Gender Dysphoria: Bad Gender Feelings

the pain, heartbreak, and alienation behind the wish to change sex

Here, in chapter 6.2 of Autoheterosexual: Attracted to Being the Other Sex (buy here), I cover gender dysphoria at length: pain, suffering, dissatisfaction, self-alienation, meaninglessness, depression, inner tension, heartbreak, and more.

a robot painted this absolute bummer of a pic

---

There’s a type of pain that the French call la douleur exquise. Translated literally, it means “the exquisite pain”.

La douleur exquise is the pain of loving someone you know you can’t have.

Maybe your love doesn’t love you back, or they live on the other side of the world. Maybe you’re having an affair and they can only be with you secretly, but you want a full-fledged public relationship. The details may vary, but la douleur exquise gnaws at your soul all the same. You want them so badly, but you can’t have them.

Writing about her cross-gender wish over a century ago, a transfem elegantly captured the essence of la douleur exquise when she wrote, “The lord brought about feelings that I knew would lead to nowhere”[i].

Unmet desires hurt, especially when it comes to love and attachment. This basic human truth helps make sense of the dissatisfaction and distress associated with autoheterosexual gender dysphoria.

Autoheterosexuality is the most common reason that people have an intense yearning to belong to the other sex. Since that desire involves attachment to the cross-gender self, perceived shortcomings of cross-gender embodiment can trigger negative feelings and downward shifts in mood known as gender dysphoria.

In everyday life, so many things can remind someone of their sex, including mirrors, social interactions, or even the sound of their own voice. For the gender dysphoric, any of these reminders can dampen their mood. Those “whose yearnings are wrecked on the hard rock of reality” may find waking life a nightmare, with dreams at night providing only shreds of solace[ii].

In practice, gender dysphoria is a broad, nebulous concept. When someone says they have gender dysphoria, there’s so much left unexplained. What triggered it? How strong is it? What are they dysphoric about and why?

Gender dysphoria is not a single entity but rather a complex set of feelings, moods, expectations, and self-evaluations associated with gender[iii]. The label indicates a person suffers in some way relating to gender, but not much else.

Gender dysphoria shows up in multiple ways in autoheterosexuals and is accompanied by many flavors of suffering. It may present as a persistent, low-grade emotional ache that lowers their happiness set point throughout life. It can make autohets never want to leave the house, lest anyone see them as their default gender. It can even make them feel like their body isn’t theirs, or that the whole world is somehow fake.

It can make them wallow in a deep hole of depression, too bummed out to shower, brush their teeth, or eat decent food because taking care of themselves just isn’t worth it. It can make existing as their default gender feel hollow and completely devoid of spiritual worth to the point that existing in their body seems like a sick joke played by a malevolent god.

Luckily, negative gender feelings are usually not this extreme. While autohets may feel sad about their gendered traits at some points in their life, many learn to compartmentalize these feelings or at least keep them at an emotional distance.

Some autohets actively manage their gender sentiments by reminding themselves that there are good things about being their default gender and that there are advantages and disadvantages to being either sex. When this works, the rose-tinted perception of the other gender becomes less prominent in their psyche, and the pedestal they’ve put it on becomes a bit shorter.

Another way that autoheterosexuals have been able to feel better about their gender situation is by drawing meaning from their default gender role through conventional heterosexual relationships, or by becoming parents and raising children. However, this risky approach doesn’t always work, and when it doesn’t, it can lead to heartbreak and family dissolution. Anyone who wants to try this approach ought to disclose their sexuality to potential partners very early in the relationship, so they can make an informed mating choice.

As bad as gender dysphoria can be, it is not inevitable that autoheterosexuals will suffer significantly from gender dysphoria. I emphasize this fact because I’ve seen quite a few self-aware autogynephilic males in their late teens or early twenties anxiously obsess over the possibility that even though they don’t have dysphoria yet, being autogynephilic means it’s inevitable that severe, intractable gender dysphoria will strike long after they’ve missed their chance at passing as the other sex.

That said, there is evidence that autohet males have more gender dysphoria than allohet males[iv]. Researchers found a very large effect: if a person were randomly selected from each group, there’s a 90% chance that the autohet male would have more gender dysphoria than the allohet male. If this difference were expressed in terms of intelligence, it’s almost as big as the difference between average intelligence and the cutoff point for mental disability.

It’s almost certainly the case that autohet females suffer more gender dysphoria than allohet females too. As discussed in Chapter 5.5, females and autoheterosexuals seem to be at greater risk of developing gender dysphoria than males or homosexuals, so autoandrophilic females are perhaps the most dysphoria-prone etiological subgroup.

Autoheterosexuality and the Medical Definition of Gender Dysphoria

The DSM-5 defines gender dysphoria as “the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender”[v]. The manual provides six criteria[vi] for a gender dysphoria diagnosis in adolescents and adults, two of which must be present for six months or more in order to qualify.

The first is a “marked incongruence” between sex traits and gender. This is the clash between body and mind so commonly associated with transsexualism. The other five criteria pertain to specific aspects of this gender incongruence. All map onto particular aspects of autoheterosexuality, which I’ve listed in brackets:

2. Strong desire to not have the sex traits of one’s default gender [anatomic]

3. Strong desire to have the other gender’s sex traits [anatomic]

4. Strong desire to be the other gender [core]

5. Strong desire to be treated as the other gender [interpersonal]

6. Strong belief that one feels or thinks as the other gender does [psyche]

Transsexualism is changing the body to more closely resemble the other sex, so it’s fitting that the first three directly relate to anatomy, and two of the latter three do so indirectly. Core autoheterosexuality is associated with a desire to have the body of the other sex[vii], and looking like the other sex is the best way to get treated as that gender.

The last criterion is associated with psyche autoheterosexuality, the cross-gender consciousness embodiment that makes autohets feel they have the thoughts, feelings, perceptions, and sensations of the other gender, as if they were looking through the other gender’s eyes. This beautiful feeling is a strong driver of cross-gender identity and a contributor to mind–body gender incongruence.

Altogether, the aspects of autoheterosexuality associated with these diagnostic criteria lead to a desire to have the body, mind, and social role associated with the other gender—and to simply be that gender. Many gender-dysphoric people want to be the other gender to the greatest degree possible. As one of Hirschfeld’s patients said, “My yearning is not limited to women’s costumes, but also extends itself to an absolute life as a woman, with all primary and secondary phenomena”[viii].

Changing the body to more closely resemble the other sex is the most effective and direct way to embody the gender associated with it. Transsexualism is a clear signal to others in everyday life that someone would like to be seen as the gender to which they’ve shifted. This permanent physical embodiment helps transsexuals socially assimilate into that gender role, feel like their body is their own, and live a life that is true to themselves.

