Why do trans women transition?

This blog post is part 1 of a blog debate that I intend to have with Jack Molay about the transgender etiology. In it, I will lay out my current beliefs about the question in the title, which includes the Blanchardian typology, as well as other things that you will see below. This post is not intended as a strong argument for Blanchardianism, nor as a detailed explanation for all of the nuances that I know, but is instead just intended as a starting point for the exchange, which will show my direction of analysis and provide options for further inquiry.

The importance of a baseline

To me, an answer to why trans women transition is a causal model that relates the various factors involved in trans women’s transition as accurately as feasible. However, if you think about it, getting a full model of this would be quite excessive. For instance, if trans women can’t get food, they die and can’t transition. So a full causal model would include farming, transport, places to buy food, cooking, digestion, and so on. And that’s just one example; there are all sorts of other domains, from limb movement to education that a full model would need to include.

One thing that these all have in common is that they are concerns that are shared between humans in general, and which are studied outside of trans contexts (e.g. in economics). Including them in the model would thus be a bit redundant; they can be taken as a baseline and we can instead focus on the differences between trans women and this baseline. There may still be cases where it would be relevant to invoke the standard factors, because they moderate some aspect of the core model, but most of the time we should be taking the standard factors for granted.

Thus, to me this changes the question to, in what ways do trans women differ from cis men, in such a way that the former end up transitioning but the latter don’t? To answer this question, we must discover some relevant axes of variation, as well as their causal relationships, which come together to explain, as best as possible, trans women’s gender issues.

Trans women transition due to gender dysphoria

Or so the saying goes. Gender dysphoria is understood as various forms of distress that trans women feel about their male characteristics. To me, it seems that it gets described in various ways, including pain, disgust and despair. It makes obvious sense that someone who feels such would want to transition to no longer be like a male, and since I experience such feelings myself, I can definitely believe that trans women do so too. Plus it would be a completely unrealistic conspiracy that so many trans women say they feel it, without them actually feeling it.

Realistically, this is a bit simplistic to me, though. Not only do trans women feel gender dysphoria, they also feel that they would be better of with female characteristics, which is sometimes called “gender euphoria”, though I think “cross-gender ideation” would be a more scientifically standard term. Most cis men don’t feel this way, but instead feel that it’d be pretty bad to be female, and it also makes sense to me that feeling this way contributes to transition. After all, if you think both male and female traits suck, that’s not much reason to seek to have the opposite kind.

Some people make a big deal out of this distinction between positive and negative feelings. I don’t really, as it seems to me that they kind of tend to flow into each other. From a practical point of view, there’s concepts like hedonic adaptation, where something that used to become positive ends up neutral, and losing it becomes upsetting. From a theoretical point of view, coarse general models of psychology I know, like rational decision theory or prospect theory, do not distinguish between positive and negative preferences like this, but instead places them all on a single continuous scale. It seems like we would need to have some detailed model of the human motivational system to untangle this, and I don’t have that yet. (Though it may be relevant to develop for these topics.) Thus I tend to lump all of this into a broader term, which I label “gender issues”. So trans women transition due to gender issues.

But wait, can we be a bit more specific with this? So gender issues are positive or negative emotions about being female or male. But what exactly are positive or negative emotions? Where do they come from? My understanding is that a core element of it lies in appraisal; positive emotions correspond to appraising something as being good for you, while negative emotions correspond to appraising something as being bad for you. So this all roughly speaking boils down to “trans women transition because they don’t like being like males and want to be like females”.

Trans women transition for reasons unrelated to gender dysphoria

Really, it’s not quite right to say that trans women transition due to gender issues. There’s also going to be all sorts of other factors contributing. For instance, in different environments, transitioning is differently viable. Over time, transitioning has become more socially accepted, and there have come to be more medical interventions to support transition.1 There are also individual differences in expected transition outcomes, which probably influences things. There may also plausibly be differences in self-acceptance or knowledge that contributes to or prevents transition. This is all pretty complex.

