Alice Dreger, autogynephilia, and the misrepresentation of trans sexualities (Book review: Galileo’s Middle Finger)

Book review: Galileo’s Middle Finger, by Alice Dreger

Table of contents

• Introduction
• 1. Background: Blanchard’s sexual typology of trans women
• 2. Dreger neglects relevant issues faced by trans women
• 3. Social and cultural factors do not account for the clinical realities of gender dysphoria
• 4. Sexual explanations are insufficient to account for gender dysphoria
• 5. Blanchard’s typology requires accusing large numbers of trans women of deception or delusion
• 6. Autogynephilia is used as a stigmatizing label in personal disputes by sexologists and by Dreger
• 7. Other issues
• 8. Societal fallout from a sexualized theory of trans women’s genders
• References

Introduction

The Lambda Literary Foundation recently rescinded the nomination of the book Galileo’s Middle Finger by historian Alice Dreger for an award in its LGBT nonfiction category. Controversy emerged due to Dreger’s coverage of various academic disputes following the publication of The Man Who Would Be Queen by psychologist J. Michael Bailey in 2003. Bailey’s book advanced a sexological theory about trans women and their experiences of gender dysphoria, claiming that they’re motivated to transition for primarily sexual reasons – an idea that was vocally protested by many trans people. Dreger describes this theory and largely endorses its themes, incorporating it into her book’s wider narrative of unpopular scientific findings being challenged by activists on a political rather than an empirical basis.

However, her presentation and interpretation of the theory is accompanied by many questionable claims and inaccurate implications, ultimately offering an incomplete and sensationalized account of trans women’s experiences of their genders. At times her perspective reveals a surprising unawareness of crucial aspects of these women’s realities that directly come to bear on the theory and its validity. She further omits many of the more doubtful claims made by sexologists in support of the theory, disguising the full extent of what she’s really endorsing. Her engagement with the controversy surrounding Bailey’s book occasionally descends into the kind of overly personal attacks that she otherwise deplores.

The central theme of Galileo’s Middle Finger is the importance of the scientific pursuit of truth to the wider social pursuit of justice – to Dreger, these aims go hand in hand, with factual accuracy as a necessity for effective advocacy (Dreger, 2015, p. 261). Her recounting of the disputes surrounding this sexual theory is just one of many vignettes intended to support these principles. Unfortunately, her uncritical acceptance of questionable science, and her dissemination of a misleading impression of trans women’s lives, cast doubt on the book’s value in advancing the very justice she prizes most.

1. Background: Blanchard’s sexual typology of trans women

The Man Who Would Be Queen popularized a theory that classifies trans women into two types on the basis of their sexual orientations. This two-type system was originally proposed by sexologist Ray Blanchard and his mentor Kurt Freund in the 1980s, and distinguishes exclusively straight trans women from trans women who are lesbian, bisexual, or asexual. The theory postulates that their distinct sexual desires can explain why they feel the need to transition.

Within this system, straight trans women are characterized as being an extreme form of feminine gay men, so innately and visibly feminine in their attitudes, behaviors, and mannerisms that they find it very difficult to function as men in society (Bailey & Triea, 2007). Dreger describes these women in their childhoods as “’sissy boys’ who like activities generally considered girly” and “more classically feminine than masculine in social interactions” (p. 56). Conversely, trans women who aren’t exclusively straight are described by Dreger as “not markedly femme in childhood”, having “male-typical occupations”, and appearing “to the outside world like typical straight men right up until transition” (p. 58).

In the case of straight trans women, Dreger explains the benefits of their choice to transition in largely sexual terms, stating that “they can and happily do take straight men as their sex partners” and “sex reassignment makes possible a more satisfying sex life” (p. 57). These are the first things she lists as positive outcomes for these women. The motivations of queer trans women are described similarly – she notes that they experience an “almost overwhelming feminine component of their selves” that involves “finding themselves sexually aroused by the idea of being or becoming women” (p. 58).

Blanchard and others have addressed these transgender fantasies by various names in sexological literature, like “cross-gender fantasy”, “fetishistic cross-dressing”, or “transvestic fetishism”. In 1989, Blanchard coined the term “autogynephilia” (Blanchard, 1989a), roughly meaning “love of oneself as a woman” and describing sexual arousal at fantasies such as having a female body, wearing women’s clothing, engaging in feminine-coded social behaviors, and so on. Crucially, he claimed:

All gender dysphoric males who are not sexually oriented toward men are instead sexually oriented toward the thought or image of themselves as women. (Blanchard, 1989b)

In other words, there are only two possible combinations within this theory: queer trans women who experience autogynephilia, and straight trans women who don’t.