Dissociation: Depersonalization/Derealization (DP/DR)

Although people who aren’t autoheterosexual or transgender can experience dissociation, when it shows up in autohet or transgender people, it might be a manifestation of gender dysphoria.

Dissociation can make autohets feel they aren’t real or don’t have a self. Lou Sullivan experienced this gender-related dissociation and wrote in his diaries about feeling his mind and body coming apart:

“Went to bed and began crying. I held myself and stroked my skin like I always do and imagining I was a beautiful boy I was sleeping with, and then it began to get too real and I felt my mind and my body separating.”[ix]

A few years later, his symptoms of dissociation had become steadier and more permanent. Sullivan felt himself an empty husk, devoid of meaning or direction:

“I’m a walking zombie and I don’t even know where I’m walking. It’s as tho my whole inner core of who or what I am is totally stripped away. I wonder how much longer I can continue to function, and that’s the truth. I feel more and more alienated from myself.”[x]

A few years later, he finally began to medically transition. A mere two to three months after starting hormones, he began reintegrating his two sides. He reported, “I’m trying to integrate my identity and my body in my head”, and “slowly slowly I feel the fog lifting”[xi].

By bringing his body in line with his identity as a man, Sullivan was finally able to be in his body and participate in his own life in a way that wasn’t possible before. The veil lifted. Life regained its color. He was a man.

For one of Hirschfeld’s transfems, the act of dressing as a woman had a similar palliative effect: “When I cast off everything male and put on the outward trappings of a woman…I can perceive almost physically how falseness and violence rushes out of me and disperses like a fog”[xii].

In autoheterosexuals and trans people who experience it, this gender-related dissociation can manifest as depersonalization and derealization[xiii]. People experiencing depersonalization (DP) feel detached from themselves, and those who experience derealization (DR) feel detached from the outside world[xiv]. In the former, they feel fake, and in the latter, the world feels fake.

DP/DR symptoms can show up as a fog-like emotional flatness or the feeling of being separated by a veil, or watching oneself from the outside as though separate from oneself[xv]. When researchers measured DP/DR symptoms in trans people, they had more than the normative comparison group[xvi]. However, when researchers dropped the question about body ownership, participants’ scores decreased by more than half[xvii], suggesting their diminished sense of physical embodiment was a large part of their dissociation symptoms.

Another study found a similar result: removing the question about body ownership decreased trans people’s DP/DR scores by more than 30%, after which their scores of overall dissociation resembled those of the general population (even before getting hormones)[xviii]. After receiving cross-sex hormones and other medical help, their DP/DR scores dropped by half[xix].

Cross-gender embodiment through meta-homosexuality can also help dissipate the fog of dissociation: a study of transgender Virginians found that a majority of MTFs (70%) and FTMs (55%) agreed that they felt more real when having sex with someone of the same sex, but less than a quarter of them said the same of having sex with someone of the other sex[xx].

It’s common for trans people to feel that their body is not their own. By alleviating gender incongruence, gender-affirming medical treatment and other forms of cross-gender embodiment may help them be at home in their bodies and selves.

Gender Envy

For autoheterosexuals, people of the other sex can seem so beautiful that it hurts. This pain, gender envy, tends to be proportional to the beauty on display. R. M. explained it best:

“I always envy a woman in proportion to my love and admiration for her. Still, there are many good women, for whom I feel sincere regard, and even affection, who are not in any way physically attractive to me, and towards whom I feel neither desire nor envy.”[xxi]

It can be hard for autohets to differentiate gender envy from attraction, which is why the familiar do/be dilemma—“do I want to do them or be them?”—pops up so often.

Due to sexual dimorphism, autoheterosexuals tend to envy the exact opposite physical features from those that nature bestowed upon them. Autohet females often want to be bigger, more muscular, taller, and hairier. Autohet males often want to be smaller, shorter, and more slender, with smoother skin.

Seeing someone of the same sex successfully attain a form of gendered embodiment can also trigger autohet gender envy in people who long to achieve such embodiment themselves. Masculine women and feminine men can spur these feelings, as can transsexuals.

In fact, seeing someone of the same sex succeed at cross-gender embodiment may cause even more powerful feelings of envy simply because it’s a powerful reminder of what’s possible. There’s a tangible sense of “that could be me” that makes this gender envy cut especially deep.

Autoandrophilic Gender Envy

Men’s physical features, such as their flat chests, deep voices, Adam’s apples, muscles, and body hair, are common sources of gender envy among autoandrophilic people. And yes, they do get penis envy[xxii]. How could they not? Penises are endowed with great symbolic weight for signifying manhood.

The linearity of men’s bodies is enviable too. They’re likely to envy the flat butts, small hips, and flat chests that men have. Autoandrophilic people also tend to envy men’s size. They almost always want to be taller, and it’s common for them to want big, veiny hands and big feet.

Some of them desire to pass so thoroughly as a guy that they could have long hair or wear makeup and still be seen as a man. This is appealing not only because it broadens their range of acceptable gender expression, but also because passing as a man while enveloped in signifiers of femininity is an especially powerful validation of their manhood.

Autogynephilic Gender Envy

Autogynephilic people tend to envy the breasts, vulvas, and big hips of women. They envy their feminine faces, long hair, smooth skin, and high voices. Even women’s small hands and feet are a source of envy. As R. M. said, “I could not look at a pretty girl without envying her”[xxiii].

And while autogynephilic people may desire certain feminine features, what those features signify is ultimately the most important: womanhood. Women are enviable simply for being women[xxiv].

Autogynephilic people can also envy those same feminine features on males lucky enough to have them[xxv]. Perhaps because it’s so relatable, this envy can be particularly salient.

R. L.’s account is an especially good example of autogynephilic gender envy. From childhood, she envied women and feminine men alike:

“When about 8 or 9, I first had the desire to be a girl, and used to envy a little boy, a neighbor, who lived with two sisters and mother, and who was dressed girlishly, which led me to think that I should like to be him and be brought up as a girl.”[xxvi]

Later in life, when R. L. went to shows of feminine impersonators, she would envy them and wish she were smaller and more feminine[xxvii]. Bitter with envy, R. L. even looked down on some women, thinking she would make a better woman and that their femaleness was wasted on them: “I look with scorn and disgust, or at least mild criticism, on some females, knowing how much better I could wear their clothes, conduct myself, and give an impression of a real lady”[xxviii].

R. L. envied just about everything concerning women. She envied their smallness, femininity, clothing, and simply the fact that they were women. Over time this envy grew, manifesting in white-knuckled levels of gender dysphoria: “I was getting miserable, and frequently suffering real pain, for the sight of a well-dressed woman would often cause me to clench my nails into my palms, suppress a groan, sometimes a swear escaping my lips”[xxix].

Her account clearly shows how intense gender envy can be, how easily it can be triggered, and how much it can detract from happiness.

