First things first, the appeals to autogynephilia are silly as Julia Serano and Charles Moser (I recommend reading these if you aren't versed on the topic) have both provided large-scale responses to the typology and pointed out its unfalsifiability, poor data use and interpretation, among many other issues. I'd also like to point out a few additional things, such that Anne Lawrence frequently conflates sexual behavior and attraction, for instance, in attempts at rebuttals, even though just about every sexologist recognizes them as distinct, and, while Serano and Moser don't explain it, Blanchard's typology too is initially circular, as Blanchard justified it based on his own research findings - essentially, he used the data he used to form a hypothesis as evidence for said hypothesis.
With that said, the first response I'd like to make is that "NotPoliticallyCorrect" blatantly conflates "transvestic disorder" and gender dysphoria. The DSM-V, which he himself cites, points out that those with TD do not experience gender dysphoria - it does claim that autogynephilia can lead to gender dysphoria (I'd like to briefly point out that Blanchard was on the DSM-V taskforce), but nowhere does it advise that they're the same, making the bulk of points he makes irrelevant.
An additional note I feel to make is the frequent citation of case reports as 'evidence.' The problem is, case reports are scientifically equivalent to anecdotal evidence. This makes them useless for scientific evaluation specifically, with their primary use being to document rare phenomena or to be the demonstration for a possible hypothesis to later investigate. Never, however, should they be seen as actual evidence for a given phenomena.
With all of this said, I'll continue on.
Following a paragraph explaining the clinical view of Dr. Mark Griffiths (Griffith supports himself with evidence, and these claims aren't relevant for the discussion), a reference is made to a paper by the aforementioned Charles Moser that documents the most women experience AGP, but a note is made in it and in the NPC discussion that, as Moser said, "It is possible that some respondents in the present study (genetic women) were aroused by the possibility of or fantasy about a sexual encounter rather than the “autogynephilic” stimuli described." However, only mentioning this section ignores a point that trans individuals have been making for decades in response to it, that Moser himself noted immediately after - "It is possible that some “autogynephilic” MTFs were aroused by the possibility of or fantasy about a sexual encounter as a female rather than “autogynephilic” stimuli." This is likely what accounts for the 'autogynephilia' phenomena. Anne Lawrence attempts to respond to the paper, essentially elaborating on the caveat that Moser noted (with additional critiques of its construct correspondence to the original AGP scale), however Moser responded and pointed out how Lawrence was blatantly misrepresenting his claims and scale, and defended its utility quite well. What I find most hilarious is how the two are apparently friends, but that Lawrence is so determined to her ideology on this that she still misrepresents him.
The next claim made are a few correlates in a paper that did a random sample of the population to find individuals with TD. I'd like to briefly note that, while the interpretation of the data is correct, there's some important caveats to note. First, at modern statistician standards of p < 0.001 (see here and here for justification) for a statistical significance level, only some of the claims are validated - them being gay sex, masturbation, pornography, and a handful of fetishes - the claims about easy sexual arousal, parental separation, and sexual life satisfaction fail to meet this threshold. Further, however, the confidence intervals for the odds ratios give broad results, presumably due to the small sample size, meaning that the difference between the two populations could be much smaller than indicated. There also was no adjustment for potential covariates such as socioeconomic status, which may have differed between the two populations had the author had a larger sample - they point this out, however, noting a lack of statistical power for most comparisons. There's also notation of a 'non-significant trend' for a linkage with sexual victimization, however the idea of 'trends' in hypothesis testing is a pretty bullshit claim, due to the fact that an increase in sample size doesn't a priori mean that a relation would be significantly observed. It may have, yes, but to point out a trend without this caveat is misleading. Further, NPC's claim of gay sex, while true, is misleading because most respondents identify as heterosexual, and none reported being attracted to men as the primary reason for cross-dressing. Also, the claim is made that
"By attempting to treat what TD is correlated with, symptoms of TD can be lessened."
However, this is incredibly, incredibly flawed. Just because something is comorbid with other paraphilias, does not mean that one causes the other. It may mean that, say, an individual is more likely to develop them. Even if they did cause one another, this doesn't mean that after TD developed, 'treating' the other paraphilias would lessen it. Also, why the fuck should it be treated? If it doesn't cause the individual any inherent harm, and they don't desire treatment, then this is hardly something that should be advocated for! It just represents a reactionary desire to see people conform to the norm because it's 'good' for some bizarre fucking reason.
Next we'll be getting into some claims made with this paper as justification.
The following paragraph essentially just points out what proponents of Blanchard's typology says about cross-dressing, although it suffers from the above flaws noted. However, a specific claim is made - being that,
"Men suffering from TD will go to any lengths to hide their secret. This then causes extreme dysfunction in their lives, which leads to a lessened quality of life."