These are the key tenets of the theory at the heart of the controversy over Bailey’s book: trans women’s choices to transition are attributed to two distinct sexual motivations, one of which is a sexual fetish that’s either universally present or universally absent based on their orientation. These generalizations are in turn associated with stereotypical descriptions of these women, their histories, their appearances, and their behavioral tendencies. This is the scientific account of trans women’s genders that Dreger presents and largely supports in Galileo’s Middle Finger.

2. Dreger neglects relevant issues faced by trans women

There are particular aspects of Dreger’s interpretation of this theory that are questionable or even just wrong. She explains that straight trans women experience sexual benefits from transitioning because they previously lived as especially feminine gay men who would not be well-liked by other gay men.

Straight men aren’t interested in having sex with them because they’re male, and gay men often aren’t sexually attracted to them because most gay men are sexually attracted to masculinity, not femininity, and these guys are really femme. (p. 57)

Once they begin living as women, they can presumably now take straight men as partners. This analysis neglects to factor in the phenomenon of transphobia. Many straight men are vocally uninterested in relationships with trans women, but Dreger doesn’t consider that this could limit a straight trans woman’s dating pool in a similar fashion. The problem with relying on this primarily sexual explanation for why these women transition is that there’s no guarantee they would be able to find more potential partners.

Dreger also mentions a non-sexual benefit experienced by straight trans women: “as women, they are not as often subject to homophobic abuse and assault, always a danger for femme men” (p. 57). She later gives an example of “a homophobic ethnic enclave” where these extremely feminine trans women “might find life survivable only via complete transition to womanhood” (p. 59). Once again, this line of reasoning ignores the existence of transphobia and its close correlation with homophobic attitudes (Nagoshi et al., 2008). A person who’s homophobic is very likely to be transphobic as well, so there’s little reason to assume that an environment which is openly hostile to gay people would be more accepting of trans people. This is especially confusing given that Dreger is supporting a theory that classifies these same trans women as, in Bailey’s words, “a kind of homosexual man” (Bailey, 2003, p. 146).

Her claim that “transition also means a safer and less painful life” for straight trans women (p. 57) is particularly unfounded. The National Coalition of Anti-Violence Programs reported that in 2014, trans women made up 55% of recorded homicides of LGBTQ people, and that these women “experienced a greater risk of homicide than other LGBTQ and HIV-affected people” (Ahmed & Jindasurat, 2015). Dreger later quotes Bailey’s conjecture that straight trans women “might be especially well suited to prostitution” (p. 58), yet this would further challenge her assertion that transitioning leads to greater safety for these women. Trans women comprise the vast majority of trans homicide victims overall, and where the identity of the killer is known, they’re almost always men. In many of these cases, these victims were also involved in sex work. Being in close contact with men certainly did not make life safer for these trans women. This is a stunning oversight for a mainstream book covering trans issues in 2015.

3. Social and cultural factors do not account for the clinical realities of gender dysphoria

In the course of explaining Blanchard’s theory, Dreger claims that trans people (or potential trans people) choose how they articulate their identities based on their cultural environment and the perceived benefits to themselves.

…in one environment — say, an urban gay neighborhood like Chicago’s Boystown — an ultrafemme gay man might find reasonable physical safety, employment, and sexual satisfaction simply by living as an ultrafemme gay man. … Whether a transkid grows up to become a gay man or a transgender woman would depend on the individual’s interaction with the surrounding cultural environment. Similarly, an autogynephilic man might not elect transition if his cultural milieu would make his post-transition life much harder. (p. 59)

The suggestion that trans people routinely conduct this kind of social cost-benefit analysis in deciding whether to transition ignores the wide array of negative outcomes faced by those who do. Trans people in the United States have twice the rate of unemployment as the general population, and are almost four times as likely to have a household income of less than $10,000 a year (Grant et al., 2011). 90% have faced discrimination or harassment at work, 26% have lost a job just because they’re trans, and 19% have experienced homelessness due to being trans. Even in the face of these adverse consequences from an unaccepting society, trans people continue to transition.

Dreger mostly disregards something else that would factor into this analysis aside from sexual benefits or social acceptance: gender dysphoria, its negative impact on trans people’s well-being, and its mitigation through transitioning. The phrase “gender dysphoria” appears only in citations of academic papers in the book’s endnotes. Throughout her explanation of Blanchard’s theory, she describes dysphoria and the benefits of treatment in only the vaguest of terms, using phrases like “a more comfortable gender presentation” (p. 57), “to enhance their sense of being a woman”, “to feel that they are living an authentic life, true to themselves” (p. 61), and “finally able to live out the gender identity she had long felt and desired” (p. 62). Her most extensive account of the positive experiences of trans women following transition is largely superficial and unhelpful:

As is the case for transkids like Juanita, transition can make the lives of people like Cher far more fulfilling. It lets them be who they feel they really ought to be, who they really are. Life is surely a lot easier when people treat you the way you feel you should be treated in terms of your gender identity and sexual orientation. (p. 62)

She also makes a passing reference to trans women “doing better psychologically” after transitioning, and experiencing “substantial improvement” (p. 62), but goes into no further detail.