Anatomic Dysphoria

Autoheterosexuals can feel dysphoric about the size or shape of their bones, muscles, cartilage, and fat deposits. The location, thickness, color, and quantity of their hair can also cause dysphoria. Ultimately, any bodily tissue that signifies gender can influence gender feelings. Due to sexual dimorphism, these gender feelings are often negative.

Primary and secondary sexual characteristics are powerful signifiers of gender laden with symbolic value. It’s these traits in particular that autoheterosexuals yearn to change.

Many autohet females would prefer to have a penis, testicles, flat male chest, strong musculature, and thick body hair. They’d also like to have their female reproductive anatomy removed and feminine fat deposits melted away.

Conversely, a lot of autohet males would prefer to have a vulva, breasts, soft facial features, feminine fat deposits, and bountiful hair on their scalp with almost none elsewhere. Many also want their male reproductive anatomy removed and coarse facial features chiseled away.

One type of autoheterosexual wants bigger bones, the other smaller. One wants bigger muscles, the other smaller. So it goes, for any physical trait that varies between males and females.

It’s anatomy that juts out, however, that carries the greatest symbolic value, is the hardest to ignore, and is most amenable to surgical interventions. As a result, transsexuals often prioritize removing protrusive anatomy[xxx].

The contours of their chests are apparent anytime they look down. The type of genitals they have often is too. If being reminded of your sex hurt your mood, yet every time you looked down your protuberances reminded you of your sex, how would you deal with it?

This is the situation that people with severe anatomic gender dysphoria find themselves in. Even when they avoid catching glimpses of themselves, these problematic protuberances can still remind their owners of their presence by jostling as they go about their everyday lives. By getting top or bottom surgery, these unwelcome protuberances can become a thing of the past. By chest binding or tucking, they can be temporarily forgotten. Aside from these interventions, however, these sensations are impossible to escape.

This is why it’s so important that trans people with severe anatomic dysphoria have access to quality medical care: so they can look downward or move around in everyday life without feeling like shit.

Autoandrophilic transsexuals often want testosterone or a double mastectomy. Some also decide to surgically remove their ovaries, uterus, or vagina. Some want a penis strongly enough to endure the long, arduous process of phalloplasty.

Autogynephilic transsexuals often want testosterone blockers and estrogen. Surgically, they may also pursue vaginoplasty, orchiectomy (castration), breast augmentation, or facial feminization.

Sartorial Dysphoria

Autoheterosexuals often feel uncomfortable in the clothing associated with their sex. This sartorial dysphoria can make them feel stifled, oppressed, weighed down, and caged[xxxi]. Crushed under the immense symbolic weight of these alien garments and estranged from themselves, their mood becomes flattened and their zest for life deadened. The sadness creeps in.

“It’s as if my entire world turns grey”, lamented a transvestite with over fifty years of crossdressing experience[xxxii]. She tried to resist the allure of ladies’ garb, but this repression always led to a sour, irritable mood and the inability to glean pleasure from life.

A European transvestite who longed to live and work as a man felt “constrained and in bondage” in women’s clothes[xxxiii]. Dressed as a man, he traveled to Rio de Janeiro, San Francisco, Yokohama, and Zanzibar. Dressed as a woman, he stayed in Europe.

Elsa B. absolutely hated being forced to wear girls’ clothing. In it, he felt ridiculous and dejected:

“To go out dressed in airy skirts and hats with ribbons and lace made me feel like a dressed-up monkey. Following promenades or visits in such clothing, I would be overcome with a deep depression and was glad when I reached home again and could tear the stuff from my body.”[xxxiv]

A transsexual man reported that after he dreamt about being forced to dress as a girl, he woke up anxious and upset[xxxv]. When dressed as a woman in waking life, he felt that people “saw through” him[xxxvi].

Like anatomic dysphoria, sartorial dysphoria can be triggered through touch alone. Women’s and men’s clothing feels different on the body. They have different materials, cuts, and styles, which make their texture, heft, and tightness different.

Having to wear clothing associated with their default gender very quickly becomes uncomfortable for autoheterosexuals who have developed sartorial dysphoria. Every little sensation is a symbolic reminder of their sex, whereas with cross-gender clothing, every little sensation helps them forget it.

R. L. described this sartorial suffering eloquently. She had multiple “lives” as a woman, but eventually had to detransition for lack of funds. Her sorrow about undressing for the last time was firmly etched in her memory:

“It was with very great sadness that I undressed for the last time one night…I slipped out into a world that was particularly distasteful to me, my collar choked me, my trousers oppressed me like bandages, my boots felt clumsy, and I missed the clasp of corsets, and the beautiful feel of underwear.”[xxxvii]

To people who don’t experience these feelings, it may seem frivolous or silly that clothing matters so much. But it does. Autoheterosexuals truly do suffer from being coerced into wearing clothing that goes against their nature.

Social Dysphoria

As social animals, how others treat us has a massive effect on how we see ourselves. Being treated as worthy tends to make us feel we are worthy, just as being denigrated tends to make us feel lesser.

It’s the same with gender. Being treated as a woman reinforces our sense of being a woman (or feminine), and being treated as a man reinforces our sense of being a man (or masculine). As a result, autoheterosexuals can experience social gender dysphoria from being treated as a member of their sex rather than the gender to which they aspire.

Dysphoria might occur if they’re addressed with pronouns corresponding to their sex, put in single-sex groups according to their sex, or hit on because the potential suitor was attracted to their natal sex traits.

Trans men can also feel burned from being emasculated. For instance, one trans man had anxiety attacks associated with having his masculinity doubted[xxxviii]. He also took offense if people thought he wasn’t a man, whereupon he would drink alcohol and start a fight with the biggest guy in the vicinity in order to prove his masculinity[xxxix].

Similarly, another trans man felt humiliated whenever he was offered children’s tickets for streetcars and trains[xl]. He also hated when men hit on him, and the one time he tried having sex with a male, he couldn’t relax and ended up fighting him[xli].

R. L. felt social gender dysphoria too. For her, the pain was rather acute: “the slightest hint or sign by anyone who knows, that they regard me other than as a real woman is like an icy draught, or a sharp pin-prick”[xlii].

For autoheterosexuals who have a deeper commitment to the cross-gender self, social dysphoria is one of the stronger types of gender pain. It stands to reason, then, that autohets who have gone through gender transition would tend to be particularly sensitive to it.

This is why the transgender movement has put so much effort into raising awareness of pronouns and their importance to trans people. Honoring their deeply felt cross-gender identification with corresponding pronouns helps them suffer less.

Behavioral Dysphoria

In everyday life, there are some activities that males and females tend to do differently, such as tasks around the house, sexual roles, and how they carry their bodies. Therefore, autoheterosexuals may develop a dislike for any activities they associate with their sex.

