapists to help us out, this could be helpful to them. Or if our kids would read this, they may take some of these ideas better from people who aren’t their parents and with whom they identify more closely.

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  3. I’m late to the discussion here, but I wanted to add another voice to the suggestion by M0506 and other commenters that more investigation of ROGD young men is needed before jumping to the conclusion (based on studies conducted before the rise of the modern Internet trans subculture) that they’re invariably cases of autogynephiles in denial.

    In particular, I think it’s worth investigating the ways in which the experiences of adolescent boys on the “gifted” and/or autism spectrum interact with “gender identity” discourse and with the psychological reinforcement effect of 24/7 social media, neither of which existed in anything like their present form as recently as a decade ago. This investigation would be valuable for understanding the female majority of ROGD cases too, of course!

    It’s clear to me that at least some MTF discourse takes the experience of being a geeky heterosexual male — not fitting in with “the bros,” preferring imaginative play to competitive sports, frustrated longing for an idealized female partner — and interprets it as evidence of a “gender identity” as a lesbian woman.

    It’s possible that all of the young men claiming a trans identity are concealing straightforward cases of erotic autogynephilia, but I think it’s worth taking seriously the possibility that they’re making honest self-reports of their own experience. (You’re certainly not wrong, of course, to point out that many of the ringleaders of online trans activism are adult autogynephiles whose denials are profoundly unconvincing.)

    My own (purely anecdotal) hypothesis is that male ROGD, as enabled by the cultlike atmosphere of the social media trans subculture, involves an element of lonely men becoming their own “ideal girlfriend” in a way that doesn’t necessarily involve sexual arousal, and I suspect (again anecdotally) that it’s incorrect to consider this a form of sexual paraphilia.

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    • Thank you for posting this. I’ve been meaning to respond on this thread but am totally engulfed in the panic and fear of knowing my son has taken new and serious steps to medically transition. He is naive and gullible, lonely and depressed, and I believe his story is exactly as you described in your post. Perhaps he recognizes the autogynephilic elements of his story as proof that he needs to transition. Mainstream awareness of ROGD can’t come soon enough. My son and others like him need to know they are not alone (just as we parents need to know this, too) so that they can see the patterns in their thinking and behaviours. Thank you to the authors and commenters in this thread who have given my husband and I hope that the tide may be turning.

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    • Honestly, I hope they’re not autogynephiles in denial. I’d rather have then be confused young men who don’t feel they fit in with other guys than fetishists who are not-so-secretly getting turned on by people treating them as female. You make a good point that a lot of this research was conducted before Internet trans subculture.

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    • EverHopeful, so sorry you’re going through this, and I’m glad it’s at least some comfort to know that you’re not alone. It’s so frustrating to recognize that there’s a common pattern in so many of these stories while being forbidden to discuss it in “respectable” venues.

      Some additional thoughts (directed towards the discussion in general):

      With all due respect to Drs. Bailey and Blanchard, I think that approaching adolescent male ROGD with the preconceived notion that it must be about a sexual paraphilia, and that if someone says it isn’t they’re either lying or in denial, isn’t likely to be a productive route of research or therapeutic inquiry.

      There’s an important distinction between the claim that “heterosexual MTFs experience sexual arousal when they imagine themself as a woman” and the claim that “heterosexual MTFs experience a complex feeling of longing and desire when they imagine themself as a woman.” Indeed, the latter is close to the tautological statement that “trans people are trans.” This seems to be what Anne Lawrence is getting at in her paper — it’s not just about sex, although that might be part of it in some cases.

      As I said, none of this is meant to deny the fact that many adult trans ringleaders are obvious autogynephiles. Zinnia Jones comes immediately to mind — flaunting his autogynephilia while disingenuously denying it seems to be part of the “game” he’s playing. But I know plenty of MTF trans people who don’t behave like this, and I think that responsible clinicians and researchers have a responsibility, in cases where bad faith isn’t obvious, to take their descriptions of their own experience at their word as honest self-reports.

