Both Types of Transgender Are Described in the DSM-5

they're described implicitly rather than explicitly, but they're described nonetheless

credit: DALL-E

When talking with people who disagree with me about the nature and origins of transgenderism, my conversation partners sometimes appeal to authoritative institutions to show that what I’m saying goes against the consensus of experts. They may argue, for example, that if the scientific literature supports the two-type model, wouldn’t this be reflected in documents such as WPATH’s Standards of Care, or the American Psychiatric Association’s Diagnostic and Statistical Manual?

When the DSM-5 is invoked for this purpose, I sincerely wonder if those invoking it have actually read the damn thing. The gender dysphoria chapter in the DSM-5 clearly describes two distinct developmental trajectories which align with the homosexual and autoheterosexual etiologies described by a two-type model of transgenderism. Instead of directly naming these etiologies, however, the DSM-5 euphemistically describes them as “early-onset” and “late-onset”:

In both adolescent and adult natal males, there are two broad trajectories for develop­ment of gender dysphoria: early onset and late onset. Early-onset gender dysphoria starts in childhood and continues into adolescence and adulthood; or, there is an intermittent pe­riod in which the gender dysphoria desists and these individuals self-identify as gay or ho­mosexual, followed by recurrence of gender dysphoria. Late-onset gender dysphoria occurs around puberty or much later in life. Some of these individuals report having had a desire to be of the other gender in childhood that was not expressed verbally to others. Others do not recall any signs of childhood gender dysphoria.

One developmental trajectory starts early in life and is associated with homosexuality. The other trajectory “occurs around puberty or much later in life” in both sexes, and is often undetectable to others during childhood. In fact, parents of children experiencing late-onset dysphoria are often surprised to learn that their child is gender-dysphoric or transgender:

Males:

For adolescent males with late-onset gender dysphoria, parents often report surprise because they did not see signs of gender dysphoria during childhood.

Females:

Parents of natal adoles­cent females with the late-onset form also report surprise, as no signs of childhood gender dysphoria were evident.

So far, these patterns match up well with the two-type model, but it isn’t enough to show that the DSM-5 implicitly supports a two-type model in which one is homosexual and the other autoheterosexual. When the allosexuality of these two groups is described, however, the resemblance to the homosexual and autoheterosexual types is pretty obvious:

Males:

Adolescent and adult natal males with early-onset gender dysphoria are almost always sexually attracted to men (androphilic). The majority of these individuals are gynephilic or sexually attracted to other posttransition natal males with late-onset gender dysphoria…After gen­der transition, many self-identify as lesbian.

Females:

Adolescent and adult natal females with early-onset gender dysphoria are almost always gynephilic. Adolescents and adults with the late-onset form of gender dysphoria are usually androphilic and after gender transition self-identify as gay men.

In both sexes, people with early-onset dysphoria are almost always homosexual.

In both sexes, people with late-onset dysphoria are usually attracted to the other sex. Accordingly, many of them adopt sexual identities that are homosexual with respect to their post-transition gender identity.

These patterns of allosexuality are exactly what we’d expect if the two-type model was accurate. When the DSM-5 brings up transvestism, however, it seems to depart from the two-type model I propose in which there are two types of trans in each sex, one homosexual and the other autoheterosexual:

Males—

Adolescents and adults with late-onset gen­der dysphoria frequently engage in transvestic behavior with sexual excitement.

Females—

Natal females with the late-onset form do not have co-occurring transvestic behavior with sexual ex­citement.

According to the DSM-5, males with late-onset dysphoria typically experience arousal from crossdressing, but their female counterparts don’t. This may seem to be damning counter-evidence against the notion that the DSM-5 implicitly includes the two-type model, but it’s not: dressing as the other sex is just one of many ways that autoheterosexuals attain cross-gender embodiment.

And besides, the DSM-5 is wrong to say that females with late-onset dysphoria don’t ever experience arousal from crossdressing: some gay and bisexual-identified FTMs report prior arousal from dressing in men’s clothes. Although accounts of FTM transvestism in the sexology literature are uncommon, some do exist. Consider this classic account of autoandrophilia from Elsa B. in which he says:

As regards clothing, I may say that simply putting on men’s clothing gives me pleasure. The whole procedure is comparable to that of tense anticipation of pleasure which subsides in relief and gratification as soon as the transvestiture is complete. I even experience lustful satisfaction in dreams of this act.

Just to show that this one guy isn’t a fluke, consider this report from an article on female transvestism:

“Today my sex life is mostly satisfied by masturbation, with transvestite episodes occasionally providing a pleasant stimulus to masturbation. I've dressed as a man, replete with moustache, and had my partner call me by a man's name. I take pleasure in being called by a man's name. Dressed as a man, I've sucked my partner's penis. I felt myself, during the experience, to be a gay male.”

Although these examples make clear that female autoandrophilia exists, the DSM-5 doesn’t mention autoandrophilia. However, it does mention that autogynephilia contributes to gender dysphoria in males with late-onset dysphoria:

Additional predisposing factors under consideration, especially in individuals with late-onset gender dysphoria (ad­olescence, adulthood), include habitual fetishistic transvestism developing into autogynephilia (i.e., sexual arousal associated with the thought or image of oneself as a woman)

Combining all these observations about age of onset, childhood gender-nonconformity, allosexuality, and autosexuality, the DSM-5 gives us a clear picture of two types:

1. One type who is dysphoric before puberty, gender-atypical in childhood, and same-sex attracted. This type does not experience arousal from crossdressing.

2. One type who becomes dysphoric during puberty or later, is gender-typical in childhood, and other-sex attracted. The males of this type experience arousal from crossdressing, but not the females.

The DSM-5 clearly lends implicit support to the two-type MTF model. Although it overlooks autoandrophilia and incorrectly states that late-onset FTMs don’t ever experience arousal from crossdressing, it nonetheless describes FTMs in a way that otherwise fits neatly into a two-type transgender model in which one type is homosexual and the other autoheterosexual.

Both types of transgenderism are described in the DSM-5. They’re described implicitly rather than explicitly, but they’re described nonetheless.