Something as simple as going to the bathroom in a particular type of gendered restroom can trigger feelings of behavioral dysphoria. One trans guy simply couldn’t bear to go to the women’s toilet[xliii], and he also felt “sick” when he was forced to behave in a feminine way[xliv]. Another trans man, stuck at home “being a thorough woman doing domestic work”, couldn’t stand it anymore and left home once again to be a sailor[xlv].

Behavioral dysphoria also affects sexual interactions. Some trans men who prefer to be with women insist on being the active partner and may even have trouble being touched in return. One such trans man described being touched during sex as “nauseating”, and when the doctor asked him about the passive sexual role he froze up, unable to speak for several minutes[xlvi].

After detransitioning due to financial limitations, R. L. complained, “instead of my own dainty movements and mental happiness as a woman, I had to act as a man to my great displeasure”[xlvii].

Physiologic Dysphoria

Sex-specific physiologic functions such as menstruation, penile erections, and ejaculation carry great symbolic weight. When puberty makes these bodily functions apparent, some autoheterosexuals despair because they’re turning into the adult form of the sex they don’t want to be.

For autoandrophilic people, the arrival of menstruation can be especially alarming. One trans man described the despair, disgust, and sheer horror he felt when he started menstruating:

“It was embarrassing. It was humiliating. It was deplorable in my mind. It was just the most disgusting thing I could think of. I thought I would rather be dead than have to go through this every month. It was like sheer torture.”[xlviii]

In addition to dismay at the features they do have, autohets may also grieve the bodily functions they lack. Autoandrophilic people can lament that they don’t have penile erections or the ability to ejaculate semen, while autogynephilic people may feel a sad longing for monthly hormonal cycles or the ability to become pregnant.

One transfem who greatly envied her wife’s pregnancy and delivery was crestfallen when she was unable to lactate herself: “With what delight…would I have suckled the child, and how sad I was when I once put on the screaming child to my breast and could give it nothing”[xlix].

Another transfem who envied her wife’s pregnancy had physiologic dysphoria so strong that it seemed like the most intense suffering she’d ever felt: “Unnatural as it may appear, when our son was born, the thought that I could not go through the experience myself, or even be with my wife at the time caused me the most acute suffering I ever felt in my life, and I did not get over it for many months”[l].

Depression and Anxiety

In autoheterosexuals, shortcomings of cross-gender embodiment can lead to irritability or melancholy. Unable to express the version of themselves they want to be, autohets may end up “depressed, isolated, and withdrawn”[li].

Would-be transsexuals frustrated in their quest for cross-sex hormones or surgeries may grow despondent, falling into a deep pit of despair. If thwarted by a medical establishment that isn’t open to helping them, they can feel that life is hopeless and they have no future.

Transvestites who don’t fulfill their drive to dress as the other sex may become sullen and irritable. Their skies go gray. Life loses its luster. Inside, the tension of unmet need gnaws at them.

The wives of transvestites know this all too well. They’ve shared that when their spouses stopped crossdressing, they became “tense, frustrated, moody, unhappy, or angry”[lii]. One said her spouse “felt like a caged lion with no escape”[liii].

This existential funk can make autoheterosexuals neglect body maintenance. If their default-gendered self becomes unrelatable, they may struggle to see the point of taking care of themselves. A trans man subjected to this self-alienation by female puberty noted how his basic grooming fell to the wayside:

“Around puberty, I started to feel like, disconnected from my body…I just wore really baggy clothing and I stopped doing a lot of self-care. I stopped, you know like, brushing my hair, and I just stopped grooming basically. I think I just stopped caring for myself because I didn’t know how to.”[liv]

Another transmasc, one who felt stressed out by the prospect of medical inspection of his genitals, showed up at the hospital hungover and covered in excoriations from endlessly picking at his skin—both signs of anxiety[lv].

Even back in the ’70s, sexologists recognized that FTMs usually had a history of severe depression. Upon examination, most were depressed to some extent, and almost one in five had made suicide attempts[lvi].

Ego-Dystonic Arousal: Being Upset about What Turns You On

For many autoheterosexual males, their first forays into wearing women’s clothing involve donning femme clothing intending to look like a female and growing erect in response. This unladylike reaction can be deeply upsetting. Shame comes to the fore. What started as a seemingly innocent desire to look like a girl ends in disappointment or regret.

For some, the cycle of contemplating being the other gender, becoming aroused, and getting upset about that arousal happens repeatedly. One autogynephilic transsexual explained it well:

“Like many of the other respondents, I too have always had these feelings of arousal at the mere thought of being female. And it always pissed me off! I hated it that putting on a dress, or wearing other feminine attire, or even just fantasizing about being a normal woman would elicit such an un-female response, both physically and mentally. I wanted so badly for the things I was doing to simply feel ‘normal.’”[lvii]

This also happened to transfems back in the day. One whose account was published in 1928 shared, “When first I began to dress as a woman, I was offended by the fact that it induced erection; this irritated me greatly”[lviii]. Another transfem reported how, as a child, she started to tie her sister’s corset around her waist and got her first erection. Startled and unsure of what it meant, she took off the corset and was left deeply dissatisfied with the experience[lix].

When arousal conflicts with one’s idealized self-image, it is called ego-dystonic arousal.

Thanks to scientific advances, the boner-killing powers of feminizing hormone treatment allow autogynephilic transsexuals to enjoy the pleasures of feminine embodiment without their bodies reminding them that their cross-gender inclination is ultimately sexual in origin.

Autogynephilic males who are comfortable living as their default gender but who wear women’s clothes as part of their sexual arousal process also experience ego-dystonic arousal. With post-nut clarity comes shame, as they find themselves wrapped in clothing that upsets their image of themselves as masculine men. Back in the hiding spot it goes (at least until next time). For autogynephilic males who want to be men, this type of ego-dystonic arousal is common.

A study of Swedish men found that only 47% of men who’d been aroused by crossdressing considered that arousal acceptable to their sense of self[lx]. By contrast, only 3% of men who hadn’t been aroused by crossdressing considered the idea of becoming aroused from crossdressing acceptable for themselves[lxi]. These figures suggest that autohet males are usually ashamed and upset about sartorial arousal at first, and this shame is particularly hard to shake off—only about half had become okay with it.

Interestingly, autoheterosexual ego-dystonic arousal seems far less common in females. One possible contributing factor to this difference is that penile erections are overt signs of arousal that are hard to ignore. Stereotypes of horny males and demure females could also play a role in generating this disparity: if being horny is seen as a guy thing, some autoandrophilic people might feel that arousal from masculine embodiment affirms their masculinity.

Shame

Autoheterosexuals commonly feel some amount of shame about their cross-gender inclinations. This is likely because of its sexual origins, but they may also feel shame about coming up short in terms of societal expectations for people of their sex.