      For what it’s worth (as longtime commenters here will know), while I’m active on 4thWaveNow because I’m a father of preschool-age children concerned about what they’re going to encounter in school in a few years, my own experience with the rapid-onset trans phenomenon comes from working and socializing in a STEM subfield which attracts an unusual number of MTF trans people — so much so that it’s one of Dr. Blanchard’s diagnostic criteria for autogynephilic dysphoria. In many ways, these are “my people” (geeky outsider males); I like to think that I have some sense of what makes them tick, and I’ve spent a lot of time reading trans material in a good faith attempt to be an “ally,” although the end result was a growing skepticism which led me to privately hit Peak Trans even before I discovered 4WN and learned that I wasn’t alone.

      This is purely my anecdotal observational theorizing, but here’s what I think is going on in some of these cases. There’s a pubertal developmental stage that many gender-nonconforming boys go through (maybe gender-conforming boys do too, though I wouldn’t know) in which they fantasize about an imaginary perfect partner: “If only there were a person who was into all the same comics and video games and computer stuff I was, and who didn’t care that I was shy and sensitive and bad at sports, but was a girl and would be my girlfriend.” Today they can express this fantasy, among other ways, by experimenting with playing as a female avatar in video and roleplaying games.

      Most boys eventually mature and develop a more nuanced view of what real-life opposite-sex relationships involve. But some stay stuck in this stage through late adolescence and young adulthood, due to high-functioning autism or arrested development or simple romantic bad luck. And then they encounter the online trans subculture, which tells them that their fantasies of a “just like me, but a GIRL” alter ego are actually evidence of a female “gender identity.”

      Again, I don’t claim to have based this on any sort of rigorous study, just my own experience as an observer of the contemporary trans subculture. But I really do think that it captures what’s going on more clearly than the assumption that they’re all getting off to it while saying they don’t. In particular, I think it’s worth making a distinction between the relatively longstanding phenomenon of middle-aged men who transition late in life after “hyper-masculine” marriage and career success (the Bruce Jenners and James Pritzkers), and the newer phenomenon of geeky younger men who transition after a social media binge in adolescence or during their awkward twenties.

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  5. Thank you for writing this article. I have been dealing with this issue for nearly two years with my now 17-year-old child, and just when I think the worst is behind us, more gets dumped on me. Our story in short: My lovely girl told us nearly two years ago that she was a trans boy. Shortly thereafter, she aborted a suicide pact she had made with a kid from school and was diagnosed with depression and anxiety–as well as gender dysphoria. My husband and I found a therapist we thought could help her unravel the underlying “stuff” that was causing her problems, but he turned out to be a guy who just sat there while my kid complained about things in her daily life. We then switched to another therapist (a straight shooter) to whom my kid refused to speak In any substantive way. Between each of these sessions, my daughter would complain non-stop about how she did not like the therapist–to the point of crying and throwing tantrums. We then switched to a trans-advocate LCSW, who my kid likes. Since going to her, we’ve changed my daughter’s legal name and let her go on testosterone (she promised to stop cutting if we allowed this–and has stopped). Now, this social worker is working with my kid to have us pay for top surgery as a graduation present. I’m so angry and frustrated I don’t know what to do. My kid is immature for her age and is a black-and-white thinker. Abstractions are lost on her, so it’s impossible for her consider the possible ramifications of her current actions. I’m so tired of dealing with all this crap that part of me just wants to throw in the towel and give her up as lost. She’s going to be 18 in 6 months, and she can do whatever she wants then anyway, I feel defeated and don’t know where to turn.

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    • Has anyone considered whether your daughter might be autistic? (Immature, black and white thinking etc). I would write a very strongly worded letter to those treating her (the social worker colluding in your daughters emotional blackmail of you), asking whether autism has been considered, and if not why not. And that not considering it is negligent. Also that in your opinion as her parent, she is not emotionally mature enough to consent to treatment, and that again there will be a negligence claim if this has not been taken into account.

