📖 Background

This series of case reports highlights a new and fascinating phenomenon that seems to occur in some androphilic men. These men are attracted to men with breasts; they are sexually aroused by the thought of having breasts as men; and they seriously consider cosmetic surgery to become men with breast implants. To the best of my knowledge, this phenomenon has never been reported in the academic literature. In my opinion, it is best understood as an internalized form of attraction with a corresponding identity inversion.

📌 Case summary

• Hassan is a case study in internalized sexual attraction and erotic target identity inversion;

• He is attracted to men with large breasts and men with large buttocks;

• His attraction is also internalized, as he is sexually aroused by the idea of having large breasts and buttocks as a man;

• This internalized attraction rises to the level of a mild identity inversion: he has the sustained interest, beyond temporary sexual arousal by erotic fantasy, to become a man with large breasts and buttocks;

• This identity inversion makes him consider pursuing cosmetic surgery (breast augmentation and Brazilian butt lift) to gain the features he desires on his body.

📝 Case report — Hassan

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📖 Background

This series of case reports highlights a new and fascinating phenomenon that seems to occur in some androphilic men. These men are attracted to men with breasts; they are sexually aroused by the thought of having breasts as men; and they seriously consider cosmetic surgery to become men with breast implants. To the best of my knowledge, this phenomenon has never been reported in the academic literature. In my opinion, it is best understood as an internalized form of attraction with a corresponding identity inversion.

📌 Case summary

• Federico is a case study in internalized sexual attraction and erotic target identity inversion;

• He is attracted to an unusual class of erotic targets: men with breasts;

• His attraction is also internalized, as he is sexually aroused by the idea of having breasts as a man;

• This internalized attraction rises to the level of identity inversion: he has the sustained wish, beyond temporary sexual arousal by erotic fantasy, to become a man with breasts;

• His identity inversion makes him seriously interested in pursuing cosmetic surgery (breast augmentation) to make his body more closely resemble his ideal self-image.

📝 Case report — Federico

Federico1 is a 37-year-old gay man from the United States who is of European ancestry. He is “mostly attracted” to men, and most of his sexual experiences have been with men. Although he has had female partners “from time to time”, he has never felt “emotionally involved” with a woman in the same way he has with men. He came out as gay in college and currently describes himself as “gay mostly” but “technically bi[sexual]”. He also describes himself as “very straight-passing and masculine-presenting”. In terms of sexual preferences, he is usually the insertive partner, but he occasionally “bottoms”.

Federico is also attracted to vaginas, on men and women alike. This means, in particular, that he is sexually attracted to natal men who undergo vaginoplasty as well as transgender men who masculinize their bodies with exogenous testosterone but retain the native vagina. To Federico, having a vagina is “an extra oomph” for a man. That said, he is not sexually aroused by the idea of having one himself.

Federico has also been with pre-operative transgender women, but he says he did not perceive them any differently from cisgender women, and he did not feel any particular way about the presence of a penis. He describes his tastes in “genital attraction” as “pretty standard-level” bisexual, but heavily leaning onto gay.

Federico has a sexual fascination with “men with big breasts”. He refers to it as his “biggest fixation for the past twenty years or so”. When talking about this topic, he draws a distinction between men who get breast implants to achieve the look of large female breasts, and men who get pectoral implants to achieve the look of a muscular male chest. Federico’s fascination is with the former, not the latter. “The more a man’s pecs look like breasts, the hotter they are to me,” he explains. He considers his interest in breasts as the only part of his attraction in which he is “really kinky”.

Federico recalls that his erotic interest in men with breasts began at the age of 16. By that time, he had already realized he was “into guys as much as into girls, and probably much more into guys”, but he was not yet open about his attraction to men. He says he was always “nipple-oriented”: he was attracted to women’s breasts—the larger, the better—and also drawn to men’s nipples.

Federico’s interest in tattoos and piercings led to his discovery of Body Modification Ezine, an online magazine about exactly what the name suggests. One day, Federico came across the topic of male breast implants on that online magazine.2 There was a masculine man who had many tattoos and piercings, a shaved head and a beard, but also large breast implants. “I stopped in my tracks,” Federico recalls. He describes what he saw as “the single most sexually arousing thing” he had ever seen in his life.

Federico found himself “obsessively” coming back to the photos of breasts on that man and masturbating to them. His obsession drove him to research this stranger’s identity. He began finding other men like him and collecting photos of them. For the purpose of masturbation, Federico collected from the internet “a huge spank bank” of photos of men with breast implants. These men included Canadian magician and gambler Brian Zembic, a heterosexual man who got breast implants in the 1990s and claimed he did so to win a $100,000 bet from a friend. According to Zembic’s story, he had to keep the implants for only a year, but he never took them out.3

Federico began to fantasize about making another man get breast implants. He would see a photo of a man “with a nice chest” and think to himself: “He’d look even hotter with a boob job.” This thought alone would arouse Federico. He would also imagine “winning billions of dollars in a lottery and setting up a fund that paid guys a million dollars’ fee to get breast implants to make it more popular and common and acceptable”. This latter fantasy was apparently inspired by the story of Brian Zembic.

Federico also knew a man online who had “some interest in having breasts”. This man, a “himbo type”, told Federico that he was the “kept boy” of a wealthy, older boyfriend who was “extremely” interested in having a “boy with boobs”. The wealthy gentleman wanted to arrange and pay for breast augmentation for his “kept boy” in another country, even deciding on the size of the implants by asking the surgeon for “the largest he could fit in”. This “kept boy” apparently obtained the implants and kept them for six years. He eventually had them removed after breaking up with the wealthy boyfriend, because the breasts became a “constant annoyance”—according to what he told Federico.

Driven by his interest in men with breasts and men with vaginas, Federico even “hooked up and had a short relationship” with a man who had both. This man had undergone both breast augmentation and vaginoplasty by pretending to his doctors that he was a transgender woman. Shortly after the surgeries, he dropped the pretense and went on testosterone instead to become a man with breast implants and a neovagina.

From the moment Federico discovered his peculiar attraction to men with breasts at the age of 16, he was also very aroused by the thought of having implants himself. He nonetheless soon found himself “walking that back”. The issue lay in the fact that Federico saw himself as a “butch” gay man; the thought of having breast implants was a “feminine thing” that conflicted with Federico’s masculine sense of self. Thus, he managed to “put that thought away” and focus on his external attraction to men with breasts instead of his inner fantasy of having them himself.

Until Federico was 29 years old, he thought of his interest in men with breast implants as only a “kink”. He was “almost” a “total top” and a “masc”, and his interest in men with breasts went well with his dominant role in bed. All this changed, however, when he had a sexual encounter with a German plastic surgeon whose “specialty” was “weekend breasts”: “injecting saline into women’s breasts so that they would temporarily look bigger for a special occasion”.

During that sexual encounter, Federico, who was “a bit under the influence”, confessed that because he “loved boobs”, he had always wanted to “try out having actual breasts sometime”. The plastic surgeon responded “very favorably” to this confession and expressed much interest in the proposition. Even after Federico “sobered up a bit”, the idea still sounded like something he wanted to try.

The doctor spent the afternoon gathering supplies as the would-be patient waited, “incredibly excited” all night. The next evening, the doctor injected saline into Federico’s chest. The new breasts were “hard and sore at first”, but the feeling soon wore off. They seemed “enormous” and made Federico feel as if he were a “huge-breasted porn star”. When the pair headed out to a nightclub, Federico wore a scoop-neck top to show off his new cleavage. To his surprise, he became the “sensation of the night”, receiving countless compliments from men on his “amazing tits”.

By the next day, the breasts were “mostly gone”, but the experience was transformative. That one night at the age of 30 was “as life-changing as seeing those original photos” of men with large breasts 13 years before. Federico came to accept that he was not only attracted to men with breast implants, but that he also wanted to be one of them.

It was this episode in Federico’s life that made him come to terms with his desire for implants on his own body, a desire he had successfully suppressed in the past. From that moment on, he “always” thought about being a muscular man with large breasts in his erotic fantasies, and he has had a “very strong desire” to pursue breast augmentation surgery.

Federico is not sexually aroused by the thought of being a woman. Although he has dressed up as a woman for Halloween, it was done for “drag”, and he was not aroused by it. Federico does, however, find bras “sexy” when he wears breast forms. He explains that the erotic appeal of bras lies in the fact that “they accompany having breasts”. He clarifies that it is sports and leather bras that appeal to him, not “the lacy Victoria’s Secret kind of thing”.

At first, Federico wanted to get implants as soon as possible, but this turned into a long-term goal for him. He hopes to get his “first set of implants in the next ten years”, after achieving financial stability. He also wants to “transform” his body first, notably by becoming more muscular with “a huge upper back and huge shoulders”. His ultimate goal is to have “very large breast implants”, which will take several operations to achieve. Federico believes that a more muscular upper body would be more proportional to the breast size he desires. A more muscular upper body will also make it easier to pass off his future breasts as “big pecs” when needed.

Federico says he does not identify as anything other than a man. His ideal self-image is a “jacked, buzzcut-wearing, bearded, tattooed, and pierced 50-year-old muscle daddy with big silicone breast implants and a big dick”. This self-image turns Federico on—especially the beard, the large breasts, and the big penis, which he calls his “holy trinity” of things that sexually arouse him in terms of his self-image.

Federico does not perceive breast implants on a man as a “feminine thing”. “On a muscled, hairy, tattooed male body, breast implants in a leather harness are like the most masculine thing imaginable,” he says. For his own goal, he is not interested in taking cross-sex hormones to develop breast tissue; he specifically wants implants.

Federico regularly wears breast forms, even in nonsexual contexts, so that others “get used to [his] having that chest size”, in anticipation of his eventual surgery. He also has “a breastplate or two” that he puts on during masturbation, “for the very realistic look” it gives him. “It really makes me think that I have implants already,” he comments. Federico says he is “very serious” about his desire to obtain breast implants to achieve his idealized self-image.

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📖 Background

Read the main article for an introduction to genital dysphoria in auto-AGMP.

📌 Case summary

• Gabriel is a case study in internalized sexual attraction and erotic target identity inversion;

• He is attracted to three unusual categories of erotic targets: men with vaginas, pregnant men, and anthropomorphic animals;

• His attraction to these targets is also internalized, as he is sexually aroused by the idea of being a man with a vagina, a pregnant man, or an anthropomorphic animal;

• His internalized attraction rises to the level of identity inversion: he has the sustained wish to be what he is attracted to, a wish that persists beyond temporary sexual arousal by erotic fantasy;

• His identity inversion into a man with a vagina, in particular, makes him seriously interested in pursuing major surgery (vaginoplasty) to make his body more closely resemble his ideal self-image.

📝 Case report — Gabriel

Gabriel1 is a 29-year-old gay man from the United States who is of European ancestry. He has “always been comfortable as a cisgender man” and has never “really felt any sort of desire to be anything else”. He knew he had feelings of attraction to men as soon as he entered puberty, and he eventually came out as gay in college. Gabriel currently defines himself as “homoflexible”, because he also finds transgender men attractive, and “very, very rarely” some women, too.

The women Gabriel tends to find attractive are the “more domineering” type, as he is “very submissive” sexually. Nevertheless, the number of women Gabriel believes he was “legitimately attracted to” can be counted on one hand. Gabriel describes his preferences in terms of sexual roles as “almost entirely submissive, almost always being penetrated or otherwise used by someone else for their pleasure and mine”. He does, however, enjoy being the insertive partner, although he does not actively seek it out.

Gabriel discovered “almost by accident” that he was attracted to transgender men who have a vagina. As a teenager, he stumbled upon a Tumblr blog that featured photo edits of female genitalia on masculine men. Even though these edits were not very accurate by Gabriel’s own estimation, he was “hooked” by the results, to the point of being “almost hypnotized”.

Besides his attraction to the look of a man with a vagina, Gabriel also experienced the erotic desire to be such a man. He began to imagine what female genitalia would look like on him. At times, he would press against his perineum during masturbation and imagine that a penis was about to penetrate him in an imaginary vagina. Later on, anal stimulation made it “a lot easier” and “a lot more erotic” for Gabriel to imagine what such vaginal penetration would feel like. He reaches climax “very quickly” when he imagines having “another hole” in the place of his penis where he could penetrate himself with toys.

Speaking about his interest in men with vaginas, Gabriel says he “forgot about it for a few years” but discovered it again in college when he came across online FtM pornography. Gabriel began to look specifically for pornographic scenes in which a cisgender man penetrates a transgender man in the vagina. With the aid of his imagination, Gabriel would at times insert himself into the role of the transgender actor, imagining what it would be like to be in his position, and wishing he could be him.

Gabriel mentions one pornographic actor in particular: Luke Hudson. “I immediately felt like that was the kind of man I wanted to look like,” Gabriel recalls. He has also seen pornography of two men with vaginas “frotting2 or doing other sexual things”, and he thought it was “hot”. Gabriel has only been with cisgender men with penises, but he wants to have sex with transgender men as well. He has tried “several times” but has been unable to do it, “for one reason or another”.

Because Gabriel is sexually submissive, he is also aroused by erotic scenarios of forced transformation. He “very often” enjoys stories of men “being forced to submit and having their penis and testicles transform into a vagina magically in the moment”. Gabriel particularly likes these stories “with as much of the transformation being described as possible”. He enjoys scenarios of forced vaginoplasty less, because surgery “feels far more invasive than an inexplicable, supernatural transformation”.

Gabriel has wished for a long time that he could actually have a vagina. He wishes he could “just snap [his] fingers and make it happen”. Although he enjoys anal penetration, he says his anus is “very sensitive”, so he cannot do it as much as he wants to. “Having a dedicated orifice for that is an enormous wish now,” he adds.

Moreover, Gabriel “never really enjoyed having a penis”, and he “especially hated having testicles and a scrotum”. That said, he feels that his dislike of his male genitalia was independent of his desire for a vagina. As soon as Gabriel started having erections, he hated the feeling, even though he has a “high sex drive” and masturbates or has sex “very often”. It was only after he was sexually active “for a while” that he started wishing he could experience the same sexual pleasure but without “the annoying factor of an erect penis or scrotum and testicles in the way”.

It was only recently, however, that Gabriel began researching vaginoplasty and understanding that it was an option for him. Gaining the knowledge that the surgery did actually create a neovagina capable of penetration while preserving the function of orgasm made him resolute in his decision to pursue it. What stops Gabriel from “immediately scheduling” vaginoplasty is not a personal issue; it is rather “bureaucratic and logistical”: “If I could make it happen without the headaches of insurance coverage and letters of recommendation from therapists, I would do it as soon as possible.”

Gabriel has already contacted a transgender health clinic to secure letters of recommendation from mental health professionals: “I intend to do whatever I can to convince them to write the letters [that] I need to convince my insurance to pay for it.” Once he obtains the letters, he will have to figure out the logistics of travel, caretaking, and electrolysis, which are the “biggest hurdle”.

There are two additional aspects of Gabriel’s sexuality that are notable. The first is his attraction to pregnant men and “men with unusually inflated or distended bellies”. He clarifies that this is different from fat or obese men, a category he does not find attractive: “To me, it’s the difference between a man’s body being like that naturally, and it being a temporary alteration caused by someone else (i.e., a man’s stomach has been inflated by someone else’s cum or something).”

Gabriel also frequently imagines himself as a pregnant man in his erotic fantasies. To satisfy his male pregnancy desires, he looks for erotic fiction and art that cater to them. He has also tried pretending to be pregnant by stuffing objects under his clothes, but such an activity “doesn’t really do much for the fantasy”. “I want to feel my actual body being altered as if to accommodate a uterus,” he explains, “but there aren’t very many ways to do so.”

For erotic purposes, Gabriel has thought about “getting into belly inflation to simulate the feel of it”, but he finds the idea “intimidating”. By this, he refers to men who either drink large amounts of water or introduce air or fluids into the gastrointestinal tract via the rectum, all with the aim of causing a temporary expansion of the belly. This practice can be dangerous, which explains Gabriel’s apprehension.

Gabriel’s fantasies of male pregnancy are “mostly about the belly”, though other aspects appeal to him as well: he mentions, in particular, lactation, labor, and the idea of a fetus inside his belly. At times, Gabriel wishes he could have “not just a functioning vagina but a functioning uterus and ovaries as well”. His wish for a uterus and ovaries, however, is “not as huge a desire” as his wish for a vaginal canal. I asked Gabriel if he would consider a uterus transplant, if such a thing ever became feasible. His answer was categorical: “I’ve considered that question several times and the answer is always an immediate yes.”

Gabriel is also a furry. He recalls several instances in which he had feelings of a sexual nature for anthropomorphic animal characters. These include the 1973 Disney Robin Hood film that depicts the protagonist as an anthropomorphic fox; the anthropomorphic Wolf O’Donnell from the Star Fox video game series; and the anthropomorphic tiger Hobbes from the Calvin and Hobbes comic strip. The last example, in particular, made Gabriel desire to be “an animal like that, with human mannerisms and anatomy but still clearly animal”. Therefore, not only was Gabriel attracted to anthropomorphic animals, but he also desired to be one.

Gabriel remembers one Calvin and Hobbes comic strip in particular where Calvin, the boy, “laments the fact that humans don’t have fangs or tails or paws or wings or other things like that”, as Gabriel explains. Even as a child, Gabriel “vehemently agreed” with the sentiment expressed by Calvin.

Gabriel also recalls reading a story in one of the Ripley’s Believe It or Not! books “about how sometimes babies are born with vestigial tails that the parents have removed”. When Gabriel learned this, he was “absolutely horrified and heartbroken that some humans have the chance to have a tail and then just don’t because society somehow sees it as ‘wrong’”.

Gabriel was “very sexually repressed” when he was young, and it was only in his twenties that he understood the nature of his feelings toward anthropomorphic animals. When Gabriel “randomly encountered” a furry artist in college, he was “immediately attracted” to the art, though he tried to convince himself that he “just liked the characters”.

Several years later, Gabriel had a partner who introduced him to “pup play”, a form of roleplaying in which individuals adopt canine personas and act like puppies or dogs, hence the name. Gabriel immediately enjoyed it wanted to explore it some more. He mostly imagines himself as an anthropomorphic animal during the activity.

There are times, however, when Gabriel imagines himself or other “pups” as “a fully feral animal”. When asked if he has ever experienced attraction toward real animals, he says that he has not, except for the times he “wondered casually what it might be like to be penetrated by a real dog or wolf” and was not “fully turned off by the idea”.

In any case, Gabriel draws a firm distinction between real and anthropomorphic animals: “To me there’s a big difference between a feral—yet sapient—furry and an actual real-life animal that isn’t able to consent. I’d happily have sex with the former, but the latter doesn’t interest me much at all.”

Gabriel met a “pup” who was a furry with an otter fursona.3 This encounter made him realize that he, too, liked to imagine himself specifically as an anthropomorphic otter. Gabriel considers being an otter “very important” to his fursona: “I’ve always loved otters from a young age, and though I’d be happy to be other species (usually canines, specifically wolves or dogs), if I had any say over what animal I could be, it would always be otter first and foremost.”

Beyond imagining himself as an anthropomorphic animal, Gabriel also enjoys the fantasy of transforming into one. He very often searches for fictional media that depict a human’s transformation into an animal, though “very few portray enough detail to satisfy [Gabriel]”. More specifically, he likes scenarios in which humans transform into anthropomorphic mammals, such as dogs or otters.

Gabriel also enjoys the fantasy of sudden, involuntary transformations occurring to humans, seemingly out of the blue—a process he likens to the one depicted in Franz Kafka’s The Metamorphosis.4 In these erotic scenarios, Gabriel does not like it when the transformation is “described as painful or distressing”; he wants to perceive it as a rather positive experience.

In terms of Gabriel’s attraction to other anthropomorphic animals and what he seeks out in others, “species isn’t as much of a factor”. Even though “there’s not really a specific species that comes to mind”, he does mention that he likes anthropomorphic dogs and canines, due to his interest in pup play.

Thus, to summarize, Gabriel’s erotic life is characterized by interest in three unusual categories of erotic targets: men with vaginas, pregnant men, and anthropomorphic animals. He experiences sexual attraction to these targets, but he also has the erotic desire to be them.

It is interesting to note how these three interests coalesce to inform Gabriel’s idealized self-image. He recalls discussing with a therapist what his “ideal” body would look like, if he could transform it into whatever he wanted. The answer he arrived at was “an anthropomorphic animal with a vagina, uterus, and ovaries, but also with a prostate and other male reproductive systems” to make anal stimulation possible. Of course, Gabriel also fantasizes about being pregnant as an anthropomorphic otter.

Gabriel dislikes body hair, especially in the pubic region. It is one of his “biggest turn-offs”. He wishes to get electrolysis on “every part” of his body, even if he never succeeds in undergoing vaginoplasty. This is worth mentioning because Gabriel’s fursona—an otter—is quite hairy. Nevertheless, he explains that he perceives fur and human hair very differently: “If I were an actual otter I’d feel differently of course, but that’s because fur to me is something very different from human hair.”

Broadly speaking about his sexual satisfaction in life, Gabriel prefers having a partner. Although he is “definitely able to satisfy [himself] a lot”, there are “plenty of times” when masturbation fails to compare to sex: “I’d say I prefer to have a partner because it tends to be more satisfying when there’s another body entering me instead of something artificial.”

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➡️ Further reading

Discover more about the wish to be a man with a vagina in the main article.

📖 Background

Read the main article for an introduction to genital dysphoria in auto-AGMP.

📌 Case summary

• Carlos is a case study in internalized sexual attraction and erotic target identity inversion;

• He is attracted to several categories of men, including muscular men, hairy men, genitally nullified men, men with large penises, men with vaginas, and men with breasts;

• He appears to internalize all these attractions, as he is sexually aroused by the idea of being a muscular man, a hairy man, a man without a penis, a man with a larger penis, a man with a vagina, and a man with breasts;

• His internalized attraction to muscular men and to men with vaginas seems to have risen to the level of identity inversion: beyond the temporary erotic desire to be muscular and to have a vagina, he has the sustained wish to become a muscular man with a vagina in reality;

• His identity inversion into a man with a vagina causes him distress in the form of genital dysphoria because he has a penis. He wants to pursue major surgery (vaginoplasty) as a solution, permanently changing his body in an attempt to become what he loves.

📝 Case report — Carlos

Carlos1 is a 35-year-old gay man from the Philippines who is of Chinese descent. He has never felt attracted to women and has never been intimate with one. His sexual attraction is directed exclusively toward men—especially muscular men, men with hairy chests, and men with thick beards. Besides cisgender men, Carlos is also attracted to men who have vaginas. This category includes transgender men who masculinize their bodies but retain the native vagina, as well as natal males who undergo vaginoplasty without gender transition. Two further categories of men whom Carlos is attracted to are “nullos”—genitally nullified men who have smooth crotches—and men with large breasts.

Carlos is sexually aroused by the mere idea of having a vagina. He believes he discovered this erotic interest when he was 11 or 12 years old. He remembers that, at a young age, he would tuck his penis to create the appearance of a smooth crotch. This “felt really great”. Nowadays, he tucks his penis between his legs to create the same appearance, and he takes photos of it for the purpose of masturbation.

Carlos is also sexually aroused by the thought of being a muscular man, like the men he is attracted to. He discovered this erotic interest in childhood, at the age of 10 or 11, when he looked through his father’s fitness magazines. Carlos found himself attracted to the muscular men displayed on the pages, but he was also sexually aroused by the idea of being one of them.

The erotic fantasy of being a muscular man with a vagina is even more potent for Carlos. In fact, he has fantasies about intimate encounters between two such men who are “fingering each other’s vaginas” and pleasuring each other orally in the 69 position. Carlos, of course, is one of the protagonists in these scenarios. His “biggest fantasy”, however, is being a muscular man with a vagina and having passionate sexual intercourse with a muscular man with a penis.

Carlos wishes he had “a more defined body” with visible six-pack muscles. This is both an erotic fantasy and an actual life goal. Although he is far from achieving his dream physique, he has been exercising and hopes to turn this dream into reality one day. Occasionally, while Carlos exercises at the gym, he gets aroused at the thought of becoming a muscular man. This especially happens when he is “pumped” and sees muscular men around him.

Carlos is also sexually aroused by the thought of being “very hairy”, with a body covered in hair, exactly like the kinds of men he is attracted to. The thought of having “a full and thick beard” is also arousing, though to a lesser extent than the fantasy of a hairy chest. In real life, Carlos has some chest hair but not much, and he also has a beard but “it’s kind of patchy”.

In the past, Carlos has had the fantasy of having a “huge penis like a big pillow that [he] can hug”. He believes he began to fantasize about this in his teenage years after coming across hentai depicting men with huge penises, which aroused him. The mere idea of having a huge penis was very erotic to Carlos. As an example, he mentions that he was very aroused by a pornographic scenario in which a man was abducted for an experiment and had a substance injected into his penis, which resulted in huge penile growth. Carlos eventually stopped having fantasies about a larger penis after he became seriously interested in vaginoplasty. The focus of his erotic imagination then shifted to the fantasy of having a vagina.

The idea of penectomy is also erotic for Carlos. More specifically, he is aroused by the thought of no longer having a penis. When he masturbates, he sometimes bends his penis downward and sits on it, which feels good. He finds it “hot” to think about the shrinkage of his penis and about no longer having erections. Carlos tries to take photos of his penis “as much as possible”, in both flaccid and erect states, so as to have comparison pictures after he undergoes vaginoplasty. “I love looking at before-and-after photos of penises turning into a vagina,” he says, “especially when the penises are big.”