A lot of these are probably things that you can learn a lot about just by being around people with various degrees of gender issues, and you can find them to make a lot of theories about it. I’m not going to go all that much in-depth with it, but I think a lot of the theories about this that you could get from people with gender issues are going to be right, with the caveat that they are likely to present the people themselves as making “the right” choice, and so possibly leading to a bias for or against transition.

One thing that often comes up is concepts like “gender identity”, “feeling that one is a woman”, and such. I get pretty 🤨 about that, because they seem to lump different things together. If we were to take things overly literally, “feeling that one is a woman” might include things like believing that one has female anatomy. However, this is rarely what trans women mean when pressed on it; instead they often seem to fall back on these terms ultimately referring to gender issues. (I.e. “wanting to be a woman is feeling like a woman”.) That said, there are some trans women who do lean all the way into it, and claim to have felt confused each time they realized what their sex characteristics were. I’m not sure how much I should really take them at face value, though.

Trans women transition due to autogynephilia

Ok, so trans women transition because of gender issues; because they don’t like being men and want to be women. But where do those gender issues come from? Let’s for a moment consider trans women who are not exclusively attracted to men. (We’ll get back to trans women who are exclusively attracted to men later.) Again and again, some peculiar things about their sexuality has been noticed.

Beginning from very long ago, they have been found to often be sexually aroused by wearing women’s clothes, a tendency which Blanchard documented statistically in his studies. This is something that has often been replicated, e.g. by critics of Blanchard like Nuttbrock. Contrast this with cis men, who generally aren’t into this. Blanchard also found that they tend to have sexual fantasies in which they imagine being biologically female. Trans women also often report having had a “gender swap fetish”, and finding being female to be erotic. I myself tend to imagine myself as female in sexual fantasies, and have at various times had sexual fantasies that had more or less focus on that.

My interpretation of this is that these and other phenomena all represent a sexual interest in being a woman. This sexual interest is called autogynephilia. Since the notion of a sexual interest is a rather central concept to my model, it is worth going into more detail:

Most people end up in relationships with people of the opposite sex. The reason they do this is because of their sexuality; people have evolved to be attracted to the opposite sex, as this tends to make them reproduce. However, people differ, and one way that they differ is in their sexual interests; some are into the same sex, some are into masochism, etc.. We can observe sexual interests in what people do in purely-sexual situations, such as what their sexual fantasies are about, or what erotic material they use, or similar. However, these sexual interests are really primarily meant to influence people’s general preferences for life, which they indeed do as can be observed by how most people reliably end up in relationships with the opposite sex.

Since we observe trans women to have a sexual interest in being women, it is logical to conclude that this is a big contributor to their gender issues. Furthermore, if we look at autogynephilic cis men, then these cis men have an incredibly dramatically large upwards shift in gender issues, as would match the understanding that the autogynephilia is a primary factor in trans women’s gender issues.

Now, autogynephilia isn’t the full story. Most autogynephiles do not transition, and there’s still the question of how they end up autogynephilic, plus the question of how autogynephilia actually mechanistically ends up influencing gender issues. And for that matter, we only have a vague understanding of autogynephilia, by lumping together various anecdotes and theory pieces. I’ve tried to create a more definite understanding by doing a qualitative survey, which you can see the results of here, but it is still limited by various factors. There’s a lot of controversy over where exactly to draw the line between autogynephilic and non-autogynephilic sexuality, and I am not going to take an opinion on that yet. Researching autogynephilia and sexuality more would definitely be good for the theory. But still, it’s at least one major piece of the puzzle.

Where does autogynephilia come from?

The origin of autogynephilia is a bit of a mystery still, just as how the origin of homosexuality is. However, we do have some hunches. A common idea, proposed by most people who think about this question, including by Ray Blanchard and Julia Serano, is the idea that Blanchard labelled Erotic Target Location Errors.

Roughly speaking, the idea goes like this: It seems kind of striking that autogynephiles desire to be women, when usually males are sexually attracted to women as partners. Plus autogynephiles seem to be less likely to be gay than non-autogynephiles. Maybe some of the mechanisms that can make you sexually attracted to women can also make you sexually attracted to being a woman, under certain as-of-yet unknown conditions.