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    • I feel your pain, every last bit of it. Our daughter is 15 and for 2 years we have been living through the same nightmare including bad therapists who made it clear that she only had to wait until 16 to get hormones. The school was calling her by a male name )I flipped out about this when I wound out and had it changed back) and today I find that they are still referring to her as “he”. I have sent a crappy letter asking for a meeting and stating that I will remove her from the school if it continues. I know this started at puberty, I know it is body image and social contagion, I know also that my daughter has had some tough times that have doubtless contributed.

      I do not understand what it is about people who do not have a stake in her life that makes them feel it is acceptable to mess more with her mind. If she had anorexia they would not tell her she was fat and give her a bucket. If she insisted that heroin made her feel better they would not give her an injection.

      Two years ago she told us that she thought she might be gay or bisexual. We told her we had no problem with that…. then bam ! The trans agenda hit like a steam train. She has a whole host of friends from the internet, at least one of which is taking hormones who I have met and it is absolutely the saddest thing to see. When she first visited I said to my daughter “how lovely it would be if you could be two girls happy together”… the r action was that they were not girls…..Our daughters might even know each other. She is adamant that wanting a sex change and being attracted to other girls who want a sex change is not gay and that she is not gay…. from such an intelligent child it beguiles belief. There is not getting through like you said.

      Perhaps ask her to read this.

      https://4thwavenow.com/2018/01/18/i-hated-her-guts-at-the-time-a-trans-desister-and-her-mom-tell-their-story/

      I know how you feel about throwing in the towel. You’re doing everything you can to make your child see how perfect they are and how loved yet the people around you who are supposed to help are just fuelling her desire. Rest in the knowledge that you are doing everything that you can.

      Much love in these hard times x

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  7. Continuing the discussion from here: https://4thwavenow.com/about/comment-page-8/#comment-25072

    Brie,

    I have not yet examined how women view sexuality and whether this interacts with their feelings on gender. However, I have looked at body image, and there seems to only be a tiny effect there. Autoandrophilia can generally explain 25% of the variance in women’s desire to be male, whereas body image issues seems to at most explain a few percent, possibly nothing.

    So far, there is little evidence to distinguish between “deciding to transition when you are AAP is socially contagious, and AAPs tend to cluster together socially” and “gender dysphoria itself is socially contagious”, but the evidence I’ve seen points towards the first. For example, AAP women tend to have their AAP start at the same time as the rest of their sexuality, suggesting that it started independently of social contagion, yet they tend to have A LOT of trans friends.

    You need to be careful when thinking about the interaction between lesbianism and ROGD/AAP. The most-lesbian women who state that they have zero attraction to men will be less AAP than the baseline, whereas the almost-lesbian women who state that they have a very strong preference for women over men will be more AAP than the baseline. When talking to a gender critical lesbian about it, she suspected that this latter group was not truly lesbian, but I suspect that this group accounts for much of the overrepresentation of lesbians among ROGDs. (Of course, the true lesbian group also transitions more than the baseline, but this is IMO through HSTS and not ROGD etiology.)

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  8. Thank you for this article. I have a child who was diagnosed with ROGD and it has been hell for my wife and I. I have had to think and read about this topic a lot and the breakdown of different types of “gender dysphoria” (an absurd label) is enlightening. Before reading the post I did have the feeling that the Autogynephilic Gender Dysphoria in males is a situation where the fetish of being a woman is so strong that the person actually wants to become a woman physically. The key thing is “fetish” which is intense desire. We medicate people now for their desires – an entirely different topic.