Carlos has another notable sexual interest: he sometimes has the erotic desire “to grow a set of boobs and squirt milk”. He discovered this interest after coming across online pornographic videos of men with gynecomastia who can produce milk from their nipples. Carlos thinks it is “really hot that they can squirt milk”. He likes to imagine being a man with breasts and “nursing guys” with them. In this fantasy, Carlos sees himself as a man with female breasts, never as a woman. Looking at pictures of men with large breasts arouses him sexually; large breasts on women do not.

The pornography Carlos consumes is consistent with his erotic fantasies. Besides typical gay pornography, he watches content that features men who have undergone vaginoplasty, penectomy, or genital nullification. Lately, however, he has been interested in pornographic content generated by artificial intelligence that features “muscular men with big boobs and big dicks”. He also looks for generated photos of men with vaginas, especially if the men are muscular and are being vaginally penetrated.

Carlos wishes he actually had a vagina instead of a penis, even though he never wanted to be a woman. He remembers, as a child, watching interviews on television with transgender people who had undergone sex reassignment surgery, and thinking that he wanted to have a vagina like them. He wishes he could “just spread [his] legs” and see that “nothing is dangling down there”. Although he tucks his penis for masturbation, he does not do so when he goes outside, because “it feels uncomfortable”.

Carlos “happened to stop thinking about” pursuing vaginoplasty during his teenage years. This wish only resurfaced when he was in college, around the age of 20. At that time, Carlos discovered Mangina Man, the stage name of a person who lived for twenty years as a post-operative transsexual woman before detransitioning to become a muscular man with a neovagina. Discovering that it was possible to live as a man with a vagina without committing to life in the role of a woman gave Carlos “a stronger desire to have vaginoplasty”.

More than ten years later, at the age of 31, Carlos discovered another man with a vagina on social media. Unlike Mangina Man, this was not a detransitioner but a man who had directly undergone vaginoplasty without ever living as a woman. Through him, Carlos found an online support group for men who were interested in vaginoplasty without gender transition. He felt comfort in finding other men like him, and this made him “seriously want to achieve [his] goal” of vaginoplasty. Carlos says that both Mangina Man and this other man were, and continue to be, his “inspiration” for pursuing vaginoplasty.

Carlos is “very serious” about pursuing this goal. He wishes he could undergo the procedure “very, very soon” because he has a “strong disgust” with his penis. “Constant adjustments are really bother[some], and sudden erections in public are so embarrassing,” he shares. The only impediments in his case are “money and location”.

Carlos dislikes his penis so much that, out of desperation, he sometimes considers the possibility of having a mere penectomy—“just to take it off”. He has even thought about underground procedures. In such a case without a penis, Carlos believes he can learn to orgasm “in other ways”. Nevertheless, he ideally wants to preserve his penis in its full size until vaginoplasty, in order to maximize the depth of his eventual neovaginal canal.

Carlos “always hated” his penis but never felt bad about his testicles. If he undergoes penectomy, he would like to preserve them, but if he undergoes vaginoplasty, he is willing to have them removed if it is necessary. He would, however, prefer in all cases to preserve his testicles if possible so he can avoid relying on exogenous testosterone for the rest of his life.

Carlos considers it important to have a romantic and sexual partner. He believes it will be hard to find one after undergoing vaginoplasty, but he wants someone who will “support and accept” him for who he is, “without any hesitations”.

As the years passed, and as Carlos began to discover more about gender and sexuality, he began to consider himself nonbinary and queer. He adopted the nonbinary identity because of his desire to be a man with a vagina, and he styled himself queer because of his attraction to “manly and muscular” transgender men with vaginas.

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➡️ Further reading

Discover more about the wish to be a man with a vagina in the main article.

📖 Background

See the main article for the other parts of this quantitative study.

💬 Discussion

In a 2022 academic article, researchers J. Michael Bailey and Kevin J. Hsu examined a very specific research question pertaining to autogynephilia, the erotic interest characterized by sexual arousal at the thought of being a woman and known to occur in some natal males. The question was whether it also occurred in natal females. Relying on a psychological scale designed to measure autogynephilia, the researchers failed to find evidence that this erotic interest occurred in samples of natal females. They concluded their work with the following remark:

Bailey & Hsu: If there were natal women who spent a great deal of time and erotic energy focusing on their feminine bodies and behavior, and if this sexual interest [were] sufficiently strong that it interfered with their interpersonal sexual relations, we would be much more credulous about the idea of autogynephilia in natal females. However, we do not know of women like this. A detailed study of natal females with high scores on [an autogynephilia scale] would be illuminating.1

I submit that the population I have been qualitatively and quantitatively studying consists of natal females who experience autogynephilia. This is the population of natal females who identify with a masculine gender identity (FtMs) and who are aroused by erotic fantasies revolving around the idea of being a woman. The appeal of this very specific kind of eroticism to these individuals often feels beyond their control. Furthermore, these erotic urges usually cause emotional distress because they conflict with the masculine gender identity. Finally, some of these individuals experience this erotic interest so intensely that it influences their view of their gender identity and transition.

📓 Study

This cross-sectional survey is the first quantitative study of autogynephilia in this population of FtMs. The sample was composed of 182 transgender or ex-transgender men from Western countries in their early twenties who mostly reported having experienced attraction to both men and women at some point in their lives. Most of these individuals experienced their first feelings of being transgender during adolescence, and most of them had been on exogenous testosterone for several years at the time of participation in the study. A large minority of them had also undergone top surgery to have their native breasts removed.

I recruited the sample from online communities catering to the erotic interest of FtMs in feminization, misgendering, and detransitioning. The participants obtained high scores on a psychological scale designed to measure autogynephilia, but these high scores did not automatically qualify as evidence that these individuals experienced genuine autogynephilia. To make such an inference, the scores had to be valid—a term in psychology that means that a scale is actually measuring the construct it is designed to measure.

At the outset of this study, I presented two alternative explanations for these high scores on the autogynephilia scale. One explained them simply as a manifestation of female sexuality in conjunction with a masculine gender identity. I quickly dismissed this explanation on the grounds that these erotic fantasies likely occur only in a minority of FtMs. If this phenomenon were simply female sexuality, it would manifest in a much larger proportion of FtMs. The other explanation was that these erotic fantasies were not genuine autogynephilia but merely an expression of masochism, which is a fairly common erotic interest in natal females. The principal aim of my study was to confront masochism and genuine autogynephilia as competing explanations for this phenomenon in FtMs by investigating the extent to which each hypothesis was supported by the data.

💡 Findings

In analyzing the scores of these participants on the autogynephilia scale, I found that they had the same dimensional structure that autogynephilia has in natal males. Put differently, the erotic fantasies of these FtMs appear to span the same content domains as autogynephilia in natal males, including aspects of anatomy, clothing, behavior, etc. Moreover, the most remarkable result was that erotic fantasies related to pregnancy were, relatively speaking, poorly associated with all the others. This is exactly the same pattern that has been observed in autogynephilic natal males. Taken together, this is evidence supporting the genuine autogynephilia hypothesis.

I also found that the autogynephilia scores of the FtM participants exhibited similar relationships to related constructs in the pattern expected of genuine autogynephilia. This pertains to three main psychological aspects: the ego-dystonic distress often occasioned by the erotic fantasies; their variable prominence in the individual’s erotic life; and their rare albeit real influence on the individual’s perception of gender identity. In the FtM participants, these psychological aspects were related to each other and to autogynephilic fantasies in a way that supports the genuine autogynephilia hypothesis.

I also administered a masochism scale to the participants to test whether the autogynephilia scale merely measured masochism in this sample, which would have invalidated the genuine autogynephilia interpretation. I found that although masochism was extremely common among participants, the autogynephilia scale was measuring a construct different from masochism. Most importantly, I found that masochism was virtually unrelated to the identity influence effect of autogynephilic fantasies. This is evidence against the masochism hypothesis.

Moreover, most participants recalled a late onset of autogynephilic fantasies, occurring mostly in early young adulthood and shortly after initiating testosterone therapy. This temporal association was intriguing and difficult to reconcile with the masochism hypothesis. Indeed, masochism is a fairly common erotic phenomenon in natal females that typically manifests in adolescence. If erotic fantasies of feminization, misgendering, and detransitioning in FtMs were merely an expression of masochism, it is unclear why these fantasies would emerge in most participants specifically after testosterone initiation. This is further evidence against the masochism hypothesis.

🔮 Interpretation

Overall, I conclude from this study that these FtM participants are more likely than not to be experiencing genuine autogynephilia. This is an extraordinary claim that goes against the conventional understanding of autogynephilia among its researchers, as illustrated in the aforequoted remark by Bailey and Hsu. Nevertheless, in light of my research into this topic, and in the absence of convincing evidence that refutes it, I submit that autogynephilia does occur in some natal females.

There are interesting aspects to this phenomenon that I did not cover in this study. One of them is autoandrophilia, the counterpart of autogynephilia that is unfortunately much less researched and not well understood. In my qualitative research into this topic, I found that autogynephilic FtMs also seemed to experience sexual arousal by fantasies associated with the thought of being a man. An even more intriguing aspect I did not explore in this quantitative study is the phenomenon I called autoandrophilic autogynephilia, which refers to erotic fantasies in FtMs of specifically being a natal male who is feminized rather than a natal female who simply reverts to being a woman from a masculine gender identity. These are topics for future research.

My study has obvious limitations, the most important of which is the lack of a comparison group of FtMs not specifically recruited for autogynephilic fantasies. The inclusion of such a group would have allowed for a better characterization of autogynephilic FtMs as distinct from non-autogynephilic FtMs, and it would have provided a rough estimation of the incidence rate of autogynephilia in FtMs. There was also a potential sampling bias in recruiting participants for my study, as I previously noted. This latter limitation, however, can only weaken the case for genuine autogynephilia, not strengthen it.

It remains for me to say a few words on the implications of the discovery of autogynephilia in natal females and the myriad research questions it opens up, especially with regard to the potential role played by testosterone in the emergence of these fantasies in FtMs.

🧠 Implications

Is the exogenous testosterone that these FtMs take as part of their treatment of gender dysphoria playing a causal role in the emergence of autogynephilia in most of them? Or is there a simpler explanation for the temporal association I found in this study?

Testosterone might play no direct role in the emergence of these fantasies. Instead, it could simply be that testosterone increases libido, which drives FtMs to seek more sexual interactions, to search for more pornographic material online, and to expose themselves to a more diverse array of erotic stimuli than before. It could be that these experiences, facilitated by testosterone’s effect on libido, simply made it more likely for most FtM participants in this study to discover their autogynephilic sexual response after testosterone initiation.

This explanation, although plausible at face value, seems unsatisfactory upon closer examination. The picture it paints of FtMs prior to testosterone therapy is that of beings largely uninterested in sex and mostly oblivious to the thought of being a woman. Evidently, this is far from the truth. Most of these FtMs had masochistic fantasies since adolescence, long before they took exogenous testosterone. Moreover, it is difficult to imagine that these individuals were simply not exposed to autogynephilic stimuli prior to testosterone therapy, as the thought of being a woman weighs heavily on the minds of many of them as a source of gender dysphoria.

So, could exogenous testosterone really be playing a causal role in the emergence of autogynephilic fantasies in these FtMs, perhaps by increasing their testosterone levels past a certain necessary threshold? The hormone does have wide-ranging and variable physiological effects in FtMs, including deepening the voice, growing facial and body hair, and male-pattern baldness to mention just a few. Testosterone also has psychosexual effects in this population, which include an increase in libido and a change in patterns of sexual attraction for some. That testosterone could also sometimes lead to the emergence of new erotic interests in FtMs is not that extraordinary of a claim.

If testosterone—and potentially its metabolites—does play a causal role in the emergence of autogynephilia in some FtMs, what effect does it have exactly? Is it organizing the neural tissue or perhaps permanently altering the function of already existing circuitry in a way that makes autogynephilia possible in these individuals, even at a relatively late age? If so, why does this occur only in some FtMs and not in the many others who take exogenous testosterone without ever experiencing autogynephilia?

Could it rather be that testosterone is only activating neural circuitry that was already there in the brains of these FtMs? If so, does returning to female levels of testosterone deactivate the function? And how did these FtMs come to have the neural structure for autogynephilia in the first place anyway? And if they did have the structure, why has it remained dormant their whole lives before being activated by high levels of testosterone?

Even more perplexing, how do most of these FtMs, in whom autogynephilia emerged shortly after starting exogenous testosterone, differ from the small minority who seem to have experienced genuine autogynephilia independently of exogenous testosterone and in conjunction with other interesting paraphilic phenomena?

Pushing the discussion even further, is there a link between the reason these natal females adopted a masculine gender identity in the first place and the fact that they later discovered autogynephilia? Could it be that they were driven to a masculine gender identity by autoandrophilia, the counterpart erotic interest? Or is there no connection at all between the masculine gender identity and the later experiences of autogynephilia?

If there is no connection and this is simply a matter of chance, does it mean that there are cisgender women out there in the world who have the neural circuitry for autogynephilia but it remains latent because it requires a testosterone level higher than the typical female range to become manifest? If that is so, is this only true of autogynephilia or of other paraphilic phenomena as well? And what does all this mean for the etiology of paraphilias?

If I have not erred in my analysis, this could be the beginning of a very interesting era of research into the nature of paraphilias. I have only scratched the surface.

🙏 Acknowledgments

I extend my thanks to the participants for their time and interest in the study. Their participation is invaluable in advancing the scientific understanding of this phenomenon. This, in turn, has the potential to help people who experience autogynephilia to lead better lives through a scientifically informed understanding of their unusual sexuality.

👍 Leave a like on this post and tell me your thoughts about it in the comments.

➡️ Further reading

Read the other parts of the quantitative study in the main article.

📖 Background

See the main article for the other parts of this quantitative study.

➤ Introduction

At the outset of this study, I considered two competing hypotheses to explain the erotic fantasies of feminization, misgendering, and detransitioning that some FtM individuals experience. These two hypotheses were masochism and genuine autogynephilia. In this post, I examine the merits of the masochism hypothesis to see the extent to which it is supported by the data as a simpler explanation of this phenomenon in FtMs.

🙇🏻‍♂️ Masochism

Masochism, as originally defined by the German pioneer researcher Richard von Krafft-Ebing, is the erotic interest characterized by sexual arousal from fantasies of subjugation to another person.1 Masochism has a vast and diverse array of expression in erotic fantasy. It could be argued that the experiences of the FtM participants in this survey are not evidence of genuine autogynephilia but merely expressions of masochism that only superficially resemble autogynephilia.

These individuals, as the argument would go, do not truly eroticize being a woman like autogynephilic males do. Instead, they simply eroticize feminization, misgendering, and detransitioning as forms of control exercised by a partner. In this reasoning, the cerebral erotic stimulus is not the thought of being a woman per se; rather, it is the masochistic element of subjugation. The logical conclusion of this argument is that this phenomenon is explained simply as an expression of masochism, not genuine autogynephilia.

In my opinion, and as I previously laid out, this argument is not convincing. For that qualitative discussion based on case reports, see my previous article:

In the rest of this post, I test the masochism hypothesis in various ways. First, I present a masochism scale and I test whether it measured same construct as the autogynephilia scale in FtM participants. Second, I examine the association of this masochism scale with the three psychological correlates of autogynephilia. Finally, I push the investigation further by testing an important prediction of the masochism hypothesis regarding the age of onset of fantasies.

🧮 Core masochism scale

To examine the masochism hypothesis in this survey in a quantitative manner, I constructed a scale of fantasy items tapping into various aspects of the core element of masochism—namely, subjugation. For the purpose of this analysis, I call this the core masochism scale.

I administered the core masochism scale to the participants and instructed them to rate the intensity of their sexual arousal by each fantasy item. I advised the participants to answer based on the highest arousal they had ever experienced in their lives in response to these fantasies, using a five-point rating system: not at all, slightly, moderately, quite, and very arousing. I coded these answers numerically from 1 to 5 for quantitative analysis.

Furthermore, because not every erotic fantasy one has is necessarily something one wishes to try in reality, I explicitly instructed the participants to consider the items as fantasies. Additionally, I referred to the dominant partner in the fantasy items in a neutral way as “someone”, instructing the participants to interpret the partner’s gender according to their own preferences.

Before using the scores on the core masochism scale for our analysis, we must first do our due diligence in examining their psychometric properties. The factor analysis presented below addresses this. The specialist reader will find the technical details in the footnotes.2 The lay reader may interpret these results as evidence of analytic rigor in using average scores on the core masochism scale for quantitative analysis.

Participants scored very high on the core masochism scale, resulting in a skewed distribution. The mean score was 3.98 (SD 1.03), roughly corresponding to the ordinal level of “quite arousing”. Slightly more than half the participants (105/182 = 57.7%) scored above 4 out of 5. It could be said that the overwhelming majority of participants in this survey are masochists according to Krafft-Ebing’s original definition.

Why are so many participants masochists? In examining this, we must ask a fundamental question: how representative is this sample of FtMs of the target population? Here, the target population is all FtMs in the world who have fantasies of feminization, misgendering, and detransitioning. The participants in this survey are only a sample of this population. With respect to the representativeness of this sample, multiple scenarios are possible:

1. Masochism is common in FtMs in general.

   This scenario is plausible. Given that masochism—as defined above—is common in females, it could also be common in FtMs by virtue of their being natal females. Furthermore, increased testosterone levels would plausibly make this erotic interest even more intense. In this scenario, the core masochism scores might be representative.

2. Masochism is not common in FtMs in general, but it is common in the target population in particular.

   This scenario is conceivable if paraphilic interests tend to co-occur, or if these fantasies of feminization, misgendering, and detransitioning are, after all, merely an expression of masochism. In this scenario, the core masochism scores might also be representative.

3. Masochism is not common in the target population.

   This would mean that the results are due to sampling bias. This scenario is plausible because the survey found more success in explicitly masochistic online communities and tended to be quickly removed in non-masochistic spaces. In this scenario, the core masochism scores are not representative.

I do not know of any research that measures masochism in FtMs and, unfortunately, I do not have a comparison group of FtMs in this study to gain insight into the representativeness of these masochism scores. For the time being, this shall remain an open question.

🆚 Masochism vs. autogynephilia

Let’s examine the scores on the core masochism scale alongside those on the general autogynephilia scale that I examined previously. In contrast to the highly skewed distribution of the core masochism scores, the general autogynephilia scores look closer to a normal distribution. The mean score was 2.79 (SD 0.98).

If is true that autogynephilic fantasies in FtMs are not genuine autogynephilia but merely an expression of masochism, then the core masochism and the general autogynephilia scales should be measuring the same construct. In that case, we would expect the correlation between the scores on these two scales to be very high. Ideally, it would equal one. Due to measurement error, however, even a calculated correlation of 0.7 could be taken as a suggestion that the scales might be measuring the same construct.

The numbers here imply otherwise: Spearman’s rank correlation coefficient ρ = 0.40 (p < 2×10^-8), suggesting that the two scales are measuring different—although related—psychological constructs.3 Ideally, this would be taken as strong evidence that fantasies of feminization, misgendering, and detransitioning in these FtM participants are not merely an expression of masochism but a distinct phenomenon, presumably genuine autogynephilia.4 Things, however, are a bit more complicated.

The problem here is that the core masochism scores suffer from a ceiling effect, which means that the scores are compressed near the top of the scale. Indeed, 21% of participants scored the maximum of 5, and the scores of many others were concentrated near that maximum. The variability among these very high scores is, statistically speaking, not very meaningful, which limits the usefulness of correlation coefficients as a measure of association. This problem can be seen in the scatter plot below on the left, where many data points stick to the maximum on the horizontal axis.5

In hindsight, perhaps this ceiling effect could have been avoided, had I included more extreme fantasy items in the core masochism scale that only some participants were interested in. Presumably, this would have broken the ties at the high scores and produced meaningful variance there.

The ceiling effect is important here because it attenuates the correlation between the two measures we are interested in. Hypothetically, with a more adequate measure of masochism, we would probably have obtained a higher correlation value than the one calculated here. That said, that value is unlikely to have been so high as to suggest that the core masochism and general autogynephilia scales were measuring the same thing.

To understand why, look closely at the scatter plot above on the left. You will see that starting from a core masochism score of approximately 3 and higher on the horizontal scale, the general autogynephilia scores are very dispersed along the vertical 1-to-5 scale. Avoiding the compression effect on the horizontal axis would not have made this dispersion disappear; it would have simply stretched it out.6 I think, therefore, that remedying the ceiling effect is very unlikely to lead to a different conclusion. Thus, the two scales are probably measuring different constructs.7

But even if we accept that the core masochism and general autogynephilia scales are measuring different constructs, the observed association between the two remains interesting. This relationship could be partly attributable to the general influence of sex drive on both erotic interests. It could also be the case that the base rate of masochism is generally high in FtMs as a whole, which means that the moderate correlation observed here is not as interesting as it seems at first glance.8

Whatever the case may be, the co-occurrence of masochism and autogynephilia in these FtM participants means that autogynephilic fantasies are masochistically colored for many of them. This can be interpreted simply as the product of interaction between two distinct erotic interests that co-occur in the same individual. This is well known in the other sex: autogynephilic natal males who are also masochists tend to have fantasies of forced feminization, in which the masochistic element of subjugation is compounded with the thought of being a woman, resulting in the fantasy of being forced to be a woman.9 A similar process likely occurs in many of these FtM participants.10

🔀 Masochism vs. correlates of autogynephilia

It is also informative to examine the association between masochism and the three psychological correlates of autogynephilic fantasies that I previously identified—namely, emotional distress, erotic prominence, and identity influence. Keeping in mind that the same reservation about the ceiling effect in the core masochism scores applies here, Spearman’s rank correlation coefficients were as follows:

• ρ = 0.22 (p = 0.003) for core masochism vs. emotional distress;

• ρ = 0.23 (p = 0.002) for core masochism vs. erotic prominence;

• ρ = 0.08 (p = 0.28) for core masochism vs. identity influence.

Core masochism was only weakly associated with the first two variables, and not associated at all with the third. The most notable result here is precisely the failure to find a correlation between masochism and the identity influence that autogynephilic fantasies have on gender identity, as shown in the scatter plot above on the right.

As a reminder, identity influence was moderately correlated with the general autogynephilia score (ρ = 0.42). Here, it is virtually unrelated to the core masochism score. This is a remarkable difference. If erotic fantasies of feminization, misgendering, and detransitioning in FtMs were merely an expression of masochism, then these would not be the expected results.

It is more likely that the general autogynephilia scale is measuring something other than masochism, and that identity influence is related to this distinct construct and not to masochism. Presumably, this construct is none other than genuine autogynephilia.

🏁 Age of onset

As an alternative explanation for fantasies of feminization, misgendering, and detransitioning in FtMs, the masochism hypothesis generates other predictions that can be tested empirically. One of these predictions relates to the age of onset of these fantasies in FtMs. But before considering this prediction, let’s examine the age of onset of masochism first.

It is well established that masochism has a typical onset in adolescence—and sometimes even in childhood—in males and females alike. To verify this, I asked the participants to recall the age at which they discovered their sexual arousal by masochistic fantasies. In the survey, this question on the age of onset was inserted immediately after the masochistic fantasy items were rated for arousal intensity.11

Most participants (156/182 = 85.7%) provided an answer that could be used in this analysis. These data are approximate at best, as they are prone to recall bias.12 In the aggregate, however, they seem generally accurate with regard to an expected onset of masochistic fantasies in adolescence or childhood. The median recalled age of onset of masochistic fantasies was 15 [IQR: 13–17]. Most participants (109/156 = 69.9%) recalled an onset at age 16 or earlier.

It is important to note that the onset of masochism is unrelated to testosterone therapy in FtMs, as masochism is common in females in general, including cisgender women who never take exogenous testosterone. If fantasies of feminization, misgendering, and detransitioning in FtMs are not genuine autogynephilia but merely an expression of masochism, then we would also expect the onset of this kind of eroticism in FtMs to be unrelated to testosterone initiation.

Indeed, this presumed expression of masochism, based on fantasies of subjugation through feminization, would be contingent only on an individual’s perception of gender identity. Under the masochism hypothesis, it suffices that this identity become masculine to unlock masochistic fantasies of being feminized. When might this happen exactly?

In this regard, it is useful to remember that FtMs typically go through three main stages in their gender transition: privately feeling transgender, socially transitioning, and initiating testosterone therapy. Under the masochism hypothesis, we would expect the age of onset of fantasies of feminization, misgendering, and detransitioning to be associated more with the first two stages (i.e., private feelings of being transgender and social transition) and less with the last (i.e., testosterone initiation).

In this sample, it took participants a median of three years to move from one stage to the next, with a median of six years from first feelings of being transgender to testosterone initiation. This six-year period is plenty of time for erotic exploration. Thus, under the masochism hypothesis, fantasies of feminization, misgendering, and detransitioning would be expected to emerge much earlier than the age of testosterone initiation. In fact, it could be argued that social transition should be the best predictor of the emergence of these fantasies, as it is the time when the FtM individual begins to live as a man and is seen by others as such after coming out to them.13

The data, however, do not support what the masochism hypothesis predicts. Indeed, I found that fantasies of feminization, misgendering, and detransitioning had a late onset, occurring at a median age of 19, which was more associated with testosterone initiation than social transition. This was especially true with regard to temporality, as the fantasies emerged shortly after testosterone initiation in most participants.14 Furthermore, linear regression revealed that testosterone initiation was a strong and statistically reliable predictor of the onset of autogynephilic fantasies in most participants, while social transition was a much weaker predictor in comparison.

