Transvestism vs gender dysphoria vs …

When I linked A Response to Bailey and Hsu (2022): It Helps If You Stop Confusing Gender Dysphoria and Transvestism to a person, I got the response:

I just realized
transvestism
and gender dysphoria
are different?

And it’s a good question. There’s a certain sense in which they are “the same”, but also a certain sense in which they are distinct.

Moser has a section in the study where he explains the distinction he is trying to get at, but his explanation is kind of dense and leaves a lot of questions unanswered:

There is a group of individuals who do report autogynephilia (or at least something like autogynephilia as Bailey and Hsu understand it) as a core of aspect of their erotic interests. These are “erotic cross-dressers” or individuals with “transvestism,” who report persistent erotic arousal to the thought or fantasy of being a woman when cross-dressed. In general, individuals with transvestism or transvestic disorder do not meet the DSM-5-TR (American Psychiatric Association [APA], 2022) diagnostic criteria for gender dysphoria and do not pursue vaginoplasty, hormonal treatments, antiandrogens, or identify as female at all times. Individuals with gender dysphoria and individuals with transvestic disorder are discussed in separate chapters in the DSM-5-TR.² It should also be noted that unlike the DSM, the International Classifcation of Diseases, 11th edition, published by the World Health Organization, both gender incongruence (dysphoria) and transvestic disorder are no longer classifed as mental disorders.

A Response to Bailey and Hsu (2022): It Helps If You Stop Confusing Gender Dysphoria and Transvestism

I of course cannot speak for Moser, but I agree that in certain contexts, particularly the one Moser was talking about, one should distinguish between some of these concepts, so I can speak for myself.

I suspect when people read this, they think stuff like “Wait, so how are you saying should we do differential diagnosis of gender dysphoria and transvestism?”. For autogynephilic trans women, this thought might be expressed as “Oh no, I wonder if tailcalled thinks I’m not trutrans.”. So I should clarify: in my view, this is not a question of differential diagnosis, it is much more superficial than that.

Distinctions vs differential diagnosis

Consider headaches and coughs. A headache is when someone feels pain in their head (and often also neck region), of various different degrees. A cough is when you forcefully push air out from your lungs through your mouth, usually because something’s irritating your throat or lungs.

Headaches and coughs are conceptually distinct; you can have a headache without having a cough, or a cough without having a headache. But sometimes they cooccur, often due to sharing a cause. It is straightforward to tell whether you have a headache or a cough, because they are totally different symptoms which look nothing alike. The fact that they are distinct means that insisting on using the same label for them or equivocating between people who have headaches and people who have coughs would be confusing, but the fact that they can cooccur and that they are straightforward to tell apart means that there is no point in doing careful differential diagnosis between them.

This is in contrast to something like a viral infection vs a bacterial infection. Both viral infections and bacterial infections can cause similar symptoms, but they need to be treated in different ways, and they rarely cooccur (unless you are particularly unlucky, have a weakened immune system, or have visited some medically dangerous area such as a hospital). Therefore to handle infections, you have to try to figure out which kind of infection, ruling out one and figuring out the true one.

When I say gender dysphoria and transvestism are distinct, I mean in the sense of a cough vs a headache. Not in the sense of a bacterial infection vs a viral infection.

Many correlated distinct characteristics

Charles Moser made a simple binary of transvestism vs gender dysphoria. I don’t really agree with that binary because I think there are many more distinctions of things that genderbendy AMABs can express¹:

• Dressing up as a woman (which can be further distinguished between public and private)
• Being sexually aroused by the thought of being a woman
• Wanting to be a woman
• Disliking being a man
• Feeling that one is unmanly and doesn’t fit in as a man
• Taking estrogen/androgen blockers
• Getting feminizing surgery (which can be further broken down into neovagina vs breast implants vs facial feminization)
• …

Many of these are obviously correlated with each other, and I would not be surprised to learn that all of them are correlated with each other. In a lot of contexts, one can just think of the overall tendencies here as a sort of “transfemininity”, without going into the specific distinctions.

However, if an argument is about the nuances of these distinctions – for instance whether trans women are as autogynephilic as cis women – then one cannot just swap them in and out without taking care about the distinction. These variables are correlated, but they are not deterministically correlated, so the results you get will depend on which ones you focus on.