For some autoheterosexuals, the shame runs deep. Super deep.

One of the most illustrative examples of this intense shame comes from a transsexual woman whose mother found a noose she’d been using for the purpose of hanging herself by her genitals. Rather than admit to her gender issues, she allowed her mother to think she was suicidal because that seemed less shameful[lxii].

Another transsexual woman reported, “I think some of us just never let go of that shame. Of course it’s about sex!”[lxiii].

Autoheterosexual shame can make someone repress their cross-gender inclinations in childhood[lxiv] or keep it so secret that they don’t tell anyone until they’re middle-aged or older[lxv]. Even if they desperately want to share that part of themselves with friends, they might still remain silent due to shame[lxvi].

This shame also has a huge impact on transgender politics, because it underlies much of the over-the-top hostility toward the concept of autogynephilia in the transgender community.

The Sex-Positive Approach to Transcending Shame

In 2000, Anne Lawrence made a second attempt to introduce the concept of autogynephilia to the trans community through the Transgender Tapestry magazine[lxvii]. The following issue contained many responses from trans women[lxviii]. Virtually all of them stood opposed to the theory. Their responses primarily focused on its implications: concerns about personal identity, discrimination protections, or access to medical treatment.

But one response stood out for its willingness to seriously consider the possibility that the autogynephilia theory might be true. In her piece, “Autogynephilia: What If It's All True?”, transgender activist and scholar Jessica Xavier sniffed out the unsavory emotion underlying the trans community’s hostility to the idea of autogynephilia: shame. She wrote, “I find the harsh condemnation of autogynephilia to be more telling than the theory itself…Behind all the nay-saying, I sense something rotten here—the stench of shame”[lxix].

Rather than run from a possibility that deeply frightened so many of her peers, she faced the potential reality of autogynephilia head-on and modeled a sex-positive approach that renounced shame:

“We need not dumb down our gender or sexual diversity in order to please others. We need not fear our own sacred sex; we should, rather, fear a sexphobic culture that persecutes us for daring to practice it. If it is substantiated by additional research, we need not be ashamed of autogynephilia, but of shame itself.”[lxx]

Unfortunately, the transgender community as a whole was unwilling to seriously consider the possibility that most of them had a type of cross-gender inclination that was ultimately sexual in nature. They turned away from this sex-positive approach and allowed shame to fester.

Over two decades later, the sex-positivity movement has grown. Societal attitudes toward sexuality have loosened. The idea that sexuality is not intrinsically shameful has gained ground. Things have changed.

It’s okay to talk about autoheterosexuality. In fact, talking about what makes us feel shame with accepting, open-minded people can be an especially fast way to leave shame behind.

It doesn’t have to be a big deal.

Repression

Countless autoheterosexuals have initially repressed their cross-gender inclinations. Faced with feelings and a sexuality that conflicted with their default identity, they tried to push it down and bury it. Some have undoubtedly succeeded, but it’s not known how often they succeed, for how long, or at what cost.

I repressed too. But once I learned about autogynephilia, I immediately changed my approach. I realized I couldn’t reason my way out of feelings that were ultimately caused by a sexual orientation. After easing my prohibitions on cross-gender expression, I began to see the psychic toll of repression.

Autohet repression requires more than blocking off obviously cross-gendered thoughts, feelings, and behaviors. To contain the cross-gender self, even thoughts adjacent to the obviously cross-gendered ones must be kept in check.

This barrier doesn’t magically maintain itself either. It requires vigilance. To repress, behaviors and thoughts must be actively monitored to ensure they don’t veer too close to The Forbidden Place.

Caged by excessive inhibition, the range of emotional and creative expression narrows. Melancholy and irritability set in. The sense of inauthenticity grows. Pressure builds. Eventually, something has to give.

As Hirschfeld noted, complete repression comes at a severe psychic cost:

“Undoubtedly many transvestites have great difficulty in bearing the temporary or permanent repression of the impulse to emphasize their femininity. Repression has a crushing and finally crippling effect on their pleasure in creative work and their abilities, and frequently it creates a great inner unrest, accompanied by a feeling of listlessness, anxiety, and deep spiritual depression. These effects can grow until they culminate in suicide.”[lxxi]

The testimony of transvestites, transsexuals, and their loved ones speaks to the pain of repressing such an important part of themselves. The wives of crossdressers report that abstaining from dressing sours their spouses’ moods and makes them anxious, irritable, and tense[lxxii].

One transfem spoke to the melancholy brought on by abstaining from dressing:

“When I stop, and I often have tried to give it up, it’s as if my entire world turns grey. The joy and happiness that I usually get from many activities is reduced. The peaks of satisfaction and pleasure are gone.”[lxxiii]

Another transfem reported similar feelings, even to the point that food didn’t taste good anymore[lxxiv].

An autohet FTM reported similar pain, including difficulty eating. When verbalizing his intent to repress his masculinity, he told his doctor, “It must be God’s will that I shall be a girl, and it might be a sin not to do His will” and said he would get a job as a domestic servant[lxxv]. During the ten weeks of repression when he dressed as a girl, he felt ill, nauseated, and unreal—and even lost about twenty pounds.

Repressing clearly wasn’t a good idea, so he started being manly again. He drank, swore like a sailor, and picked up chicks to show off his masculinity, and quickly regained the lost weight[lxxvi].

Attempts to repress their cross-gender aspirations can even make some autoheterosexuals feel suicidal: “Four times this year, I have decided that…I simply must remain male. And all four times, I became seriously suicidal within a week”[lxxvii], reported one autogynephilic trans woman.

Autoheterosexual repression has some consistent patterns. Purging and renewed commitment to heterosexuality are especially common repression strategies. Strategies such as drug abuse, doubling down on the default gender role, and being too busy to have idle time have showed up as well.

Repressing through Purging

A carnival was coming up, and a transfem looked forward to finally getting a chance to dress as a lady in public for the first time. She saved up for months to buy an outfit. But afterward, she wasn’t completely satisfied with it. Seized with the impulse to burn it, cloth became smoke and ash[lxxviii].

She had purged her feminine possessions. But it didn’t last long: “Then my fancy for feminine clothes abated, but after an interval it revived with greater intensity and persistence. I then bought good, well-fitting clothes…including everything a woman has”[lxxix].

Some autohets purge when they don’t like how their cross-gender inclinations reflect on their sense of self. This behavior is driven by feelings of shame, guilt, and disgust[lxxx].

Countless transfems have gone through binge-and-purge cycles just like this one. For a time, it seems to work. The urge is gone, seemingly for good. But that state usually doesn’t last. Instead, the desire comes back even stronger, and before long, they’ve bought more clothes than they purged in the first place.

This pattern of behavior quickly gets expensive.

If you’re autoheterosexual and thinking of purging your cross-gender possessions, consider leaving them with a trusted friend for safekeeping. Chances are, you’ll want them back later.