🎯 Conclusion

At the outset of this study, I presented two competing explanations for erotic fantasies of feminization, misgendering, and detransitioning in FtMs. These were the hypotheses of genuine autogynephilia and masochism. The first hypothesis posits that this peculiar phenomenon in FtMs is the same as what autogynephilic natal males experience. The second hypothesis posits that it is merely an expression of masochism, only superficially resembling the autogynephilia of natal males.

In the foregoing analysis, I tackled the masochism hypothesis. I found that the autogynephilia scale was measuring a construct different from masochism, that the masochism scale was not associated with the identity influence of autogynephilic fantasies, and that the age of onset of these fantasies was not consistent with predictions of the masochism hypothesis. In interpreting these results, one must concede, at the very least, that the masochism hypothesis has poor explanatory power.

This quantitative evidence, which psychologists would call discriminant validity, should be considered together with the point I made elsewhere regarding another prediction of the masochism hypothesis. If the invalidation of transgender identity were by itself an erotic stimulus in masochism, then we would expect some transgender women to experience this eroticism as well. Presumably, such a transgender woman would be sexually aroused by erotic fantasies of masculinization, misgendering by being referred to as a man, and detransitioning from living as a woman back to being a man. It appears, however, that this kind of eroticism does not exist.

It is also my impression that there are many FtMs who are masochists but find no appeal whatsoever in erotic fantasies of feminization, misgendering, and detransitioning. These thoughts elicit no sexual response in these individuals; they only trigger dysphoric feelings. The masochism hypothesis fails to explain why such a stark difference exists among masochistic FtMs.

In the final analysis, the masochism hypothesis cannot be considered a plausible explanation for fantasies of feminization, misgendering, and detransitioning in FtMs. In the absence of any other contender, this leaves genuine autogynephilia as the only possible explanation for this peculiar phenomenon. Given that most researchers of autogynephilia believe it only occurs in natal males, the claim that some FtMs experience genuine autogynephilia is extraordinary to say the least. Nevertheless, it is a claim that has found plenty of supporting evidence in this survey.

👍 Leave a like on this post and tell me your thoughts about it in the comments.

➡️ Further reading

Read the other parts of the quantitative study in the main article.

📖 Background

See the main article for the other parts of this quantitative study.

➤ Introduction

I previously analyzed three psychological correlates of autogynephilic fantasies in FtMs: the emotional distress they occasion, the prominence they hold in the individual’s erotic life, and the influence they have on gender identity. In this post, I explore potential differences between subgroups of participants in these three psychological correlates according to certain variables of interest.

🌀 Group differences

Let’s examine whether there are any meaningful differences between subgroups of participants in the three main psychological correlates of autogynephilic fantasies—namely, emotional distress, erotic prominence, and identity influence.

In reading this analysis, it is imperative to keep two things in mind. First, the three scales of psychological correlates measured the participants’ feelings at any point in the past or at present, not merely the latter. Second, this study is probably underpowered to detect very small differences among participants, but such small differences are not relevant to the main aim of the study.

I had no specific hypotheses about differences in psychological correlates, so this analysis is exploratory in nature and itself serves to generate interesting hypotheses. I will use Spearman’s rank correlation coefficient ρ, as well as non-parametric statistical tests for group differences, interpreting p-values continuously with no threshold. In the following, the sample size differs slightly each time due to the varying availability of data.

🪪 Gender identity (N = 182)

Dividing the participants on the basis of their stated gender identity into three groups (N = 93 for “man”; N = 52 for “transmasc”; N = 37 for other identities), there were no significant differences between these three groups in emotional distress and erotic prominence, but there was a highly significant difference in identity influence:

• Kruskal–Wallis H test: H = 0.88 (p = 0.64) for emotional distress;

• Kruskal–Wallis H test: H = 1.24 (p = 0.54) for erotic prominence;

• Kruskal–Wallis H test: H = 19.29 (p < 7×10^-5) for identity influence.

Post hoc comparisons on identity influence revealed the following results:

• Participants with a gender identity other than “man” or “transmasc” scored higher on identity influence than those with a “man” identity.

  → Mean score: 2.23 vs. 1.58.

  → Dunn’s test: p = 3.3×10^-5 (unadjusted), 10^-4 (Bonferroni correction).

  → This is a large difference: Cohen’s d = 0.78 [0.38, 1.17].

• Participants with a “transmasc” gender identity also scored higher on identity influence than those with a “man” identity.

  → Mean score: 1.98 vs. 1.58.

  → Dunn’s test: p = 0.007 (unadjusted), 0.02 (Bonferroni correction).

  → This is a medium difference: Cohen’s d = 0.46 [0.12, 0.81].

• The remaining comparison ("transmasc” participants vs. those with an identity different from both “man” and “transmasc”) was not significant (unadjusted p = 0.11; Bonferroni correction: p = 0.34).

These results suggest that autogynephilic fantasies might have played a role in the decision of some participants not to identify strictly as “man”, thus adopting alternative identities such as “transmasc”, “nonbinary”, or “genderfluid”. This hypothesis is further supported by the fact that many of the participants who reported a gender identity other than “man” or “transmasc” also reported having identified as “man” in the past. It is therefore compelling to hypothesize that autogynephilic fantasies influenced these individuals’ perception of their gender identity, at least partly.

💞 Sexual orientation (N = 150)

Considering the participants whose reported sexual orientation identity was exclusively androphilic (N = 42) vs. bisexual (N = 108), there were no significant differences between these two groups:

• Mann–Whitney U test: U = 2286.5 (p = 0.89) for emotional distress;

• Mann–Whitney U test: U = 2148.0 (p = 0.47) for erotic prominence;

• Mann–Whitney U test: U = 2081.0 (p = 0.32) for identity influence.

🎂 Current age (N = 182)

With respect to the current age of the participants, there was a weak negative association across all three psychological correlates of autogynephilia:

• Spearman’s ρ = -0.13 (p = 0.08) for current age vs. emotional distress;

• Spearman’s ρ = -0.14 (p = 0.05) for current age vs. erotic prominence;

• Spearman’s ρ = -0.16 (p = 0.03) for current age vs. identity influence.

💡 Time since discovery (N = 172)

The three psychological correlates were not significantly associated with the number of years since participants discovered their autogynephilic fantasies, as calculated from their recalled age data:

• Spearman’s ρ = -0.01 (p = 0.84) for number of years vs. emotional distress;

• Spearman’s ρ = 0.12 (p = 0.13) for number of years vs. erotic prominence;

• Spearman’s ρ = 0.02 (p = 0.74) for number of years vs. identity influence.

💉 Time on testosterone (N = 155)

The three psychological correlates were not significantly associated with the number of years that participants have been on testosterone:

• Spearman’s ρ = 0.00 (p = 0.95) for number of years vs. emotional distress;

• Spearman’s ρ = 0.12 (p = 0.13) for number of years vs. erotic prominence;

• Spearman’s ρ = 0.06 (p = 0.46) for number of years vs. identity influence.

⚗️ Testosterone form (N = 163)

I split the participants into three groups based on the form of testosterone they reported taking: enanthate or cypionate (medium-acting injectable esters, N = 103); undecanoate (long-acting injectable ester, N = 22); and topical gel (N = 38). There were no significant differences between these three groups:

• Kruskal–Wallis H test: H = 1.70 (p = 0.43) for emotional distress;

• Kruskal–Wallis H test: H = 1.83 (p = 0.40) for erotic prominence;

• Kruskal–Wallis H test: H = 2.98 (p = 0.22) for identity influence.

❓ Testosterone status (N = 182)

Dividing the participants into current (N = 155), former (N = 12), and never (N = 15) users of testosterone, there were no significant differences between these three groups in emotional distress and erotic prominence, but there was a difference in identity influence:

• Kruskal–Wallis H test: H = 1.46 (p = 0.48) for emotional distress;

• Kruskal–Wallis H test: H = 1.12 (p = 0.57) for erotic prominence;

• Kruskal–Wallis H test: H = 6.87 (p = 0.03) for identity influence.

Post hoc comparisons on identity influence revealed the following results:

• Former users scored higher on identity influence than current users.

  → Mean score: 2.56 vs. 1.75.

  → Dunn’s test: p = 0.02 (unadjusted), 0.05 (Bonferroni correction).

  → This is a large difference: Cohen’s d = 0.87 [0.27, 1.47].

• The other two comparisons were not significant (unadjusted p > 0.18).

This difference between former and current users of testosterone is consistent with the fact that some participants who stopped taking the medication mentioned that their “kinks” played a role in their decision.

🪡 Top surgery (N = 182)

Considering the participants who have undergone top surgery (N = 68), those who wish to undergo it (N = 90), and those who have no interest in it (N = 24), there were no significant differences between these three groups in emotional distress and erotic prominence. There was, however, a significant difference in identity influence:

• Kruskal–Wallis H test: H = 2.35 (p = 0.31) for emotional distress;

• Kruskal–Wallis H test: H = 1.83 (p = 0.40) for erotic prominence;

• Kruskal–Wallis H test: H = 11.78 (p = 0.003) for identity influence.

Post hoc comparisons on identity influence revealed the following results:

• Participants who had no interest in top surgery scored higher on identity influence than those who had undergone top surgery.

  → Mean score: 2.30 vs. 1.69.

  → Dunn’s test: p = 7×10^-4 (unadjusted), 0.002 (Bonferroni correction).

  → This is a medium difference: Cohen’s d = 0.59 [0.11, 1.07].

• Participants who had no interest in top surgery also scored higher on identity influence than those who wished to undergo top surgery.

  → Mean score: 2.30 vs. 1.80.

  → Dunn’s test: p = 0.03 (unadjusted), 0.08 (Bonferroni correction).

  → This is a medium difference: Cohen’s d = 0.56 [0.10, 1.02].

I have previously found results suggesting that participants who had no interest in top surgery were more sexually aroused by the fantasy of having breasts. This led me to hypothesize that the autogynephilic interest in breasts could be acting as a disincentive to pursue top surgery in some FtMs.

These results are in the same vein: it could be that some participants’ lack of interest in top surgery is due to the identity influence effect of autogynephilic fantasies, which, in turn, is due to a strong sexual response to the erotic fantasy of having breasts. If that is true, then the identity influence effect of autogynephilic fantasies manifests not only in detransition but also in incomplete transition.

One aspect I unfortunately neglected to explore in this survey is regret concerning certain aspects of gender transition. In this context, it would have been interesting to measure regret about top surgery among participants who have undergone it, and to see how this regret relates to other variables, such as arousal by the fantasy of having breasts and the identity influence effect of autogynephilic fantasies.

✍ Participant comments

In the foregoing analysis, there were meaningful differences in only one of the three psychological correlates of autogynephilic fantasies: identity influence. Participants volunteered thoughts on this topic in open-ended questions. Some described experiencing autogynephilic fantasies as a purely erotic phenomenon, while others reflected on how these fantasies influenced various aspects of their lives, including their perception of gender identity, their comfort in their own bodies, their gender-dysphoric feelings, and their attitudes toward their gender transition.

For the sake of illustration, and with minimal language corrections, I present select examples of these comments below, highlighting the variability in FtMs of the influence of autogynephilic fantasies on identity.

✅ Presence of identity influence

• A 20-year-old participant who identifies as a bisexual man. He initiated testosterone at the age of 18 and recalls discovering autogynephilic fantasies at 19:

  [These fantasies] influenced my thoughts on gender positively, bringing a more liberating kind of femininity.

• A 32-year-old participant who currently identifies as a gay man after holding a bisexual identity for a long time. He started testosterone at the age of 27 and recalls discovering autogynephilic fantasies at 29:

  These fantasies have made me more comfortable with being considered female or admitting I’m biologically female. I’ve gotten a lot more comfortable with people referring to my genitals with feminine or biological terms, like pussy or clit, and prefer my partners to use whatever words they feel comfortable with (or whatever they find sexy). These fantasies have also made me wonder if I am trans (and wonder about what being trans even is). Sometimes I think of myself as a “female man.” I also sometimes feel like a female transvestite, or a female who passes as male.

• A 32-year-old participant who identifies as an androphilic man. He started testosterone at the age of 17:

  I started presenting more femininely after I got hysterectomy at the age of 28 and started to accept feminine pronouns.

• A 26-year-old participant who identifies as transmasc and pansexual. He started testosterone at the age of 25 and had top surgery at the same age:

  I got top surgery because I hated my body literally anytime I wasn’t using it sexually. But if I was masturbating or having sex I loved my tits and the sensitivity my nipples had. I wouldn’t change it ’cause living in my previous body was horrible, but I’ll be sexting and engaging in this fantasy and it’s a bummer sometimes when I don’t have them to play with or show off.

• A 27-year-old participant who identifies as transmasc nonbinary “with gender fluidity”. He currently identifies as asexual after previously holding bisexual and pansexual identities:

  I am masc-leaning but my pregnancy and breeding kinks lead me to be a lot more comfortable with my current physical layout (breasts, T-dick, vulva, vagina, etc.). I find myself incredibly aroused by [the thought of] getting impregnated, and some level of bio-essentialism is involved here. […]

• A 20-year-old participant who identified for two years as a transgender man and as transmasc then detransitioned. She does not label her gender identity but “is fine with everyone calling [her] a woman”. She describes herself as “mostly heterosexual” (i.e., androphilic):

  While the fantasies did help me to be more comfortable with being a female, it was not the sole purpose1 for my detransition. I also attempted to deconstruct ideas of gender and that was more important to me.

• A 19-year-old participant who identifies as transmasc. He took testosterone for two years until he stopped using it at the age of 18:

  The kink made me doubt myself and I didn’t want to ruin my body if I wasn’t sure, I wanted to be in a relationship as a woman.

• A 25-year-old participant who identified as a gay transgender man for nine years. He started testosterone, discovered autogynephilic fantasies, and detransitioned all at the age of 23:

  Initially I thought it was kinky and hot, but eventually realized I was just a woman.

❌ Lack of identity influence

• A 25-year-old participant who identifies as a bisexual man. He started testosterone at the age of 21 and recalls discovering autogynephilic fantasies at 22:

  Everything about this kink is strictly sexual for me. Any of these things outside of the bedroom are extremely dysphoria-inducing.

  I used to have shame in the past [about these fantasies]. I didn’t think it made me not transgender but I worried other people would think that.

• A 27-year-old participant who identifies as nonbinary (masc-leaning) and bisexual. He started testosterone and discovered autogynephilic fantasies at the age of 25:

  I like things in a kink space but not when they affect my real everyday life.

• A 24-year-old participant who identifies as transmasc and biromantic. He started taking testosterone at the age of 18 and recalls discovering autogynephilic fantasies at 22:

  Breeding and pregnancy are super erotic to me [in] dirty talk and theory, but in reality it becomes very dysphoric.

• A 24-year-old participant who identifies as a man and has a “heavy preference for women” but describes himself as bisexual because he is also attracted to “penis possessors if they look like women”:

  Outside of a sexual context, most of these things cause dysphoria. […] Outside of sexual fantasy, being female is not something I really identify with. Dissociating myself from what I am during sexual activities has allowed me to feel more comfortable doing those sexual activities, but I’m not sure if that is a good thing necessarily.

• A 23-year-old participant who identifies as transmasc and queer after previously identifying as lesbian:

  For all that I indulge in and enjoy this kink, I have never regretted or even considered stopping HRT.

🎯 Conclusions

In this analysis, I explored whether there were meaningful differences among subgroups of FtM participants in the three psychological correlates of autogynephilic fantasies—namely, emotional distress, erotic prominence, and identity influence. I failed to find meaningful differences in the first two correlates, but the results on the third were intriguing.

If the erotic fantasies that these FtM participants are experiencing are the manifestation of genuine autogynephilia—i.e., the same phenomenon that natal males experience—then it is no surprise that some of them experience a certain degree of identification with their erotic self-image of a woman, beyond temporary sexual arousal. The foregoing exploratory analyses suggest that this identity influence might be manifesting in different ways.

There might, for instance, be a change in the individual’s perception of gender identity, influencing it in the man-to-woman direction. Note that this does not necessarily mean that the individual completely abandons the transgender identity and reverts to being a woman; instead, the individual may adopt an in-between identity, such as nonbinary or genderfluid. Accordingly, this change in identity may have the downstream effects of adopting new pronouns and changing one’s appearance.

The identity influence may also pertain to medical aspects, such as the decision to cease hormonal treatment by quitting testosterone, as well as the lack of interest in pursuing certain FtM surgeries—most notably top surgery (i.e., double mastectomy). These effects need not be contingent on any change in gender identity, as an individual may, for instance, continue to identify as a man after quitting testosterone, or he may decide to retain native breasts as a transgender man.

These hypotheses about the identity influence effect of autogynephilic fantasies are particularly relevant to researchers who study desistance and detransition in FtMs.2 In recent years, multiple studies on this topic have identified multiple factors playing a role in the decision to desist or detransition.3 To the best of my knowledge, however, erotic fantasies have never been investigated as a potential factor.

Broadly speaking, autogynephilic fantasies are unlikely to be a major factor in desistance and detransition, as these fantasies appear to occur only in a minority of FtMs, and it is only a minority of that minority that experiences the effect of identity influence. Nevertheless, autogynephilic fantasies ought to be investigated as a potential factor for a more complete picture of the causes of desistance and detransition.

In this context, it should be kept in mind that autogynephilic fantasies are generally a taboo topic for FtMs. It is unlikely that participants in detransition research will bring it up on their own, especially when participation is not anonymous. As such, researchers ought to inquire explicitly about autogynephilic fantasies, preferably in research designs that make it comfortable for participants to talk about sexuality.

For the time being, my research here has only served to generate interesting hypotheses that can be tested in future research. Such research can also examine the extent of regret among autogynephilic FtMs about various aspects of gender transition, and the potential association of regret with autogynephilic fantasies. In this line of inquiry, researchers should aim to identify correlates of regret in the hope of helping FtMs make better-informed medical decisions. If it is established, for instance, that FtMs who are particularly aroused by the erotic fantasy of having breasts are significantly more likely to feel regret after undergoing top surgery, then this would be a valuable heuristic in advising FtMs.

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➡️ Further reading

Read the other parts of the quantitative study in the main article.

📖 Background

See the main article for the other parts of this quantitative study.

➤ Introduction

The discovery of autogynephilic fantasies in FtMs often occasions significant emotional distress, especially since these fantasies gain a certain degree of prominence in the erotic lives of many individuals. These experiences even influence the way some FtMs perceive their gender identity. In this post, I examine this triad of psychological correlates—namely, emotional distress, erotic prominence, and identity influence—and their relationship to autogynephilia.

𝚿 Psychological correlates

In my previous qualitative work based on case reports,1 I observed that autogynephilic fantasies in FtMs have three main psychological correlates:

1. The emotional distress occasioned by the fantasies due to the conflict between the individual’s erotic self-image as a woman on the one hand and the professed masculine gender identity on the other. This distress is fairly common, and it leads to attempts to avoid indulging in the fantasies because of their ego-dystonic character;

2. The prominence of the fantasies in the individual’s erotic life, which varies from person to person. For some individuals, these fantasies are only one erotic interest among many. For others, they are the mainstay of eroticism and a necessary condition for sexual satisfaction;

3. The influence of the erotic fantasies on the individual’s perception of gender identity, which is also a variable effect. For many individuals, this influence is small. For some, however, the effects may go as far as changes in gender identity and detransitioning.

I also pointed out that these correlates bear a very strong resemblance to what is known about autogynephilia in natal males. Since the main aim of this study is to investigate whether these erotic fantasies in FtMs are genuine autogynephilia—i.e., the same phenomenon as in natal males—or something else that only superficially resembles it, these psychological correlates offer one avenue of inquiry into this question.

By looking at the data, we can quantitatively verify whether the subjective experiences of FtMs who have these erotic fantasies match what we would expect to find if the phenomenon were genuine autogynephilia. If the data line up with our hypotheses, it would count as some evidence in support of the view that these FtMs are experiencing genuine autogynephilia.

To aid us in this exercise, we will use a tool that psychologists call a nomological network, which is a simple way of organizing different concepts and the theoretical relationships that might exist between them. In this case, the network would conceptually link the construct of autogynephilia with its three psychological correlates. With empirical measures of these theoretical constructs, we may then examine the correlations in the data to see if our hypotheses about these relationships are confirmed or disconfirmed.

To make matters precise, I made the following simple hypotheses:

• Autogynephilia would be positively associated with all three of its psychological correlates: emotional distress, erotic prominence, and identity influence;

• Emotional distress would be fairly common among participants;

• Erotic prominence would be observed on a spectrum;

• Identity influence would be relatively rare;2

• Erotic prominence would be positively associated with emotional distress: individuals for whom the fantasies are more prominent will tend to report more emotional distress;

• Erotic prominence would be positively associated with identity influence: individuals for whom the fantasies are more prominent will tend to report more influence on gender identity.

These relationships are visually represented in the diagram below, where the circles represent the theoretical constructs, the arrows illustrate the hypothesized associations between them, and the plus signs indicate that we expect to find positive correlations in our measures of these constructs. Evidently, the key aspect here is identity influence: while many unusual sexual phenomena can become prominent in an individual’s erotic life and also cause emotional distress, there is no sexual phenomenon other than autogynephilia that is known to influence an individual’s gender identity in the man-to-woman direction.

To investigate these hypothesized relationships quantitatively, I devised a scale containing six items for each psychological correlate of autogynephilia, for a total of 18 items. I asked the participants to rate how true each of the 18 statements was for them, at any point in the past or at present, on a five-point rating scheme: not at all, slightly, moderately, quite a bit, and very much. I coded these answers numerically from 1 to 5. Below, I analyze the structure of the scale scores, I report their descriptive statistics, and I investigate the correlations to see if they match the hypothesized theoretical relationships.

🧮 Factor analysis

Before analyzing the results, we must first assess how appropriate it is to use the scores on this scale as measures of the three psychological correlates we are interested in. The following exploratory factor analysis verifies some of this. The specialist reader will find the technical details in the footnotes.3 The lay reader may interpret the figure below as providing analytic rigor in averaging the scores of items for each of the three psychological correlates we are investigating.

📊 Descriptive statistics

Based on the factor analysis, I constructed the three scales of emotional distress, erotic prominence, and identity influence. The descriptive statistics of these scale scores are listed below and shown visually along with the histograms of the score distributions. In the table, the last column (ω_T) is a measure of the reliability of each scale’s scores, which was excellent for all three.

• Emotional distress: It was common for participants to report that autogynephilic fantasies caused them emotional distress. In fact, the distribution of these scores (in pink) is slightly negatively skewed, which means that participants tended to report more than moderate levels of emotional distress.

• Erotic prominence: It was also common for participants to report that autogynephilic fantasies were prominent in their erotic lives. The distribution of these scores (in green) looks rather uniform, which suggests a fairly balanced spectrum along which roughly equal numbers of participants fall. On one end of this spectrum, the fantasies are not very prominent; on the other end, they are very much so.

• Identity influence: In contrast, it was not common for participants to report that autogynephilic fantasies influenced their view of their gender to any significant extent. The distribution of these scores (in gold) is highly positively skewed, which means that most participants reported very little identity influence. Nevertheless, a small minority (17/182 = 13.7%) reported more than moderate levels of influence.

So far so good! These findings are as expected.

🌌 Intercorrelations

Next, we will examine the relationships between the three psychological correlates of autogynephilia. The table below reports three types of correlation between the scores of the three scales:

1. The first column lists the latent variable correlations found in the factor analysis. You can think of these as approximations of the theoretical correlations between the constructs;

2. The second column lists the Pearson correlation coefficients calculated directly from the data. These are the correlations typically reported in studies;

3. The third column lists the Pearson coefficients corrected for attenuation. This is an estimate of the correlations between what psychologists call true scores, which are scores in the ideal scenario with no random measurement error.4

The three types of correlation are very similar, which is expected. The pairwise relationships are shown in the graphic below,5 and the discussion that follows uses the corrected Pearson coefficients as a guide.

• Erotic prominence had a moderate positive correlation (r = 0.44) with emotional distress. This is not surprising, as individuals who do not prominently experience these fantasies do not have much to get hung up on. The ones who are most distressed are probably those who feel unable to resist the appeal of these fantasies, despite their best efforts.

• Erotic prominence also had a moderate positive correlation (r =0.40) with identity influence. This is not surprising either, as autogynephilic fantasies must hold a certain degree of prominence in the individual’s erotic life for them to have the potential for a significant effect on gender identity. It is not a sufficient condition, but it is necessary.

• Emotional distress had a relatively weaker correlation (r = 0.29) with identity influence. This relationship is difficult to interpret in a static fashion, as I instructed the participants to report the highest feelings they had experienced at any point in the past, not limited only to the present. A more informative examination of the relationship between emotional distress and identity influence would require tracking the change in these variables over time, as the relationship is probably dynamic.

To sum up, the positive relationships found between erotic prominence and the two other psychological correlates of autogynephilic fantasies match the hypotheses we outlined in the nomological network. So far, still good!

🆚 Autogynephilia scores

Next, we will look at the relationship between the scores of these three scales of psychological correlates and the autogynephilia scale that I administered to participants. As a reminder, I previously calculated a general autogynephilia score by averaging the entire scale that rated the highest arousal experienced by participants in response to 32 fantasy items.

Do individuals who score high on general autogynephilia report having experienced greater emotional distress than those who score lower? Do they report a greater prominence of these fantasies in their erotic lives? Do they report more influence on their gender identity due to these fantasies? These are the questions this analysis will answer.

