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ABSTRACT The increasing prevalence of male-to-female (MtF) transsexualism in Western countries is largely due to the growing number of MtF transsexuals who have a history of sexual arousal with cross-dressing or cross-gender fantasy. Ray Blanchard proposed that these transsexuals have a paraphilia he called autogynephilia, which is the propensity to be sexually aroused by the thought or image of oneself as female. Autogynephilia defines a transsexual typology and provides a theory of transsexual motivation, in that Blanchard proposed that MtF transsexuals are either sexually attracted exclusively to men (homosexual) or are sexually attracted primarily to the thought or image of themselves as female (autogynephilic), and that autogynephilic transsexuals seek sex reassignment to actualize their autogynephilic desires. Despite growing professional acceptance, Blanchard's formulation is rejected by some MtF transsexuals as inconsistent with their experience. This rejection, I argue, results largely from the misconception that autogynephilia is a purely erotic phenomenon. Autogynephilia can more accurately be conceptualized as a type of sexual orientation and as a variety of romantic love, involving both erotic and affectional or attachment-based elements. This broader conception of autogynephilia addresses many of the objections to Blanchard's theory and is consistent with a variety of clinical observations concerning autogynephilic MtF transsexualism.
MALE-TO-FEMALE (MtF) transsexualism has become increasingly common in Western countries.A few decades ago, the estimated prevalence of MtF transsexualism was about 1 in 37,000 in Sweden and 1 in 100,000 in the United States (Landén, Wålinder, and Lundström 1996). Recent prevalence estimates from Western countries are nearly an order of magnitude higher, with about 1 in 12,000 men having undergone sex reassignment surgery, and about 1 in 7,400 having sought treatment for transsexualism (Bakker et al. 1993; De Cuypere et al. 2007;Wilson, Sharp, and Carr 1999). Most of the increase in MtF transsexualism can be accounted for by men who would have been considered atypical- and probably inappropriate-candidates for sex reassignment only a few decades earlier. These men are usually unremarkably masculine in their appearance and behavior, and they typically seek sex reassignment after having lived outwardly successful lives as men, often in male-dominated professions such as engineering or computer science. Most have been married to women, and many have fathered children. They invariably have a history of sexual arousal with crossdressing...