Archive: 3 Models of Transsexuality

(The following archives an article from May 2008.  Some of my thinking has since changed, and this will not reflect this.)

Before going into a basic overview discussion of three models of transsexuality — HBS, Zucker/Blanchard’s and transgender — I want to start with a couple of clarifications about some of the discussion that has been happening here and elsewhere on the controversy surrounding the Work Group drafting changes to how transsexuality is treated.

1. Dr. Kenneth Zucker does indeed advocate reparative therapies for transgender children. He does not advocate them for gay and lesbian adults. [These reparative therapies should also be noted as being applied to “fix” gender identity rather than sexual orientation, since this is the distinction made when he claims not to use reparative therapy.] Where I consider his power as the Chair of the Work Group redefining “Sexual and Gender Identity Disorders” to be dangerous to GLB folk is in the potential entrenchment of reparative therapies at all. If it becomes legitimized for the treatment of transgender children, you can bet that the ex-gay movement will seize upon this as being validation of what they do. NARTH already cites Drs. Zucker and Susan Bradley and their reparative treatment of transgender children extensively.

2. Zucker’s model does allow for transition of “homosexual transsexuals” (i.e. they have to be attracted only to people who are the same gender as their birth sex). While he subscribes to Dr. John Money’s belief (despite the evidence to the contrary) that psychological gender in childhood is malleable (which also makes him an advocate of “assigning” intersex children), and can be “repaired” by conditioning, he does also believe that by adulthood, there are transsexuals who can only be integrated by society by gender transition (The Clarke Institute that Zucker and Blanchard both hail from is notoriously restrictive, however, so they do not make many such exceptions).

In retrospect, this makes the appointment of Dr. Cohen-Kettenis to oversee the specific entry for GID make sense. I believe that the Work Group’s aim is to entrench:

  1. Zucker’s model for treatment of trans youth and children (reparative therapy)
  2. Blanchard’s model of “Autogynephilia” (more explanation of this model later) to relegate a large segment of the community to a paraphiliac category, and
  3. Cohen-Kettenis’ direction of treatment of the far fewer transsexual adults who would qualify.

I am speculating, of course, but if correct, then Zucker’s appointment is likely the APA’s frightened response to the controversy surrounding the revolutionary new treatments of trans youth by therapists like Dr. Norman Spack.

3) I do believe that the therapists concerned seriously believe that they’re trying to help people. That doesn’t change the fact that their agendas are dangerous. Therapists of all stripes see only a small sampling of the truth. With the transsexual and transgender communities, they only see those who choose to go through the established gatekeepers’ path toward GRS. They are not privy to a wider sampling of transfolk, and then those who they do see measure their words, and withhold anything that they think their therapist does not want to hear, or that might jeopardize their process.

The APA, and therapists in general, need to find a way to build a better rapport with the communities they treat (and likewise, the communities with the therapists). We may be seen as the equivalent of “barstool poets” in their literary midst, but we can recognize quicker than they when someone is overreaching, and being too much poet, and not enough barstool. Community advocates need to be heard.

4) In regards to the HBS assertion that I should leave the advocacy to them, I am a transsexual, many people I care about are transsexuals (most of them surgically-inclined!), many of the people who have embraced the transgender communities that I interact with are transsexuals and I will not just turn advocacy for all of us over to a group that has already excluded much of my community and declared that they consider me nothing more than a “male fetishist,” just because they’re jumping up and down, throwing a fit, and screaming, “It’s my sandbox! It’s my sandbox!” You are welcome to debate the data, but you are not the only people who are “real,” nor the only people with something at stake. Suffice it to say, HBS radicals don’t speak for Mercedes, either.

3 Models of Transsexuality

Okay, now it’s fun time. Granted, reopening the HBS debate is not as fun as wearing polka-dots to a game of Twister, but what the hell. Actually, I do believe that taking a narrow look at the specific hypotheses being debated is useful — maybe even necessary, so that things like “HBS” or “autogynephilia” don’t seem like vague unknowns to those hearing about them or in the case of the latter, sound like a category that “applies only to transvestites.”

Many readers already know the basic gist of at least two of the models being discussed, so I’m just going to have the headings hyperlink to diagrams and let you visit them if you feel you need them (or have been too embarrassed to ask). The rest is analysis and discussion.