To investigate these associations, I will rely on Spearman’s rank correlation coefficient:6

• ρ = 0.26 (p < 5×10^-4) for general autogynephilia vs. emotional distress.

• ρ = 0.52 (p < 6×10^-14) for general autogynephilia vs. erotic prominence.

• ρ = 0.42 (p < 3×10^-9) for general autogynephilia vs. identity influence.

These relationships, along with the correlation coefficients, are shown in the scatter plots below.7

General autogynephilia scores had a moderate correlation (ρ = 0.52) with scores of erotic prominence. This shows that, to some extent, high scores on general autogynephilia indicate a more intense experience of autogynephilia. Nevertheless, the fact that this correlation was only moderate and not high in magnitude should be taken as caution: general autogynephilia scores should not be assumed to be an adequate measure of the relative intensity of autogynephilia between individuals.

To understand this, remember that the general autogynephilia scale measures the average arousal intensity across many different fantasies. As such, it measures both the intensity of sexual arousal and the scope of erotic fantasy. Some individuals may have a limited range of erotic exploration, focusing on a small number of fantasies but experiencing intense arousal by them. Such individuals would have similar general autogynephilia scores with others who may fantasize about a wider range of autogynephilic content but with a less intense response overall. This is the reason I introduced the scale of erotic prominence for a better measure of the perceived importance of autogynephilia in the erotic lives of participants.

The conflation of arousal intensity with fantasy scope is perhaps why general autogynephilia scores had a relatively weaker positive correlation (ρ = 0.26) with scores of emotional distress. This means that some individuals who scored high on the general autogynephilia scale did report greater levels of distress, but the picture is more complicated. For instance, many participants reported high distress even while scoring low on general autogynephilia.

Finally, general autogynephilia scores had a moderate correlation (ρ = 0.42) with scores of identity influence, reflecting the fact that, for some participants, experiences of autogynephilic fantasies are associated with influences on gender identity in the man-to-woman direction, leading them over time to view their gender differently and, in the extreme cases, to detransition completely.

All in all, these relationships match the hypotheses we made in the nomological network, painting a solid picture that this erotic phenomenon in FtMs resembles the autogynephilia of natal males in terms of psychological correlates.

🎯 Conclusion

The proverbial duck test posits that if something looks like a duck, swims like a duck, and quacks like a duck, then it is probably a duck. What we have been doing is akin to a scientifically rigorous duck test. Applied to the research question at hand, we could say that if the erotic phenomenon that these FtMs experience has the same dimensional structure as autogynephilia, and if it exhibits the same psychological correlates in the same pattern of relationships as autogynephilia—especially the aspect of influence on gender identity—then this phenomenon might just be genuine autogynephilia.

I previously found that the dimensional structure of autogynephilia is replicated in these erotic fantasies of FtMs. Here, I examined another aspect of the scientific duck test. I started out with some hypotheses regarding the psychological correlates that would be expected if the participants were experiencing genuine autogynephilia, and I found that the data confirmed the hypothesized relationships. In other words, this phenomenon exhibits the same effects in FtMs as autogynephilia does in natal males.

This kind of evidence is what psychologists would call nomological validity. As part of the broader scientific duck test, it provides additional support for the view that these FtMs are experiencing genuine autogynephilia, not a phenomenon that merely bears superficial resemblance to it. That said, this kind of argument is not conclusive; like the duck test, it is merely suggestive.

👍 Leave a like on this post and tell me your thoughts about it in the comments.

➡️ Further reading

Read the other parts of the quantitative study in the main article.

📖 Background

See the main article for the other parts of this quantitative study.

➤ Introduction

The scores of FtM participants on the scale of autogynephilic fantasies appear to be well modeled by a general factor (i.e., the general trait of autogynephilia) and several secondary content domains (i.e., the seven dimensions of autogynephilia dealing with anatomy, clothing, behavior, etc.). In this post, I analyze the feasibility of computing various scores from the scale and I examine the potential correlations and subgroup differences of these scores with other variables of interest.

🏗️ Scales of fantasies

Based on the previous factor analysis of the data and the associations that emerged between the fantasy items and the dimensions of autogynephilia, I calculated several scores, one for general autogynephilia by averaging the entire scale, and seven for the dimensions of autogynephilia by averaging the respective subscales.1

📈 Descriptive statistics

The descriptive statistics—mean and standard deviation—of each scale are shown below, in descending order of score, with general autogynephilia in pink and the seven dimensions in green. In the table, the last three columns are very important but technical. I give a comprehensive explanation of their meaning in the footnotes, for readers who are interested in psychometric details.2

The technical insight provided by the last three columns in the table tells us that we should only be confident in using two of these scores in further analyses: the total scale score of general autogynephilia, and the subscale score of physiologic autogynephilia. The other six subscale scores are rather poor indicators of the autogynephilic dimensions they are supposed to be measuring, and we should be very cautious in using them in further analyses, lest we overreach in drawing conclusions.

It is notable that the dimension of behavioral autogynephilia, which contains fantasies of adopting a feminine comportment and mannerisms, has the lowest score among the seven dimensions. Previous research on autogynephilic natal males has also found that behavioral autogynephilia is the rarest facet.3 While these results could mean that this dimension is indeed rare in both natal males and FtMs, the alternative explanation is that the items that investigate this dimension do not adequately capture its most common erotic expressions.

🌌 Dimension correlations

Putting aside physiologic autogynephilia for a moment, all other dimensions are moderately correlated with each other, as shown in the heatmap below (range for Spearman’s ρ = 0.46 to 0.68). These moderate correlations are driven by the influence of the general factor across dimensions. The notable exception is physiologic autogynephilia, which has weaker correlations with the other dimensions (range for Spearman’s ρ = 0.29 to 0.45). Overall, no dimension is so highly correlated with another as to question the meaningful distinction of each.

The first column in the heatmap below shows the correlation of each dimension (= rows) with the general scale minus the items composing that particular dimension—hence, the complement. In other words, this column is a measure of how well the score on each part of the scale is related to the score on all the others combined. With the exception of physiologic autogynephilia (Spearman’s ρ = 0.45), all complement correlations are high (range for Spearman’s ρ = 0.67 to 0.77), driven again by the influence of the general factor across dimensions. All correlations in the heatmap below are extremely significant (p < 6×10^-5 for all).

🌀 Group differences

Let’s examine whether these autogynephilia scores differ between subgroups of participants according to other variables of interest. Heeding the previous caution about the justification of scoring subscales, I only examine the general and physiologic autogynephilia scores, referring to the latter as pregnancy fantasies for a more accurate description of the content.

I had no specific hypothesis about these differences, so this analysis is exploratory in nature and serves to generate interesting hypotheses. I will use Spearman’s rank correlation coefficient ρ, as well as non-parametric statistical tests for group differences, interpreting p-values continuously with no threshold. In the following, the sample size differs slightly each time due to the varying availability of data.

🪪 Gender identity (N = 182)

Dividing the participants on the basis of their stated gender identity into three groups (N = 93 for “man”; N = 52 for “transmasc”; N = 37 for other identities), there was no significant difference between these three groups:

• Kruskal–Wallis H test: H = 2.10 (p = 0.35) for general autogynephilia;

• Kruskal–Wallis H test: H = 1.20 (p = 0.55) for pregnancy fantasies.

💞 Sexual orientation identity (N = 150)

Considering the participants whose reported sexual orientation identity was exclusively androphilic (N = 42) vs. bisexual (N = 108), there was no significant difference between these two groups:

• Mann–Whitney U test: U = 2424.0 (p = 0.68) for general autogynephilia;

• Mann–Whitney U test: U = 2196.5 (p = 0.60) for pregnancy fantasies.

🎂 Current age (N = 182)

With respect to the current age of the participants, the general autogynephilia score had a negative correlation that was weak in both magnitude and statistical significance, while the correlation with the pregnancy fantasies score was negligible:

• ρ = -0.13 (p = 0.07) for current age vs. general autogynephilia;

• ρ = 0.07 (p = 0.32) for current age vs. pregnancy fantasies.

💡 Time since discovery (N = 172)

Considering the number of years since participants discovered their autogynephilic fantasies, calculated based on their recalled age data, the general autogynephilia score had a negligible correlation while the pregnancy fantasies score had a positive correlation that was weak in both magnitude and statistical significance:

• ρ = 0.09 (p = 0.25) for years since discovery vs. general autogynephilia;

• ρ = 0.13 (p = 0.09) for years since discovery vs. pregnancy fantasies.

💉 Time on testosterone (N = 155)

Neither the general autogynephilia nor the pregnancy fantasies scores were correlated with the number of years that participants have been on testosterone:

• ρ = 0.02 (p = 0.85) for years on testosterone vs. general autogynephilia;

• ρ = 0.00 (p = 1.00) for years on testosterone vs. pregnancy fantasies.

⚗️ Testosterone form (N = 163)

I split the participants into three groups based on the form of testosterone they reported taking: enanthate or cypionate (medium-acting injectable esters, N = 103); undecanoate (long-acting injectable ester, N = 22); and topical gel (N = 38). There were no significant differences between these three groups:

• Kruskal–Wallis H test: H = 2.50 (p = 0.29) for general autogynephilia;

• Kruskal–Wallis H test: H = 1.77 (p = 0.41) for pregnancy fantasies.

❓ Testosterone status (N = 182)

Dividing the participants into current (N = 155), former (N = 12), and never (N = 15) users of testosterone, there was a significant difference in the general autogynephilia score between these three groups, but no difference in the pregnancy fantasies score:

• Kruskal–Wallis H test: H = 7.99 (p = 0.02) for general autogynephilia;

• Kruskal–Wallis H test: H = 4.30 (p = 0.12) for pregnancy fantasies.

Post hoc comparisons revealed the following interesting result:

• Former users scored higher than current users on general autogynephilia.

  → Mean score: 3.56 vs. 2.74.

  → Dunn’s test: p = 0.005 (unadjusted), 0.01 (Bonferroni correction).

  → This is a large difference: Cohen’s d = 0.85 [0.25, 1.45].4

The confidence interval is large due to the small sample size of former users, but the effect is evident. In interpreting this finding, remember that I instructed participants to report the highest arousal they had ever experienced in response to autogynephilic fantasies. Why, then, did former users of testosterone score higher on general autogynephilia than current users? I can think of two plausible explanations:

• Survivorship effect: If cessation of testosterone leads to a decrease in libido, it is reasonable to assume that FtMs who quit testosterone will also tend to quit visiting the adult online communities from which I recruited participants. Perhaps individuals who continue visiting those communities are precisely those with an exceptionally strong interest in autogynephilic fantasies that persists even after quitting testosterone. This is what psychologists would call a survivorship effect in sampling.

• Identity influence: If autogynephilia played a role in the decision of former users of testosterone to quit the medication, as some participants explicitly stated in their survey responses, then it is reasonable to assume that such an outcome is more likely in individuals with a particularly strong interest in autogynephilic fantasies.5

These explanations are not mutually exclusive, so both could be true to some extent.

🪡 Top surgery (N = 182)

Considering the participants who have undergone top surgery (N = 68), those who wish to undergo it (N = 90), and those who have no interest in it (N = 24), there were no significant differences between these three groups:

• Kruskal–Wallis H test: H = 1.03 (p = 0.60) for general autogynephilia;

• Kruskal–Wallis H test: H = 3.45 (p = 0.18) for pregnancy fantasies.

There was, however, a suggestion of some difference among participants regarding the fantasy of having a woman’s breasts (item #3 in the scale):

• Kruskal–Wallis H test: H = 5.75 (p = 0.06).

Post hoc comparisons revealed the following two interesting results:

• Those who had no interest in top surgery rated the fantasy of having breasts as more arousing than those who had undergone top surgery.

  → Mean score: 3.88 vs. 2.96.

  → Dunn’s test: p = 0.02 (unadjusted), 0.05 (Bonferroni correction).

  → This is a medium-to-large difference: Cohen’s d = 0.59 [0.11, 1.07].

• Those who had no interest in top surgery also rated the fantasy of having breasts as more arousing than those who want to undergo top surgery.

  → Mean score: 3.88 vs. 3.22.

  → Dunn’s test: p = 0.07 (unadjusted), 0.22 (Bonferroni correction).

  → This is a small-to-medium difference: Cohen’s d = 0.44 [-0.02, 0.90].

These differences are weak in statistical significance, especially since we are doing multiple pairwise comparisons, and the confidence intervals are rather large, crossing zero in the second comparison. Nevertheless, these results suggest that perhaps FtMs who are particularly aroused by fantasies involving their breasts are less likely to want to pursue top surgery to remove them. Thus, a particular autogynephilic fantasy might be acting as a disincentive to pursue a particular medical aspect of gender transition—at least for some individuals. This is an intriguing hypothesis that ought to be investigated in future research.6

🎯 Conclusion

The analyses here failed to find meaningful differences between participants in their general autogynephilia scores on the basis of several variables of interest. On the measure of this general trait of autogynephilia, these participants do not seem to differ based on gender identity (e.g., man vs. nonbinary), sexual orientation identity (i.e., androphilic vs. bisexual), testosterone form (e.g., injectable vs. topical), or top surgery status.

Of course, there may be very small differences between these subgroups that my study did not have enough statistical power to detect, but detecting small differences is not the objective of my study. It is rather to investigate whether the erotic fantasies experienced by the participants are genuine autogynephilia—the same phenomenon that is well-known in natal males—or something that only superficially resembles it.

I previously found suggestive evidence that autogynephilic fantasies emerged after testosterone initiation in most of the FtM participants, raising the hypothesis of a causal link. Of most interest to this hypothesis is the apparent lack of influence of two important variables on the measure of the general trait of autogynephilia: the number of years since starting testosterone and the time elapsed since discovering these fantasies.

Put differently, participants who recently discovered autogynephilic fantasies likely experience them in a similar way to participants who discovered them many years ago. Likewise, participants who are fairly fresh on exogenous testosterone likely experience these erotic fantasies in a similar way to seasoned users of the medication.

These results are not consistent with the view that autogynephilic fantasies were cultivated gradually over time by the participants. On the contrary, these results suggest that, in most of these individuals, autogynephilic fantasies suddenly emerged and quickly reached a plateau in terms of the breadth of erotic content and the intensity of sexual response. This makes it more compelling to hypothesize that these fantasies are underlain by a trait (i.e., autogynephilia) that perhaps emerges in most FtMs due to a threshold effect of testosterone.

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➡️ Further reading

Read the other parts of the quantitative study in the main article.

📖 Background

See the main article for the other parts of this quantitative study.

➤ Introduction

In my previous qualitative work based on case reports, I observed that autogynephilic fantasies in FtMs emerged in early young adulthood. In fact, the individuals I interviewed discovered these fantasies sometime after starting testosterone. In this regard, FtMs who have these fantasies differ from autogynephilic natal males, for whom the fantasies most often emerge during puberty and sometimes even in childhood. It is useful, then, in this quantitative study, to examine the onset of autogynephilic fantasies in this sample of FtMs and to explore the extent to which testosterone initiation can predict the emergence of autogynephilic fantasies.

🏁 Onset of autogynephilic fantasies

I asked the participants to recall the age at which they discovered their sexual arousal by any of the 32 fantasies that compose the scale—if they were aroused by any of them. In the survey, this question on the age of onset was inserted immediately after the 32 fantasy items were rated for arousal intensity. It is important to note that this question on the age of onset was not connected with those that requested recalling the age of various milestones of gender transition. Those questions were placed in an entirely different section of the questionnaire. I will rely on all of these recalled age data in the following analysis.

🧠 Recall bias

Evidently, there are always problems with recall bias in asking people to date autobiographical events in their lives. More specifically in our case, the issue is what cognitive psychologists call the telescoping effect. It occurs when an individual recalls the date of a past event as being closer or more distant to the present than it actually is, resulting in forward or backward telescoping.1

In my qualitative work based on case reports, I observed that the discovery of sexual arousal by autogynephilic fantasies in FtMs tends to occur in early young adulthood, which is not far off in the past for the participants of this survey, as most of them are in this age range. Furthermore, the discovery of autogynephilic fantasies in FtMs tends to be a surprising, salient event, often accompanied by psychological distress. These FtMs can often recall the exact circumstances surrounding the discovery.

It seems reasonable to assume that such a salient, recent event that makes its mark on the individual’s memory would generally be less susceptible to the telescoping effect than if it were more distant and mundane.2 This consideration makes me more confident in the accuracy of the recalled age of onset of autogynephilic fantasies in this sample.3

That said, some inaccurate recall is just a matter of course when considering individual data points. Nevertheless, if this inaccuracy is mostly attributable to random error rather than systematic error, then aggregate data will reduce it. Stated differently, in the results that follow, we should pay more attention to the general trend that emerges rather than exceptions due to single observations.

🔔 Recalled age of onset

Nearly all participants provided an answer for the age of onset of their autogynephilic fantasies; only seven did not answer or said they were never aroused by the fantasies. For fifteen answers, I had to extract an age value by making reasonable assumptions whenever this was possible; otherwise, I discarded the data.4

The recalled age of onset is shown below, for the participants for whom data were available (172/182 = 94.5%). The median recalled age of discovering autogynephilic fantasies was 19 [IQR: 18–21]. Most participants recalled making the discovery during early young adulthood (i.e., roughly from 18 to mid-twenties).

The following demarcation may be made in these data:

• The large majority of participants (133/172 = 77.3%) recalled discovering their sexual arousal by autogynephilic fantasies at the age of 18 or later;

• A minority of participants (33/172 = 19.2%) recalled discovering it between the ages of 12 and 17, plausibly during puberty;

• A few participants (6/172 = 3.5%) recalled discovering it in childhood.

It is difficult to interpret the responses of the last segment of participants—those who recalled an onset in childhood—as they are very few. It is more informative to consider the other two segments, and especially those who recalled an onset in early young adulthood, which constitute the majority of participants.

The median number of years since the participants discovered their sexual arousal by autogynephilic fantasies was three [IQR: 1–5]. Most participants (114/172 = 66.3%) discovered their arousal by autogynephilic fantasies at most three years before taking the survey.

💎 Correlation with transition milestones

It is potentially useful to examine which—if any—of the three major milestones of gender transition is most predictive of the onset of autogynephilic fantasies in the participants. The three milestones are first feelings of being transgender, social transition, and testosterone initiation. I asked the participants to recall the age of each of these milestones in their gender transition journey.

It seems reasonable to assume that the provided ages of these three milestones differ in their susceptibility to inaccurate recall, for two reasons:

1. First, these milestones are most often sequential in time. Testosterone initiation, being the most recent event, is likely the most accurately dated. Social transition, which is often more distant in the past, is likely less accurately dated. First feelings of being transgender, being the most distant in time, is likely the least accurately dated.

2. Second, these three milestones differ in how temporally definite they are as events. Testosterone initiation is clearly defined by the first injection or topical gel application. Social transition is less clearly defined as an event, as it may entail multiple actions (e.g., coming out in different contexts) or a gradual execution over time. First feelings of being transgender are evidently the least definite of the three milestones.

Thus, for these two reasons—recency and definite character—the recalled ages of these three milestones of gender transition most likely differ in the accuracy of their dating by the participants. This caveat should be kept in mind in interpreting the results that follow.

The recalled ages of these three milestones vary in their correlation strength, as measured by Spearman’s coefficient:5

• ρ = 0.40 (N = 170, p < 5×10^-8) for feelings of being trans vs. social transition;

• ρ = 0.73 (N = 163, p < 3×10^-28) for social transition vs. testosterone;

• ρ = 0.29 (N = 161, p < 2×10^-4) for feelings of being trans vs. testosterone.

The recalled age of onset of autogynephilic fantasies was only weakly correlated with the age of first feelings of being transgender, but it was moderately correlated with the ages of social transition and testosterone initiation, with a slightly stronger correlation for the latter, as measured by Spearman’s coefficient:

• ρ = 0.19 (N = 166, p = 0.013) for feelings of being trans vs. autogynephilia;

• ρ = 0.40 (N = 164, p < 9×10^-8) for social transition vs. autogynephilia;

• ρ = 0.44 (N = 157, p < 6×10^-9) for testosterone vs. autogynephilia;

We can safely disregard the association of the first transition milestone—first feelings of being transgender—with the onset of autogynephilic fantasies, as the correlation is weak. This leaves us with the other two milestones: social transition and testosterone initiation. Both are moderately correlated with the recalled age of onset of autogynephilic fantasies, which is not surprising, as both milestones are highly correlated on their own (ρ = 0.73, as shown above). How, then, can we proceed to examine which of these two transition milestones is more associated with the onset of autogynephilic fantasies?

🆚 Social transition vs. testosterone

Let us first examine the time elapsed between each milestone on the one hand, and the onset of autogynephilic fantasies on the other. In the plots shown below, the golden dashed vertical line separates the participants on the basis of whether the recalled onset of autogynephilia was before or after the age of the transition milestone. Zero indicates the coincidence of both events at the same age.

The median time from social transition to the onset of autogynephilia was four years [IQR: 2–6], whereas the median time from testosterone initiation to the onset of autogynephilia was only one year [IQR: 0–2].

As we can observe, the recalled onset of autogynephilia clusters more tightly to the immediate aftermath of testosterone initiation than to the immediate aftermath of social transition. There are two other ways to visualize this:

1. Below on the right: I calculate the cumulative distributions of the previous graphs of elapsed time. The golden dashed vertical line shows when the recalled onset of autogynephilia coincides with the age of the respective transition milestone.

2. Below on the left: I plot the recalled age of onset of autogynephilic fantasies against the age of each transition milestone. The golden identity line similarly indicates the coincidence of both ages.6

As can be observed on the left, the pink markers representing testosterone initiation tend to lie closer to the coincidence line than the green markers representing social transition, which are more dispersed. As can also be observed on the right, the pink curve (testosterone) saturates much quicker than the green one (social transition) after the coincidence line.

To dig further, let us examine the temporal sequence of the three recalled events and calculate the number of participants who fit each possible sequence. A total of 153 participants provided recalled age data on all three events (social transition, testosterone initiation, and discovery of autogynephilic fantasies). The following table presents the raw number of participants who followed each path. An ampersand represents a coincidence in recalled age, whereas an arrow represents a strict difference of at least one year in recalled age. Keep in mind, again, that these data are imperfect.

The large majority of these participants (116/153 = 75.8%) appear to have experienced a temporal sequence in which the onset of autogynephilia coincided with testosterone initiation or occurred afterward. In contrast, only a minority (37/153 = 24.1%) appear to have discovered autogynephilia before initiating testosterone, at least based on these imperfect recalled age data.

📈 Linear regression

Let us go a step further and see which of the two transition milestones is a better predictor of the emergence of autogynephilic fantasies. To minimize any potential issues with recall bias, I will only consider the participants who reported a recent onset of autogynephilic fantasies, at most three years before taking the survey. Of these, 101 provided both the age of social transition and the age of testosterone initiation. Between these two transition milestone ages, which one better predicts the age of onset of autogynephilic fantasies?

The right tool for this question is multiple regression. We will plug the two milestone ages in a multiple linear regression model as the independent variables (x_S and x_T) and attempt to predict the age of onset of autogynephilic fantasies as the dependent variable (y_AGP).7 It will be as simple as this:

The results are shown below. The plots are two-dimensional projections of the solution, visualizing the effect of each predictor separately by holding the other constant at its mean.

Together, the two ages of transition milestones explain a substantial portion of the variation in the age of onset of autogynephilic fantasies (R² = 0.53, F(2, 98) = 55, p < 10^-16). In other words, slightly more than half of the differences between these individuals in the recalled age of onset of autogynephilic fantasies can be accounted for simply by knowing the age of the two transition milestones.

There is, however, an important difference between these two variables: the age of testosterone initiation is a strong and statistically reliable predictor (a = 0.70, p < 7×10^-7), but the age of social transition is much weaker, in both strength and statistical significance (b = 0.22, p = 0.08). This means that the age of testosterone initiation is much more predictive of the onset of autogynephilic fantasies. Once testosterone is taken into account, the age of social transition has little predictive power.

🖼️ Bigger picture

Taking a step back from this analysis, it is worth remembering that the overwhelming majority of participants in this study (91.8%) report that they have taken testosterone. The participants were not specifically recruited for this; they were only recruited for being gender-variant natal females who frequent online communities dedicated to certain types of erotic interests.

A priori, there is no reason that such a high percentage of participants in this survey would have taken testosterone. A recent large cohort study found that, in the adult population of gender-variant natal females in the United States, only slightly more than half (678/1,194 = 56.8%) have ever taken testosterone.8 This rate is significantly lower than in the present survey, which raises an important question: why are there so few participants who have never taken testosterone?

A simple explanation would be that gender-variant natal females who use testosterone have higher libido, which drives their increased participation in the online erotic communities from which I recruited participants. Another explanation, however, is what the foregoing analysis has suggested so far: autogynephilic fantasies generally emerge after testosterone initiation in these individuals. These two explanations are not mutually exclusive, so both could be true.

🎯 Conclusion

I have previously speculated that testosterone could play a causal role in the emergence of autogynephilic fantasies in FtMs who experience them.9 The quantitative analysis of the age of onset of these fantasies in this sample is consistent with this hypothesis. Most participants recalled an onset in early young adulthood, and this onset is temporally associated with the initiation of testosterone, mostly occurring within two years of the start of treatment. Another important transition milestone for FtMs—namely, social transition—is a poor predictor of the emergence of autogynephilic fantasies after testosterone is taken into account.