Something that could be understood as further supporting this would be research on other sexual interests in being something. For instance, furries are known to be interested in being anthropomorphic animals, but they are also attracted to anthropomorphic animals. As another example, some pedophiles also report a sexual interest in being children. And there is a condition known as Body Integrity Identity Disorder, which functions much like gender dysphoria except with disability instead of gender, and people with BIID are often attracted to amputees.

It is very unlikely that ETLE can account for all autogynephiles. Some autogynephiles are gay, and obviously ETLE cannot account for them. It might also be that ETLE isn’t real at all; one would then need some other set of explanations to account for the previous observations, but that doesn’t seem all too difficult, at least with our current knowledge. But we’ll see.

The transsexual typology

Trans women who are not autogynephilic are usually found to be exclusively attracted to men, as you can see in the studies I linked earlier. There’s also a number of other characteristics in which non-autogynephilic trans women are striking, such as being more feminine and transitioning younger. These are known as HSTSs (homosexual transsexuals).

I find it pretty difficult to untangle why exactly they transition, and this certainly isn’t helped by the fact that their reasons for transition hasn’t been studied much. A lot of people seem to just find it “obvious”, probably because they equate masculinity/femininity with gender satisfaction, which I think is wrong. But I can give some conjectures for what is going on with them.

First, it is well-known that there is a connection between masculinity/femininity and sexual orientation; conditional on sex, those attracted to men are more feminine than those attracted to women. This likely explains a good part of why HSTSs are more feminine. But as I will explain shortly, I think there is more to it than that.

I think the femininity is probably related to their gender issues in some way. For instance, in many cases society has various forms of gender norms, where men are preferred to be masculine and women are preferred to be feminine; if one is a feminine male in these sorts of places, then it would make sense that one would end up with dissatisfaction about being male.2

I think there may be other connections too, though. For instance, if you’re attracted to men, you’re going to have an easier time fitting in as a woman than if you are attracted to women. And if probably some aspects of femininity, such as presentation, are more a result of rather than a contributor to gender dissatisfaction.

But there’s another important point to be made about what distinguishes HSTSs and AGPTSs, namely desistance. Some clinicians deal with boys who experience gender dysphoria, and these boys are typically very feminine and typically grow up to be attracted to men, just as would be associated with HSTSs. However, they also typically desist from their gender issues, and become happy with being male. See e.g. this qualitative and this quantitative study for some more overview of what that may look like. So one characteristic of HSGD is that it tends to go away with time.

My theory for why this is is that there are specific conditions where HSGD tends to apply; for instance, maybe boys face stronger gender norms as children than as adults. These conditions likely also lead to further separation between AGPTSs and HSTSs; so I think part of what makes HSTSs more feminine is that they tend to come from contexts where femininity is more likely to lead to gender problems, and not just because homosexuality is linked to femininity.

Ultimately, untangling HSTSs is still something I’m working on, and a big problem in this is that it often comes back to a vaguely defined notion of “femininity”. One of my current major projects is to make “femininity” more crisply defined; once this is achieved, perhaps it can support us in getting a better understanding of HSTS.


All of this really needs more research, and unfortunately there’s not really anyone doing much research on this. I think this model is a good starting point in understanding things, though.

1. This is part of why I am pretty 🤨 about aspects of “Rapid Onset Gender Dysphoria” theories, which claim that gender issues are transferred by “social contagion” between individuals with no predisposition towards gender issues. There are all sorts of social factors that could contribute to transition being more viable, and which could “look like” social contagion. But that’s a topic for another blog post.

2. One major place where this may especially play out is in the dating market. Gay men have a preference for masculine men, and so that may be an obstacle to feminine men. For many, this may not be as much of a problem because the preference against feminine men is weaker among feminine men; so “fem4fem” is pretty viable. Some anecdotes say that HSTSs have a particular preference for masculine men, which makes sense in this framework. Especially since the most masculine men tend to be attracted to women. But it has AFAIK never been demonstrated that HSTSs have a preference for masculine men, and there is some evidence to contradict it. I would really like to see this studied more carefully.

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