Repressing through Alloheterosexuality

Countless autoheterosexuals have tried to repress through heterosexual hookups or relationships. Whether enacted through promiscuity or serious commitment, this approach may work for a few months or a few years, but it’s usually not a lasting solution.

As the new relationship energy fades, the nagging feeling that something’s missing grows: “Like a pendulum…my transsexual desires increased as the novelty of the sexual relationship diminished”[lxxxi]. This period of conventional heterosexual expression can give way to even greater gender dysphoria than what came before[lxxxii].

One transfem married with the hope that her sexual relationship with her wife would subdue her inner feelings of womanliness. This plan backfired: her wife got pregnant, which caused a burning envy in her[lxxxiii]. In a similar situation, another transfem lamented: “I had thought love and marriage would make an end of my longing to adopt woman’s dress. They did not”[lxxxiv].

Plenty of autoheterosexuals have married and had kids, yet the cross-gender urge remained. Some kept their gender issues secret until death, while others disclosed their feelings. Some met their needs with occasional crossdressing, while others transitioned gender.

Romantic relationships rarely survive gender transition intact, and even lesser forms of cross-gender commitment often cause relationships to unravel. Autohets are usually in heterosexual relationships, so their cross-gender expression is often incompatible with their partner’s sexual orientation.

It’s important for autoheterosexuals to disclose their cross-gender sexuality to their partners—the earlier in the relationship, the better. Hiding something that significant from potential partners and spouses is unfair to them. If something could be a deal breaker, it’s important for them to know.

Crisis of Meaning

Some autoheterosexuals consider living as their default gender to be absolutely devoid of spiritual worth, so they may question the value in continuing to exist if they can’t live as the gender they want.

This is a dangerous frame of mind to be in.

Losing a sense of purpose or hope in life can lead to rapid declines in mental state[lxxxv]. Drowning in suffering and without a positive vision of the future, people can lose their hold on life and begin to fade away.

Since our sexualities have so much potential to confer meaning in our lives, the inability to express them can render life meaningless, even to the point of suicide.

Hirschfeld saw this dynamic play out plenty of times. In fact, it was the suicide of a young homosexual man that precipitated Hirschfeld’s switch from general medical practice to sexology[lxxxvi]. He knew that homosexuals and transvestites alike were vulnerable to suffering from unexpressed sexuality to a degree that could culminate in suicide: “Sexually abnormal persons who are forced into a lifestyle that stands opposed to their nature often thereby fall into depressed mental states that at times even lead to suicide”[lxxxvii].

Lou Sullivan reached this point of existential crisis. A little over a year before he finally started testosterone, he languished in deep despair. His life had no meaning:

“Sitting in my apt, crying because I feel so goddamn empty inside. My whole goddamn life is a waste of time—just trying to think up things to do to waste time until I die. Nothing means a goddamn thing.”[lxxxviii]

When every fiber of their being screams out that they ought to be the other sex, yet they feel confined to a body utterly lacking in gendered worth, autoheterosexuals may even feel their predicament is a “trick that nature had played” or an “injustice done…by nature”[lxxxix].

To right this cosmic injustice, an autogynephilic child routinely sought the help of God. She had only one wish—to become a girl: “I prayed to God every night…to put right the mistake that was made in me and to transform me into a girl”[xc].

Obstructed in their desire to be the other gender, autoheterosexuals may feel they are in a perpetual state of exile[xci]. In this state, it can be hard to keep a grip on life.

Eventually, some let go.

Suicidality

In 1903, a thirty-two-year-old transvestite checked into a hotel[xcii]. The following day, she dressed in the privacy of her room and donned a white wedding dress, complete with a veil. Atop her head, she placed a garland of myrtle.

Later, she laid down in bed, pointed a gun at her chest, and shot a hole through her heart. In the note left by her side, she asked to be buried in her wedding dress.

Six years later, in 1909, Michael Semeniuk came down with a fever[xciii]. His neighbors grew worried about him and called a doctor. When the doctor came, Michael refused to be physically examined, so the doctor left without making a diagnosis.

Michael’s corpse was found the next day. Unwilling to live through the discovery of his sex, he had poisoned himself that night.

The pain of being unable to live as their cross-gender selves can drive autoheterosexuals to kill themselves. The constant desire for something unattainable leads to madness, the frustrations accruing over the years until it all feels hopeless. As Richard T. described:

“Because not one of my wishes was realized I became restless, angry. Especially lately this condition has assumed forms bordering on madness. Even the strongest will is powerless against such a natural force. I have often wished for death as the only solution.”[xciv]

The crisis of meaning underlying gender-based suicidality can be so intense that it takes on spiritual importance. This might be why the Hungarian physician attributed her continued existence to her religious practice: “I have nothing to thank but positive religion; without it I should have long ago committed suicide”[xcv].

Back in those days, even the inability to wear dresses could bring on suicidality. One of Hirschfeld’s patients longed to wear dresses, but the culture of her time prohibited it. She despaired over her condition. The inability to wear dresses rendered life meaningless:

“If I ever came to the definitive decision that I would never get my wish to wear dresses, I would finally throw my life away, because it would be absolutely worthless to me…Life is completely loathsome to me without dresses!”[xcvi]

Being able to wear a dress was a matter of continued existence for her. In modern times, the advent of medical transition has shifted the goalposts, so autoheterosexuals today can feel a similar despair over the inability to get hormones or surgeries.

In Sum

• Just as autoheterosexuals can feel good about having bodies, behaviors, clothes, and social roles that they associate with the other sex, they can also feel bad about perceived shortcomings in those same domains. These bad gender-related feelings are known as gender dysphoria. This gender pain is the outcome of a gender-related conflict between desire and reality. Such feelings can be especially excruciating because they are as significant as those caused by conventional love.

• The medical profession codifies gender dysphoria as distress associated with gender incongruence. The diagnostic criteria for gender dysphoria in the DSM-5 map onto aspects of autoheterosexuality that pertain to the desire to have the body, mind, and social role associated with the other sex. Autohet transsexuals change their bodies in order to grow more at peace with themselves and to help others see them as the gender to which they aspire.

• Autoheterosexuality drives autohets to think of themselves as the other sex, and in the process, it can generate a dissociative alienation from their bodies or the world around them (depersonalization or derealization). Gender-affirming sexual interactions and hormones can help alleviate dissociation by helping trans people feel at home in their bodies.

• For autoheterosexuals, people of the other sex can be so beautiful it hurts. Due to sexual dimorphism, autohets often lack the same traits they admire in others, so it is common for them to envy people of the other sex. They may also envy people of their sex who possess attributes associated with the other sex.

• An unmet desire for cross-gender expression can make autoheterosexuals feel tense and irritable. The inability to feel peaks of pleasure can flatten their mood and leave them depressed. This existential funk can leave them unable to take pride in their physical appearance and uninterested in taking care of themselves.

