Yesterday, I posted part one of my interview with Michael Bailey on the topic of Caitlyn Jenner and autogynephilia. In that segment, Bailey covered the basics about autogynephilia and why he thinks Jenner manifests autogynephilic characteristics. In this segment, Bailey tackles what is known about outcomes for autogynephilic individuals, issues relating to minors with gender dysphoria and addresses critics of the concept. He also mentions one case where autogynephilia disappeared with the administration of leuprolide.
I also wrote GLAAD three times and asked for comment on autogynephilia generally and yesterday’s interview specifically with no response. GLAAD produces a tip sheet for journalists that doesn’t mention autogynephilia. Bailey addresses the media silence at the end of the interview.
I want to thank Michael for sharing his time and knowledge.
WT: What are the long term trajectories for autogynephilic individuals? What is the proper therapeutic response?
MB: Persons with autogynephilia often struggle, because of shame, lack of understanding, and the disapproval of others. Also, there is a real tension between achieving autogynephilic goals and maintaining conventional romantic relationships. Autogynephilic males who cross dress often go through binge-purge cycles, in which their cross dressing increases periodically, they get fed up and throw away their female clothing, and then later begin the cycle again. Some are fortunate to find partners (generally women) who accept their autogynephilia-driven behavior–some women even cooperate and participate. Some autogynephilic individuals never acquire partners, and they avoid the aforementioned struggle.
Some persons with autogynephilia are content to remain male. Those who get their gratification primarily from cross dressing are less likely to want to progress than those whose fantasies involve having female bodies, especially genitalia. Those, of course, can acquire female genitalia via surgery. Those who go that route generally undergo electrolysis and hormonal therapy prior to genital surgery.
As for “proper therapeutic response,” this is surely best considered at the individual level. But gender dysphoria due to autogynephilia doesn’t merely go away. Again, autogynephilia is like a sexual orientation, and that doesn’t change. I suspect that if there were more honesty about autogynephilia, then those who have it would understand themselves sooner, be less likely to commit to romantic interpersonal relationships, and would be more likely to pursue earlier sex reassignment. Evidence suggests they would be happier doing so, and there would be fewer wrecked families; quite parallel with the case of men hiding their homosexuality and getting heterosexually married.
WT: In your answer about proper therapeutic response, you said autogynephilia doesn’t change. Is this based on research or on the classification of autogynephilia as a sexual orientation?
MB: Many men with autogynephilia would like not to have it. But I have never met a man who said his autogynephilia went away. Some transwomen say that it diminishes or vanishes after a sex change. Remember, the sex change also removes testosterone, which fuels male sex drive.
I should mention one other therapeutic approach that has not been widely used, to my knowledge. Still, I know one autogynephilic man who was on the verge of changing sex. He was, however, conflicted because he would have lost everything: his family fortune, his job, and his family. He was put on a course of leuprolide, a powerful drug that removes testosterone from the body. His desire to change sex virtually vanished. He’s happy and somehow able to have sex with his wife (viagra helps).WT: I assume you are talking about adults. In other words, do you have different advice for minors?
MB: The controversy over how and whether to treat preadolescent children experiencing gender dysphoria is irrelevant to controversies concerning autogynephilia. These preadolescent children are not autogynephilic. Autogynephilia almost never manifests in an obvious way before adolescence.
Lots of autogynephilic transsexuals wish they’d transitioned earlier. I can imagine this would have been better for them. If only people were more open about autogynephilia and people were more honest about it–and here I include journalists along with people with autogynephilia among those who have conspired to keep it secret–we could collect better data and ideally learn the optimal treatment for autogynephilic individuals of various subtypes.
I worry when autogynephilic transsexual activists (this includes all who were born male who have not always been exclusively attracted to men) advise families of preadolescent gender dysphoric children. The older activists have completely distinct conditions from the children, and the activists’ experiences are not an accurate guide to what the youngsters feel or how they will turn out. As we have argued, most preadolescent gender dysphoria does go away, and it is at least questionable whether it is in preadolescent children’s interests to change sex, socially (because this may lead to persistence requiring serious medical treatment).
WT: Why is there so little media coverage of the autogynephilia angle?
MB: I think it’s a mixture of ignorance, political correctness, and fear. Most journalists know what they know from the media and from transgender activists — who do not mention autogynephilia. In fact, a few activists have managed to convince a lot of people that autogynephilia theory has been disproved (when in fact, it has substantial scientific support) and that anyone who agrees with it is anti-transgender (when in fact its major proponents, including me, have been quite supportive of transgender rights). As for fear, transgender activists (especially Lynn Conway, Andrea James, and Deirdre McCloskey) were so enraged by my writing about these ideas in my book that they tried to ruin my life. They were unsuccessful–their major success was to help Alice Dreger write a terrific article (and recently, a book) about the controversy–but I’m sure few people want to risk that. We will have made progress when Conway et al. are more ashamed of what they did to me than of autogynephilia.
WT: Is there anything else you would like to mention?
MB: I’ve noticed disapproval among some journalists–even Jon Stewart on the Daily Show went there–of the focus on Caitlyn Jenner’s attractive photographs in Vanity Fair. I can assure you (and Stewart): Caitlyn’s thrilled with that attention. It’s an autogynephilic fantasy.
Again, thanks to Michael for this information. Readers can leave follow up questions in the comments section which may form the basis for a return to the issue at a later time.