    The reason why the term “dysphoria” is absurd in this context is that it comes from ancient Greek. Did ancient Greeks have gender dysphoria? Probably not as it is a result of humans inventing a self in the mid-eighteenth century. See “The Invention of the Self”, John Lyons 1978. The medical world does everyone a disservice by using such terms as “dysphoria” as labels for “diseases” as it gives people the impression that such ailments are timeless maladies of the human condition when they are not. In modern times, they are most often now an intense preoccupation with the “self” and that is why teenage girls are so vulnerable to this “disease.”

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  11. The mention of dysphoria in the context of psychosis was very interesting. I have encountered this twice in my life – once in the context of my work (I am a mental health professional of sorts) and once was a close friend of mine. He had his first psychotic episode years ago now, which I supported him through including having him admitted to an inpatient unit. One of his more intense delusions, besides believing his apartment was haunted, was that he is in fact transgender and transitioning would be the answer to his intense distress and misery. He persisted with it until the anti-psychotics had well and truly taken effect.

    I asked him if he’d be interested in speaking/writing about this and he said that he would be very open to doing so. I spoke with a social worker while he was in there and she asked me about the gender dysphoria thing, so I would assume it’s on his hospital records to prove his story. I have thought about both of these experiences over the years and have always considered it to be a primary argument against ease of self-identification, mainly because I assumed it was common.

    If 4WN or the authors of this article would be interested in hearing from my friend I’d be happy to arrange something.

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  12. Hi! I’m Nova, biologically male but with a pretty severe case of gender dysphoria that doesn’t fit into any of these explanations. Can you help me with figuring it out?

    So I’m asexual and only attracted to nonbinary people romantically with preferences for certain types of nonbinary people. I have no sexual fantasies and I’m 16 and have gone through the bulk of puberty (that was hell). I feel I have no gender at all, but I do feel more feminine. I never had any problems in childhood with gender, mainly because of the fact that being male really didn’t mean anything. I played with who I wanted, did sorts of playing “male” and “female” toys (which i got almost no female toys since my parents didn’t like that but i didn’t care since they were both good), and generally lived a totally gender neutral childhood. I’ve always liked programming and 3D modeling.

    My dysphoria first started at about 12 or whenever I started puberty (I can’t remember since I was on 2.5mg of Risperdal per day for autism misdiagnosed as ADHD from 7-14). To be clear, I’ve only felt dysphoria for secondary sex characteristics. My penis is fine and it’s just annoying in terms of taking up space, but honestly there’s really no big deal with it. Although I am starting to doubt me not caring, as I have had many surgeries which have caused a lot of trauma psychologically. So it’s possible I actually would feel better with SRS but my trauma is covering it up over fear. I do however hate libido. It’s so badly annoying and fires at terrible times when I just wanna kill it already! It doesn’t have any use since I don’t want to have sex with anyone. I have issues more with body hair which is just so badly distressing, I’ve been depersonalized from my body ever since puberty started, and I’ve been googling since 12 about how to remove testosterone (and somehow came up with only results of people wanting MORE testosterone which idk how that’s possible but google is weird). I can’t stand the deeper voice, the body hair, the bone structure, the height, or the rougher and oily skin. It’s really distressing because I have to live with my body 24/7 and these things won’t go away no matter how much I’d want them to. The reasons why I’d want to go on estrogen are as follows: it reduces libido in most cases because of the antiandrogens without progestrone (spiro for example), it makes the skin softer and more sensitive (which would make me feel more comfortable in general), it causes breast development (which I never really cared about until I thought about it and realized that it actually would feel better emotionally for me to have breasts than any of the drawbacks (in physical comfort, picking out clothing, sexualization by other people, etc.), and lack of any more advancement of testosterone puberty (meaning no more body hair development, no chance for a deeper voice than what I already have, bone structure won’t be more masculine and given my age possibly slightly feminized, etc). Ever since I’d heard of these effects happening I couldn’t stand the thought of them happening to me… but because of my Risperdal (an antipsychotic) I couldn’t really understand or express these feelings to anyone, leading my parents to think it was caused by an outside emotional source. So as puberty hit it was essentially trapping me in these effects and I didn’t know how to get out and feel better about myself.