Such broad strokes offer little in the way of meaningful clarity, and a more useful understanding of gender dysphoria undermines many of her arguments here. Dysphoria is known to be associated with a number of symptoms, including depression (Gómez-Gil et al., 2012; Colizzi, Costa, & Todarello, 2014), anxiety (Gómez-Gil et al., 2012; Colizzi et al., 2014), elevated stress levels (Colizzi, Costa, Pace, & Todarello, 2013), dissociation (Colizzi, Costa, & Todarello, 2015), depersonalization, overall body uneasiness, and uneasiness with several specific body parts (Fisher et al., 2014). Crucially, these symptoms are frequently reduced in severity after trans people undergo hormone therapy, various transition surgeries, and other procedures intended to treat dysphoria.

These are a matter of biological changes, not just cultural or social changes. A person who’s uncomfortable due to the physical features or hormone levels of their body won’t necessarily become more comfortable by not changing those features and just moving to a different place. While wider societal attitudes can obviously have a substantial negative impact on trans people’s well-being, Dreger presents no evidence that a person considering transition will experience a similar set of benefits from instead choosing to live in a more tolerant area. Unfortunately, someone who’s unfamiliar with the phenomenon of gender dysphoria would learn almost nothing about it from reading Galileo’s Middle Finger, and they likely wouldn’t notice anything amiss here.

4. Sexual explanations are insufficient to account for gender dysphoria

Dreger’s coverage of Blanchard’s theory glosses over one of its central claims: that arousal at cross-gender fantasies actually causes the development of gender dysphoria. Sexologist Anne Lawrence, one of the most active proponents of this theory, proposes that queer trans women’s identities as women are “an epiphenomenon” of an “underlying mental disorder” (Lawrence, 2011). Lawrence states:

In nonhomosexual [queer] MtF transsexuals, cross-gender identity can be considered an epiphenomenon, because it develops years or decades after the mental dysfunction that putatively gives rise to it has become apparent. In persons who will eventually become nonhomosexual MtF transsexuals, a dysfunction in the mental mechanism responsible for accurately locating erotic targets in the environment—as evidenced by the onset of erotic cross-dressing—typically becomes apparent “just before, during, or after puberty” (Whitam, 1997, p. 192; see also Blanchard, Clemmensen, & Steiner, 1987; Doorn, Poortinga, & Verschoor, 1994). The development of a cross-gender identity in these men, however, typically occurs decades after the onset of erotic cross-dressing and is usually preceded by experiences of complete cross-dressing, public self-presentation while cross-dressed, and adopting a feminine name (Docter, 1988).

The developmental sequence of events described by Lawrence is based on observations from decades ago, when there was very little public acceptance of trans people or widespread understanding of what it means to be trans. In that time, secretive exploration within more accessible and less identity-threatening cultural constructs like “cross-dressing” or “transvestism” would be typical. But many trans women no longer experience a protracted, decades-long period of this tentative questioning and confusion about their identities before resolving this and recognizing themselves as women.

Another problem with this conceptualization of trans women’s gender identity development is that it infers a causative mechanism from a mere sequential ordering of events. For some trans women, eroticism and cross-gender fantasies about womanhood in a limited sexual context may precede the awareness, clarification, and open recognition of their larger overall identities as women. There’s nothing surprising about a person’s interests taking on an additional sexual dimension at the onset of puberty. But this doesn’t therefore mean that these sexual urges marked the very first manifestation of transgender inclinations, or that these desires must have later grown into an entire gendered identity. Identification with womanhood and fantasizing about oneself sexually as a woman can both arise from the same underlying inclination, and this is an experience often reported by trans women:

It was often described as a side effect of cross-gender fantasizing itself, not as the compelling reason for the behavior. In other words, sexual fantasies and arousal would emerge during cross-gender fantasizing. (Doorduin & van Berlo, 2014)

Women tend to regard themselves as women in sexual fantasy – this is as true for trans women as it is for cis women. Really, why would we expect women to see themselves as anything else? This was illustrated by a particularly revealing episode in the history of sexological research into Blanchard’s theory. Responding to a study measuring autogynephilia in trans women (Veale, Clark, & Lomax, 2008), Lawrence and Bailey claimed that this sample’s scores on two measures were so high that almost every trans woman in the study should have been interpreted as experiencing autogynephilia (Lawrence & Bailey, 2009). However, as Charles Moser later pointed out, 52% of cis women controls in the study also scored highly enough on these two measures to be considered autogynephilic under Lawrence and Bailey’s interpretation (Moser, 2010). An analogous phenomenon of seeing oneself as one’s gender during sexual fantasy has also been observed to occur among trans men (Freund, 1985; Doorduin & van Berlo, 2014) and even cis men (Lawrence, 2009a). Depicting this aspect of sexual arousal as being exclusive to trans women wrongfully gives the impression that their very genders are uniquely sexual in nature.