This is exceedingly misleading, however, as the study does NOT report every individual who has TD as having ego-dystonic distress; rather, while it reports a majority (over 50%) does, this is not an inherent characteristic towards the paraphilia.
The next paragraph is some very shifty and misleading bullshit, for reasons I'm sure will be apparent when I show the whole thing.
"Less than three percent of males suffer from TD in the American population, as such, it is classified as a deviant lifestyle as it deviates from the norm of the population. It causes distress due to them not wanting their secret to be discovered. This, in turn, leads to dysfunction where the individual cannot live their daily lives to the fullest due to their abnormal disorder. It finally leads to danger due to their secret beginning to consume their lives so that they’re not discovered."
This whole paragraph is made without any given evidence (save for the bit of less than 3% of men having TD). Just because it deviates from what's societally classified as the 'norm' does NOT mean that it is 'deviant,' which is clearly the author trying to imply it's bad. This is a flawed argument, since it rests on circular reasoning; it inherently presumes a norm, and since a norm exists, that means anything that deviates from it is a 'deviant' action, and the reason it is 'deviant' is because it disagrees with the established norm. It leaves no room for paraphilias being a typical, albeit rare, 'normal' part of human sexuality. If it doesn't cause people harm in a way they don't consent to, then this can hardly be called 'bad.' I'd again like to emphasize that discussions of TD are irrelevant for transgender individuals.
It also, by later presuming that it needs to be 'treated,' places the blame on the victim, which is all kinds of fucked up. It shifts the blame from an oppressive, normative society that forces its roles on people and instead chooses to blame victims as if they're at fault for expressing their sexuality. The very fact that not all people experience distress from it proves that it isn't inherent, and it cannot be called bad. Of course, I anticipate NPC - if he responds to this - to not really address this point, dismissing it as some 'feminist bullshit' or something of that ilk.
Anyway, what's next cited is a case report which administrates fluoxetine, a medication that, among other things, is used to treat obsessive compulsive disorder, and reports a reduced desire to masturbate. Of course, the case report suffers from numerous flaws, such that no quantitative data is available, the sample of 1 is too small for there to be statistically significant results, and no mention of it possibly being a placebo effect. It also had clear parallels to OCD. There's mention of another study that uses the same medication and makes the claim, however I'm not able to view this study, although considering its age and the fact that the authors don't mention caveats, I'd bet it suffers from the same methodological problems too. The authors also cite five more studies about the topic, two of which NPC mentions, so I'll handle those separately. The three case studies will be handled independently though; and, of course, they are (Rubenstein and Engel, 1996), (Fedoroff, 1988), and (Praharaj, 2004). I wasn't able to view the Rubenstein and Engel study, however I did find this study which also administers fluoxetine and suffers from the same methodological caveats in both cases reported. It also reports three case reports of similar treatments for other paraphilias, one of which reported three in one, and unfortunately I'm not able to view it. Another was on a patient with scizophrenia, another that I again can't view, and a final one which notes that the patient seemed very akin to someone with OCD. There's also a link to a case report where lithium, something they claim is used to treat bipolar disorder, in a patient with bipolar disorder and scizophrenia were reported along with things such as hallucinations, in a TD individual. The Fedoroff study, which reports using busiprone hydrocloride, something used for anxiety disorders, to 'treat' TD in an individual who also had an anxiety order is one I am also unable to view. However, the same author has another paper using the same treatment on a different individual who had an abundance of psychiatric disorders. This patient, however, wasn't TD either (this is only discussed in a brief paragraph where the patient stopped having cross-dressing fantasies before taking busiprone) - in fact, he had later revealed he had a desire to have sex with his adoptive sister in a masochistic manner that I'd prefer not to describe here - view at your own discretion. It's pretty fucked to say the least, especially since he desired to enact upon them later on. Busiprone had no effect on this. He did report they got better a couple months after treatment, but they still remained intensely. What I'll grant this case report is that, in the discussion, it points out all the limitations I did, save for the quantitative one.
After viewing these, it should become apparent that, of the ones able to be viewed, they all either had symptoms of or comorbidity of psychiatric diagnoses - something that clearly makes these not generalizable to the bulk of TD individuals, who, as far as I'm aware, do not have these in terms of a significant majority - the study NPC linked didn't provide evidence of this either. In actuality, it's likely the desire to cross dress from these cases resulted from the disorders, which certainly can't be said to be generalizable to most TD individuals, due to the fact that there's no evidence it, in any population, causes a significant degree of TD attraction. In fact, the aforementioned reference to Griffiths supports this, as he notes that not all TD individuals do it for sexual reasons, with Griffiths even claiming most TD individuals never seek psychiatric help, suggesting against a psychopathological cause. As if this, for some reason, needed to be argued against in the first place.