• Some autogynephilic people become upset when crossdressing or thinking about being female brings upon arousal. The reason they become upset depends on which self-image this arousal affects. It may conflict with their cross-gender self because it makes them feel unwomanly, or it may conflict with their self-image as masculine men.

• Autogynephilic people commonly feel shame about their sexuality. This unaddressed shame underlies much of the excessive hostility toward the concept of autogynephilia within the transgender community.

• Faced with feelings of shame and a sexual propensity that conflicts with their idealized self-image, some autoheterosexuals try various methods of repressing their cross-gender proclivity. Engaging in cycles of binging and purging their cross-gender possessions is common, as is repressing through heterosexual relationships. They can also repress by making a concerted effort to adhere to the gender role associated with their sex.

• Since sexuality has so much potential to bring meaning to our lives, some autoheterosexuals consider living as their default gender to be absolutely devoid of spiritual worth. They may question the value of continuing to exist if they can’t live as the gender they want. The crisis of meaning brought on by this perpetual inner heartbreak can result in suicide.

---

[i] Magnus Hirschfeld, Transvestites: The Erotic Drive to Cross-Dress, trans. Michael A. Lombardi-Nash (Buffalo, NY: Prometheus Books, 1991), 178.

[ii] Magnus Hirschfeld, Sexual Anomalies and Perversions: A Summary of the Works of the Late Professor Dr. Magnus Hirschfeld, ed. Norman Haire (London: Encyclopaedic Press, 1966), 216.

[iii] Richard F. Docter, Transvestites and Transsexuals: Toward a Theory of Cross-Gender Behavior, Perspectives in Sexuality (New York: Plenum Press, 1988), 90, https://doi.org/10.1007/978-1-4613-0997-0.

[iv] Kevin J. Hsu, A. M. Rosenthal, and J. Michael Bailey, “The Psychometric Structure of Items Assessing Autogynephilia,” Archives of Sexual Behavior 44, no. 5 (July 2015): 1301–1312, https://doi.org/10.1007/s10508-014-0397-9.

[v] American Psychiatric Association, ed., Diagnostic and Statistical Manual of Mental Disorders: DSM-5, 5th ed. (Washington, DC: American Psychiatric Association Publishing, 2013), 451, https://doi.org/10.1176/appi.books.9780890425596.

[vi] American Psychiatric Association, 452.

[vii] Hsu, Rosenthal, and Bailey, “The Psychometric Structure,” 7; Ray Blanchard, “The Concept of Autogynephilia and the Typology of Male Gender Dysphoria,” The Journal of Nervous and Mental Disease 177, no. 10 (October 1989): 619, https://doi.org/10.1097/00005053-198910000-00004.

[viii] Hirschfeld, Transvestites, 28.

[ix] Lanei M. Rodemeyer, Lou Sullivan Diaries (1970-1980) and Theories of Sexual Embodiment, Crossroads of Knowledge (New York: Springer, 2018), 25.

[x] Rodemeyer, 156.

[xi] Rodemeyer, 184.

[xii] Hirschfeld, Sexual Anomalies and Perversions, 188.

[xiii] Zinnia Jones, “Depersonalization in Gender Dysphoria: Widespread and Widely Unrecognized,” Medium, February 27, 2018, https://zinniajones.medium.com/depersonalization-in-gender-dysphoria-widespread-and-widely-unrecognized-baaac395bcb0; Zinnia Jones, “In Our Own Words: Transgender Experiences of Depersonalization,” September 1, 2017, https://www.academia.edu/34611836/In_our_own_words_transgender_experiences_of_depersonalization.

[xiv] Jocelyn Badgley and other contributors, “The Gender Dysphoria Bible,” 12–13, accessed August 18, 2022, https://genderdysphoria.fyi/gdb.pdf.

[xv] Jones, “Depersonalization in Gender Dysphoria.”

[xvi] Anette Kersting et al., “Dissociative Disorders and Traumatic Childhood Experiences in Transsexuals,” The Journal of Nervous and Mental Disease 191, no. 3 (March 2003): 184, https://doi.org/10.1097/01.NMD.0000054932.22929.5D.

[xvii] Kersting et al., 184–85.

[xviii] Marco Colizzi, Rosalia Costa, and Orlando Todarello, “Dissociative Symptoms in Individuals with Gender Dysphoria: Is the Elevated Prevalence Real?,” Psychiatry Research 226, no. 1 (March 2015): 176–77, https://doi.org/10.1016/j.psychres.2014.12.045.

[xix] Colizzi, Costa, and Todarello, 178.

[xx] Jessica Xavier, Julie A. Honnold, and Judith B. Bradford, The Health, Health-Related Needs, and Lifecourse Experiences of Transgender Virginians (Virginia Department of Health, 2007), 27, https://doi.org/10.1037/e544442014-001.

[xxi] Havelock Ellis, “Eonism,” in Studies in the Psychology of Sex, vol. 7, Eonism and Other Supplementary Studies (Philadelphia: F. A. Davis Company, 1928), 98, https://wellcomecollection.org/works/njv7bbq7.

[xxii] Wilhelm Stekel, Sexual Aberrations: The Phenomena of Fetishism in Relation to Sex, vol. 2 (London: John Lane, 1930), 299, https://archive.org/details/b29817043_0002; Robert J. Stoller, Splitting: A Case of Female Masculinity, The International Psycho-Analytical Library, no. 97 (London: Hogarth Press, 1974), 37–38.

[xxiii] Ellis, “Eonism,” 97.

[xxiv] Docter, Transvestites and Transsexuals, 88.

[xxv] Hirschfeld, Sexual Anomalies and Perversions, 218.

[xxvi] Ellis, “Eonism,” 71.

[xxvii] Ellis, 79.

[xxviii] Ellis, 85.

[xxix] Ellis, 83.

[xxx] Ira B. Pauly, “Female Transsexualism: Part I,” Archives of Sexual Behavior 3, no. 6 (November 1974): 504, https://doi.org/10.1007/BF01541134.

[xxxi] Hirschfeld, Sexual Anomalies and Perversions, 188.

[xxxii] Docter, Transvestites and Transsexuals, 190.

[xxxiii] Hirschfeld, Transvestites, 101.

[xxxiv] Stekel, Sexual Aberrations, 282.

[xxxv] J. H. Vogt, “Five Cases of Transsexualism in Females,” Acta Psychiatrica Scandinavica 44, no. 1 (March 1968): 79, https://doi.org/10.1111/j.1600-0447.1968.tb07636.x.

[xxxvi] Vogt, 79.

[xxxvii] Ellis, “Eonism,” 87.

[xxxviii] Vogt, “Five Cases of Transsexualism in Females,” 79.