Lawrence nevertheless persists in describing gender dysphoria as having a wholly sexual origin, saying:

For autogynephilic MtF transsexuals, the distress of wrong embodiment reflects an inability to actualize the intense erotic desire to have a female body. This can be understood as analogous to the distress a normophilic man would feel if he were never able to express or actualize his sexual desires. (Lawrence, 2011)

Compare this to the variety of severe psychological symptoms commonly associated with untreated dysphoria. Does anything about this resemble the difficulties of not getting laid? The struggles faced by trans people with dysphoria clearly extend far beyond some conjectured frustration with not being able to enact a sexual fantasy, and the benefits of treatment are much more comprehensive than an orgasm.

Regardless, Dreger’s description of one of the main subjects of Bailey’s book echoes Lawrence’s sexual focus:

As a boy and young man, Chuck seemed like a pretty typical guy. But unlike most guys, Chuck made elaborate pornographic films of himself dressed as a woman, complete with female masks, homemade fake breasts, and a glue-on vulva. (He pushed his penis up into his body and used an adhesive to hold it there, a feat made easier by having been born with only one testicle.) Chuck made robots to simulate heterosexual sex, so that he could experience sex as he thought a woman might. Eventually he realized he needed to be seen by all as the woman felt inside. And so, with the help of gender-affirming hormones and surgery, Cher emerged. (p. 62)

From her childhood to the point where she chose to transition, this trans woman’s gender and personal development are described entirely in terms of “female masks”, prosthetic vulvas, and sex with robots. To say that this does not reflect most trans women’s experiences would be an understatement.

5. Blanchard’s typology requires accusing large numbers of trans women of deception or delusion

Blanchard’s two-type system, with its associations of sexual orientation with self-directed fantasies of womanhood, is categorical in nature: all trans women are presumed to be either queer and experience autogynephilic arousal, or straight and not experience this arousal. One issue that arises as a result is that other combinations are regarded as invalid. Straight trans women who do experience arousal at the thought of themselves as women, and queer trans women who don’t, are assumed not to exist under this theory.

Unfortunately for the theory, such trans women continue to appear in the results of their studies. For instance, subjects in a study by Blanchard showed great diversity when plotted on a graph of their attraction to women or men compared to their degree of “cross-gender fetishism”:

X-axis: Attraction to women — Attraction to men; Y-axis: Cross-gender fetishism (Blanchard, 1985)

The two-type system would require drawing a line somewhere to separate that data into two segments. To address this, Blanchard, Lawrence, Bailey, and other researchers studying this typology did not elaborate or extend the theory, but rather developed an extensive array of responses to dismiss any data which is inconsistent with the theory. Queer trans women who don’t report experiences of autogynephilia are believed to be experiencing it nonetheless, but lying or mistaken about this. Straight trans women who do report these experiences are similarly presumed to be lying about being straight, or even attracted to men for the “wrong” reasons.

Why would trans women offer inaccurate or deceptive reports? Blanchard and others have contended that false reports of heterosexuality by queer trans women, or of a lack of autogynephilia by autogynephilic trans women, are due to a social desirability bias (Blanchard, Clemmensen, & Steiner, 1985). They note that these women may have been trying to present themselves in accordance with an expected traditional narrative of trans identity and experience, often required by clinicians in decades past as a precondition to accessing transition treatment. Dreger correctly points out that many doctors mistakenly believed any trans woman who wasn’t straight, or who ever experienced anything resembling autogynephilia, should be disqualified from accessing transition treatment, so these women would have good reason to lie about this (p. 64).

However, she also states that Blanchard supports this treatment for trans women regardless of their orientation or autogynephilic experiences, and that he’s testified in favor of public funding for transition care (p. 62). Many medical organizations and researchers now agree that these factors should not pose a barrier to transitioning. The problem with dismissing trans women’s self-reports on the basis of this particular reason to lie is that it continues to become less relevant – it depends on norms and standards that are evolving, not fixed. As this happens, fewer self-reports can be disregarded as inaccurate and attributed to this motivation.