    As you’ve mentioned in the article, some forms of gender dysphoria are caused when kids and adolescents read a bunch about transgender people in the media and then start to feel they aren’t comfortable in their birth sex. That doesn’t apply to me since my parents actively prevented me from knowing transgender people even existed. What happened is last June (2015) I had my first and so far only crush, on a nonbinary person, and when they told me about themselves (they are biologically female) then I started to do research on being transgender. I knew I didn’t feel comfortable being a girl, but I also knew I felt more uncomfortable with being male. Then I found nonbinary people and decided that agender fit me best, after looking through many identities which did not feel they fit me at all. Me identifying as agender is completely separate to my gender dysphoria, though I do very much feel more comfortable with being called Nova and people using they/them pronouns for me. I know they don’t have to, but it is a sign of respect for me. I don’t annoy people to death over it though.

    So to summarize: I feel extremely uncomfortable with male secondary sex characteristics but not primary (unless my surgery trauma has hidden that), I feel more comfortable with female secondary sex characteristics, I am asexual and have no sexual fantasies but I do have a libido (which is annoying), I see myself as agender, my dysphoria emerged at puberty, and I prefer gender neutral pronouns. And I hadn’t even known trans people existed until 3 years after puberty started in which case I promptly realized what was happening to me.

    So what kind of gender dysphoria do I have? It doesn’t seem to fit any of the types in the article but I would like to know what is going on. If you have any questions I’m open to answering them!

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  13. Hi Nova
    I am not sure if Dr Bailey and Dr Blanchard are still replying to questions, and after reading your heartfelt account I felt compelled to respond.
    The first thing I want to say is that at 16 you a still in the life-stage of identity formation. Sexual identity is part of that. It is totally normal for you to be working out how you feel about sexuality. Wait until at least 25 before you make any decisions. The decision-making and executive functioning etc part of your brain will not be fully developed until then. One wonderful thing about being on the autism spectrum is that you don’t just buy the whole gender stereotyping thing. That is so wonderful, as it is such nonsense. What toys you preferred to play with as a child, and what interests you have, have nothing to do with your sexuality/gender. They may be influenced by societal pressure and norms, but you have more resistance to that than neuro-typicals.
    It is totally normal for you to have a variable degree of discomfort with the changes to your body that you are experiencing as a result of puberty. I should imagine that being on the spectrum may heighten that discomfort. In time you most probably will adapt to all the changes. Teenagers on the spectrum are often “late-bloomers” and take longer to be ready for relationships. You do, however describe that you felt attracted to some-one biologically female and who is now gender non-binary. I would think that someone else also exploring sexual identity, to the extent that you are, would be attractive to you. Shared experiences are very bonding, and you have a deeper understanding and acceptance for each other.
    It would be wonderful for you to see a therapist who specialises in autism and body image issues etc, and who is knowledgeable about gender dysphoria and will not just push you to transition. Someone who is experienced in treating teenagers, and has not been influenced in the whole rush into transition ideology. This is not easy these days as professionals are terrified of losing their licenses to practice.
    Another very important thing is to try and avoid pressure to rewrite your history and feelings about things. I do pick up that you are conflicted about who you really are and what you are reading on the internet. Be true to yourself.
    Try and seek out the other side of the story as well, as you may be by visiting this site. True research does not just look at one side of things. Be aware of bias in research and interpretation of research. Be aware of weak methodology in research.
    Try and think things through calmly and don’t rush to make any decisions. Be aware that as humans we tend to get things terribly wrong sometimes. If people refuse to listen to politely and respectfully delivered arguments, that go against what they believe, there is something very wrong. Respectful debate should always be allowed. Rushing young people into making decisions with permanent consequences just doesn’t sit well with me.
    Wishing you everything of the very best as you journey along this road. Always remember that you are wonderful and lovable just as you are. I hope that in time you become comfortable with your body, and embrace your future (which sounds like may be in programming etc). Try and focus on your interests. School/college can be tough for those that don’t conform to stereotypes. But school/college comes to an end in a few years, and things will be much easier for you after that, as you pursue your interests. And in time you will find a special someone to share your life with, and special friends. Just be patient and never give up hope.

