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The idea that substantial numbers of MtF transsexuals belong to cholesterol test effect not fasting order generic tricor from india a putative "third type" that is neither homosexual nor autogynephilic is inconsistent with my clinical experience and is cholesterol levels u.k order tricor online now, in my opinion cholesterol jones and his band tricor 160mg without a prescription, inconsistent with the best available empirical evidence. The concept itself was only the beginning, however: Blanchard continued to conduct research on autogynephilia during the early 1990s, further extending and developing the associated theory. Chapter 2 Theory and Case Histories Further Research Studies of Autogynephilia in Transsexuals After Blanchard proposed the concept of autogynephilia and the MtF transsexual typology associated with it (Blanchard, 1989a, 1989b), he continued to conduct research to extend the concept, develop the theory associated with it, and explore its clinical manifestations and therapeutic implications. His work resulted in several important publications in the early 1990s (Blanchard, 1991, 1992, 1993a, 1993b, 1993c; Freund & Blanchard, 1993). Eventually, however, clinicians and researchers again began to recognize and study autogynephilia in transsexuals and examine the diagnostic and therapeutic implications of the concept of autogynephilia. Different Types of Autogynephilia Blanchard (1991) addressed the topic of autogynephilia in a major review article that also introduced new concepts and new data. He observed that there appeared to be four broad, nonexclusive categories of autogynephilic fantasies and behaviors: physiologic, involving female physiologic functions. He noted that "the most common behavioral fantasies of adult autogynephilic men involve the thought of themselves, as women, engaging in sexual intercourse or other erotic activities" (p. These results were consistent with the recognized tendency of paraphilic sexual interests to co-occur or cluster (Abel & Osborn, 1992; Gosselin & Wilson, 1980). Regarding the former, Blanchard suggested that anatomic autogynephilia, transvestism, and fetishism for female garments all involved "a kind of error in locating heterosexual targets in the environment" (p. He presented his ideas on this topic in greater detail in an article that appeared 2 years later (Freund & Blanchard, 1993); because his formulation is a complicated one, I will defer a detailed explanation until I discuss that article later in this chapter. Blanchard (1991) further theorized that nonhomosexual MtF transsexualism has its origin in autogynephilic sexual arousal but can eventually develop a sustaining force of its own, one in which sexual arousal per se plays little or no part. His analysis is important enough to quote at length: Any viable theory relating the etiologies of autogynephilia and transsexualism must explain the following well-established observation: Gender dysphoria, in young nonhomosexual males, usually appears along with, or subsequent to, autogynephilia; in later years, however, autogynephilic sexual arousal may diminish or disappear, while the transsexual wish remains or grows even stronger. Such histories are often produced by gender dysphoric patients, but one does not have to rely on self-report to accept that the transsexual motive may attain, or inherently possess, some independence from autogynephilia. The same conclusion is suggested by the fact that surgical castration and estrogen treatment-which decrease libido in gender dysphorics as in other men-usually have no effect on the desire to live as a female or the resolve to remain in that role. One may speculate that the above developmental sequence reflects the operation, in autogynephilic men, of certain normal heterosexual behaviors. Many men, after years of marriage, are less excited by their wives than they were initially but continue to be deeply attached to them; in other words, pair-bonding, once established, is not necessarily dependent on the continuation of high levels of sexual attraction. It is therefore feasible that the continuing desire to have a female body, after the disappearance of sexual response to that thought, has some analog in the permanent love-bond that may remain between two people after their initial strong sexual attraction has largely disappeared. However, the transsexual wish could eventually be sustained by something resembling pair-bonding-a form of attachment-after the erotic elements that characterized its early phase diminished or disappeared, just as a conventional romantic relationship can be sustained by pair-bonding or attachment after the intense erotic attraction of its early phase begins to fade. Buckner (1970) had previously observed that the typical heterosexual transvestite also "acts toward himself in a way that a normal person acts toward a socio-sexually significant other" (p. Buckner added that When a male adopts this pattern [of masturbation with articles of feminine clothing] and elaborates it into an entire feminine identity, he finds it gratifying in both sexual and social ways. When it becomes fixed in his identity, he begins to relate toward himself in some particulars as if he were his own wife. I have previously noted that the term cross-gender identity is aspirational, at least as it is often operationally defined: It denotes the gender that the gender dysphoric person wants to become, not the gender that he or she already is. But with time and lived experience in the opposite gender role, the cross-gender identity of a gender dysphoric man need not remain wholly aspirational: It can become a well-developed, highly valued part of his selfsystem and can eventually supplant his original male gender identity and become his (or her) dominant gender identity. Both Docter (1988) and Doorn, Poortinga, and Verschoor (1994) conceptualized the development of "secondary" or "lateonset" MtF transsexualism-roughly synonymous with nonhomosexual MtF transsexualism-as reflecting the ascendency of an increasingly powerful and esteemed female gender identity within the self-system of a gender dysphoric man. A few years later, Blanchard (1993c) would express these same ideas slightly differently in his observation that the "behavior and motivation [underlying nonhomosexual MtF transsexualism] is subjectively experienced as a desire for physical union with a feminine self-image" (p. He hypothesized that "autogynephilia arises in association with heterosexuality but also competes with it" (p. Blanchard interpreted these results as consistent with the theory that autogynephilia is a variant form of heterosexuality that also competes with heterosexual interest. Men with little heterosexual attraction evince low levels of autogynephilia, and autogynephilia increases with increasing heterosexual attraction, at least to a point. Then increasing heterosexual attraction becomes associated with slightly but significantly lower levels of autogynephilia as a result of the theorized competition. Blanchard (1992) further theorized that autogynephilia was competitive with heterosexual attraction in two distinctly different ways. He observed that, although autogynephilia and heterosexual attraction usually coexisted, there were some cases in which autogynephilia was so intense that it effectively replaced heterosexual attraction.

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