This Week in Gender: Bailey and the Two-Type Diagnosis

Hey again,

Monday's episode features an excellent essay by Tobi Hill-Meyer about the history of "autogynephilia" as a concept. I'm posting the full transcript below, including Tobi's citations and an extended bio, in case it helps to follow along or refer back to. (The full episode transcript will also eventually be up on our website.) 

And, hey, if you read this in the three hours before the full episode goes live, it's like a fun sneak preview of the ep. Thanks for being a patron so that we can afford to pay folks like Tobi to write and record essays for us! :)

Bio: Tobi Hill-Meyer is an Indigenous Chicana trans woman who creates stories that have the power to give us strength, encouragement, and can create greater empathy. She is editor of the Lambda Literary Finalist anthology Nerve Endings: The New Trans Erotic, author of children's books A Princess of Great Daring and Super Power Baby Shower, and director of the award winning erotic documentary series Doing it Online.

Tobi is dedicated to community support and fighting for positive change at a local level, is a founder of Gender Justice League, and currently serves on the WA State LGBTQ Commission. She lives in Olympia, WA with her polyamorous family and young child, where she loves gardening, land restoration, and working on small building projects.

Recently, Buck Angel and a few other people released a letter called, “Trans Men Fight Back.” It left many shocked and confused. The main argument was that conversion therapy could be beneficial to some trans people, but that trans women - specifically autogynophiles - had taken leadership of the trans movement in order to get conversion therapy banned. The whole thing read like it was written by a TERF who somehow tricked some trans men into signing it. Did they really want conversion therapy? And what is an autogynephile?

I can’t really answer that first question, but I have some answers for the second one. In his 2003 book, The Man Who Would Be Queen, J Michael Bailey presented an argument that all trans women transition for one of two reasons. Supposedly, some trans women are gay men who want to become feminine as a part of their relationships with men. Essentially, these are straight trans women, who he misgenders by calling “Homosexual Transexuals.” All other trans women, queer, lesbian, bi, pan, and even asexual, he depicts as straight men who fetishize women so much that the idea of becoming one is a sexual turn on.

The idea of splitting all trans women into two groups isn’t new. Going back to some of the first western doctors working with trans patients, there’s always been a two-type model for trans people. First it was the “True Transexual” and “Secondary Transexual.” Then it was the “Transexual” and “Transvestic Fetishism.” In the DSM-V they changed Gender Identity Disorder to Gender Dysphoria but Bailey’s mentor, Ray Blanchard, snuck in “Autogynephilia” as another diagnosis to join it.

In each case, there’s one diagnosis that is seen as more legitimate, more deserving of treatment, and more real. While the other diagnosis weaponizes sexual shame to denigrate and dismiss the trans women they see as undeserving. The first gender clinics turned away a strong majority of the people seeking their help. They were under pressure to prove the legitimacy of their work, and they believed that turning so many away would prove that those they accepted were truly deserving. This two-type diagnosis is how they decided who to accept and who to reject for treatment.

The main criteria for being deserving or not was always around sexuality. When living as a woman, did you ever get sexually aroused and masturbate, or were you too disgusted by your genitals to consider it? Were you interested in your own sexual pleasure, or mostly interested in sex to be validated as desireable to straight men? After transition, did you plan to blend into society as a straight cis man’s wife, or were you interested in cis women, other trans people, being single, or hanging out with queer or trans people? For decades, they almost universally refused to give medical care to anyone who wasn’t going to appear straight after transition.

At one point, whether or not your doctor was attracted to you was actually an official diagnostic criteria. Because the assumption was that the doctor was a straight man and if he was attracted to you, you must be sufficiently a woman. If he wasn’t attracted to you or turned off by you, then you were really a man who was just confused. Apparently, the doctor’s libido never lies.

They later removed that unprofessional diagnostic tool, but the desires of male doctors continued to play a role all the way up to Bailey. Doctors were clearly motivated to make trans women into viable sexual partners for normal straight men. One of the highest priorities of early vaginoplasty was having adequate depth to accommodate the average penis. The patient’s own pleasure was deprioritized, and sometimes not considered at all.

Bailey’s mentor, Ray Blanchard, claims to have invented the idea of the homosexual transexual and the autogynephile, but mostly he just renamed the two-type diagnosis and created a more specific definition. Bailey is credited with popularizing it. And Bailey embodies all the worst qualities that have influenced this system over the years.

While Bailey claims not to discriminate against autogynephiles, on page 206 of his book he lets others make the case that they shouldn’t be allowed surgery. Bailey describes autogynephiles as “men trapped in men’s bodies” (p. 168) and more likely to have surgery regrets (p. 207). On the other hand, he describes “homosexual transexuals” as “naturally feminine” (p. 168), “better looking than autogynophiles” (p. 180), “more attractive than the average genetic female” (p. 141), having male levels of sex drive, and “well suited to prostitution,” (p. 185). It reads like a description of his fantasy trans woman more than anything else.

It would be difficult to hide this stark belief from his psychotherapy patients. And since he would have the ability to grant or deny medical access, it’s likely many of his patients attempted to conform to his ideas about the deserving trans woman. That’s why I was not surprised when, just after his book came out, he was caught having sex with his patients and publishing their experiences without permission. It already appeared as if he was exploiting his patients. Apparently he wasn’t opposed to sexually exploiting them as well.

He bases most of his theory on his own patients, but were they even telling the truth? Even Bailey recognized some patients were telling him what he wanted to hear in order to get access to surgery, but he just concludes that autogynephiles commonly lie to hide being an autogynephile (p173).

Conveniently, this also sets up a perfect defense to his ideology: if any trans woman disagrees with his theory or claims that neither of the two models apply to her, then she must just be an autogynephile trying to deny it. This is a classic fallacy of being non-falsifiable. Then there’s the circular logic where he forces everyone into these two types based on his diagnostic criteria, then points to the fact they match his criteria as proof that it is a natural distinction.

The stories of these two types might ring true for a few trans people out there, but the idea that all of us can only exist within these two stories would be laughable if it wasn’t so harmful.

When a guy declares that there are two types of women in the world - attractive subsurvient women who are available for sex with men, and the pitiable ugly bitches who disagree with him, most of us would assume he was a pickup artist or an incel. In the end, this theory put together by Bailey and the doctors before him is little more than the sexual fantasy of abusive men exploiting trans women’s own shame and vulnerability to force them to present the kind of womanhood that they find most desireable.

Hypothetically, some trans men could be autoandrophiles, but that’s never discussed and not stigmatized. It’s one of the great ironies of this letter that Buck Angel fits the autoandrophile definition perfectly, yet he can claim to be one of the good ones while pointing to the undeserving trans women because being a man interested in sex is just normal.

So when TERFs or the trans men who wrote that letter decry trans women in positions of leadership, they are just grasping at the same tired old misogyny in order to tear down women they are threatened by. And as weird as their argument sounds, when you understand the full context, it just becomes all the more ridiculous.