Transgenderism in nonhomosexual males as a paraphilic phenomenon: implications for case conceptualization and treatment

Transvestic fetishism and the nonhomosexual type of male-to-female (MTF) transsexualism are closely-related entities, but the former is usually considered a paraphilic phenomenon, whereas the latter is not. I argue that it is useful for therapists to think about both entities, and the clinical spectrum to which they belong, as paraphilic phenomena. Both of these forms of nonhomosexual male transgenderism can be understood as outgrowths of autogynephilia, or paraphilic sexual arousal to the thought or image of oneself as a female. Autogynephilia resembles a sexual orientation, in that it consists of both erotic elements and elements that are not explicitly erotic. Autogynephilia plausibly explains the development of cross-gender identities in nonhomosexual transgender males. Understanding the meaning, significance and implications of autogynephilia can assist therapists in case conceptualization and can facilitate respectful, empathetic therapeutic work with nonhomosexual male transgender clients.