Some of these sexologists have also treated autogynephilia as a permanent and lifelong trait, in spite of evidence that this form of arousal is often a transient phenomenon for many trans women. Blanchard acknowledges that “in later years, however, autogynephilic sexual arousal may diminish or disappear, while the transsexual wish remains or grows even stronger” (Blanchard, 1991). He compared this persistence after arousal has faded to the “permanent love-bond that may remain between two people after their initial strong sexual attraction has largely disappeared.” This would require assuming that trans women are somehow unable to tell the difference between what it’s like to be in a fulfilling long-term relationship with a person you deeply love, and what it’s like to be so completely obsessed with a sexual fantasy that you literally fall in love with yourself and mistake this for a gender. It’s a farfetched interpretation, but it’s the standard response of researchers like Blanchard, Lawrence, and Bailey who don’t believe autogynephilia ever really goes away.

However, other sexologists have made note of trends that suggest a more straightforward explanation. In a study of hundreds of trans women, sexual arousal associated with dressing in feminine attire was reported by 49–78% of those who only dressed this way in private – but this decreased to 8–11% among trans women who publicly lived as women all the time (Nuttbrock, Bockting, Rosenblum, Mason, & Hwahng, 2011). This explains the tendency for sexual fantasies of oneself as a woman to fade after trans women come out and transition. When expressing one’s gender is limited to sexual contexts, it becomes closely associated with sexual arousal – and when one’s gender becomes the backdrop to everyday life outside of sex, it’s no longer inherently sexually interesting. Similarly, there’s not necessarily as much of a need to fantasize about having a woman’s body once you actually do have a woman’s body.

Blanchard and others who support the typology also dismiss the self-reported sexual orientations of straight trans women who have a history of sex with women prior to coming out and transitioning. They conjecture that these women are not expressing genuine attraction to men, but are instead essentially using them as props to satisfy their autogynephilic desires and affirm their own womanhood through enacting the fantasy of a man making love to them as a woman. The assumption that their sexual activity before transition is more accurately reflective of their orientation than their sexual activity after seems arbitrary – when cis gay men come out after years or decades of living a typical heterosexual lifestyle, how frequently is their homosexuality treated as false and misleading? Many trans women report learning to give the impression of a normatively masculine and heterosexual persona from a very early age, often due to discouragement, punishment, and even violence inflicted upon them by parents and others for showing any sign of femininity (Gagné & Tewksbury, 1998). As might be expected, these women frequently note that their sexual experiences when living as men served to fulfill social expectations, and did not reflect or clarify their genuine desires:

…most had sexual relationships before coming out as transgender. However, they frequently expressed the sense that these sexual activities did not bring them closer to learning about their own sexual desires, nor did they feel they could satisfactorily practice their skills in communicating about their own and their partners’ sexual likes and dislikes. … Rosa, for example, experienced sexuality as something instrumental: “That which took place was simply the managing of a physical reaction to create a child. Instrumentally, it is a mechanic you put into action. I knew enough about biology to know that my body reacts if you perform the right actions. [. . .] Well, that is not sexuality.” … Also, many participants indicated that they tried very diligently to meet social expectations others had for them based on their birth-assigned sex and gender category. Being so attuned to other people’s expectations made it difficult to get in touch with their own (gender and sexual) wishes and boundaries. (Doorduin & van Berlo, 2014)

Given that autogynephilic arousal is far more common when trans women keep their genders a secret, and less common when they come out and begin publicly living as women, what reason is there to expect that their attraction to men after transitioning is merely an outgrowth of that self-focused arousal? The notion that the act of sex with a man as a woman is uniquely affirming of womanhood is also relative to social norms. As gay and lesbian relationships become increasingly accepted and valued in society, the act of sex with a lesbian woman as a woman could be similarly affirming – and trans women have indeed reported experiencing validation from this:

For example, one post-operative transsexual lesbian described her first sexual interaction as a woman with a female (before she had undergone SRS):

“Even though I did not really find this person very attractive, she was forceful and she was directive and taking more of a leading role and telling me what to do and how to be. . . . I didn’t feel masculine with her. She accepted that female part of me. I didn’t have to be male with her. Being sexual with her was very different. It was easy to think of it as other than male-female.” (Gagné & Tewksbury, 1998)

If Blanchard, Lawrence, and others are willing to dismiss trans women’s reports of attraction to men on this basis, why aren’t they similarly dismissive of trans women’s reports of attraction to women? These are just some of the inconsistencies that can emerge when a theory is allowed to define the data, rather than the other way around. As other sexologists have noted, regarding all exceptions to the theory’s predictions as “measurement errors” is “highly speculative” (Nuttbrock, Bockting, Rosenblum, Mason, & Hwahng, 2010).