While temporality is typically taken as the most important criterion in establishing a causal association, I should clarify that this study’s design does not permit causal inference. After all, this is merely a descriptive cross-sectional study, akin to taking a snapshot in time of a sample from a specific population (i.e., FtMs who experience autogynephilic fantasies), without a comparison group (i.e., FtMs who do not experience these fantasies). Therefore, all discussion of causality is necessarily speculative, as it relies entirely on the recalled ages of various events in a single group.

For a rigorous investigation of the causal link suggested here between the initiation of exogenous testosterone and the emergence of autogynephilic fantasies, another type of study is required, one that is analytic rather than descriptive, and prospective rather than cross-sectional. Such a study would follow two appropriately matched cohorts of FtMs over time: those who start medically prescribed testosterone and those who do not—duly controlling for any previous use of exogenous androgens.

In such a cohort study, the exposure would be testosterone initiation, and the outcome would be the emergence of autogynephilic fantasies, assessed with a scale like the one I used. At the study’s conclusion, the comparison between the two groups would be strong evidence for or against the causal link in question. Such a study would also be able to estimate the incidence rate of autogynephilic fantasies in FtMs, as these fantasies appear to emerge in only a minority of FtMs overall. This ought to be accounted for in choosing an appropriate sample size for adequate statistical power.

Finally, I do not claim that testosterone is causally implicated in the emergence of autogynephilic fantasies in all FtMs who experience them. Indeed, a small minority of participants recalled that these fantasies appeared many years before starting testosterone or without ever having taking it. After performing a preliminary follow-up with a few of these individuals, I had the sense that they credibly experienced autogynephilic fantasies in childhood or adolescence, in conjunction with other paraphilic phenomena. These individuals appear to constitute a distinct subpopulation. This is a topic I plan to investigate in the future.

To conclude, investigating the causal link between testosterone and the emergence of autogynephilic fantasies in most FtMs who experience them is the logical next step in this line of research. The suggestion I provided is one possible approach. While I hope someone will take this step, the chances that such a study will ever happen are, unfortunately, very slim.

👍 Leave a like on this post and tell me your thoughts about it in the comments.

➡️ Further reading

Read the other parts of the quantitative study in the main article.

📖 Background

See the main article for the other parts of this quantitative study.

➤ Introduction

The autogynephilic fantasies of natal males have a certain dimensional structure that spans several subdomains. Is this structure replicated in the erotic imagination of FtMs who fantasize about feminization, misgendering, and detransitioning? This is the question I tackle in this post, which is written for the layperson and the expert alike. Although the analysis is rigorous, I explain the concepts in plain language and keep the technical details in the footnotes for readers versed in psychometrics.

🧩 Dimensional structure

Autogynephilic natal males experience a wide array of erotic fantasies that express the idea of being a woman. In the academic literature, five distinct aspects of these fantasies have been identified, involving anatomy, clothing, physiology, behavior, and interpersonal relations.1 Moreover, the structure of autogynephilic fantasies in natal males is dimensional, which means that the fantasies tend to incorporate elements from more than one aspect simultaneously rather than focusing exclusively on a single aspect at a time. This is why these aspects are more properly called dimensions.

In my previous qualitative work based on case reports, I analyzed the erotic fantasies of feminization, misgendering, and detransitioning in FtMs, and I found that they had a similar dimensional structure. Furthermore, beyond the traditional five dimensions of autogynephilic fantasies, I identified two new candidates: a dimension that revolves around occupying traditional gender roles in society, and a dimension that eroticizes procedures of gender change. If you are not familiar with these concepts, you might be interested in reading my previous article:

Now, I will quantitatively test whether the same dimensional structure is replicated in the sample of 182 FtMs I surveyed. Why is this interesting to explore? Remember that the main goal of this survey is to investigate whether the erotic fantasies of feminization, misgendering, and detransitioning in FtMs are genuine autogynephilia or something else. If the dimensional structure of autogynephilia is replicated, it counts as some evidence for genuine autogynephilia; if it is not, it counts as some evidence against.

🛠️ Method

I started with the General Autogynephilia Scale (GAS), a 22-item instrument that contains various autogynephilic erotic fantasies of natal males, spanning the traditional five dimensions.2 I supplemented this scale with various new items of my own, mainly to explore the two new candidate dimensions I identified.

I administered this extended scale to the participants and instructed them to rate the intensity of their sexual arousal, throughout their lives, by the erotic fantasies it contained. I advised the participants to answer based on the maximum intensity of arousal they ever experienced in response to the fantasies. They rated this arousal on a five-point scale: not at all, slightly, moderately, quite, and very arousing. I coded these answers numerically from 1 to 5.

Additionally, because not every erotic fantasy that one has is necessarily something that one wishes to try in reality, I explicitly instructed the participants to consider the items as fantasies. For this analysis, I include the original GAS with two items removed3 and 12 new ones,4 bringing the total item count to 32. All these items are presented further below.

To explore the dimensional structure of the erotic fantasies of FtMs, I use a method called exploratory factor analysis. In a nutshell, this method analyzes the mathematical structure of the data, identifying patterns based on the statistical correlations in the way the participants rated the items. Erotic fantasies that had similar answers will show up in the same dimension, distinct from erotic fantasies that were rated differently. This effectively reveals the hidden structure in the data.

If you are not familiar with these concepts, do not be discouraged! I will keep the text highly readable for the layperson, all while providing the necessary technical details in the footnotes.

📊 Item distribution

Before delving into the factor analysis, it is informative to carry out a visual inspection of the way the answers on every item are distributed.

The distributions of some items are highly negatively skewed (i.e., respondents tended to score high on them). An example is the fantasy of having sex with a man as a woman. These items probably represent common erotic fantasies for most participants.

The distributions of other items are highly positively skewed (i.e., respondents tended to score low on them). An example is the fantasy of going to the women’s bathroom or locker room in public. These items probably represent uncommon erotic fantasies for most participants.

The distributions of yet other items appear bimodal (i.e., respondents tended to score either high or low, with fewer answers in the middle). Examples include the fantasy of having sex with a woman as a woman, and the fantasy of lactating or breastfeeding. This pattern suggests that some erotic fantasies in the scale are common only for some participants and not for others.

🧮 Exploratory factor analysis

One way to go about analyzing the structure of the erotic fantasies is to use a bifactor model. The bifactor model assumes that there is a general trait that underlies all the items and thus explains much of the variance in the answers, along with secondary factors—called group factors—that each explain their own share of the variance. The bi in bifactor refers to the dichotomy of general and group factors.

In the case of autogynephilia, a bifactor model would account for a general trait of autogynephilia that ties together all the erotic fantasies, along with secondary dimensions that explain the variation in types of fantasies (i.e., anatomic, sartorial, interpersonal, etc.).

The results of the factor analysis are shown in the image below.5 For the reader who is not familiar with psychometrics, interpreting the figure is much easier than it looks. Each row shows a single item that the participants rated.6 The first eight columns represent the previously mentioned general factor (G = general autogynephilia) along with seven group factors (F1 to F7 = secondary dimensions of autogynephilia).

The numerical values shown in the cells of these columns are called factor loadings. These represent how strongly each erotic fantasy (= rows) belongs to each factor (= columns). The loadings have a magnitude ranging from 0 to 1, and a sign that indicates the direction of the effect. For simplicity, I only show numerical values for loadings that are not negligible (i.e., magnitude > 0.2).

The stronger an erotic fantasy loads on a factor, the more clearly it belongs to that factor. To grasp this visually, I color-coded the values: low loadings are dark in color, and high loadings are either green or pink, depending on their sign. Nearly all notable loadings are positive, so there is not much pink in the heatmap.

The last four columns are more useful for the specialized reader, but I explain their meaning in the footnotes.7

As you can see, nearly all items load strongly on the general factor (G = first column), with a few exceptions that are relatively weaker but still moderate in magnitude. This means that all erotic fantasies are more or less accounted for by a general trait that may simply be called general autogynephilia.

As you can also see in the green cascade across the middle columns (F1 to F7 = group factors), groups of items tend to cluster on each group factor. This means that, beyond general autogynephilia, there exist secondary dimensions that meaningfully explain the diversity of the erotic fantasies.8

How important is the general factor compared to the group factors? With only two exceptions on which I elaborate further ahead, all items load with similar or even greater strength on the general factor than on any group factor. Considering only the variance explained by the model, the general factor’s share is, on average, 53% across items, leaving 47% up to the group factors. This is essentially what the values in the p² column mean. This is strong evidence of a single underlying trait (i.e., general autogynephilia) with meaningful secondary dimensions.9

🔮 Interpretation of group factors

To interpret what each group factor means, we have to look at the items that load on them. Some items have a much stronger loading on one group factor compared with all the others. Interpretation in this case is straightforward. Other items, however, load on more than one group factor simultaneously—a situation called cross-loading. These items are trickier, but it is useful to think about why they might cross-load.10

I will go through each group factor in reverse order.

7️⃣ Gender-role autogynephilia

The seventh factor has moderate loadings from the erotic fantasies of occupying traditional female gender roles (items 28–32), which supports the interpretation of this factor as the dimension of gender-role autogynephilia.

6️⃣ Procedural autogynephilia

The sixth factor has moderate loadings from the erotic fantasies of the process of detransitioning (items 22–27), which supports its interpretation as the dimension of procedural autogynephilia.

5️⃣ Behavioral autogynephilia

The fifth factor has moderate loadings from the erotic fantasies of feminine comportment (items 18–21), which supports its interpretation as the dimension of behavioral autogynephilia.

• Item 19: Going to the women’s bathroom or locker room in public. This item has some cross-loading on the dimension of procedural autogynephilia. This is likely because some participants thought of it more as a consequence of detransitioning than as an opportunity to behave in a feminine manner.

4️⃣ Physiologic autogynephilia… or something else?

Erotic fantasies of pregnancy, lactation, and breastfeeding in natal males have traditionally been thought of as a dimension of autogynephilia, reflecting female physiologic functions. Nevertheless, previous research has found that this presumed dimension is the least correlated with the other dimensions of autogynephilic fantasies. More specifically, fantasies of pregnancy, lactation, and breastfeeding had the lowest loadings on the general factor of autogynephilia. These findings have cast doubt on the interpretation of these fantasies as a manifestation of autogynephilia, and researchers have speculated that it could be a distinct erotic interest.11

A similar pattern is seen in the erotic fantasies of FtMs. Items 16 and 17 load much more strongly on their group factor than on the general factor. Indeed, the p² column shows that the group factor explains a much greater share of the common variance than the general factor (79% vs. 21%, and 75% vs. 25%, respectively for the two items), which is highly unusual in these data. This means that these erotic fantasies cannot be meaningfully interpreted as a manifestation of autogynephilia alone.12

3️⃣ Sartorial autogynephilia

The third factor has moderate loadings from the erotic fantasies of wearing women’s clothing (items 13–15), which supports its interpretation as the dimension of sartorial autogynephilia.

2️⃣ Interpersonal autogynephilia

The second factor has more or less moderate loadings from the erotic fantasies of being perceived by others as a woman (items 8–12), which supports its interpretation as the dimension of interpersonal autogynephilia. Three items are worth examining in more detail:

• Item 9: Having a stranger mistake me for a woman. This item loads almost equally on interpersonal and procedural autogynephilia, which suggests that it elicited different ideas in the minds of the participants. Some might have seen it in the interpersonal sense, while others might have thought of it in the context of detransitioning.

• Item 12: Having a man take me out for a romantic evening as a woman. This item simultaneously loads on the three dimensions of interpersonal, sartorial, and gender-role autogynephilia. This suggests a similar divergence in interpretation: some participants might have seen this fantasy in the interpersonal sense; others might have thought of it as an occasion to dress up for a date; and yet others might have seen it in the context of traditional gender roles in dating.

• Item 11: Picturing myself as a woman having sex with another woman. This item loads highest on interpersonal autogynephilia, but the loading on both this group factor and on the general is weak. Indeed, the item has a low communality (0.31), which means that 69% of its variance is unexplained by the entire model. This is likely because this fantasy requires having a current erotic interest in women, which not all participants have, and which is not adequately accounted for in the model.13

1️⃣ Anatomic autogynephilia

The first factor has moderate loadings from the erotic fantasies of having female anatomy (items 2–7). The first item about being a woman also loads the highest on this factor. This supports the interpretation of this group factor as the dimension of anatomic autogynephilia.

🎯 Conclusions

The basic dimensional structure of autogynephilia is replicated in the erotic fantasies of feminization, misgendering, and detransitioning in FtMs, with a single general underlying trait dominating the scale. This provides some evidence supporting the interpretation of this phenomenon as genuine autogynephilia.

Testing whether a scale measures the same underlying psychological construct across different groups of people is what psychologists call measurement invariance. It has several levels, the most basic of which is configural invariance, which is verified when the basic model structure of the psychological construct is replicated across different groups. My work may be seen as a first foray into investigating the configural invariance of autogynephilia in natal males and FtMs. My work, however, is only exploratory in nature; there exist more sophisticated psychometric tools that may be employed by researchers in confirmatory analyses of refined scales.

Researchers should use this factor analysis as a guide in designing improved scales for investigating autogynephilia in both natal males and FtMs. For FtMs, several items from the original GAS show cross-loadings and need to be revised; the aspect of having sex with a woman as a woman ought to be expanded with novel items; and the items from the original GAS that may not represent common erotic fantasies for FtMs might benefit from replacement. The new items I introduced for gender-role and procedural autogynephilia may be useful in designing analogs to investigate these dimensions in natal males.

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➡️ Further reading

Read the other parts of the quantitative study in the main article.

📖 Background

See the main article for the other parts of this quantitative study.

➤ Introduction

In this post, I summarize the methods of the survey of autogynephilia in FtMs, discussing in particular the integrity of the data. I also present the detailed demographics of the 182 participants, delving into their background regarding gender and sexual orientation identities, their transition trajectories, and their history of medical interventions related to gender dysphoria. I conclude by briefly describing the average participant in this survey, based on the picture that emerges.

📋 Methods

💻 Internet survey

The survey was aimed at FtMs and ex-FtMs who have experienced erotic fantasies of feminization, misgendering, or detransitioning. This group of people includes both natal females who currently identify with a masculine gender identity, as well as female desisters and detransitioners who adopted a masculine gender identity in the past.

I conducted the survey using an anonymous Google Forms questionnaire. I advertised it as a “survey of feminine erotic interests for FtMs, trans men, transmasc, ex-FtMs, etc.” The survey asked about demographic data, such as participants’ gender and sexual orientation identities, as well as medical interventions related to gender dysphoria, and it measured participants’ self-reported sexual arousal by various erotic fantasies, as well as their attitudes about those fantasies.

The survey ran for approximately one month, starting on November 21, 2025. I posted it on various online communities on Reddit dedicated to these erotic interests in FtMs. The survey received 198 responses, 13 of whom I removed because they indicated that they were natal males. I removed two more responses because they were cisgender women who did not indicate a past variant gender identity. Furthermore, two responses were exact duplicates, submitted within seven seconds of each other, probably due to a technical bug. I kept only one of them. This brings the total respondents included in the analysis to 182, all of whom were over the age of 18. Participants gave informed consent.

⚖️ Data integrity

Doing this kind of research is tricky. Unfortunately, there are individuals in online transgender spaces who actively attempt to derail survey research into the sexuality of transgender people. Motivated by ideological reasons, these individuals may try to misrepresent their natal sex, give nonsensical answers, or input false data with the malicious intention of manipulating the results.

This unfortunate circumstance naturally raises questions about the integrity of any data collected through online questionnaires on the sexuality of transgender people. This concern is even more pertinent in this case, because I did not activate mechanisms to prevent multiple submissions from the same individual on the platform I used to administer the survey.1

Despite these concerns, I have high confidence in the integrity of the data from this survey, because the overwhelming majority of the participants provided detailed information in optional, open-ended questions on their gender identity background, past sexual orientation identities, testosterone dosage, and history of surgeries related to gender dysphoria.

Only a minority of the respondents included in the analysis (26/182 = 14.3%) did not provide these details. Still, all those 26 respondents answered other optional questions on the age of social transition, the age of starting testosterone, and the age of onset of their erotic fantasies. All in all, if there were ill-intentioned agents who might have sought to manipulate the data, it is highly unlikely that they would have reached this level of sophistication in submitting false answers.

🗺️ Demographics

🌐 Region and age

Most respondents were from North America and Europe and in their early twenties, with a median age of 23 [IQR: 21–26].2

♂️ Gender identity

Respondents were asked about their current gender identity. Seven options were provided, along with the possibility of a custom answer.3

The overwhelming majority of respondents (168/182 = 92.3%) identified with a masculine gender identity:

• 93 = man;

• 52 = transmasc;

• 23 = masc-leaning nonbinary.

The rest of the respondents (14/182 = 7.7%) reported miscellaneous labels for their current gender identity, and most of them identified with a masculine gender identity in the past:

• 5 = genderfluid (2 previously identified as a man);

• 3 = fem-leaning nonbinary (2 previously identified as a man or transmasc);

• 2 = “unlabeled” gender identity (1 previously identified as a man and is now “fine with everyone calling [her] a woman”);

• 1 = agender (previously identified as a man);

• 1 = demigender (previously identified as a man);

• 1 = “genderless tomboy”;

• 1 = woman (previously identified as a man).

Respondents were also asked to provide optional information on any past gender identities. About a quarter of the sample (46/182 = 25.3%) reported a pattern of adopting at least one nonbinary identity before moving on to a masculine one at some point.

💞 Sexual orientation identity

Respondents were asked about their current sexual orientation identity. Five options were provided, along with the possibility of a custom answer.4

I sorted through the answers, cross-checked them with current gender identity, and classified them according to whether the current sexual orientation identity indicated an interest only in men, only in women, in both, or in neither.

• 108 (59.3%) reported a current interest in both men and women (e.g., bisexual, pansexual, omnisexual, biromantic);

• 42 (23.1%) reported a current interest only in men (e.g., homosexual man, androphilic, heterosexual woman);

• 7 (3.9%) reported a current interest only in women (e.g., lesbian);

• 6 (3.3%) reported some form of asexuality (e.g., asexual, demisexual);

• 4 (2.2%) reported sexual orientation uncertainty (e.g., unlabeled, unsure);

• 15 (8.2%) reported a “queer” orientation identity, which was ambiguous.

Respondents were also asked to provide optional information on any past sexual orientation identities. I sorted through the reported patterns of shifting identities to determine the proportion of respondents who likely experienced, at some point in their lives, interest in either men, women, or both:

• The overwhelming majority of respondents (167/182 = 91.8%) could be said to have experienced some interest in men;

• A somewhat smaller majority (148/182 = 81.3%) could be said to have experienced some interest in women;

• A comparably smaller majority (143/182 = 78.6%) could be said to have experienced interest in both men and women.

🏳️‍⚧️ Transition history

🏁 Onset of transgender feelings

Respondents were asked to provide optional information on the age at which they first experienced feelings of being transgender. Nearly all respondents gave an answer (178/182 = 97.8%).

Some of these answers were not single age values, so I made some reasonable assumptions. For instance, when there was a range given, I took the lowest age. When there were multiple ages given for different kinds of feelings, I took the one most indicative of gender identity variance rather than mere gender nonconformity. I also removed three answers that did not explicitly provide an age value.5

The median age of onset of feelings of being transgender was 12 [IQR: 11–14]. Nearly all respondents included in this analysis (163/175 = 93.1%) reported an onset between the ages of 8 and 21. Thus, the overwhelming majority of individuals in this sample likely experienced an onset of gender dysphoria in adolescence, at the start of puberty or some time after. Adolescent-onset gender dysphoria is currently the most common type of gender dysphoria in natal females, and its rates have skyrocketed in recent years.6

Some respondents reported a very young age for their first feelings of being transgender, ostensibly before puberty. It is difficult to ascertain whether these answers indicate a genuine onset of gender dysphoria in childhood. It is my impression that FtMs sometimes retrospectively interpret signs of gender nonconformity in childhood as being indicative of having been transgender at that young age, even though they did not identify as a boy at the time.7

This interpretation may be formulated in the following way by certain FtMs: “I always knew I was a boy, ever since I was a child, but I lacked the language to express it until I discovered as a teenager that I was transgender.”8 These experiences are evidently different from those of FtMs who not only show signs of gender nonconformity as young children, but either assert that they are the other sex or express a strong desire to be it.9

📢 Social transition

Participants were asked to provide optional information on the age at which they socially transitioned. Nearly all respondents provided an answer (174/182 = 95.6%). As mentioned above, I made some reasonable assumptions in inferring age data when more than a single age value was provided. When multiple age values were given for different aspects of social transition (e.g., different gender identities), I took the youngest age.

The median age of social transition was 16 [IQR: 14–18].

The median number of years from first feelings of being transgender to social transition was three [IQR: 1–6]. Most respondents (103/170 = 60.6%) socially transitioned within three years of first feeling transgender.

💉 Testosterone

Participants were asked to provide information on their testosterone usage. The overwhelming majority of respondents have taken testosterone (167/182 = 91.8%), and only a small minority have not (15/182 = 8.2%).

Most of the respondents who have taken testosterone (164/167 = 98.2%) specified the form they were taking:

• Most (103/164 = 62.8%) took the medium-acting injectable esters enanthate or cypionate;

• Some (39/164 = 23.8%) took topical gel preparations;

• A few (22/164 = 13.4%) took the long-acting injectable ester undecanoate.

Participants who have taken testosterone were asked to provide additional, optional information on the age at which they started it. The median age was 18 [IQR: 18–21]. Most respondents (126/167 = 75.5%) started testosterone between the ages of 16 and 21.

The median number of years from socially transitioning to starting testosterone was three [IQR: 1–5]. Most participants (139/163 = 85.3%) started taking testosterone within five years of socially transitioning.

Participants who currently take testosterone have been taking it for a median of four years [IQR: 2–4]. Most of them (101/155 = 65.2%) have been on testosterone for four years or less.

Some respondents (12/167 = 7.2%) reported having stopped taking testosterone. For these, the median time they were on testosterone was three years [full range: 1–7], and the median time since they stopped was one year [full range: 0–3].

I asked these respondents to provide optional information on the reason they stopped taking testosterone. All but one provided an answer, with some mentioning more than one reason:

• Four mentioned lack of access due to financial issues or mental health;

• Four mentioned some change in the way they see their gender;

• Two mentioned medical considerations (hair loss, future pregnancy);

• Two mentioned satisfaction with the permanent effects of testosterone;

• Three mentioned the influence of their “kinks”.

🪡 Surgery

Respondents were asked whether they underwent “top surgery”.10

• A large minority of respondents (68/182 = 37.4%) underwent top surgery;

• Half the sample (90/182 = 49.4%) did not undergo top surgery but indicated interest in doing so in the future;

• The rest (24/182 = 13.2%) reported having no interest in top surgery.

The median number of years since undergoing top surgery was three [IQR: 2–8]. The median age of undergoing top surgery was 20.5 [IQR: 18–23]. Unsurprisingly, respondents who have undergone top surgery are, on average, two years older than those who have not (median age: 24 vs. 22, Mann–Whitney U test: U = 4996, p = 0.001). This suggests that some of the participants who are interested in top surgery will go on to have it in the near future.

Respondents were asked to provide additional information on any other surgeries they received related to gender dysphoria. A few respondents (15/182 = 8.2%) reported hysterectomy, one mentioned an unspecified “bottom surgery”, and two mentioned facial surgeries.

🎯 Conclusion

Based on these data, the picture of the average participant emerges:

• He is a transgender man from a Western country in his early twenties;

• He has most likely experienced attraction to both men and women, at least at some point in his life;

• He likely experienced his first feelings of being transgender during adolescence, at the onset of puberty or some time after;

• It took him three years to socially transition, and another three to start taking testosterone. He has been on testosterone for about four years or less;

• He is likely to have undergone top surgery or to be interested in doing so in the future, but he is unlikely to have undergone any other surgeries related to gender dysphoria. In particular, he did not undergo bottom surgery (i.e., phalloplasty or metoidioplasty).

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➡️ Further reading

Read the other parts of the quantitative study in the main article.

📖 Background

Before diving into this quantitative study, you might enjoy reading my previous qualitative work on this phenomenon, based on vivid case reports.

➤ Introduction

For some time now, I have been researching a peculiar phenomenon that occurs in natal females who identify with masculine gender identities, whom I refer to as FtMs for short. Some of these individuals, after expending considerable time and effort to masculinize their bodies and transition to living as men, discover that they are sexually aroused by erotic fantasies that bring them back to the femininity they longed to escape and the womanhood that caused them much suffering and dysphoria.

I was the first to research this phenomenon, as I could find no mention of it in the academic literature. Over many months, I carefully collected and published case reports that captured in vivid detail the experiences of individuals who have these erotic fantasies of feminization, misgendering, and detransitioning.

I could not help but notice a strong resemblance between these fantasies and those of natal males who are sexually aroused by the thought of being a woman—a phenomenon called autogynephilia.1 I began to wonder if autogynephilia could occur in FtMs as well, and if it was the explanation for the experiences I was documenting. It was an intriguing question that had never been asked before. Indeed, autogynephilia is believed to be a phenomenon that occurs exclusively in natal males,2 so the proposition that it could occur in FtMs—who are natal females—was sure to raise some eyebrows.

My careful analysis of the case reports I published revealed similarities but also differences between these peculiar erotic fantasies of FtMs and the autogynephilic ones of natal males. The valuable insight gained in that qualitative endeavor proved useful in generating hypotheses that could be tested in a quantitative study, which was the next step I took in my research into this fascinating phenomenon.