A disclaimer: these are all theories — and more specifically, my personal take on those theories. In the case of the Zucker-Blanchard model, I do not have inside information, I can only speculate on what their objective is based on their past history. There are more, and variations of these. As such, specifics are not always nailed down or proven/provable. The models of HBS and Transgender are often stated different ways by different adherents, and so my interpretation will not be the same as everyone else’s. And yes, I couldn’t help throwing in a couple little subtle bits of sarcasm. Just my little way of revenge for the many gobs of it that I’ve ignored in the past. 🙂

Zucker-Blanchard Model of Transsexuality

  • By separating transsexuals into three different groups (two by the diagram, because there wasn’t enough room) plus a horde of possible unaccounted anomalies, they’re unnecessarily complicating the issue. Occam’s Razor tells us that the simplest, most direct explanation that encompasses all of the data is probably the right one. Here, they’re giving three explanations for three contrived groups of data and still not accounting for everything.
  • Blanchard’s theory of “autogynephilia” specifically makes assumptions that have to date not been proven, only supported by shoddy data and conclusion-jumping. Some of this also falls apart when looking at comparative data. We certainly know women who enjoy dressing up and feeling sexy — to assume that entire transgender identities amount to a sexual-only motivation for the same behaviour is remarkably short-sighted and sex-negative. There’s a lot of confusion and misinformation about this. For me (as a bisexual, I might be interpreted by this model as either a homosexual in denial or an autogynephile), the idea of becoming a woman was never a turn-on of itself. However, in my pre-transition, er, sexual fantasies, I happened to be female — just as in all my other daydreams. Just because the “self as female” is present in fantasy does not make it the trigger, nor is “feeling sexy” a paraphilia of itself.Blanchard’s theory completely overlooks that many of us do not function well sexually prior to transition, because of our aversion to our own bodies. It also ignores the fact that post transition, for MTFs, libido is low — and under long stretches of HRT with T-blockers is sometimes practically nil — and this usually doesn’t seem to be an issue for us.I don’t think modern psychiatry adequately understands “fetish” yet, throws the word at everything related to sex and gender, and too easily equates it all with paraphilia. An “image, act or action that elicits fixation or an erotic response” can conceivably include candlelight dinner, if it puts someone in a romantic enough mood. My own view of “fetish” is much different. I don’t understand foot fetish myself, for example, but have never seen harm in a basic attraction to feet. Many men feel exactly the same kind of thing from looking at breasts — foot fetish is only stigmatized because the particular body part of focus is considered socially unacceptable. I don’t think the fetish itself is a danger. I think that stigmatizing it, submerging it so deeply that it stews and brews into some obsessive fixation and can only express itself in some sexual indiscretion… that’s the whole danger of fetishizing something (don’t get me wrong: I’m not saying that every paraphilia is necessarily harmless). And what autogynephilia seeks to do is to reduce our identities to the level of fetish, force people to submerge them, make them live in denial and let them stew until they explode. Which some in our community do already (some TSes get pretty messed up from coping issues). Thus ironically seeming to validate “autogynephilia.”This is just like when male clinicians in the Victorian era decided to stigmatize womens’ ability to feel sexual pleasure by inventing and fetishizing “nymphomania.” And the presence of “autogynephilia” as a paraphilia in the DSM in any form will only serve as a step backwards in the diagnosis and treatment of transsexuality.
  • Dr. Zucker’s approach with transgender children reasserts Dr. John Money’s philosophy that gender identity is malleable and can be conditioned in a clinical setting. This philosophy has proven incorrect, highlighted by Money’s own star example, named as “John/Joan,” and now known to be the late David Reimer. This approach not only threatens to psychologically damage more transgender children, it also seemingly validates the surgical “assignment” of gender for intersex infants — something that has also been extensively shown to be damaging.

The Zucker-Blanchard model of Transsexuality is what happens when you put a bunch of similarly-charged magnets together. They explode outward in all directions, although they think they’ve organized it well enough that the different concepts can co-exist cohesively.

A final note: most people who maintain the existence of autogynephilia point to those occasional fringe folk who end up in the newspaper, flashing people while dressed in stockings or doing other seriously off-the-wall things. They are out there. There is currently a diagnosis in the DSM-IV for “Transvestitic Fetish” to address this, although this is what is possibly what Autogynephilia would replace (and expand to include all lesbian transsexuals). TF itself is an abused diagnosis, being leveled at every crossdresser, even if they live in a safe, responsible, respectful and consensual manner — and again, not every “fetish” needs to be made a paraphilia. However, for the sake of the fringe (which the clinicians unfortunately see in a disproportionate number), something does need to be stated in the DSM — it just needs to be reined in so as to not stigmatize otherwise healthy people.

HBS Model of Transsexuality

  • I actually do agree on a number of the scientific fundamentals of HBS, where they exist. I also do believe that a biological trigger will be found to demonstrate transsexuality as a physical / medical issue rather than mental. Keeping this in perspective, it would actually place us as a smaller part of the larger Intersex community, rather than the other way around. Consequently, we are overreaching when we think to speak for all intersex persons. That science, however, is not there yet. We can encourage it, publicize it, but we can’t act like it is unmitigatable fact.
  • Refusal to examine related data that follows the HBS model but is instantly characterized as paraphilia (i.e. non-surgical or partial-surgical transsexuals) despite evidence to the contrary (what hormones do to our libido and the fact that we still consider that a welcome trade) is not scientific method. Scientists do not look only at the data that agrees with them and dismiss what they don’t like — at least, not unless you’re J. Michael Bailey. In order for HBS to develop into a viable model, it has to adequately address all the data. This returns to the concept of Occam’s Razor.
  • HBS adherents’ unwillingness to do this, and their frequent discussion of seperation from “transgender” (rehashing a long-outdated version of the term which is no longer the typical use of it, regardless of who coined it) and the GLBT community betrays bigotry. Medical science will never validate a theory replete with selective discrimination.