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  14. I’m 24 and started to transition, from m to f, whenever I was 19. I have been “heteroflexible” (prefer muscular men; would engage sexually with other feminine, pre-op trans women; would never engage sexually with natal women) since I was 15 years old. I am also non-op, meaning that I don’t think I could survive something like sex reassignment. I have always liked what I have “down there”, maybe because I am sexually attracted to it in other people.

    Anyway, I’d definitely like to know if there’s a sub-type of gender dysphoria for someone like myself. I was very into bodybuilding during my teen years, which suggests that I was masculine, but I started down that path because I was always made fun of for being small (I have been 5’9, 130 lbs. since I was 12 years old). I realized, when I was about 16, that I was into muscular men sexually, and that encouraged me to attempt to become muscular myself, which eventually resulted in autoandrophilia (sexual attraction to myself with muscles).

    However, I simply wasn’t progressing through puberty as a male; it pretty well stopped at 12 or 13, so I have a higher voice (for instance) than many natal women. When I turned 18 and went to college, the shame around being so feminine became unbearable, and I tried oral steroids for a short time. They caused my skin to get oily and my body to get a bit hairier… And this is where I realized that male puberty was scary, so I went to a gender therapist and started transitioning, male to female, which I’ve been doing nonstop for many years now. I’m feminine to the point that you wouldn’t be able to tell I’m TS, and I’m just really glad I caught it in time.

    However, I have NO idea where I fit into all of this, as I know for a fact that autogynephilia is legitimate (I’ve met too many trans women who share autogynephilic fantasies with me, and creep me out). I was okay with my gender, all throughout childhood. And when I attempted to live as a masculine boy (i.e., going to the gym a lot), some people would have described me as masculine, even though family says it was obvious that I was not a straight male. My dysphoria started when I started to progress through male puberty, and it has honestly gotten worse, the longer I’ve transitioned. Even though I’m very feminine in appearance, I think I’ve developed something far worse than gender dysphoria (maybe body dysmorphia). I have had two plastic surgeries (one on my face) in the past year, and it’s simply not enough to make me feel as feminine as I feel on the inside. I’ve wondered if my transition is driven by body-image issues, to be honest. Regardless of why I am the way I am, you can’t hold a conversation with me, or walk past me, without thinking I’m obviously a female. I just wish I knew where I fit, and I know a therapist isn’t equipped to help since they likely don’t subscribe to autogynephilia.

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      • Goodness, thanks for reading and responding! I cannot access the article but read the abstract – and yeah, I am definitely autoandrophilic. Arousal by my muscles happened frequently, and I acted on it on a daily basis (hopefully not too much information). However, I also want to mention also that my attraction isn’t limited to masculine males. I like feminine, pre-op trans women and drag queens as well. I know that I have the erotic target location error mentioned in the article, as I get aroused by emulating any of the aforementioned groups of people, Consequently, I am an extremely successful TS webcam performer, as well as a drag queen. But some things makes me very different from the autogynephilic majority of the trans-female community, since I could qualify as autogynephilic myself. And that is that I’ve been bisexual my entire life. In fact, since I am repelled by the female sexual anatomy, I might even qualify as a “heteroflexible” trans female. I chose to live as a woman because I really felt I had no choice with how feminine I was, and I think the femininity stems from a severe eating disorder i had while growing up. My point in this huge, long post is that I 100% believe everything you’ve shared about AGP vs. HSTS trans women, but I do think I’m one of the few who’s in a gray area of sorts.

