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Autogynephilia and autoandrophilia

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Autogynephilia (/[미지원 입력]ˌɔːtoʊˌɡaɪnəˈfɪliə/; from Greek “αὐτό-” (self), “γυνή” (woman) and “φιλία” (love) — "love of oneself as a woman") is a term coined in 1989 by Ray Blanchard, to refer to "a man's paraphilic tendency to be sexually aroused by the thought or image of himself as a woman." Alternative terms proposed for this notion include automonosexuality, eonism, and sexo-aesthetic inversion. The DSM-IV-TR includes an essentially equivalent definition, and recognizes autogynephilia as a common occurrence in the transvestic fetishism disorder, but does not classify autogynephilia as a disorder by itself. The analogous term autoandrophilia refers to a woman's tendency to be sexually aroused by the thought or image of herself as a man. It classified as a type of transvestic fetishism in a proposed revision to the DSM-5. (Blanchard has served on the gender dysphoria sub-working group for the DSM-IV and of the paraphilia sub-working group for the DSM-5.)

Autogynephilia is most notable for its sole use in Blanchard's taxonomy to explain the presence of gender dysphoria in "non-homosexual" (gynephilic) male-to-female transsexuals, in contrast to the gender dysphoria observed in "homosexual" (androphilic) transsexual people. Autogynephilia has also been suggested to pertain to romantic love as well as to sexual arousal patterns. While Blanchard claims that autogynephilia does not exist in natal (from birth) women, Veale et al. (2008) and Moser (2009) report that it does exist in natal women at rates close to or equal to that of non-homosexual transsexual people. This is controversial.

Blanchard provides case examples to illustrate the autogynephilic sexual fantasies that people reported:

Philip was a 38-year-old professional man referred to the author's clinic for assessment....Philip began masturbating at puberty, which occurred at age 12 or 13. The earliest sexual fantasy he could recall was that of having a woman's body. When he masturbated, he would imagine that he was a nude woman lying alone in her bed. His mental imagery would focus on his breasts, his vagina, the softness of his skin, and so on—all the characteristic features of the female physique. This remained his favorite sexual fantasy throughout his life.

According to Blanchard, "An autogynephile does not necessarily become sexually aroused every time he pictures himself as female or engages in feminine behavior, any more than a heterosexual man automatically gets an erection whenever he sees an attractive woman. Thus, the concept of autogynephilia—like that of heterosexuality, homosexuality, or pedophilia—refers to a potential for sexual excitation" [emphasis in original].

Blanchard classified four subtypes of autogynephilic sexual fantasies, but noted that "All four types of autogynephilia tend to occur in combination with other types rather than alone."

• Transvestic autogynephilia: arousal to the act or fantasy of wearing women's clothing
• Behavioral autogynephilia: arousal to the act or fantasy of doing something regarded as feminine
• Physiologic autogynephilia: arousal to fantasies of female-specific body functions
• Anatomic autogynephilia: arousal to the fantasy of having a woman's body, or parts of one.

There also exist biological males who report being sexually aroused by the image or idea of having some but not all female anatomy, such as having female breasts but retaining their male genitalia; Blanchard referred to this phenomenon as partial autogynephilia.

Autoandrophobia (from Greek “αὐτό-” (self), “άνδρας” (andras/man) and “φόβος” (phobos/fear) — "fear of oneself as a man") is a related but different term to autogynephilia which was coined by Moser (2010). Some male-to-female transsexual people in whom estrogen has been contraindicated (e.g., due to deep vein thrombosis) have found that antiandrogens alone were sufficient to relieve their gender dysphoria. This seems to suggest that male-to-female transsexual people are not just motivated to transition by autogynephilia, but also due to a desire to block their masculine characteristics. Such a symptom is not characteristic of other paraphilias. In any case, the relative roles of autoandrophobia and autogynephilia in gender dysphoria in male-to-female transsexual people is not entirely clear, and further research appears to be necessary to elucidate them.