[xxxix] Vogt, 79.

[xl] Vogt, 77.

[xli] Vogt, 76.

[xlii] Ellis, “Eonism,” 84.

[xliii] Vogt, “Five Cases of Transsexualism in Females,” 76.

[xliv] Vogt, 76.

[xlv] Hirschfeld, Transvestites, 100.

[xlvi] Vogt, “Five Cases of Transsexualism in Females,” 79.

[xlvii] Ellis, “Eonism,” 87.

[xlviii] Aaron H. Devor, FTM: Female-to-Male Transsexuals in Society (Bloomington, IN: Indiana University Press, 2016), 195.

[xlix] Hirschfeld, Sexual Anomalies and Perversions, 199–200.

[l] Ellis, “Eonism,” 96.

[li] L. M. Lothstein, “The Aging Gender Dysphoria (Transsexual) Patient,” Archives of Sexual Behavior 8, no. 5 (September 1979): 434, https://doi.org/10.1007/BF01541199.

[lii] Docter, Transvestites and Transsexuals, 189.

[liii] Docter, 189.

[liv] Stefan Rowniak and Catherine Chesla, “Coming Out for a Third Time: Transmen, Sexual Orientation, and Identity,” Archives of Sexual Behavior 42, no. 3 (April 2013): 457, https://doi.org/10.1007/s10508-012-0036-2.

[lv] Vogt, “Five Cases of Transsexualism in Females,” 79.

[lvi] Ira B. Pauly, “Female Transsexualism: Part II,” Archives of Sexual Behavior 3, no. 6 (November 1974): 512, https://doi.org/10.1007/BF01541135.

[lvii] Anne A. Lawrence, ed., “Thirty-One New Narratives About Autogynephilia: Plus Five Revealing Fantasy Narratives,” AnneLawrence.com, 1999, no. 41, accessed January 30, 2023, available at https://web.archive.org/web/20120208181716/http:/www.annelawrence.com/31narratives.html.

[lviii] Ellis, “Eonism,” 62.

[lix] Hirschfeld, Transvestites, 69.

[lx] Niklas Långström and Kenneth J. Zucker, “Transvestic Fetishism in the General Population,” Journal of Sex & Marital Therapy 31, no. 2 (2005): 90, https://doi.org/10.1080/00926230590477934.

[lxi] Långström and Zucker, 90.

[lxii] Anne A. Lawrence, ed., “Thirty-One New Narratives About Autogynephilia: Plus Five Revealing Fantasy Narratives,” AnneLawrence.com, 1999, no. 19, accessed January 30, 2023, available at https://web.archive.org/web/20120208181716/http:/www.annelawrence.com/31narratives.html.

[lxiii] Lawrence, no. 3.

[lxiv] Hirschfeld, Transvestites, 22.

[lxv] Lawrence, “Twenty-Eight Narratives About Autogynephilia,” no. 2.

[lxvi] Ellis, “Eonism,” 67.

[lxvii] Anne Lawrence, “Sexuality and Transsexuality: A New Introduction to Autogynephilia,” Transgender Tapestry 92 (Winter 2000), 17, https://archive.org/details/transgendertapes9220unse/page/16/mode/2up; Anne Lawrence, “Narratives on Autogynephilia,” Transgender Tapestry 92 (Winter 2000), https://archive.org/details/transgendertapes9220unse/page/22/mode/2up; Anne Lawrence, “Autogynephilia: Frequently-Asked Questions,” Transgender Tapestry 92 (Winter 2000), 9, https://archive.org/details/transgendertapes9220unse/page/24/mode/2up; “References and a Reading List on Autogynephilia,” Transgender Tapestry 92 (Winter 2000), 13, https://archive.org/details/transgendertapes9220unse/page/28/mode/2up.

[lxviii] Lori Buckwalter, “Autogynephilia: All Dressed Up and No One To Be,” Transgender Tapestry 93 (Spring 2001), https://archive.org/details/transgendertapes9320unse/page/22/mode/2up; Katherine K. Wilson, “Autogynephilia: New Medical Thinking or Old Stereotype?,” Transgender Tapestry 93 (Spring 2001), https://archive.org/details/transgendertapes9320unse/page/20/mode/2up; Kate Barnes, “Some Observations on Autogynephilia,” Transgender Tapestry 93 (Spring 2001), https://archive.org/details/transgendertapes9320unse/page/24/mode/2up.

[lxix] Jessica Xavier, “Autogynephilia: What If It’s All True?,” Transgender Tapestry 93 (Spring 2001), https://archive.org/details/transgendertapes9320unse/page/22/mode/2up.

[lxx] Xavier, 24.

[lxxi] Hirschfeld, Sexual Anomalies and Perversions, 222.

[lxxii] Docter, Transvestites and Transsexuals, 189.

[lxxiii] Docter, 190.

[lxxiv] Hirschfeld, Transvestites, 72.

[lxxv] Vogt, “Five Cases of Transsexualism in Females,” 77.

[lxxvi] Vogt, 77.

[lxxvii] Lawrence, “Twenty-Eight Narratives About Autogynephilia,” no. 4.

[lxxviii] Hirschfeld, Sexual Anomalies and Perversions, 138.

[lxxix] Hirschfeld, 138.

[lxxx] Harry Benjamin, The Transsexual Phenomenon, electronic edition (Düsseldorf: Symposium Publishing, 1999), 22.

[lxxxi] Lawrence, “Twenty-Eight Narratives About Autogynephilia,” no. 15.

[lxxxii] Lawrence, “Thirty-One New Narratives About Autogynephilia,” no. 42; Hirschfeld, Transvestites, 22.

[lxxxiii] Hirschfeld, Sexual Anomalies and Perversions, 199–200.

[lxxxiv] Ellis, “Eonism,” 60.

[lxxxv] Viktor E. Frankl, Man’s Search for Meaning (Boston: Beacon Press, 2006).

[lxxxvi] Heike Bauer, The Hirschfeld Archives: Violence, Death, and Modern Queer Culture (Philadelphia: Temple University Press, 2017), 39–40.

[lxxxvii] Hirschfeld, Transvestites, 154.

[lxxxviii] Rodemeyer, Lou Sullivan Diaries, 165.

[lxxxix] Vogt, “Five Cases of Transsexualism in Females,” 73.

[xc] Hirschfeld, Sexual Anomalies and Perversions, 199.

[xci] Ellis, “Eonism,” 99.

[xcii] Hirschfeld, Sexual Anomalies and Perversions, 222–23.

[xciii] Hirschfeld, 223.

[xciv] Hirschfeld, 200–201.

[xcv] Richard von Krafft-Ebing, Psychopathia Sexualis, 12th ed., trans. F. J. Rebman (Rebman Company, 1906), 322.

[xcvi] Hirschfeld, Transvestites, 109.