To be fair, there is much difference of opinion within the HBS community about what HBS is and what it asserts. Some adherents will actually believe in the existence of a partial continuum (I’ve occasionally even found some that will allow for non-operative transsexuals; moreso for those who are non-op due to health or financial reasons).

HBS provides an attractive option for transsexuals who are new in transition or homophobic / transphobic themselves, and who have had limited (or possibly poor) experiences with others in the transgender community. They are often in the process of defining themselves and differentiating themselves from sensationalistic connotations of drag queens and crossdressers, and feel empowered and liberated from that stereotype when they insult others in the community in the process. Quoting from the song used in the movie “Better Than Chocolate,” I’ve often pointed out that there’s a big difference between “I’m not a drag queen” and “I’m not a fucking drag queen.” I am all for self-definition, if that process of self-definition is not deliberately accompanied by attempts to demonize others and burn bridges with them. For some, the initial belief is that the total casting off of other transfolk and turning to spit on them is the only way to earn respect for themselves (they learned that in the schoolyard — and believe it or not, I mean that as a comment on peerism, and not as a snide jab)… and most restrict contact with the transgender community in such a way that they will never have to be challenged with anything that might tell them otherwise.

Of course, they might be rather surprised if they made an honest and objective attempt to get to know some crossdressers and accord them equal dignity (and to be fair, in some places the crossdressing community has its aversion for transsexuals, so I don’t mean to imply that this is always easy to do). Having known crossdressers and others in several different communities, and having come to know them as human beings, rather than stereotypes, I have found them as a group to be incredibly diverse. I have to revisit some of what I’d expressed in “Transbigotry?” here, but it is relevant.

Some crossdressers live part-time lives despite needing to transition, because of concerns for wives, children, careers… all the things that are put at risk by going through the medical process. Many of us couldn’t bear to live like that, but that doesn’t mean that we should fault those who do. To my thinking, it would have to be the most difficult path of all.

Others experience gender dysphoria (I use the term because no other term has been devised to apply to the trans continuum and reached consensus, not because I’m reasserting it as a “mental health” issue) as well. Harry Benjamin himself at one point proposed a continuum based on Kinsey’s model, with surgical transsexuals at the extreme end of it (Type VI), and crossdressers at the median or low end (Types III to I). For CDs, the compulsion to live as a gender other than their physical birth sex is there, but less intense, to the point where part-time, limited experience is enough for them. Some even feel the need to express both genders at various times.

The gender dysphoria is there. Just because dual-expression or other manifestations have not been our experience does not make them less valid.

Transgender Model of Transsexuality

Okay, I don’t claim this to be a definitive model, but I do think it adequately looks at all the data in a cohesive and basically scientific manner (including FTMs, who I think are particularily forgotten or victims of conclusion-jumping in the other designs). We cannot set up a wall and refuse to see past it. On the contrary, I have found the diversity in thought and originality in experience to be quite illuminating.

Is the model “right?” It’s a theory. It’s something to build upon and prove or disprove. Have at it.

Respecting Identities

When asked to disseminate the single most important issue facing the transgender community (a huge task), I arrived at “the respecting of identities.” Transsexuals need their families, co-workers, medical professionals and society at large to acknowledge them as the gender to which they identify. All else — legal rights, medical rights and coverage, etc. — should theoretically follow suit. This being as it is, we must also be willing to respect each others’ identities.

My partner has come back from GRS, is healing up and feels that she has stepped past “transgender” and “transsexual” to become a “woman.” Over time, I am certain that this conviction will become stronger. And I can fully respect that. She has paid her dues and earned this entitlement. One can argue that in 100 years, an archaeologist would still declare her remains “male,” but to me that is irrelevant. She is female, and I see no reason not to respect this. If she remains as an advocate in the transgender community, then I believe that she still chooses to share some affinity with it, and remains an ally, as “post-operative.” But if she ever wants to drop the post-op label and move on into full stealth, I see no reason to deny her this.

This is something that HBS people have raised, and sometimes validly so, but this is also something that has to be mutual. It’s one thing to classify oneself as a “woman of transsexual origin” — it’s quite another for one to diagnose people as sex fetishists without ever having met them, and while completely dismissing perfectly reasonable and personal reasons to remain non-operative TS or a crossdresser.

So there. Everyone has their game cards. HBS people wanted in on the debate, and so be it. Please play nice.

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