Researchers Reassess Whether Autogynephilia Theory Still Explains Transfeminine Identity

One of the most contested ideas in the science of sexuality and gender identity is back at the center of debate. In a letter to the editor published in the peer-reviewed journal Archives of Sexual Behavior, researcher Anne A. Lawrence argues that autogynephilia theory—despite decades of fierce criticism—still offers a scientifically useful framework for understanding a substantial subset of transfeminine identities and sexualities. The intervention, published as the field confronts a rapidly growing and increasingly visible transgender population, reignites a dispute that has persisted since the concept was first formalized in the late 1980s.

Autogynephilia, a term coined by the sexologist Ray Blanchard, refers to a male’s propensity to be sexually aroused by the thought or image of himself as a woman. Blanchard, working with gender-dysphoric patients at the Clarke Institute of Psychiatry in Toronto, proposed in 1989 that male-to-female gender dysphoria was not a single phenomenon but rather divided into two distinct types. One type, he argued, involved classic, early-onset femininity—homosexual gender dysphoria in which androphilic (attracted-to-men) males transition young and show a childhood history of marked femininity. The other, he proposed, was driven by autogynephilia: a paraphilic orientation toward the self as female, typically emerging later, often in gynephilic (attracted-to-women) or bisexual individuals, and frequently accompanied by a history of erotic cross-dressing.

Lawrence, an independent researcher and clinician based in Seattle who has published extensively on the topic, contends in the new letter that the empirical evidence supporting the typology has accumulated rather than eroded. She points to psychometric work such as a 2015 study by Kevin Hsu, Alyssa Rosenthal and J. Michael Bailey, which found that items assessing autogynephilia cluster reliably around a coherent latent factor, and to more recent work by Hsu and colleagues comparing the sexuality of male cross-dressers and transfeminine individuals through the autogynephilia framework. She also cites Bailey and Hsu’s 2025 argument, also in Archives of Sexual Behavior, that psychometric data support treating paraphilia as a “natural kind”—a real, bounded category in nature rather than an arbitrary clinical label.

The theoretical stakes are considerable. If a significant proportion of transfeminine people experience gender dysphoria as an expression of an erotic orientation toward their own imagined female body, proponents argue, that has implications for how sexuality changes after transition, how patients describe their motivations in clinical settings, and how researchers parse the heterogeneity within the transgender population. Lawrence has previously documented, in a 2005 study of sexuality before and after male-to-female sex reassignment surgery, patterns of change in erotic interest that she interprets as consistent with the autogynephilic account, and she developed these arguments at length in her 2013 book “Men Trapped in Men’s Bodies.”

Critics, however, have mounted sustained and pointed objections. Julia Serano, a biologist and writer, and Jaimie Veale argued in a 2023 letter to the same journal that autogynephilia is a flawed framework for understanding female embodiment fantasies, noting that such fantasies are also reported by cisgender women and that erotic arousal to the idea of being one’s gender is not unique to any one group. Moser’s earlier 2009 paper claiming to find “autogynephilia in women” sharpened that challenge, suggesting the construct may simply describe an ordinary component of female—or indeed human—sexuality rather than a male-specific paraphilia. Serano and others have further argued that the theory has been weaponized by anti-transgender activists, a concern she elaborated in widely read commentary linking autogynephilia discourse to anti-trans activism.

Lawrence addresses the women-comparison objection directly in her letter. She argues that what distinguishes autogynephilia in the clinical sense is not the mere presence of female-embodiment fantasy but its intensity, exclusivity and motivational force—the degree to which it organizes a person’s identity, sexuality and ultimately the desire to transition. She also draws on earlier empirical work, including Blanchard’s 1992 finding of a nonmonotonic relationship between autogynephilia and heterosexual attraction, to defend the internal coherence of the construct against claims that it is psychometrically vacuous.

Another front in the letter involves the shifting clinical and cultural landscape. Lawrence notes that the context in which people access gender-affirming care has changed dramatically since Blanchard’s Toronto clinic studies. Informed-consent models of care, in which patients access cross-sex hormones without extensive gatekeeping assessment, have spread widely; surveys of clinic practice published by Madeline Deutsch in 2012, and subsequent research by Spanos and colleagues in 2021 showing high patient satisfaction under such models, illustrate how far practice has moved from the intensive evaluation protocols of previous decades. At the same time, prevalence estimates for transgender identity have risen: surveys such as Kuyper and Wijsen’s Dutch study in 2014, Pew Research Center’s 2022 finding that about 5 percent of young U.S. adults identify as a gender different from their sex assigned at birth, and the Williams Institute’s 2025 population update all document substantially greater visibility and numbers than when the typology was formulated.

Lawrence argues that these changes cut both ways. On one hand, a larger and more diverse population of people seeking gender-affirming care makes explanatory parsimony harder: any single-cause account of transfeminine identity looks increasingly implausible. On the other hand, she contends, the growth of self-diagnosis—fueled partly by social media, a phenomenon examined in a 2024 study of TikTok-inspired self-diagnosis and its implications for educational psychology—means that self-reported narratives may be less reliable than ever as evidence about underlying motivations. Here she invokes an old methodological finding from Blanchard, Clemmensen and Steiner’s 1985 study, which documented systematic distortion and social-desirability responding in the self-reports of adult male gender patients. Self-report, in other words, has always been a contested data source in this field, and Lawrence argues that structural measures of sexuality and erotic history remain essential complements.

The letter also engages with a neighboring research literature: the link between autism spectrum conditions and gender diversity. Studies such as Bejerot and Eriksson’s 2014 case-control study of sexuality and gender role in autism spectrum disorder, Kallitsounaki and Williams’s 2020 work on mentalising and gender dysphoric features, van der Miesen and colleagues’ 2018 finding on the wish to be of the opposite gender among autistic adolescents and adults, and Stauder and colleagues’ 2011 study of the “extreme male brain” theory have all documented elevated rates of gender variance in autistic populations. A 2024 systematic review by Wattel, Walsh and Krabbendam maps the competing theories explaining this association. Lawrence suggests that this literature—much of which operates outside the autogynephilia debate entirely—underscores the multidimensional nature of gender diversity, but does not, in her view, displace the need for motivational typologies among the many people who do not fit those profiles.

Finally, Lawrence situates the debate in its political moment. Global analysis of transgender rights, such as Williamson’s 2024 Trans Rights Indicator Project published in Perspectives on Politics, and tracking of healthcare law and policy by the Movement Advancement Project, document a world in which access to gender-affirming care is simultaneously expanding in some jurisdictions and under severe restriction in others. In that climate, she acknowledges, scientific claims about the motivations of transfeminine people carry social consequences far beyond the seminar room. Critics argue this is precisely why the theory should be treated with caution; Lawrence counters that scientific questions are not settled by their political valence, and that understanding heterogeneity—including sexuality-related heterogeneity—serves clinical care rather than undermining it.

Whether the letter changes any minds is doubtful—the positions in this decades-long dispute are entrenched, and the letter appears in a journal that has hosted many rounds of it. But it usefully consolidates the current state of play: a psychometric literature that supporters say vindicates the construct, a critique tradition that views it as a male-centered misreading of universal female-embodiment fantasy and of diverse trans experiences, and a clinical world that has, in practice, largely moved past the gatekeeping contexts in which the theory was born. What remains clear is that autogynephilia is not going away as a research topic, and neither is the argument about what, exactly, it explains.