The other case reports discussed by NPC is a 1993 review of 13 patients which I am unable to view as a whole, however it flat out points out that paraphilias were most resistant to treatment whilst 'sexual obsessions' received the greatest response, which supports what I said in the earlier paragraph. To be fair to NPC, he does note this, however he claims that
"They end up concluding that paraphilias and other related disorders are on the impulsive end of the spectrum compared to the compulsive end. These impulsions, then, have those men suffering from TD have the urge to dress in women’s clothes to fulfill their sexual impulsion."
This is plainly false; the authors don't conclude anything in the conclusion, but rather speculate with the usage of 'perhaps' prior to the statement itself. Further, he misrepresents what 'impulsivity' means - it's not spontaneously making a choice as is implied, but rather, in psychiatry, it's “"a wide range of “actions that are poorly conceived, prematurely expressed, unduly risky, or inappropriate to the situation and that often result in undesirable outcomes,” or more simply put, a tendency to act prematurely and without foresight. Moeller and colleagues defined impulsivity as “a predisposition toward rapid, unplanned reactions to internal or external stimuli without regard to the negative consequences of these reactions to the impulsive individual or to others."” In other words, it's an indicator of undergoing actions without regard for consequence without much plan beforehand, not a spontaneous impulse to jump aboard something.
Next is a final case report of two people specifically CHOSEN to be comorbid with TD and OCD, and for some reason NPC chooses to act as if it means ALL TD people are (though he later admits in the comments that it only means some are, which would be true for anything; it doesn't mean that there's more people with TD who have OCD than the general population). While both were treated with various medications, neither reported a complete loss of cross-dressing; in fact, case 1 reported decreased libido as a whole, which, unless we want to assume that sex with someone's wife is something to be treated, should be indicative that it's silly to assume cross-dressing behavior is 'unnatural' due to treatments like this. I already pointed out the flaws with this sort of research, though, so I won't repeat myself on this.
Finally, it's claimed that hormone replacement therapy and genital reassignment surgery have no effect on well-being, citing a study on suicide attempts among trans people being in the 40% range, higher than the national average, being, at most, 7.4%. The problem is, this study only assessed transgender identity, not people who have transitioned, except for table 5, where the authors note "respondents who said they had received transition related
health care or wanted to have it someday were
more likely to report having attempted suicide than those
who said they did not want it." However, they flat out point out that they don't assess when this took place, and so it's likely people who were more gender dysphoric, and thus more likely to attempt suicide, transitioned. This survey even cites studies in the discussion that support this view. Further, however, they mention their methods likely overestimated the quantity of trans people who report this (though I can't imagine why their methods would inflate it to such a high degree, especially since other studies support that trans people are more likely to be suicidal), and a lack of controlling for prior mental health status (though this, in my opinion, is redundant if we assume dysphoria leads to mental health issues). Furthermore, they report it's nonrepresentative.
So let's take a look at some studies that demonstrate the benefits of transitioning. A study in Sweden reported that, "In line with the increased mortality from suicide, sex-reassigned individuals were also at a higher risk for suicide attempts, though this was not statistically significant for the time period 1989–2003," meaning that, among more recent transitioned individuals, they have comparable suicide rates to the general population (View citations within too to see more data). The older ones, which the authors point it could be very well due to increased societal acceptance of these individuals and better healthcare. This is likely when we view the confidence intervals of the data, as the more recently transitioned group has a far smaller range for confidence intervals than the older group, suggesting less heterogeneity and thus less error in the data. Since more reliable estimates of suicide attempts are in the 32% - 50% range, with it being fairly consistent across countries (though none of the studies were in Sweden), this suggests a strong effect of transitioning. Another more recent study only found two people, 20 years after genital reassignment surgery, had committed suicide, being a 2% suicide rate. The suicide attempt rate (I couldn't find information on the suicide rate) is about .1 in some Denmark regions, being lower in others. This certainly is a higher than we should expect (although much lower than the USA suicide rate), but it's still incredibly low, and the rate of attempted suicides in America - and, considering the small sample size, it's unknown if these would generalize to a larger one. Further, as it's the oldest respondents doing this, it's likely either independent of being transgender, or a result of discrimination from this - as if it were due to psychopathology we should expect much higher rates much sooner. This is supported by the Sweden study.
Other evidence comes from a large meta analysis pointing towards beneficial effects, with study after study after study supporting beneficial results. I plan on doing a larger post in the future to analyze all of these studies, but for now they can be summarized as supportive of beneficial effects of transitioning.
And so, NPC concludes by essentially summarizing all prior points that are rebutted. Of course, I'll have to make another post to respond to something he posted in the comments - that being trans is a 'compulsive' disorder, which is not a view held by any medical professional as far as I'm aware. In fact, study after study after study of the largest, and thus most generalizable, samples in the literature find consistently that trans people have a similar proportion of "Axis II" disorders to cisgender controls. But I'll do a detailed response to this later anyway just to point out the bad science behind it.
So there you fucking go.