Nevertheless, the denial of any inconsistent data is an enduring trend among proponents of the theory. Blanchard himself considers it “preposterous” when trans women report that it’s “relaxing” to wear “heels and makeup and a wig and a corset” (Bloom, 2002). He shows little awareness that a cis woman for whom such artificialized femininity is experienced as normative and coercive will perceive this much differently than a trans woman with gender dysphoria who’s been denied access to any feminine expression throughout her life. Lawrence has authored an entire book in which she collects trans women’s various experiences and perspectives of autogynephilia, approving of those testimonies that support the theory while comprehensively rejecting those that don’t (Lawrence, 2013). Blanchard wrote the foreword, where he described this extended exercise in confirmation bias as superior to Magnus Hirschfeld’s pioneering text Die Transvestiten.

Dreger herself tries her hand at this, speculating that trans women who disagree with Blanchard’s typology are doing so because their supposed autogynephilia is “erotically disrupted simply by being labeled”:

For Bailey or anyone else to call someone with amour de soi en femme an autogynephile or even a transgender woman—rather than simply a woman—is at some level to interfere with her core sexual desire. Such naming also risks questioning her core self-identity in a way that calling the average gay man homosexual simply can’t. One really must understand this if one is going to understand why some trans women came after Bailey so hard for naming and describing autogynephilia. When they felt that Bailey was fundamentally threatening their selves and their social identities as women—well, it’s because he was. That’s what talking openly about autogynephilia necessarily does. (p. 67)

Considering that the trans women who are central to the disputes over Bailey’s book are all very much out as trans – and have been for years – it seems unlikely that their beliefs are based on the perception of a threat to a sexual tendency that’s both transient and associated with secrecy. These women have provided extensive materials informing the public about Blanchard’s theory and the concept of autogynephilia, arguably doing just as much to raise awareness of it as Bailey. This is not consistent with the notion that these women resist being known as trans or discussing autogynephilia, and the suggestion that they only disagree because the theory interferes with their personal fetishes is more sophomoric than scientific.

6. Autogynephilia is used as a stigmatizing label in personal disputes by sexologists and by Dreger

Dreger depicts Bailey’s book as being largely focused on the scientific aspects of Blanchard’s typology, and describes Bailey as almost obliviously unconcerned with this sexualized theory’s potential impact on the lives of trans women:

And yet, while some of Bailey’s best friends really were gay men and trans women, in his clueless privileged way, he didn’t worry about his work’s political implications for sexual minorities. He worried only about what’s right scientifically, and he decided that Blanchard’s taxonomy was right about the salience of sexual orientation to male-to-female transsexuality. … But Bailey made the mistake of thinking that openly accepting and promoting the truth about people’s identities would be understood as the same as accepting them and helping them, as he felt he was. Where identities as stigmatized as these are concerned, it just isn’t that simple. (p. 65)

Contrary to this narrative of simple ignorance or indifference toward the possibility of inflicting further stigma, supporters of the theory have openly applied its sexual labels in extremely personal ways. Anne Lawrence made a clear reference to Andrea James, an activist who played a key role in organizing the initial response to Bailey’s book, in a paper on “Shame and Narcissistic Rage in Autogynephilic Transsexualism”:

The grandiosity of some of Bailey’s opponents comes across most clearly in the Internet sites that some of them maintain, which contain, for example, claims of their supposed ability to pass undetected (in “deep stealth”) as natal woman, despite the presence of many unmistakably masculine features, and reports of their discovery of supposed facts about transsexualism that have escaped the notice of other researchers for decades. (Lawrence, 2008)

(Deep Stealth Productions is the name of Andrea James’ media production company.) Lawrence offers no acknowledgment that passing is not entirely about a trans person’s appearance – it’s also about variations in perception among individual observers. Many trans women have experienced being perceived as women by some people and as men by others throughout the course of a day, and even “unmistakably masculine features” are sometimes disregarded. A trans woman’s experience of rarely being perceived as trans is not at all outside the realm of possibility, let alone inherently indicative of narcissistic tendencies. Picking a specific trans woman as an example because she disagreed with your friend, describing this woman as mannish, calling her narcissistic and grandiose for not recognizing how mannish she supposedly is, and then attributing this to her alleged “autogynephilia”, is not a serious or useful application of a sexological theory. Nonetheless, Dreger approvingly quotes Lawrence’s assessment of “narcissistic rage” as “the only real way to explain” these critics’ reactions to Bailey (p. 100).

This isn’t the only instance of Lawrence getting personal with Bailey’s detractors. In a later paper on “Transgenderism in nonhomosexual males as a paraphilic phenomenon” (Lawrence, 2009b), she cites several excerpts from economist Deirdre McCloskey’s memoir about transitioning, presenting her experiences as an example of various aspects of autogynephilia. McCloskey, who also took a substantial role in the campaign against Bailey’s book, is the only person used as such an example throughout Lawrence’s paper. While Dreger devotes most of her coverage of this controversy to the personal attacks against Bailey, it’s clear that such attacks were far from unidirectional.

