I am going to do a series on Bob’s work because it covers a lot of ground. I will deal with the different sections in the same order, as the paper, starting with a case of autogynephilia encountered in Bob’s own clinical practice. ( He also covers other motivations to transition, the role of pharmaceutical companies, and the phenomenon of detransition. He ends with some hypothetical, therapeutic scenarios using fictional ”cases” to avoid ethical issues arising from using real cases. All important issues)

I was unable to access a PDF to save but you can read the whole thing here:

Transgender Medicalisation

Here is the abstract:

Detransitioned Autogynephile.

This article begins with a, sympathetic, portrayal of a man who is an autogynephile. For neophytes this is a man who is sexually aroused at the thought of himself as a woman. Chris sought therapy from Bob when he realised identifying as a woman had not eradicated the feelings which drew him to a transgender identity. He feels let down by the therapists who assessed him. The therapists he saw facilitated access to the, misleadingly named, ”sexual reassignment surgery” (SRS). This is a misnomer because It is not possible to change sex. Latterly this is being called by the even more euphemistic, and deceptive, term “gender affirming surgery”. A surgery some people come to regret as is the case with Chris.

Women’s Rights.

Before I tell this story, a word about women’s rights. It is my position that no males, however they identify and irrespective of surgical status, belong in women’s spaces. Nevertheless I can exercise compassion for *some* men who find themselves in this situation. I am glad there are therapists seeking to help men with AGP before they take irrevocable decisions. For this therapy to be helpful it should not simply validate their identity. It should aim to contain it before they hurt themselves, and others. I do not think it is helpful to affirm anyone in the belief they are a woman, trapped in a man’s body. It is harmful to the man and the women expected to provide, free, therapeutic support; in the form of validation and admittance to women’s spaces. When a clinician demands prove of “living in role” and tacitly encourages males to trespass on women’s spaces you are force-teaming women. This is not ethical.

My sympathy, for men with this condition, is qualified. It ends when a man, with or without autogynephilia, demands his condition be normalised, uses women’s spaces and promotes gender identity ideology, especially to children. When this is motivated by a desire to gain acceptance for a sexual paraphilia, we need to be able to point out this is unacceptable.

Withers opens with a poem and his interpretation of the underlying motivations for Attis’s madness and motivations for castration, followed by a return to sanity and regret.

Bob’s interpretation of the mythical experience of Attis is as follows:

We then leave the realms of poetry to meet a patient who rejects his maleness and locates the source of his distress in his male sexual organs. He tries to cut out his ”madness” by surgical inversion/removal of his penis. Following surgery his first emotion is one of relief: 👇

Chris retained his identity as a “woman” for nine years but, like Attis, his attempt to evade his maleness was doomed to failure. Chris could ”pass” as a woman but he still experienced the rage he had associated with his maleness, as a result, he had decided to detransition. As I have covered before, in my work on detransitioners, the medical professions are unskilled in this area and Chris had not been provided with the male hormones he could no longer produce himself. He now finds himself suicidal and his attempts to blog about his experience had also incurred the wrath of the ”trans” community.

Chris sincerely wishes he had received appropriate analysis before he took irreversible steps. We learn that his father was an abusive alcoholic who abandoned the family and his mother could only love him as a girl. It is not clear whether this is his mum’s actual stance, a trauma response to his maleness, perhaps, or if this is Chris’s projection. {I certainly have seen more than one case of a mum enthusiastically claiming a male child is her daughter which deserves psychological evaluation, of her motives, conscious or not, before medicalising the child}.

Chris had no positive, male, role model. His flight from the characteristic he shares with his father is complicated by maternal rejection, real or perceived, and further confused by early erotic experiences. Autogynephilia is described as an erotic target location error where a heterosexual man is aroused by the idea of himself, as a woman. It has been described as ”becoming the thing he loves”, it is a sexual paraphilia. Unsurprisingly Trans activists do not wish this to be discussed. I am probably not the first person to call this ”the love we would rather you didn’t name”. It is hard to sell trans rights on the back of a sexual paraphilia.

Even with my research into this area, as a lay person, he is describing common patterns of arousal, shame, purging and the accompanying rage. He had what passed for analysis at a gender clinic but was not challenged and became fixated on his goal. Impatient with waiting lists he found a private provider to perform the surgery.

That last sentence is important. “the evidence base supporting the efficacy of such treatment is extremely poor“.

This will be part one of a series. The next one looks at puberty blockers.

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