To this end, I designed an internet survey and administered it to about 200 individuals who frequent online FtM spaces dedicated to the erotic interests of feminization, misgendering, or detransitioning. Of these, 182 qualified for inclusion in the analysis as FtMs or ex-FtMs. I will be publishing the results gradually over the coming weeks. In the rest of this article, I present some compelling preliminary data to introduce the subject.

⚖️ General Autogynephilia Scale

One way to investigate whether FtMs experience genuine autogynephilia is to administer a measure of autogynephilia to a sample of FtMs. The best available measure of autogynephilia is the General Autogynephilia Scale (GAS), developed in 2014.3 The GAS is a 22-item instrument that measures self-reported sexual arousal from various erotic fantasies connected with the idea of being a woman, spanning five known dimensions of autogynephilic fantasy. These dimensions deal with aspects of anatomy, clothing, physiology, behavior, and interpersonal relations.

The GAS has been administered to various samples of people, including autogynephilic natal males as well as control groups of cisgender men and women.4 Unsurprisingly, groups of autogynephilic natal males score higher than control groups on the GAS, which supports the validity of interpreting the scores on the scale as a measure of autogynephilia.

I was curious to see how my sample of FtMs would score on the GAS. I expected them to score similarly to samples of autogynephilic natal males, and much higher than control samples. This prediction was verified. The figure below lists all the available GAS data in the literature and plots them on the same graph for easy comparison. The autogynephilic samples are shown in pink, the control samples in green, and my FtM sample in gold. Autogynephilia is sometimes abbreviated as AGP.

For a meaningful comparison of the FtM score with the other groups, I pooled the mean and standard deviation of the four autogynephilic samples and the four control samples separately. Then, I compared the FtM score to each pooled group by computing a measure of difference of their means. More specifically, I calculated the difference in the mean scores in terms of the pooled standard deviation. This quantity is called Cohen’s d, and it is one measure of effect size in statistics.

As expected, the difference in the mean scores between the FtM and the pooled autogynephilic samples was much smaller than between the FtM and the pooled control samples. The 95% confidence intervals are indicated in brackets:

• FtM vs. pooled control samples: Cohen’s d = 2.11 [1.93–2.29].

  → This is a huge difference, as the two mean scores are more than two standard deviations apart.

• FtM vs. pooled autogynephilic samples: Cohen’s d = 0.34 [0.19–0.50].

  → This is a much smaller difference, as the two mean scores are only about a third of a standard deviation apart.

If psychological measurement were a simple matter, we would conclude that these FtMs are indeed autogynephilic, and that autogynephilia does occur in some FtMs. Things, however, are more complicated than that. A central issue in psychological measurement is what psychologists call validity: how do we know that any scale is actually measuring the psychological construct it is designed to measure?

This is not a trivial matter, and there is an entire field of study dedicated to it called psychometrics. In our case, it could very well be that the GAS is not actually measuring autogynephilia in this sample of FtMs, but another psychological construct. Thus, we have to dig deeper for clues into the validity of interpreting these high scores as a measure of genuine autogynephilia. This is the principal aim of this quantitative study.

❓ Hypotheses

If the phenomenon of erotic fantasies of feminization, misgendering, and detransitioning in FtMs is not genuine autogynephilia, what could it be? When I undertook this study, I had in mind two other potential explanations besides autogynephilia, which yielded three hypotheses in total:

1. Female sexuality: These fantasies are merely the expression of typical female sexuality in conjunction with a variant gender identity. In other words, this is the “normal” sexuality of women; it only appears surprising because FtMs identify as men, thereby causing a conflict between sexuality and gender identity.

2. Masochism: These fantasies are merely sophisticated expressions of masochism, the erotic interest characterized by arousal at the thought of being subjugated to a partner. Masochism is a complex phenomenon that has myriad forms of expression; erotic fantasies of feminization, misgendering, and detransitioning are just another avenue of expression for the masochistic drive in some FtMs.

3. Genuine autogynephilia: These fantasies are the same phenomenon as autogynephilia in natal males, which is distinct from both female sexuality and masochism.

The first hypothesis—female sexuality—is easily rejected. It predicts that these erotic fantasies should occur in most, if not all, FtMs. This is not the case, however, as it appears that only a minority of FtMs have these fantasies. Therefore, this phenomenon cannot be the same as “normal” female sexuality. That said, there could very well be certain aspects of these fantasies that reflect female sexuality, but they are not defining features of the phenomenon.

This leaves two competing explanations: masochistic expressions that only superficially resemble autogynephilia, and genuine autogynephilia. The main purpose of my quantitative study is to test predictions generated by these two candidate explanations, to see which one is more supported by the data.

The task is not easy. The problem is compounded by the fact that masochism and autogynephilia are known to interact synergistically in the erotic fantasies of natal males who experience both phenomena, making them difficult to disentangle. The matter is further complicated by the possibility that these peculiar fantasies of FtMs could be wholly attributable to masochism in some individuals but not others. The issue becomes even trickier with the possibility that the psychological construct of autogynephilia—if it is indeed what these FtMs experience—may be expressed somewhat differently than in natal males.

Keeping all this in mind, I hope you enjoy reading the results of the study. Thoughtful critique of my research is welcome.

📚 Reading list

👍 Leave a like on this post and tell me your thoughts about it in the comments.

📖 Background

See the main article for the case reports and the other parts of the analysis.

🙇🏻‍♂️ Masochism

Masochism, as originally defined by the German pioneer Richard von Krafft-Ebing, is the erotic interest characterized by arousal from fantasies of subjugating one’s will to a man or a woman, depending on one’s preferences.1 This core idea of subjugation may be expressed in rich and diverse ways in the erotic fantasies of masochists.

When masochism co-occurs with another erotic interest, the individual’s fantasies tend to incorporate elements from both in synergistic fashion. For instance, a heterosexual natal male who has both autogynephilia and masochism will tend to have erotic fantasies of forced feminization by a woman.2 These fantasies simultaneously draw on autogynephilia (i.e., the thought of being a woman) and masochism (i.e., the idea of being subjugated to a woman), coalescing into the erotic fantasy of being forced by a woman to be a woman.

All individuals in the case series report experiencing erotic fantasies that are masochistic in character, according to Krafft-Ebing’s original definition as outlined above.3 Some of these fantasies appear to be masochistic autogynephilia; others are not particularly connected with the idea of being a woman. Individuals in the case series also differ in how masochistic they are: for some, masochism colors nearly all their erotic fantasies; for others, masochism appears rather infrequently. The following is my attempt at thematically organizing the masochistic urges and fantasies reported in the case series.

💃🏻 Forced feminization

Most individuals in the case series report fantasies of being forcibly feminized in appearance, most often through the device of clothing.

Max is aroused by the thought of being forced to dress femininely.

Bruno fantasizes about being forcibly feminized, made to wear women’s clothes, and instructed on his anatomy and on the proper way to dress.

Chloé was aroused by the thought of being forced by someone to be a woman, an “incredibly attractive” idea that included wearing feminine clothes, shaving, and doing makeup.

James imagines he is a natal male who is forcibly feminized due to being sexually inadequate as a man.

Julian sometimes watches “sissification” pornography, the genre that caters to men’s forced feminization fantasies of being turned into a “sissy”.

William imagines being forced to feminize his appearance by growing his hair and wearing girly clothes—especially women’s underwear and lingerie.

Phoenix occasionally fantasizes that a man would force her to dress in a feminine way, against her will.

⛔ Forced detransition

Most individuals in the case series report fantasies of being forced, coerced, or manipulated into detransitioning and reverting to living as women. Beyond the aforementioned forced feminization fantasies that place the emphasis on clothing, these forced detransition fantasies focus more on the social and medical aspects, often involving elaborate plans with hormones and their imagined effects on the body.

Chloé enjoyed reading erotica depicting scenarios in which transgender characters are forced to detransition.

James likes to imagine being coerced by a partner to detransition. The partner would make James quit testosterone through force, persuasion, manipulation, or even the surreptitious sabotage of his medical supplies.

William fantasizes about being the helpless victim of forced detransitioning plots that include forcing him to quit testosterone and to take estrogens.

Leo likes to imagine being forced to detransition as part of the complete control that a master would exercise on him as his slave.

Phoenix sometimes fantasizes about being coerced by a man to accept her femininity and womanhood, and to change her body accordingly.

Roman fantasizes about going through the process of detransitioning and reverting to living as a woman. Taking estrogens is a particularly “hot” idea to him. Coming out as a woman and presenting as such in public is also “mildly arousing”, because it shows “a level of submission”.

👁️ Forced exposure

Some individuals in the case series report additional fantasies of being publicly exposed, against their will, as a woman.

Max was intensely aroused when his partner talked about how everyone would see Max as a girl and how he would introduce Max as his “girlfriend”.

Bruno fantasizes about being exposed or outed as a natal female in public situations to a person or a group of people, through forced undressing. This would urge the strangers to point out Bruno’s female anatomy.

🚨 Illegitimate identity

Many individuals in the case series are sexually aroused by the thought of being forced to accept the curious proposition that their transgender identity is illegitimate. It follows from this erotic premise that they are not really men, but only women who pretend to be men under a false belief.

There appear to be three masochistic prongs to this erotic premise:

1. The first is interpersonal, dealing with suffering misgendering by others in the form of degrading comments. In other words, the erotic premise that the transgender identity is illegitimate comes primarily from others;

2. The second has an important intrapersonal aspect, dealing with the forced internalization of the idea that the transgender identity is illegitimate, and the consequent anchoring of oneself in the reality of being of the female sex;

3. The third is interventional, dealing with forced interventions imagined to have a corrective effect in remedying the anomalous transgender thinking. The most potent corrective device imagined in this context is the reception of vaginal intercourse from a straight man.

🫵 Delegitimization via misgendering

Misgendering is a very potent device for expressing the idea that the transgender identity is illegitimate. Misgendering occurs when a transgender person is referred to with language that reflects natal sex rather than gender identity. Many individuals in the case series report that being misgendered by others in a degrading way is an erotic stimulus. Even suffering “transphobic” comments or having one’s gender dysphoria triggered may be eroticized in this manner.

Chloé sought degrading comments from strangers online on “what a woman” she was.

Matteo likes to be misgendered by a man who insults him during sex and who treats him in a “transphobic” way.

William likes to be misgendered in a degrading way by his sexting partners.

Leo is sexually aroused by being misgendered in a degrading way.

Roman likes to be described “in a way that is feminizing” and demeaning. He imagines scenarios in which others intentionally misgender him.

🙏 Internalization of fake identity

Under the premise that the transgender identity is illegitimate, a distinction is often drawn, in the online FtM communities that cater to these erotic interests, between “real” transgender men and “fakeboys”. Many individuals in the case series report being aroused by the forced internalization of this premise, which delegitimizes their transgender identity and anchors them in the reality of being female. As part of this masochistic process, some individuals fantasize about being made to confront the reality of being female by accepting their female anatomy and using their female genitalia for sexual purposes. This further demonstrates, in their erotic imagination, that they are really women and not men.

Bruno imagines being coerced into pleasuring himself using his “girl parts”. It is only in these scenarios that he resorts to taboo vaginal penetration.

Julian, when aroused, thinks that he looks “ridiculous” in men’s clothes, “trying to be something [he is] not”.

William likes to be told that he will never be a boy, that he still looks feminine, and that he should be punished for thinking he is a man.

Leo fantasizes about being reduced to his biology and submitting to it, which includes being forced to accept his anatomy, to use his female parts, and to call them female names.

Phoenix fantasizes sometimes about being coerced by a man to accept her womanhood as an “immutable” and “intrinsic” part of her. She also imagines having a straight boyfriend who “can’t help but see [her] as a woman despite trying not to”.

🤝 Correction via vaginal intercourse

The erotic premise that the transgender identity is illegitimate yields the possibility that this mental anomaly may be repaired. Indeed, some individuals in the case series are aroused by the fantasy of being “fixed” by a straight man through submitting to penile–vaginal intercourse with him. In their erotic imagination, this activity is perceived as “corrective”, implying that the transgender identity is an aberration that ought to be rectified. These fantasies sometimes incorporate the additional element of sexual violation, in which case the sexual intercourse is thought of as “corrective rape”.

James fantasizes about being “snapped out of the delusion” of being a man. He was aroused once by art depicting an FtM character’s reception of vaginal intercourse from a man as a form of “corrective rape”.

Leo fantasizes about a corrective reversion to being a woman through vaginal penetration by a straight man.

Phoenix was very aroused by a social media post talking about “‘real men’ fixing a fakeboy”.

🎯 Synthesis

It seems that all these masochistic aspects are underpinned by the same erotic idea that the transgender identity is illegitimate. This imagined illegitimacy has two facets: an anchoring in the reality of being of the female sex, and a contrast with a supposed class of “real” transgender men. Overall, most individuals in the case series appear to draw on this basic idea—that the transgender identity is illegitimate—as a source of arousal in some of their masochistic urges and fantasies.

🤰🏼 Forced impregnation

Some individuals in the case series report fantasies of being forcibly impregnated by a man.

Leo fantasizes about his forced impregnation by other men, which would lead to “the ultimate form of degradation, torture, and submission”.

Roman is aroused by the idea of impregnation through unprotected sex with men, especially when the intravaginal ejaculation is forced upon him.

💥 Sexual violation

Many individuals in the case series fantasize about being sexually violated—or, in other words, being the recipient of non-consensual sexual activity.4

Bruno fantasizes about suffering “inspections” from strangers who touch and grope him, and who coerce him into masturbating in front of them.

Julian enjoys fantasies of his sexual coercion—so-called “consensual non-consent” scenarios.

Leo is very aroused by receiving erotic rape threats from strangers online.

Roman has erotic fantasies of being raped by a group of men.

🧎 General subjugation

Most individuals in the case series fantasize about their subjugation in general. This includes submitting to a dominant partner, obeying commands, suffering punishment, surrendering freedom, and rendering services—especially sexual services, which invites the idea being objectified by being sexualized.

Chloé fantasized about sexually performing as a submissive woman who is dominated by a partner.

James enjoys the submissive role in sex. He imagines having a more useful purpose as a woman who is objectified, “built to serve”, and coercively shaped to fit her partner’s desires and cater to his needs.

Matteo likes to be dominated and even hit by men in bed. He imagines being a “very actively submissive” and “completely sexual” “whore” who begs for sex and willingly submits to any sexual act a man desires.

Julian likes the idea of being a “bimbo”—a hypersexual but unintelligent woman—and a sexual object specially designed for men’s pleasure.

William likes the idea of providing “lesbian entertainment” for a male viewer by having sex with a woman.

Leo likes the idea that someone would take “complete control” of him sexually, turning him into a “personal sex slave”.

🔒 Other interests

James stands out in the case series for an array of additional masochistic interests that include eroticizing the sexual inadequacy of having a small penis, surrendering his sexual agency to a dominant partner by locking his penis in a chastity cage, and subjecting himself to purported mind alteration techniques, such as hypnosis, to aid in the process of feminization. These interests are typically found in male masochists, and they are unusual in the case series, as only James reports having them.

💬 Discussion

In light of this analysis, it appears that all individuals in the case series are masochists, although they differ in how strongly masochism colors their erotic fantasies of being a woman. What are we to make of this observation?

One interpretation is that the erotic fantasy of being a woman in these individuals may be accounted for by masochism alone, without resort to the concept of autogynephilia. In this view, these individuals are aroused by the thought of being a woman in the context of a relationship of subjugation to a dominant partner. Being feminized is a means to express the control that this partner exercises on the submissive individual.

If this view is correct, then these individuals do not experience genuine autogynephilia; they merely experience forms of masochism that superficially resemble autogynephilia. These individuals—so the argument would go—are not aroused by the idea of being a woman per se, but by the thought of being men who are dressed in women’s clothing as a form of humiliation, and always in the context of a relationship of subjugation to a dominant partner.

In my opinion, this view is simplistic, because it fails to account for the full breadth of the erotic fantasies experienced by the individuals in the case series. While masochism accounts for many facets, it hardly explains, for instance, why Matteo contemplates going out in public dressed in women’s clothing, or why Julian imagines having a night out dressed like a woman to be picked up at a bar by a man.

Likewise, masochism hardly explains why William fantasizes about having breasts again, or why Roman goes from hating his breasts to liking them when he is aroused, and even wishes they were larger. It also fails to explain why Julian fantasizes about having absurdly huge breasts, watches specialized pornography of women who rub theirs, and inserts himself into their role. The lack of explanatory power is especially evident in the case of Phoenix, whose reported erotic fantasies of being a woman largely lack masochistic coloring.

Indeed, some individuals explicitly report that the source of erotic stimulation in their fantasies is not the thought of being a man who makes for an unconvincing woman, but the thought of actually being a woman. This sentiment is explicitly stated in the cases of Julian and Roman:

Julian, when aroused, thinks he looks “ridiculous” in men’s clothes but “so beautiful and feminine” in women’s clothes. After orgasm, however, he thinks he “looks so much like a man in lingerie” in those same photos.

Roman’s sexual arousal stems from the thought that he really is a woman, rather than the thought that he is just a man dressed like a woman or things along those lines.

Perhaps the nail in the coffin for the explanation of these erotic fantasies as mere expressions of masochism comes not from what we observe, but from what we do not. If these FtMs eroticize the negation of their transgender identity through masochism alone, then why do masochistic MtFs not eroticize the negation of theirs?

Based on my own observations, there are virtually no online MtF communities of transgender women who fantasize about being called fakegirls, are sexually aroused when referred to as men, imagine interventions to fix their supposedly anomalous transgender thinking, and entertain elaborate scenarios in their erotic imagination of their detransition and reversion to being men.

While it is conceivable that there are FtMs who are solely motivated by masochism in their erotic fantasies of being feminized, it appears to me that masochism is insufficient as a sole explanation for most individuals in the case series I presented. In the final analysis, I believe that the erotic fantasies of feminization, misgendering, and detransitioning in most individuals in the case series are best explained by autogynephilia that occasionally—perhaps often—occurs alongside masochism. This is the opinion I favor at this stage in my research.

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➡️ Further reading

Read the other parts of the case analysis in the main article.

📖 Background

See the main article for the case reports and the other parts of the analysis.

🧑🏻 Autoandrophilia & homoerotic media

Autoandrophilia is the counterpart phenomenon to autogynephilia. It is characterized by sexual arousal from fantasies connected with the idea of being a man. Autoandrophilia is known to occur in some gay men.1 It has been argued that autoandrophilia also occurs in some natal females, and particularly in FtMs.2

Both autoandrophilia and autogynephilia are believed to be internalized sexual attractions, a class of erotic phenomena in which external attraction is directed inward, confounding the erotic target with the self, and resulting in the fantasy of being the erotic target.3 In this theoretical understanding, autoandrophilia requires androphilia (i.e., the sexual attraction to men), just as autogynephilia requires gynephilia (i.e., the sexual attraction to women).

Internalized sexual attraction tends to be expressed across all of an individual’s external attractions.4 All FtMs in the case series report experiencing attraction to men and women, at least at some point in their lives. Given that they seem to be internalizing their attraction to women, it is worth exploring whether they internalize their attraction to men as well. In other words, do these individuals, who seem to experience autogynephilia, also experience autoandrophilia?

Indeed, some individuals in the case series report experiencing sexual arousal from fantasies consistent with the concept of autoandrophilia.

Max is aroused by thoughts connected with the idea of being a man, such as having a deep voice, being more muscular, being shirtless with a flat chest, being a powerful and dominant male, and wearing men’s clothes.

Matteo is attracted to muscular bodies in others, and is very attracted to his own masculinized body. He is turned on by watching his reflection in the mirror and seeing himself having sex on video.

William is aroused by thoughts of having a masculine chest and a “muscular belly”.

Phoenix sometimes imagines being a more masculinized trans man, with “accentuated masculine features”, more muscle mass, and a deeper voice.

Roman recently started to cultivate the erotic fantasy of having a penis. He finds it very arousing to think about the “power and commanding nature” that he believes comes with having a native penis.

Some individuals in the case series report having peculiar erotic fantasies in which they imagine themselves as natal males who are feminized in some way. These fantasies appear to be simultaneously autoandrophilic and autogynephilic. For that reason, this peculiar phenomenon may be called autoandrophilic autogynephilia.

Max reports that imagining himself in a skirt is much more erotically appealing when he imagines having a penis rather than female genitalia.

Bruno, when he penetrates his vagina, thinks of himself as a natal male who penetrates his anus and only imagines having a vagina.

James fantasizes about being a sexually inadequate natal male who is feminized, because his imaginary penis is too small. He thinks of his clitoris as a micropenis, and he is aroused when this micropenis is called a clitoris.

Phoenix occasionally fantasizes about being a cisgender man who is “feminized in some way”.

Roman imagines on rare occasions, in his erotic fantasies of feminization, that he is a natal male instead of a transgender man.

It is perhaps due to autoandrophilic autogynephilia that Matteo finds an erotic appeal in the image of a muscular man who wears women’s clothing.

Matteo is sometimes aroused by the thought of being a “sexy twunk in lingerie”, contrasting his masculine body parts (e.g., muscular back) with feminine attire. He finds this mixed appearance “unironically hot”.

Autoandrophilia in natal females has been associated with an interest in a specific type of fictional media known as yaoi or Boys’ Love (BL).5 These media depict homoerotic relationships between men, cast in a distinct dynamic written by women for women.6 Many female BL consumers—known as fujoshi, or fujo for short—apparently insert themselves into the role of the male characters in these media and become sexually aroused by imagining themselves as gay men. This kind of eroticism is consistent with the concept of autoandrophilia.

Some individuals in the case series—Matteo, William, and Phoenix—report a history, prior to their transition, of interest in BL. It is notable that two of them—Matteo and William—also report experiencing autoandrophilic fantasies. BL apparently played a role in their transgender identification.

Matteo first thought about being transgender due to what he calls jealousy of homosexual relationships between men. He went through a fujo phase during which he adored depictions of relationships between masculine men. He also went through a “gay envy” phase during which he idealized gay men and wanted to be one of them.

William was very fond of BL before his transition. He found depictions of gay relationships “hot” and saw himself in them. It was through these explorations that he realized he was transgender.

Phoenix became a fan of BL at the age of 11. She would insert herself into the role of gay men in homoerotic stories, perceiving herself as a protagonist in such a relationship. She was only into BL romance at first, but she got into the erotic aspect at the age of 17.

I did not emphasize the topics of autoandrophilic fantasies and homoerotic media during the interviews I conducted. I neither asked all participants about them nor explored the topics in depth with those who mentioned them. Nevertheless, it is notable that many individuals in the case series appear to have experienced the phenomenon of autoandrophilia, which would be expected if their erotic fantasies of being a woman are, indeed, genuine autogynephilia.

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➡️ Further reading

Read the other parts of the case analysis in the main article.

📖 Background

See the main article for the case reports and the other parts of the analysis.

📈 Developmental course

In this section, I summarize the developmental course of autogynephilic fantasies in the case series, exploring the age of onset, the method of discovery, the degree of interest in them, the effects that detransition has on them, the emotional distress they occasion, the strategies employed to cope with them, as well as their impact on gender identity and views on actual pregnancy.

🏁 Age of onset

Most individuals in the case series report the age they discovered their sexual arousal from autogynephilic fantasies. This reported age varies between 18 and 25. Thus, autogynephilic fantasies have an onset in early young adulthood for the individuals in the case series. This is in stark contrast to the onset of autogynephilic fantasies in natal males, which most commonly occurs during puberty, and sometimes even in childhood.1

It is notable that all the individuals in the case series who recall the age of onset of their autogynephilic fantasies report discovering them after starting testosterone. For some of these individuals, it took only a few months for the fantasies to emerge (e.g., two months for Max); for others, it seems to have taken several years (e.g., five years for Julian).

It is tempting to explain the temporal discrepancy in onset between natal males and FtMs by testosterone. In natal males, autogynephilia emerges most often in puberty, a period during which boys experience a dramatic rise in testosterone levels. The goal of testosterone therapy in FtMs is to bring their levels to the “normal” male range. This suggests that testosterone plays a potential role in the emergence of autogynephilic fantasies, in natal males and FtMs alike.

Evidently, only some FtMs experience autogynephilic fantasies. This means that testosterone cannot completely account for autogynephilia in FtMs. If testosterone plays any role in the emergence of these fantasies, it is only in individuals who are somehow predisposed to autogynephilia. Perhaps the emergence of autogynephilia happens through a threshold effect: the predisposed individual needs to reach a certain level of testosterone for autogynephilic fantasies to emerge. If this putative threshold is never reached, autogynephilia may remain latent and never manifest.

🎁 Method of discovery

Many individuals in the case series report the way they discovered their sexual arousal from autogynephilic fantasies. This discovery often occurred either through exposure to online pornography and other adult content, or through sexting with an online partner who ventured into the territory of erotic misgendering.

Max discovered his arousal during an intimate episode with his long-distance partner, when that partner began talking about how he would force Max into a skirt and how everyone would see him as a girl.

Matteo seems to have made the discovery through watching heterosexual and FtM pornography.

Julian discovered these fantasies with an online sexting partner who told him: “I’m going to call you my girl.”

William discovered his arousal during an online sexting session, when his partner talked about lingerie and how attractive William would look in it.

Leo made the discovery through online adult communities that cater to the kinks of misgendering and detransitioning in FtMs.

Phoenix made the discovery by coming across adult content on social media (Tumblr) catering to erotic misgendering and detransitioning.

🎢 Degree of interest

Many individuals in the case series report that their arousal by autogynephilic fantasies is intense, beyond the usual degree of erotic stimulation obtained through other means.