Taking a cue from Lawrence’s approach, Dreger attempts to apply Blanchard’s typology to Lynn Conway, another trans woman who helped to coordinate responses to Bailey:

…I now found one prominently featured section of Lynn Conway’s Web site—“Photos of Lynn”—sort of ironically funny. Here was this woman dedicating most of her life, it seemed, to attacking the concept of erotic arousal from the idea of being a woman as the basis for one form of male-to-female transsexualism, while simultaneously putting up—on her university Web site—multiple pictures of herself in a skimpy bikini, shot from various angles. In addition, there were pictures of Professor Conway in miniskirts, in a little black dress, and in her white bridal gown. As if that weren’t enough, Conway gave her measurements (41-32-41) and did not neglect to mention that her hair is light brown/auburn and her eyes are blue. Just your average computer engineering faculty Web site, nothing sexual, right? (p. 75)

Dreger omits a great deal of relevant context in her characterization of Lynn Conway’s website. Among these pictures of Conway in miniskirts were photographs from her appearances in Scientific American and the L.A. Times. Despite Dreger’s implications, these images were apparently not so sexual as to preclude their use in major publications. Other “miniskirt” photos include one with Conway’s grandniece, and another by transgender portraiture artist Loren Cameron. Several of the “skimpy bikini” and “little black dress” photos are noted to have been taken during vacations and cruises. The presence of these media appearances, vacation albums, and poolside photos would be entirely typical on any cis woman’s Facebook profile. Yet when the subject of these photos is a trans woman, this is pathologized by Dreger, attributed to unsavory motivations, and brought under the sexual umbrella of “autogynephilia”.

Additionally, large sections of Conway’s website offer useful information to other trans women on the surgeries that are available as part of transitioning, including graphic imagery of the results of genital surgery. Given that she provides extensive recountings of her own experiences, the inclusion of Conway’s personal measurements is hardly out of place here. Contrary to the predictions about sexual orientation associated with autogynephilia under Blanchard’s theory, Conway’s site also contains detailed advice to trans women on how to go about finding suitable male partners. Unlike the claims of Blanchard and others that “autogynephilic” trans women only pursue men in a generic fashion to affirm their own womanhood, much of Conway’s advice suggests a focus on the man himself and his desirability. She specifically advises trans women against assuming they can find just any man to help them fulfill an idealized fantasy of what they believe sex will be like. Dreger does not make note of this or consider that it would complicate the typology’s contention that trans women must fall into one of two neat and orderly boxes. Like Lawrence, she simply erases all of this complexity so she can use a trans woman with whom she disagrees as a definitive example of autogynephilia.

7. Other issues

Several other elements of Dreger’s coverage of this controversy in Galileo’s Middle Finger are inconsistent or otherwise questionable. She applauds Bailey for providing several trans women with free recommendation letters that were required from psychological professionals prior to genital surgery (p. 81). Later, she notes that Bailey faced accusations of practicing psychology without a license due to providing these letters (p. 94), at which point she downplays their significance, stating that the letters were “obviously based on a few short conversations” and of limited value to these trans women (p. 95). In the paragraph following this, she once again suggests that Bailey saved these women “thousands of dollars in therapy charges” and should have been celebrated by trans activists.

Dreger indicates her distaste for a passage in Bailey’s book where he describes one trans woman’s attractiveness in terms of male heterosexual interest:

“When [the transkid Kim] came into my laboratory, my initial impression was reconfirmed. She was stunning. (Afterward my avowedly heterosexual male research assistant told me he would gladly have had sex with her, even knowing that Kim still possessed a penis.)” I got that in this passage Bailey was trying to convince people to get over their knee-jerk transphobia—but honestly, calculating a trans woman’s attractiveness using this particular metric seemed a bit much for a book by a scientist. (p. 70)

Despite her criticism of this appraisal, Dreger herself later characterizes the appearance of another one of Bailey’s interviewees in an almost identically objectifying fashion:

Looking at photos and videos of Juanita, including an erotic seminude photo of Juanita that Conway posted on her site, I could well imagine that a straight guy who is not transphobic would be interested. (She’s gorgeous.) (p. 98)

Unlike her interpretation of Conway’s personal photos, Dreger does not seem to regard Juanita’s explicitly erotic photo as evidence of autogynephilia.