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  15. Kyla, thank you for your comment. What you say – “I’ve wondered if my transition is driven by body-image issues” – is very interesting and I’ve wondered if this is the case for my daughter too. She is 21 and started transitioning as soon as she turned 18. She shows signs of OCD and has made comments that show her fixation on how she looks physically. Now that youth are plowing ahead with any diagnostics & counseling, it seems a lot of what is being called “gender dysphoria” is really other things…the so called “underlying issues” that used to be treated first.

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    • I’m so glad that you care enough about your daughter that you will investigate the rationale behind her gender dysphoria/transition… I wish my own parents were that involved, but they’re instead out of my life. Regardless of why she’s transitioning, it’s still a gender transition nonetheless, especially if she’s living as her target gender. It’s all very real to her, I’m sure, just as it is to me. Even though it’s possible that OCD is part of the equation, in my case, going on as a male simply wasn’t possible. I was not only too inadequate, but I realized how much I’d be missing out on socially if I had not undergone the transition. I got my degree; and I became very outgoing, as opposed to timid and unable to make eye contact. I’ve overcome, and all that remains is the debilitating trauma from family not accepting what I so obviously am. So, please always be there for her, even if the rationale behind her decision is confusing to you.

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  16. Pingback: Svensk lovforslag om å senke alderen for kjønnsskifte uten foreldres samtykke – vårt standpunkt – ROGD Skandinavia

  17. I’m glad to see there’s a site where respected gender dysphoria researchers are involved in disseminating information, but it’s shameful to see such a lack of compassion for gender dysphoric males (which Blanchard and Bailey clearly have) among readers.

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  18. Lee. Speaking for myself only… I have a lot of compassion for gender dysphoric males. The same forces that make a gender nonconforming girl feel bad about herself can also be applied to males. I think every parent here can acknowledge how hard growing up can be for a feminine boy. I think where women start to lose compassion is when transwomen publicly are posting questionable and blatant sexual behaviors while at the same time not having one ounce of compassion as to why women want and need single sex spaces. A lot of the transactivists that scream the loudest appear to be autogynephic males. They do not seem very willing to consider female points of view and try to compare young dysphoric females to their own experience and agitate for laws ,language and any safe guarding for dysphoric males or females shut down or changed. Compassion and respect are a two way street

    Liked by 1 person

    • Hi, I saw this comment and had to express my agreement. I’m a young transitioner (transitioned into a woman at age 19), and I find myself feeling extremely uncomfortable around the part of the community to which you’re referring. Most of the people who are vehemently pro-trans rights aren’t even living full-time as women. It’s almost as if they live as women strictly on the internet, such as on Susans.org or Second Life. Ever since I went to a trans support meeting, got interrupted every time i would try to talk about my own struggles as a trans woman, saw that some 40-something trans woman was checking me out the entire meeting, and I went home and had a flirty FB message from her, I’ve been so repelled by AGP. I don’t want them in the same restroom, especially since part of her flirting entailed looking at my genitals through my yoga pants. That was 3 years ago, and I still want the worst for this part of the community. And here’s the worst part: I’m a sex worker, and I hear these types go on about how they wish they could be the trans sex workers. So, they try to emulate us by posting disgusting photos on social media, which they collectively encourage. They’re sick men, and display an obvious “us vs. them” mentality. They have their own, unique language (e.g., “cis”, appropriating the word “queer”, vilifying anyone who uses the word autogynephilia, neo-pronouns), and it’s catching on at academic institutions, which angers me.

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  19. autogynephilic gender dysphoria only occurs in males? What about if there’s a female who is aroused at the thought of herself having sex as a man and becomes so focused on this feeling she identifies as transgender? I believe I know a person like this. She was really into ‘yaoi’, homosexual Japanese anime and manga.

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  20. Pingback: Autogynephilia – An Introduction – Daisy Chains & Marmalade

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