Max experienced intense arousal the first time he discovered this interest.

Julian also experienced intense sexual arousal when he made the discovery.

Matteo reports that his sexual arousal is enhanced by misgendering.

Phoenix’s arousal by these fantasies was “by far” more intense than her usual experiences of erotic stimulation. Her interest intensified further after top surgery, and even further after doubling her testosterone dose. These fantasies became “one of the very few ways” she could orgasm.

Roman is so drawn to these erotic fantasies that he likens them to an “addiction” in which he cannot stop himself from indulging.

Some individuals—Bruno, Julian, and William, for instance—report that their interest in autogynephilic fantasies ebbs and flows. They go through periods during which they are intensely interested in these fantasies, and other periods during which that intensity subsides. For other individuals, however, these fantasies seem to hold a constant appeal in their erotic imagination, as is the case for Phoenix and Roman, for instance.

These experiences parallel those of autogynephilic natal males, who also differ in the degree of their interest in autogynephilic fantasies. Some only experience them occasionally; others feel as though their whole sexuality is subsumed in autogynephilia.2

⛔ Effects of detransition

Chloé, who detransitioned, reports that autogynephilic fantasies lost their appeal after she quit testosterone. Phoenix, who is just beginning to detransition, reports a general decrease in libido, but it is too soon to tell how her interest in autogynephilic fantasies might change.

The experiences of these detransitioners parallel those of autogynephilic natal males who take cross-sex hormones to feminize their bodies. These hormones have the additional effect of lowering testosterone. These natal males also commonly experience a general decrease in their autogynephilic fantasies, due to the decrease in their testosterone levels.3

There is nonetheless an important difference: autogynephilic natal males who take cross-sex hormones are most often those who experience autogynephilia intensely enough that it makes them desire to transition. In contrast, autogynephilic FtMs who detransition may have unrelated motivations, and thus they may not necessarily have been experiencing intense autogynephilic fantasies.

💥 Emotional distress

All individuals in the case series, with the exception of Chloé, report experiencing emotional distress from their unexpected arousal by autogynephilic fantasies. The crux of the issue is evidently the conflict between the erotic self-image of a woman and the professed gender identity of a man, keeping in mind that the reality of being a woman caused gender dysphoria in these individuals in the past. For these reasons, psychologists would say that these erotic fantasies are ego-dystonic.

The reported negative emotions associated with autogynephilic fantasies include guilt, shame, confusion, embarrassment, horror, disgust, regret, as well as a sense of immorality and a feeling of invalidation.

Max strongly dislikes being seen as feminine, which triggers his gender dysphoria. He felt very depressed the day after he first masturbated to the idea of being feminized.

Bruno easily becomes uncomfortable and disgusted after climaxing to his fantasies. These feelings were very intense at the beginning, and they made him feel dysphoric and insecure about his masculinity.

James felt conflicted and “incredibly guilty and stupid” for masturbating to these fantasies. He felt that his behavior was “stupid and pitiful”.

Matteo felt “terrible” for indulging in his erotic fantasies, due to the cognitive dissonance between what arouses him and what he wants to be. He hates this contradiction. The erotic appeal of his native vagina also conflicts with his strong wish to have a penis.

Julian felt embarrassed and ashamed when he first began exploring these erotic interests.

William’s fantasies were “very confusing” to him.

Leo was regretful, embarrassed, and ashamed. He felt that his fantasies were “disgusting” and that they invalidated his identity. He also felt that he was “debasing [himself] and [his] morals for male attention”.

Phoenix felt shame and guilt at times for indulging in her fantasies. She would “sit in misery” with these negative emotions or try to “sleep it off”.

Roman feels intense negative emotions after indulging in his erotic fantasies, with “immense shame and disgust and confusion”.

These individuals differ in when they experience emotional distress from their autogynephilic fantasies. Some—Julian and William—experience it during sexual arousal. Most, however, experience the negative feelings only after climax, not during masturbation. These individuals enjoy the erotic fantasies while they last, but they are distressed in their post-orgasmic state of mind.

These experiences parallel those of autogynephilic natal males, whose erotic experiences are almost always accompanied by emotional distress, especially when they first discover their autogynephilic fantasies.4 Evidently, the erotic desire of autogynephilic natal males to be feminine also temporarily dissipates immediately after orgasm.5

🩹 Coping strategies

Some individuals in the case series, while struggling to reconcile their erotic interests with their gender identity, report that the emotional distress became manageable through certain techniques or personal interpretations. Some report that the negative emotions mellowed over time on their own.

Max reports that “aftercare” by his partner helped. The partner reassured Max’s masculine identity and reminded him that he sees him as a man.

Bruno learned to “slip back” into a “normal” state of mind after orgasm.

James came to recognize that exploring his erotic fantasies in a safe environment does not necessarily mean that those fantasies should have implications in nonsexual contexts.

Julian came to see his erotic fantasies as a way to embrace what he feels dysphoric about “in a controlled and time-limited setting”. He is reassured by his clear-headed post-orgasmic state of mind, in which he sees the dissipation of the urge to be feminine as affirming his transgender identity.

Phoenix’s negative feelings weakened with repeated indulgence in her fantasies. She reports that these feelings are mostly absent now.

Roman interprets these erotic fantasies as “a coping mechanism to help mitigate the suffering that comes with being transgender”.

Some individuals report attempting to avoid indulging in the kind of eroticism responsible for engendering these negative emotions, but they describe the appeal of autogynephilic fantasies as beyond their control. Their efforts to avoid engaging in these interests are not very successful.

Leo tried to repress his erotic fantasies, but he found himself indulging in them over and over again, every time he became sexually aroused.

Phoenix has engaged in a pattern of purging, deleting her online accounts in a desperate attempt to “cleanse” herself of the unwanted erotic fantasies, but she always found herself coming back to them again.

Roman knows that some cisgender men also have feminization fantasies. With this in mind, he imagines on rare occasions being feminized as a natal male, in an attempt “to mitigate the guilt and shame”. Roman also attempts to cultivate erotic fantasies of masculinization as a substitute, but this effort has only been mildly successful in avoiding what he perceives to be the “addiction” of erotic feminization and misgendering.

The unsuccessful attempts to rid oneself of unwanted fantasies, driven by the emotional distress they occasion, are fairly frequent in autogynephilic natal males. Some of them go through similar patterns of purging their wardrobes of women’s clothing, deleting their online accounts, and vowing never to indulge in autogynephilic fantasies again.6 These efforts, like gay men’s attempts in earlier times to rid themselves of their homosexual desires, are not very successful, because autogynephilia, like homosexuality, tends to be a stable feature of sexuality for the individuals who experience it.7

❓ Questioning gender

A few individuals—Leo and Roman, for instance—say they were never seriously disturbed in their transgender identity by their autogynephilic fantasies. Many, however, report otherwise.

Bruno started questioning his gender identity because of his erotic fantasies. He currently keeps an open mind about potential future changes in the way he feels about his gender.

Chloé saw autogynephilic fantasies as “testing the waters” of being a woman before detransitioning, but the exact role they played in her decision to detransition is unclear, due to her troubled psychiatric history.

Matteo’s erotic fantasies make him feel like an impostor at times, and he is fearful that they might make him question his transition in the future.

William questioned whether he was really transgender and what that even meant. He also wondered whether his decision to transition was a mistake.

Phoenix, under the influence of her fantasies, gradually came to doubt being transgender, and she has started the process of detransitioning. She regrets having her breasts removed.

These experiences have parallels with those of autogynephilic natal males. The impact of autogynephilia on a natal male’s sense of gender identity is a well-known phenomenon that occurs on a spectrum:

• Some autogynephilic males are never seriously disturbed in their gender identity; they are fine with being men, and they see their autogynephilic fantasies as a purely erotic phenomenon.

• Some autogynephilic males experience transient disturbances in their gender identity. They fluctuate between desiring to transition to being women and being content with their lives as men. Some of them even go through cycles of taking cross-sex hormones and giving them up with the waxing and waning of transgender feelings. Some adopt nonbinary identities, perhaps as a compromise between their two sides.

• Some autogynephilic males experience a sustained wish to transition to being women. They have stable cross-gender identities that develop gradually over the years after an established history of autogynephilic fantasy. Their dysphoric feelings from being men may reach severe levels. This gender dysphoria, which is an outgrowth of autogynephilia, is one of two known types that occur in natal males.8

A somewhat analogous spectrum appears to be reflected in the individuals in the case series, spanning the experiences of Leo and Roman, who were never seriously disturbed in their identity as transgender men; Bruno and William, who questioned their transgender identity due to their autogynephilic fantasies; and Phoenix, whose erotic experiences played an important role in her decision to detransition.

There is, however, an important difference between autogynephilic natal males and the individuals in the case series. The latter have experienced gender dysphoria from being female and living as women. Their distress was severe enough that they transitioned to living as men. They discovered their autogynephilic fantasies only after starting testosterone, and they still carry a history of gender dysphoria. In contrast, autogynephilic natal males have no analogous experience of life as a woman when they discover their autogynephilia, let alone an experience that is comparably negative.

It is conceivable, then, that any impact of autogynephilia on gender identity would generally face greater resistance in FtMs than in natal males. In this context, it is illustrative to consider the sentiment expressed by Matteo regarding the prospect of going back to living as a woman.

Matteo has chills from the idea of detransitioning. Reverting to a skinny body, getting periods and mood swings, and having fat storage in breasts and hips are all things that disgust him to think about.

🤰🏼 Views on pregnancy

Evidently, FtMs can become pregnant because they are natal females. This opens up the possibility that autogynephilic fantasies may influence how FtMs view actual pregnancy. The case is different for autogynephilic natal males because they cannot possibly become pregnant; for them, all thoughts of pregnancy are bound to remain, by force of circumstance, in the realm of fantasy.

In the case series, many individuals who experience erotic fantasies of pregnancy dread the prospect of actually becoming pregnant. For them, pregnancy is merely an erotic scenario; the real thing would be a disaster.

James is very uncomfortable with the idea of becoming pregnant, which “sounds like a nightmare” and makes him feel dysphoric.

Matteo does not want children. He says that actually becoming pregnant would make him want to kill himself.

Leo finds the prospect of actual pregnancy “horrible and traumatizing”. It is “a big fear” of his, and he thinks of it “in a very negative light”.

Roman is “terrified” by the thought of actual pregnancy, and he “would never, ever want to do it”.

For Phoenix, however, the prospect of pregnancy has an appeal beyond mere eroticism. Even before she discovered her erotic interest in pregnancy, she had the desire to breastfeed her kids, but it seems that her erotic fantasies have strengthened this desire over time.

Phoenix’s “baby fever” was occasional and “just in the background”; over time, her fantasies made it “almost daily” and brought it to the foreground.

No individual in the case series has undergone a drastic change in feelings about actual pregnancy, going from rejecting it to desiring it. It is conceivable that autogynephilia might have this effect in some individuals, but I have not observed it.

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➡️ Further reading

Read the other parts of the case analysis in the main article.

📖 Background

See the main article for the case reports and the other parts of the analysis.

🌐 Demographics and medical history

The individuals in the case series vary in age from 18 to 28. All of them, except Phoenix, disclosed their ethnicity and country. Except for Bruno, who is Brazilian, all individuals are from Western countries and of European ancestry. Julian also has Mexican heritage.

In the following, I analyze the demographic background of these individuals with regard to their gender and sexual orientation identities, as well as their histories of medical interventions related to gender dysphoria.

♂️ Gender identity

All individuals report that they began to question their gender at the onset of puberty or shortly after. The youngest age was 10, for Chloé; the oldest was 16, for William. All individuals in the case series would therefore count as having had the type of gender dysphoria characterized by an onset in adolescence. In recent years, this type of gender dysphoria, which predominantly occurs in natal females, has skyrocketed in rates.1

Some individuals in the case series report a history of gender nonconformity in childhood: they recall being masculine girls before they began questioning their gender. They do not, however, remember asserting that they were the other sex in childhood.

Bruno stopped wearing dresses and skirts at the age of 7 or 8. He always befriended boys and wanted to play with boy toys.

Matteo was masculine as a child, to the point that he was bullied for being a masculine girl.

William was a “tomboy-ish” girl in his teenage years.

Roman remembers being a masculine girl ever since he was very little.

Most individuals in the case series either identify simply as men or have a masculine gender identity. The two exceptions are the detransitioners—Chloé and Phoenix—who lived as transgender men for an extended period of time before reverting to living as women. Chloé identified as a man for ten years, and Phoenix did so for three.

Some individuals report going through a period of gender exploration, during which they adopted nonbinary identities before ultimately deciding on a masculine one.

Chloé experimented with various nonbinary labels before settling on a transmasculine identity.

James identified as nonbinary in high school, then used they/them pronouns in college, before settling on his current identity of demiboy.

Julian identified as nonbinary before realizing, after a year on testosterone, that he felt more like a man.

Leo came out as transmasculine, then became unsure of what gender he was and “kind of identified as everything”. He then adopted a nonbinary identity before he eventually identified as a man.

💞 Sexual orientation identity

The current sexual orientation identity in the case series is evenly split between those who identify as bisexual (Max, Bruno, Chloé, Matteo, and William) and those who identify strictly as gay men (James, Julian, Leo, Phoenix, and Roman). The latter, however, report either a past attraction to women or a past sexual identification as lesbian or bisexual. Many individuals—Max, Matteo, William, and Roman—also explicitly report having past female partners.

As such, all individuals in the case series have probably experienced attraction both to men and women. Most, however, appear to have experienced uncertainty or confusion about their sexual orientation, as evidenced by a pattern of exploring diverse identities and cycling through various labels.

Chloé, before identifying as bisexual, believed for two years as a teenager that she was exclusively attracted to men.

James came out as bisexual, then identified as “aroace” (aromantic and asexual) before currently identifying as demiromantic, demisexual, “with a preference for men”. He simplifies this by calling himself a gay trans man.

Matteo believed he was only attracted to women, but he discovered his attraction to men after transitioning. He currently identifies as bisexual, although his romantic attraction seems directed more toward women.

Julian identified for a long time as bisexual and pansexual, but he developed a “preference” for men after masculinization, which led him in his twenties to identify strictly as a gay man.

William believed he was only attracted to boys but realized in puberty that he was also attracted to girls. He still saw himself as a gay trans man before identifying as bisexual, though his romantic attraction extends only to men.

Leo’s identities went from “gay girl” to pansexual to gay transgender man.

Phoenix went through phases of identifying as a lesbian girl, a bisexual transgender man, a straight girl, and a gay transgender man.

Roman’s sexual orientation identity has been “tumultuous”. Before identifying as a gay transgender man, he believed at various times that he was attracted exclusively to girls, exclusively to boys, and to both.

This uncertainty about sexual orientation and the consequent shifts in identity labels appear to be a fairly common feature of the FtM experience, at least for some.2

💉 Hormones

All individuals in the case series began taking exogenous testosterone to treat gender dysphoria. The age at which they started testosterone varies between the mid-teenage years and the early twenties. Chloé is the only one who reports taking puberty blockers (leuprorelin) prior to starting testosterone.

Most individuals were prescribed testosterone in an injectable preparation—most commonly the medium-acting esters enanthate and cypionate that are injected either weekly or every two weeks, but sometimes also the long-acting ester undecanoate that is taken every twelve weeks or three months. A few individuals—James, Matteo, and Julian—began with topical gel preparations before switching to injectables. Only Matteo switched back to gel.

🪡 Surgeries

Only three individuals—Chloé, William, and Phoenix—have undergone top surgery (double mastectomy) to have their breasts removed.

Many others—Bruno, James, Julian, Leo, and Roman—indicate some interest in undergoing top surgery in the future.

No one reports undergoing bottom surgery (phalloplasty, metoidioplasty, or hysterectomy).

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➡️ Further reading

Read the other parts of the case analysis in the main article.

📖 Background

See the main article for the case reports and the other parts of the analysis.

👱🏻‍♀️ Autogynephilic fantasies

Autogynephilic fantasies in natal males have been studied in the academic literature along five dimensions, involving sexual arousal from having female anatomy, wearing women’s clothing, being perceived by others as a woman, exhibiting female physiologic functions, and behaving femininely. Autogynephilic natal males often incorporate elements from several of these dimensions simultaneously in their fantasies.1 All five dimensions are found in the erotic fantasies documented in my series of case reports.

Additionally, there appear to be two other dimensions of autogynephilic fantasies that are conceptually different from the classic five, and that are also found in the case reports. The first dimension revolves around scenarios of adopting traditional female gender roles in society; the second revolves around procedures undertaken in the process of detransitioning and reverting to living as a woman. I tentatively propose these two additional aspects as new candidate dimensions of autogynephilia.

In this article, I highlight these seven dimensions in the erotic fantasies reported in the case series.

🦴 Anatomic autogynephilia

Anatomic autogynephilia is the dimension of female anatomy, along which sexual arousal is elicited by the thought of having a woman’s body or certain features of the nude female form. Most individuals in the case series report sexual arousal from imagining having certain features of female anatomy—especially female genitalia, breasts, and a smooth, feminine skin, but other features as well.

Many individuals are aroused by the reality of having female genitalia. Simply looking at it is arousing for some.

Bruno considers it taboo to use his vagina for masturbation, so he usually only stimulates his “T-dick” (clitoris), but his feminization fantasies give him the urge to penetrate his vagina.

Matteo is aroused by his vagina and likes to look at it in the mirror.

Julian derives great pleasure from focusing on his body, and he likes to watch himself masturbate in the mirror and on video, especially when he looks at his genitalia.

William is aroused by his female genitalia when freshly shaved.

Leo’s erotic fantasies make him focus on his genitalia, recognizing it distinctly as part of a female anatomy—something he otherwise ignores.

Phoenix is aroused by her female genitalia.

Many individuals are drawn to the idea of breasts. Those who had them removed fantasize about having them again. Those who still possess them imagine them even larger.

Julian is incredibly aroused by the thought of having breasts much larger than the small ones he has. He inserts himself into the role of actresses with large implants in pornographic videos. He also uses nipple pumps.

William is especially aroused by the thought of having small breasts like the ones he used to have prior to mastectomy.

Leo’s arousal makes him focus on the reality of having breasts, recognizing them distinctly as female anatomy—something he otherwise ignores.

Phoenix, who underwent top surgery, is aroused by the mere thought of having breasts.

Roman is aroused by the mere thought of having larger breasts. When he is not aroused, he hates having breasts; when he is, he likes them.

Most individuals are drawn to the fantasy of having smooth, feminine skin, which makes them want to trim, shave, or wax their body hair.2

Chloé was aroused by the idea of shaving her body.

Julian likes to imagine having a smooth, feminine body, for which purpose he trims his body hair.

William is aroused by the thought of having a more feminine body. He trims hair on his arms and legs, and he waxes the rest of his body.

Leo is aroused by the thought of having a very feminine body. He shaves his pubic hair and has thought about shaving his legs.

Phoenix is aroused by the idea of having a feminine body.

Roman fantasizes about having a softer and more feminine body.

Some individuals report fantasies of having a curvier body or imagining the femininity of other anatomic features.

Leo is aroused by the thought of being a curvaceous woman. He likes to wear tight shirts that show off his chest and accentuate his breasts.

Phoenix fantasizes about having “bigger hips, thighs, and ass”, as well as a more feminine face and more feminine hands.

Roman fantasizes about having a curvier body, and he used to imagine gaining weight to achieve it. He is also aroused by the mere thought that his female hips are unalterably wider than a natal male’s, and that they would become even wider during pregnancy.

👠 Sartorial autogynephilia

Sartorial autogynephilia3 is the dimension of female attire, along which sexual arousal is elicited by the thought or act of wearing women’s clothing, as an expression of the idea of being a woman. Nearly all individuals in the case series report sexual arousal from the thought of wearing women’s clothing or from actually doing so.

Articles of women’s clothing considered “sexy”, such as lingerie, thongs, panties, bras, and short skirts, have an especial erotic appeal in these fantasies, but more typical garments and even makeup may elicit arousal. Some individuals report frequently wearing these clothes for masturbation, and some feel the urge to look at themselves, either in the mirror or in photos and videos, clad in feminine clothing.

Max is intensely aroused by the thought of wearing feminine clothes such as short skirts.

Bruno likes thongs and lacy panties, and he has a pair he wears to masturbate. He also fantasizes about wearing skirts.

Chloé was aroused by the idea of doing her makeup and wearing feminine clothes, such as skirts, shorts, and bras.

Matteo experiences intense arousal by wearing lingerie and women’s clothing in general, which he often does to masturbate.

Julian very often wears lingerie and women’s clothing in general to masturbate, and he sometimes applies makeup. He also wears push-up bras, and he wanted to buy breast forms. He thinks he looks “so beautiful and feminine” in the photos he takes, which arouses him even more.

William is sexually aroused when he dresses in lingerie, and he likes to gaze at his reflection in the mirror. He wears feminine articles of clothing for the purposes of masturbation and sexting.

Leo is aroused by the thought of wearing women’s clothing that is sexually revealing. He feels “sexy” when he wears G-strings, short skirts, and tight shirts while he engages with online sexting partners, and the mere feeling of these clothes on his skin arouses him.

Phoenix is aroused by the thought of wearing women’s clothing, especially the “sexy” kind, such as bras, underwear, and lingerie. Mundane articles, such as “an average dress or tank top”, also arouse her. Dressing up arouses her even more than merely thinking about it, and she does it to masturbate.

Roman sometimes thinks about wearing bras, which is something he has never done before. He is curious to see how he would look in a bra, because it is “a uniquely womanly thing to do”.

Some individuals fantasize about going out in public dressed in women’s clothing or have actually done so, mimicking male-to-female transvestites.

Chloé would go out in public wearing hyperfeminine clothes, choosing ever more revealing outfits over time to arouse herself sexually.

Matteo contemplates the possibility of going out in public dressed like a woman, in a place where no one knows him.

Julian fantasizes about going out at night dressed in feminine clothes.

Motivated by their erotic desires, some individuals have collected over time a wardrobe of women’s clothing that they use for masturbation.

William bought lingerie and more “girly stuff” as time went on, including skirts, a choker, necklaces, cute socks, and panties.

Phoenix owns a sizable wardrobe of women’s clothing, including several wigs, makeup, lingerie, breast forms, and bra pad inserts.

👫 Interpersonal autogynephilia

Interpersonal autogynephilia is the dimension of interpersonal relations, along which sexual arousal is elicited by the idea of being perceived as a woman by others. All individuals in the case series report fantasies along this dimension.

The fantasy of being misgendered—addressed as a woman on the basis of natal sex rather than as a man on the basis of gender identity—is very frequent.

Max is aroused when his partner calls him a girl or talks about how he would introduce him to others as his girlfriend, which would make them see Max as a girl.

Bruno is aroused by the thought of being outed as a female in public and being perceived as such by everyone.

Chloé used to post nude photos of herself online and ask others to tell her “what a woman” she was. This aroused her greatly.

James is aroused by the thought that his partner would comment on how much better he looks as a woman after stopping testosterone.

Julian is intensely aroused when he is misgendered, and he imagines himself enthusiastically encouraging it.

Leo is aroused by simply being called a girl or told he is pretty.

Phoenix fantasizes about having a boyfriend who cannot help but see her as a woman, despite her being a trans man who presents masculinely.

Roman has an erotic desire “to be described in a way that is feminizing”. He fantasizes about being seen as a woman and being misgendered by others, both intentionally and accidentally.

The interest in adopting the role of a woman in sexual encounters is also frequent—mostly in a heterosexual encounter with a man, but also in a lesbian encounter with a woman.

Matteo is aroused by the idea of adopting the role of a woman in sexual encounters with men.

Julian fantasizes about going out at night dressed like a woman to be picked up by a straight man at a bar and to have sex with him. Julian also watches straight pornography and inserts himself into the woman’s role.

William is aroused by the idea of having sex as a woman with another woman, for the sake of providing “lesbian entertainment” for a male viewer.

Leo is greatly aroused by the thought of having sex with a straight man who sees Leo as a woman during the act.

Phoenix fantasizes about having a straight boyfriend. She also likes to interact sexually online with men who see her as a woman.

Roman fantasizes about sexual encounters with a group of straight men.

Leo and Roman provide great insight into a subtle aspect of these interpersonal fantasies. While they are usually only interested in gay men, they report that their erotic fantasies make them experience a sexual interest in straight men. In these scenarios, the imagined partner’s heterosexuality serves as a means to reinforce the idea of being a woman, since a heterosexual man is, by definition, only interested in women.

This phenomenon, which may be called autogynephilic heteroeroticism, has parallels with the phenomenon of autogynephilic bisexuality in natal males: some autogynephilic heterosexual males develop a secondary erotic interest in sexually interacting with men, because it serves as a potent expression of the fantasy of being a woman.4 Autogynephilic heteroeroticism in FtMs serves the same purpose.

🩸 Physiologic autogynephilia

Physiologic autogynephilia is the dimension of female physiology, along which sexual arousal is elicited by thoughts of exhibiting female functions such as pregnancy, lactation, or menstruation. Most individuals in the case series report fantasies of this kind, most often about pregnancy.

James is aroused by the idea of becoming pregnant, and he especially likes talk of breeding and impregnation during sex.

Matteo is aroused by the idea of becoming pregnant from a sexual encounter.

William is aroused by thoughts such as being impregnated through a male partner’s intravaginal ejaculation and having a pregnant belly.

Leo fantasizes about scenarios in which he is impregnated and carries the baby, as it means his body would naturally become more feminine, and his breasts would grow and start to lactate.