In addressing accusations that Bailey had sex with Juanita during the writing of The Man Who Would Be Queen, Dreger describes Juanita in terms that are reminiscent of a defense attorney’s cross-examination:

In her segment, Juanita—the woman who a year or so later would anonymously play a wounded, innocent shy girl outed and sexually used by the ruthless cad Bailey—went on like this, with a confident smile: “When I was a she-male [and] I prostituted myself, . . . I enjoyed it . . . easily making about a hundred thousand [dollars] a year.” (p. 82)

Dreger later offers evidence that Bailey and Juanita did not have sex on the date that Juanita claimed in an affidavit (p. 98). She also notes that she was persuaded by Bailey that even if he did have sex with Juanita, this would not have been unethical (p. 97). If Dreger feels she has sufficient proof that this incident never happened, and believes that this is a non-issue anyway, what need is there to present Juanita’s history of sex work as if to imply that she could not be wounded, innocent, or sexually used? This is a jarring approach to a question that could have been fully answered on evidential grounds.

She also suggests that sex research on trans women was being discouraged or perhaps even “censored” by Lynn Conway and the wider campaign against Bailey’s book. Referring to her experiences at a conference in 2008, Dreger says:

How was this panel censoring people like Bailey or me? But I thought, come on. The note on the door, the Web pages, the video camera, and what so many sex researchers had said to me: that no one in sex research will touch male-to-female transsexualism with a ten-foot pole anymore. Which must have been just what Conway meant to do. (p. 130)

Despite her concerns, a substantial amount of sexological research has been published on trans women since that time, including a great deal of research on autogynephilia. If anything, publications on the topic are even more diverse now, with many findings that call into question the tenets of Blanchard’s theory. Unfortunately, none of these illuminating studies are mentioned in Galileo’s Middle Finger.

8. Societal fallout from a sexualized theory of trans women’s genders

Dreger acknowledges that promoting Blanchard’s sexualizing typology can present particular risks to trans women due to the widespread stigma they already face. She recognizes that trans women experience rights violations and danger in society from frequent discrimination and violence. She rejects the notion that a fundamentally sexual nature of trans women’s genders would justify such prejudice, and she decries Paul McHugh’s invective against transition treatment, analogies comparing transitioning to indulging anorexic self-image, Janice Raymond’s transphobic rhetoric, and the exclusion of trans women from the Michigan Womyn’s Music Festival (p. 64).

These are all helpful and conscientious stances to take, and they’re a rare moment of clarity in an otherwise rapid-fire series of inaccuracies. However, Dreger’s presentation of Blanchard’s theory has the potential to cause a number of harms that she does not mention. No matter how much these sexologists may voice their support for transitioning, this theory treats trans women’s public existence as women as the ultimate enactment of sexual motives, and it does so in a society where these women are already maligned as posing a sexual threat.

At the same time that the rallying cry of “no men in women’s bathrooms” is being used to support legislation forcing trans women into men’s bathrooms under threat of prosecution, Dreger admiringly quotes a researcher who continues to describe trans women as “men trapped in men’s bodies” (Lawrence, 2013). Such a notion urges cis people to look at their trans woman family members, friends, neighbors, and coworkers, and view them as men who are overwhelmed with an all-consuming lust for womanhood and publicly engaging in a sexual fetish.

With this understanding as the lens through which trans women are seen, coupled with Dreger’s lackluster coverage of the very real health benefits of transition, it’s suddenly a far greater challenge to encourage social acceptance and respect of their existence. It becomes that much harder to expect the public to accept being asked to recognize such a person’s gender, name, and pronouns, accept the impact that their transition can have on families and workplaces, accept their use of medical resources, or accept their place in women’s restrooms and locker rooms, because all of these things are being pursued in furtherance of an overgrown sexual whim.

And should anyone be tempted to believe our own testimony about the nature of genders, the theory assures them that we cannot be trusted and are so thoroughly deluded by our sexual motivations that we can’t even acknowledge they exist. It dismisses trans women as fundamentally mistaken about who we are, discourages others from making the same “mistake”, and ultimately undermines any publicly comprehensible justification for our existence.

It also depicts trans women as constitutionally dishonest in even the most basic aspects of their lives, as the backdrop to an investigation into whether trans women were dishonest in the course of their campaign against Bailey. Dreger is not an incompetent researcher by any means – her lengthy, in-depth investigation into the use of dexamethasone to prevent masculinity and lesbianism in female fetuses is revelatory and significant. She’s clearly capable of taking a far more measured and accurate approach to scientific controversies, so the deficiencies and gross distortions in her coverage of Blanchard’s typology are especially disappointing. In light of these shortcomings, her appeals to social justice through the pursuit of empirical truth come across as hollow and even mocking. A reader who has no familiarity with the scientific literature in this field would not be able to recognize the numerous flaws in her account, and would likely come away from Galileo’s Middle Finger believing that this highly contested theory is settled fact. What kind of justice can Dreger claim to be promoting here?

Galileo’s Middle Finger: Heretics, Activists, and the Search for Justice in Science, by Alice Dreger. New York: Penguin Press. 352 pp. $27.95. ■

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