This is what I take Moser to be pointing out: when people talk about “trans women”, they are usually talking about someone who is medically and socially transitioning genders, and who as part of this has been diagnosed with “gender dysphoria” which basically boils down to “wants to be a woman/dislikes being a man. If you filter AMABs for the criteria of being a trans woman, then it is an empirical (… and theoretical) question how autogynephilic they will be. It is not tautologically guaranteed that they will be maximally autogynephilic, because you are not filtering directly on autogynephilia itself; there are good empirical reasons to think that they will have elevated levels of autogynephilia, but the degree of elevation is dependent on complex factors.

Making fun of “How Autogynephilic Are Natal Females?” – a short analogy

There was a new infection going around, which laymen called “the coughs”. Its symptoms involved coughs and headaches. Dr. White was studying The Coughs, and he came up with the hypothesis that it was caused by a bacterion called Generobacter. Generobacter is most strongly known for causing sleepiness, so one of Dr. White’s suggested diagnosis methods was to look at the amount of time spent in bed (though his preferred diagnosis method was just to rule out all other possible causes of headaches).

Dr. Moss suggested that Dr. White’s diagnosis method might be biased, because maybe people with headaches feel sick and don’t want to get out of bed, even if their headache is not caused by Dr. White’s Generobacter. To illustrate this, he polled some sick people, and found that they generally reported some tendencies to not get out of bed. He had a lot of distinct ways of asking about this, getting much more nuanced view than “amount of time spent in bed”, though his way of quantifying them were pretty sketchy, and he did not actually have a comparison group of people with the coughs to compare to.

Dr. Whiskey and Dr. Zora took objection to Dr. Moss’s claim. Yes, sick people don’t want to get out of bed, but this effect is modest and what they had in mind is something much stronger. So they wanted to do a more proper comparison, with a group of people that they were certain had Generobacter.

So they went to the Pulmonology Department in a hospital and found some people who were hit hard by coughs, and asked them how much time they spent in bed. And then they compared it to the people who were just ordinarily sick, and to the people who were not sick at all, and found that ordinarily sick people and people who were not sick at all answered similarly to each other and distinct from the people who were in the hospital. They concluded that Dr. Moss must’ve been wrong.

Dr. Moss found this ridiculous, so he published a paper in response. However, Generobacter is sot of Dr. White’s pet theory, and most people in the field including Dr. Moss don’t accept it; instead they just use the lay term “the coughs”. So he titled “It helps if you distinguish the coughs and headaches”, pointing out that by sampling people with severe coughs at a hospital, of course he’s gonna find people who spend a lot of time in bed, because you lie in hospital beds while recovering from your sickness.

In response, Dr. Whiskey released a paper saying that they weren’t investigating anything to do with headaches, they were investigating Generobacter, because Dr. Moss had suggested that sick people might spend as much time in bed as people with Generobacter do.

Explanation of the analogy

In the above analogy, Dr. White is Ray Blanchard, Dr. Moss is Charles Moser, Dr. Whiskey is Michael Bailey, Generobacter is true autogynephilia, being in bed is autogynephilia-like sexuality, coughing is wearing women’s clothes and “the coughs” is transvestism, people getting treated for the coughs at the Pulmonology Department are autogynephiles highly engaged in online erotic AGP communities, headaches are gender dysphoria/transsexuality, and sick people are women.

😅 This analogy came off as being bizarrely pathologizing. I should note that this is meant to capture the abstract causal structure as accurately as feasible, not all of the greater implications.

The point is, in the story, Dr. White and Dr. Moss were arguing about people with headaches (trans women) and the amount of time they spend in bed (autogynephilia-like sexuality). Dr. Whiskey decided to replace this argument with a tangentially related argument about people in hospitals with the coughs (highly active members of online erotic AGP communities). But there is a special relationship between being in the hospital and spending time in bed (being a highly active member of online erotic AGP communities and having autogynephilia-like sexuality), due to patients recovering in hospital beds (online erotic AGP communities providing material for the expression of autogynephilia-like sexuality), which presumably dominates whichever effects they could find and so makes it uninformative about people with headaches (trans women).

The maddening thing about this debacle is, it’s right there in the text of the studies! Like, Michael Bailey is in denial about it, and that’s to be expected because Michael Bailey is an absolutely ridiculous person, but the fact that some other people let it slide really seems to show how they don’t care about valid inference and just care about pushing the typology with whatever means are necessary.

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Footnote 1: I suspect Moser also understands that there are many different variations that can occur, and that he was just trying to be brief. Also I suspect Moser doesn’t really have a precise idea about the exact distribution of cooccurrences, and so just goes with the official handbooks even though they are obviously not complete.