Phoenix is greatly aroused by fantasies of carrying a pregnancy, lactating, and breastfeeding, which are functions that only females can exhibit. The idea of menstruation has also aroused her by reminding her of her fertility.

Roman is aroused by the thought of being impregnated, and he sometimes fantasizes about “the early phases of pregnancy” and how his body would change during that period. He is also aroused by the thought that his hips are wider than a natal male’s for the sole purpose of facilitating childbirth.

Some of these fantasies are about carrying the pregnancy and are therefore recognizably autogynephilic. It is unclear, however, whether the mere fantasy of being impregnated through unprotected sex, as reported by some individuals, is autogynephilic per se. After all, it is not uncommon for cisgender women to be sexually aroused by similar thoughts—what is colloquially known as the “breeding kink”.

💅 Behavioral autogynephilia

Behavioral autogynephilia is the dimension of feminine comportment, along which sexual arousal is elicited by the thought of acting femininely or adopting feminine mannerisms.5 Some individuals in the case series report fantasies consistent with this dimension.

Julian fantasizes about being a “bimbo”—a hypersexual but unintelligent woman.

William is aroused by the idea of speaking in a feminine voice and learning to walk femininely in high heels. He likes to take photos and videos of himself posing in feminine ways while dressed in girly outfits.

Leo alters his voice to make it “a lot lighter and more feminine” while engaging in his erotic fantasies.

Roman takes photos of himself posing in feminine ways, and he sends these photos to online sexting partners.

🏠 Gender-role autogynephilia

Some individuals in the case series report finding a particular erotic appeal in fantasies of taking on traditional female gender roles. These fantasies appear to be conceptually distinct from those of behavioral autogynephilia, as they do not revolve around the person’s comportment. Rather, these fantasies are about the imagined social context of occupying traditional gender roles, which does not depend on having a feminine comportment. Thus, gender-role autogynephilia is likely a distinct dimension that, in past research, has not been isolated from behavioral autogynephilia.6

Chloé is aroused by the idea of being a housewife and by a host of other fantasies she refers to as “performing womanhood”.

Julian is drawn to erotic scenarios in which he fulfills the traditional female gender role in a heterosexual relationship.

Phoenix is drawn to the erotic fantasy of occupying a traditional gender role as a woman. She often fantasizes about scenarios in which she takes care of the house, caters to a husband, and raises children.

⏳ Procedural autogynephilia

Many individuals in the case series report sexual arousal from scenarios in which they imagine stopping testosterone and starting the process of detransitioning. They picture how their bodies would naturally revert to being feminine, and some fantasize about taking estrogens to make their bodies even more feminine than before. It seems that the arousal in these fantasies stems from imagining the procedures undertaken in the process of detransitioning, which would tentatively make this a distinct dimension of autogynephilia.7

Chloé enjoyed reading erotica that depicts the detransition of transgender characters.

James is aroused by the thought of abandoning his gender identity and reverting to being a woman. He imagines that stopping testosterone would make his body more feminine again.

Julian fantasizes about getting breast implants, and about how his body would naturally become more feminine over time if he stops testosterone.

William fantasizes about scenarios of detransitioning, which include stopping testosterone, taking estrogens, and feminizing his appearance by growing his hair out and wearing more girly clothes.

Leo enjoys erotic scenarios in which he detransitions.

Phoenix fantasizes about accepting her femininity and womanhood as intrinsic and immutable parts of her. She imagines a boyfriend who encourages her to accept those things, which leads her to change her body.

Roman fantasizes about the process of detransitioning and reverting to living as a woman. The idea of taking estrogens is particularly “hot” to him, for the feminizing effects this would have on his body. He is also mildly aroused by the thought of coming out and presenting as a woman in public.

Beyond the case series, I have observed, in the online FtM communities that cater to these erotic interests, other fantasies that are consistent with the dimension of procedural autogynephilia. These additional fantasies include forgetting to take testosterone or skipping injections, persuading one’s doctor to lower the prescription dose, discarding testosterone supplies in the trash, canceling planned gender-affirming surgeries, pursuing feminization procedures (e.g., breast augmentation and lip fillers), having appointments with OB-GYN doctors, undergoing psychotherapy that affirms being female, taking voice training lessons to sound more feminine, and telling one’s friends and family about detransitioning.

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➡️ Further reading

Read the other parts of the case analysis in the main article.

📖 Background

Read the main article for an introduction to these erotic fantasies.

📝 Case report — Roman

Roman1 is an 18-year-old natal female from the United States who is of European ancestry and identifies as a man. He remembers being a masculine girl ever since he was very little. At the age of 11, he “found out about the concept of being transgender on the internet”, and he “instantly knew” that it applied to him. After this discovery, he wanted to take puberty blockers, but his parents did not “warm up” to the idea until he was 16 years old, the age at which he started taking testosterone. He says he never had any interest in Boy’s Love—homoerotic media, also called yaoi.

Roman takes weekly injections of testosterone cypionate. He began with a dose of 30 mg and is currently on 46 mg per week. He says he passes very well as a man and lives his life as such. He has not received any other gender-affirming care, though he wants to pursue both top and bottom surgeries (double mastectomy, hysterectomy, and perhaps metoidoplasty).

Roman’s sexual orientation identity has been “tumultuous”. At various times, he believed he was attracted exclusively to girls, exclusively to boys, and to both. When he was “very little”, all his friends were boys and he believed he would marry one of them—something he now believes was due to “societal conditioning”. In elementary school, he thought he liked girls. In middle school, he had a “huge crush” on a boy, which he now sees as “gender envy”.

Roman then dated a boy who transitioned to being a girl a few months into the relationship. This made Roman think of himself as a straight transgender man. Nevertheless, he did not genuinely like his partner, and he only stayed because it was the first time someone had shown interest in him. After they broke up, Roman got another girlfriend, for whom he “certainly felt things” that were “very real”.

Ever since this last relationship ended a few months ago, Roman has been experiencing “a profound attraction to men”. What he currently feels toward women is “weird”. “I can appreciate that they are sexy,” he says, “but I have no desire to act on it.” He feels that his romantic attraction extends only to men, and he currently identifies as a gay transgender man.

Roman experiences sexual arousal from erotic fantasies of feminization, misgendering, and detransitioning, all of which are almost always colored with masochistic themes of domination, coercion, and humiliation. Despite this, Roman’s sexual arousal stems from the thought that he really is a woman, rather than the thought that he is just a man dressed like a woman or things along those lines. He does not recall exactly when or how he discovered he had these erotic fantasies.

Roman is aroused by the idea of impregnation through unprotected sex with men, especially when he imagines that the intravaginal ejaculation is forced upon him. He does not fantasize about lactation or childbirth, but he sometimes thinks about “the early phases of pregnancy” and how his body would change accordingly to become more feminine. He imagines that his breasts would grow larger, his hips would “somehow get wider”, and his body would become softer and curvier overall. In reality, however, actual pregnancy “terrifies” Roman, and he “would never, ever want to do it”.

The hips hold a special importance in Roman’s fantasies of having a more feminine body. He believes this is because he “can never change them”. He is aroused by the mere thought that his hips are wider than a natal male’s, simply by virtue of being a natal female, and that this difference is “for the sole purpose of childbirth”—to facilitate it. Whereas other parts of Roman’s body have masculinized under the effects of testosterone, his hips remain womanly.

Roman is also aroused by his breasts. In a nonsexual context, he hates the fact that he has breasts, and he does not want others to see them “whatsoever”. But when he is aroused, he likes his breasts and wishes they were even bigger. The mere thought of having larger breasts arouses him. Roman also sometimes thinks about wearing bras, which is something he has never done before. “I’m interested in how it would make me look,” he says, “and it definitely is a uniquely womanly thing to do.” He also used to have fantasies specifically about gaining weight, which would make his body curvier and more feminine, but he does not have such fantasies as much anymore.

Roman has an erotic desire “to be described in a way that is feminizing”, especially when done in a demeaning way. The idea of being seen as a woman by others frequently features in his erotic fantasies. He imagines scenarios in which people are able to tell that he is a transgender man, and they purposely misgender him by calling him ma’am for instance. He also fantasizes about suffering accidental misgendering from others.

The idea of being seen as a woman also features in Roman’s fantasies of having sex with men—specifically straight men. Outside these erotic fantasies, Roman is only interested in gay men, but when he is aroused by fantasies of feminization, the heterosexuality of his imagined partners serves to reinforce the thought of being a woman. “The straightness represents the fact that I ‘truly am a woman’”, he explains. Roman also has erotic fantasies of being raped by a group of straight men, a scenario that would end with his forced impregnation.

Roman also has fantasies of going through the process of detransitioning and reverting to living as a woman. The idea of taking estrogens is particularly “hot” to him, because of the imagined feminizing effects those hormones would have on his body, making it curvier and more feminine than it ever was. The thought of coming out as a woman and presenting as such in public is also “mildly arousing”. “It serves to show a level of submission,” he explains, “the fact that I’d go against every bone in my body just to appease some outside party.”

Roman indulges in his erotic fantasies of feminization, misgendering, and detransitioning through sexting. He usually sends pictures of himself in feminine poses to partners online, and he expects to receive comments on how wide his hips are and things along those lines.

During masturbation, Roman becomes so sexually aroused that he feels he cannot stop himself from engaging in these erotic fantasies. But after he orgasms, he experiences intense negative emotions, feeling “immense shame and disgust and confusion”.

On rare occasions, Roman imagines in his erotic fantasies of feminization that he is a natal male instead of a transgender man. He does this in an attempt “to mitigate the guilt and shame” that these erotic fantasies induce, by reminding himself that some cisgender men have similar fantasies.

Lately, Roman has been actively trying to cultivate erotic fantasies of masculinization instead of feminization. More specifically, the idea of having a native penis “has been mouthwateringly appealing” to him. “It is very arousing to imagine the sort of power and commanding nature of a penis that I assume one experiences,” he explains, “and I like to imagine how it would feel to touch it.”

When Roman discovered, about three or four months ago, that he was aroused by the fantasy of having a penis, he hoped that he would be able to become more interested in this type of eroticism, as it does not conflict with his gender identity, and he feels good after indulging in it. He hoped these fantasies would be a way to “stop doing the misgendering stuff”.

Every time Roman becomes aroused, he tries to steer his erotic imagination away from feminization and misgendering, and more toward what he himself refers to as “the ‘autoandrophilia’ idea”.2 This, however, has only been “mildly successful”. The appeal of the unwanted fantasies is “like an addiction” he cannot escape, even though he knows “it will end badly” for him emotionally.

Roman’s erotic fantasies of feminization, misgendering, and detransitioning hold a constant intensity in his erotic life. Despite his struggle to deal with them, he says they never made him question his gender identity. “I think that the fantasies are a coping mechanism to help mitigate the suffering that comes with being transgender,” he muses, “and in reality it doesn’t make me any less of a man.”

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➡️ Further reading

Discover more about these erotic fantasies in the main article.

📖 Background

Read the main article for an introduction to these erotic fantasies.

📝 Case report — Phoenix

Phoenix1 is a 21-year-old natal female who lived as a transgender man for several years and is currently in the process of detransitioning, although she remains uncertain about her gender identity. She did not wish to disclose her ethnicity and country. She requested that I use female pronouns to refer to her in this account. Due to the considerable length of the text, I conveniently split into three parts, which explore Phoenix’s gender history, the content of her erotic fantasies, and the impact her kinks have had on her gender identity.

🪶 Gender history

Phoenix recalls having feelings of gender incongruence for the first time at the age of 10, when she thought about cutting her hair to shoulder length. The idea behind this plan was that she could be a girl when she wore her hair down and a boy when she wore it up. She also had thoughts of using masculine-sounding unisex nicknames that could accommodate both genders.

At the age of 11, Phoenix became a fan of so-called “mlm” (men loving men) fiction—also known as BL (Boys’ Love). She would insert herself into the role of fictional male characters in homoerotic stories and perceive herself as a protagonist in such a relationship. Phoenix believes she has “always wanted acceptance and love”, which she “didn’t really get” as a child. “The next best thing was inserting myself into the fantasy of mlm couples as one of the two men,” she explains. Phoenix found male characters to be “more relatable” than female ones, and she was also drawn to them because they were free of what she calls “the misogyny problem”. Phoenix was only into mlm romance at first, and she only got into the erotic aspect much later, at the age of 17.

Phoenix came out as lesbian at the age of 11 and then as both bisexual and transgender at the age of 12. She chose a new name, began using masculine pronouns, and started binding her chest. At the age of 13, she “dropped it all” and began presenting as a girl again, although she did not tell anyone about no longer identifying as transgender. At that age, she felt attracted only to men and wanted to be only with them.

From the age of 14 to 15, Phoenix “doubled down HEAVY on the trans stuff”2 by adopting a boy’s name and masculine pronouns again. She came out to her family for the second time, cut her hair short, and returned to binding her chest. Phoenix was prescribed testosterone at the age of 17. Her regimen was a weekly dose of 50 mg of an injectable preparation (testosterone cypionate).

Phoenix stayed the course for almost two years. During that time, she only had erotic fantasies about men, even though she still considered herself bisexual. In fact, throughout her whole life, Phoenix has only ever fantasized about men, never about women. Her apparent lack of attraction toward women is in sharp contradiction with her initial coming out as lesbian as well as her subsequent identification as bisexual. There is a subtle explanation for this.

Phoenix could not fathom being in a relationship with a man as a woman, but she did not think she “could be a man with a man” either. Faced with this problem, she thought “the next best thing” was to be “butch lesbian”. “I’ve never had any fantasies about women, so I’m not sure what gave me the impression that ‘butch lesbian’ was the correct thing for me,” Phoenix says of her initial identification as lesbian at the age of 11.

Once Phoenix learned “what trans was”, and once she discovered she “could just become a man” if she wanted to, she was able to “admit” to herself her attraction to men, which led to her identification as bisexual at the age of 12. It was only much later, at the age of 20, that she thought about “re-evaluating” the label she used for her sexual orientation, when she realized she was only attracted to men.

At the age of 19, Phoenix quit testosterone for a period of one year. She grew her hair out, stopped binding, chose female pronouns, and adopted a female nickname online. She also “started moving in women-only spaces”. Phoenix never told anyone about this detransition, which she did not even conceive of as such. “It didn’t even cross my mind that’s what I was doing,” she says. This short-lived period was “the happiest [she’d] been in a while”. At this age, she was also diagnosed with borderline personality disorder.

Phoenix got back on testosterone at the age of 20. She “tripled down on the trans stuff”, going back to her masculine name, pronouns, and presentation. She cannot pinpoint the reason she did this, but she mentions the influence of “an older trans woman” who had entered Phoenix’s life as a “parental figure”. This trans woman “passed extremely well” and was on estradiol for years, which made Phoenix think that she had to be on testosterone to be “trans enough”, because she did not want that parental figure to think she “wasn’t trans” or to doubt or judge her.

Phoenix had been indecisive about top surgery (mastectomy) since the age of 19, but she underwent the operation days before she turned 20. Her initial hesitation was due to various reasons, including the fact she “liked [her] breasts in sexual scenarios and when at home”, liked that men liked them, and wanted to be able to breastfeed her future children. Her decision to pursue top surgery was made “after a bad experience with a man”.

Around the time Phoenix had top surgery, she had her first and only sexual encounter with a woman. She “hated it”. Phoenix had dated women before her transition, but she never liked it either, and she “never thought to question why”. She always assumed it just “wasn’t with the right woman”. In any case, after her first and only sexual encounter with a woman, Phoenix began identifying as “a strictly gay man”, thus letting go of her bisexual identity.

Phoenix was “never super attached to the idea of bottom surgery” (phalloplasty). For a while, she thought she “had to want bottom surgery” in order “to be a ‘real’ trans man”, but she abandoned this idea when she realized she wanted to carry her own kids. Moreover, Phoenix was “never uncomfortable with what [she] had”, referring to her female genitalia. In fact, she liked penetration in the vagina and hated it in the anus. All this made bottom surgery seem pointless, especially as she learned more about the typical outcomes and the difficult recovery.

🧚🏻‍♀️ Erotic fantasies

Phoenix believes she discovered she was aroused by the thought of being a woman last year, when she came across some adult content on the social media platform Tumblr. She does not distinctly remember what the post was about, but she vaguely recalls talk of “‘real men’ fixing a fakeboy”3 and turning him back into a woman. Phoenix thinks this particular post was probably made by a transgender man.

At first, Phoenix was “off-put and confused”, as she “didn’t really understand” the purpose of that type of content, but she was also “strangely aroused”. This was an unusual experience for Phoenix, because the stimulus immediately aroused her upon exposure, to an extent that was “by far” more intense than were her usual experiences of erotic stimulation. After this discovery, she delved deeply into the online world that catered to those erotic interests, and she explored all the ways she responded sexually to those novel stimuli.

Phoenix is aroused by the idea of having a feminine body. Breasts, which she no longer possesses after top surgery, are the most important anatomical part in her erotic fantasies. Simply imagining herself with female breasts is enough to arouse her. At a “close second” is the thought of having female genitalia, which Phoenix actually possesses.

More generally, Phoenix “really like[s] the thought of bigger hips, thighs, and ass”. Even the thought of having “a more feminine face” is arousing sometimes. She also mentions that the idea of having feminine hands can be erotic to her, especially after she noticed that her hands have changed due to testosterone and that they look different from those of her sister or mother.

These ideas of possessing feminine parts of a woman’s body arouse Phoenix on their own. Their association with a partner who forces or encourages her in the fantasy is not necessary for arousal, although it does make the scenario “slightly more arousing”. Phoenix even quantifies this small increase in arousal with “10% more”.

Phoenix is also aroused by the ideas of pregnancy, lactation, and breastfeeding, which feature in her fantasies “to a very major extent”. The idea of menstruation is not erotic per se, but it has aroused her in the past by way of reminding her of her fertility, which was erotic. Phoenix even admires and envies pregnant women, especially those who “carry the pregnancy incredibly well and look good doing it”. She wishes she could be one of them.

According to Phoenix’s intuition, thinking about these physiological functions arouses her sexually because only a female body can exhibit them. Her introspective analysis sheds much light on this aspect: “I just think of myself with a big, pregnant belly or lactating breasts and it feels incredibly female—not just feminine but female—and that’s what I like. It’s not something a male can do, so it’s kind of like physical proof of what I am.”

Phoenix is also aroused by wearing women’s clothing—especially items considered “sexy” like bras, underwear, and lingerie, although she is also aroused sometimes by more mundane garments, such as “an average dress or tank top”. The mere thought of wearing these articles of clothing arouses Phoenix, and actually doing it is even more arousing. She usually indulges in these erotic desires by dressing up alone, but she also loves the idea of “a man’s involvement”. She says she is “equally aroused by viewing [herself] as a woman and being viewed as a woman by someone else”.

At times, Phoenix imagines in her cross-dressing fantasies that a man would force her to dress in a feminine way against her will. At other times, the man would simply be encouraging her “to do what makes [her] happy”. Phoenix has never tried to put this fantasy into practice with a man in real life, so she only lives these scenarios in her imagination.

When Phoenix fantasizes about interpersonal scenarios, she mostly imagines a man who would encourage her to accept her femininity and womanhood as “immutable things” and “intrinsic parts” of her, and would tell her that “it’s okay to be happy” with them. Phoenix loves the idea that the man she loves would “mutually agree with [her] to ‘claim’ and change her body” in a female way. Most of the time, these scenarios do not involve coercion on the man’s part, but about 40% of the time, per Phoenix’s estimate, they do.

Phoenix often has fantasies about having a straight boyfriend. In some of these scenarios, she is just a woman and is viewed as such by the boyfriend. In others, however, she would be with him for many months or even years before he shockingly reveals that he is straight and that he has always seen Phoenix as a woman.

In yet other scenarios, this imaginary boyfriend is actually bisexual but “can’t help but see [Phoenix] as a woman despite trying not to”, or he has always “preferred masculinity” until he got with her. It is more arousing when Phoenix imagines that she is “not actively trying to be feminine or present femininely” but the boyfriend “still reads everything [she] do[es] and everything about [her] as feminine regardless”.

Most of Phoenix’s erotic fantasies are about accepting and embracing her natural femininity as a natal female. The idea of adopting feminine mannerisms in the way she talks, walks, and acts is not really appealing to her, but she loves the fantasy of occupying a traditional gender role as a woman. “The idea of being the one to take care of the house or take care of my husband or the kids is often arousing,” she cites as an example.

Phoenix does not “care much” for erotic fantasies of degradation. Most of the time, the scenarios she imagines do not involve any overt humiliation. Only occasionally do such fantasies “pop up”, usually when Phoenix is “feeling particularly bad”.

Phoenix has occasional erotic fantasies in which she is dominant. In these scenarios, she imagines being a cisgender man or a more masculinized version of herself as a transgender man, with “accentuated masculine features” such as more muscle mass and a deeper voice. In either case, she still imagines being “feminized in some way”. She does this to “bring attention to the contrast” created by the feminine, “delicate clothes” on a masculine body. Phoenix’s erotic persona in these particular fantasies is different from real life, as no such contrast can be created on her actual body, which passes “pretty well” as a woman when clad in women’s clothes.

💥 Aftermath

Indulging in the erotic fantasies outlined above brought about negative feelings of shame and guilt at times. Phoenix only experienced these feelings after orgasm, never during sexual arousal. When she first discovered these kinks, the feelings of shame and guilt were “quite strong”. She would delete her online accounts4 in a desperate attempt to “cleanse” herself, and she would “sit in misery” or try to “sleep it off”. With time, however, and with repeated indulgence, these negative feelings weakened. “Most of the time they’re absent now,” she says. In fact, sometimes she even feels “great” after orgasm.

Phoenix has been heavily indulging in these erotic fantasies for the past five months. She notes, unprompted, that they seemed almost to get “worse” after top surgery, and even worse when she doubled her testosterone dose about three months ago with her doctor’s approval. She wanted to increase the dose because she thought she “wasn’t having enough effects” in terms of masculinization, but a higher dose did not lead to the physical effects she expected, as it “did absolutely nothing even after several months”.

Doubling the testosterone dose did, however, affect Phoenix’s erotic fantasies by increasing the intensity of her erotic urge to feminize herself. “Dressing as a woman became incredibly sexually arousing,” she explains. This eventually led to owning a sizable wardrobe of women’s clothes: “I have several wigs, makeup, a ton of lingerie, a breast form (DD cup), and a ton of bra pad inserts that I stack on top of one another to make a B cup.”

Phoenix likes to interact sexually as a woman with men online. In fact, to be seen as a woman, to be treated as one, or to imagine herself as a woman on her own, is “one of the very few ways” she could reach orgasm during the time immediately preceding her medical detransition. She estimates that in her daily masturbation, she resorted to the erotic fantasies of detransitioning or being a woman “60–80% of the time”.

Before Phoenix underwent top surgery, her peculiar erotic interests made her doubt whether she really wanted to lose her breasts, but she “went forward with it anyway”. Reflecting now on her decision, she is “90% sure” she regrets it.

These kinks did not perturb Phoenix’s gender identity at first, but that changed gradually with time. For the past six months, she has been wondering if she is “really trans”. She is now “70% sure” she is not transgender and has begun the process of detransitioning. She quit taking testosterone during the time I was interviewing her, and she says she wants to keep detransitioning medically even “if it turns out [she] actually [is] trans”.

Phoenix has not told anyone in real life about her decision, so she is “still navigating the world as a gay man”. She has begun to think of herself as a straight woman sometimes. Her relationship with gender remains complicated: she wishes she could be acknowledged as a woman in a relationship with a man but be treated as a gay man instead of a woman.

Even so, Phoenix still gets “upset” when she is referred to with female pronouns, and she usually “can’t imagine” herself as a feminine woman except when she pictures her wedding day. “The most I can imagine is a masculine woman,” she adds. She also reports having “crazy baby fever” and wishing she could breastfeed. She regrets top surgery but thinks at the same time that her quality of life “would be so shit” had she not gone under the knife.

Phoenix is excited about the noticeable effects that stopping testosterone will have on her body, including fat redistribution, changes in hair texture, mitigation of hair loss, decrease in acne, and menstruation resumption. These are effects she already lived during the one year she stopped taking testosterone at the age of 19.

Phoenix also likes the idea of “being seen as a pretty woman again” and being respected as a woman. She thinks “women tend to get treated as sex objects and somehow third-class—not even second-class—citizens”. Misogyny and the thought of women’s sexualization fill Phoenix with dread. She wishes she could keep the respect she gets as a man after she detransitions.

More importantly perhaps, Phoenix is excited about the prospect of motherhood and being a man’s wife. She leaves open the possibility that she could just be a “spouse” or even a “husband” instead of a wife, but she definitely wants to take on the traditional gender role of a woman in marriage. That said, Phoenix hates “the assumptions and expectations placed on women”. She succinctly summarizes her mindset in these words: “When I’m just imagining my personal life, my own little bubble, I feel great. When I’m imagining the social and societal impact outside of that, I dread it. It’s people’s view of me and how their perception of me would change, whether they knew I used to be trans or not, that I hate.”

Even before discovering her erotic interest in being a woman, Phoenix knew she wanted to breastfeed her kids and to look like her mother. She had the thought that it would be easier to be “a parent like that” if she were a woman instead of a man. These thoughts, however, were not “nearly as overwhelming” as they are now in the aftermath of her erotic fantasies. “They were kind of just in the background and popped up occasionally,” she says of those thoughts. “Now they pop up almost daily and are always in the foreground.”

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➡️ Further reading

Discover more about these erotic fantasies in the main article.