Home › Research › Blanchard typology

Blanchard typology: two routes, a contested theory

Ray Blanchard, a clinical psychologist at the Clarke Institute (Toronto), described a typology starting in the 1980s that divides male transsexuality into two sharply separated pathways. The typology is contested: part of the research supports it, other research contradicts it. Bailey's book that popularised it became the target of a campaign against its author.

The two types

Based on thousands of clinical records, Blanchard distinguished two fundamentally different routes:

• HSTS — early-onset homosexual transsexuality. Biologically male, female in behavior from a young age, sexually attracted to men. Early development, small size, no erotic motive. Statistically speaking, boys who, outside this context, would likely have become homosexual men.
• AGP — late-onset autogynephilic transsexuality. Biologically male, transitioning in adulthood, sexually attracted to women (or bisexual/asexual). Based on autogynephilia : erotic arousal at the thought of oneself as a woman. Fundamentally a sexual pattern, not an "identity".

Research: support and contradiction

• Blanchard (1989) — in 212 adult male-to-female transsexuals, all three non-homosexual groups were more likely than the homosexual group to report sexual arousal at the fantasy of being a woman (source).
• Lawrence (2005, 2017) — a study of the sexuality of 232 patients (2005) and a review of the typology and the controversies around it (2017; source).
• Smith et al. (2005) — compared treatment outcomes: homosexual transsexuals functioned better after treatment in many respects than non-homosexual ones; the worst outcomes were reported by non-homosexual applicants with much psychopathology and body dissatisfaction (source).
• Nuttbrock et al. (2011) — among 571 transgender women in New York, large but not deterministic differences between homosexual and non-homosexual groups; contrary to Blanchard, they also found differences within the subtypes of the non-homosexual group (source).
• Veale et al. (2008, 2014) — in 2008 partly in line with Blanchard's theory, partly contrary to it (those classified as autogynephilic scored higher on attraction to males; source); a taxometric analysis in 2014 found little support for two types (source).

This is not a marginal hypothesis, but it is a contested one: research yields both support and contradiction.

Why the distinction can matter

If the two routes really differ, as Blanchard holds, an average over both groups together says little. Smith et al. (2005) found differences in outcomes between homosexual and non-homosexual transsexuals (see above), an argument for keeping the groups apart in research. Whether the typology itself is correct is contested. See also regret rates.

The attack on the researchers

Many trans activists reject the typology. Bailey's book The Man Who Would Be Queen (2003) became the target of a campaign against its author, which Alice Dreger (2008) documented in detail (source). Substantive criticism also exists, such as the studies by Nuttbrock et al. and Veale mentioned above. See publication bias and intimidation .

Implications for current gender care

Blanchard's typology concerns male transsexuality in adults and says nothing about the adolescents, mostly girls, who are presenting to gender clinics in growing numbers. The Cass Review describes a shift in referrals from mainly boys before puberty to mainly girls in or after puberty, without a clear explanation (source). For part of this group Lisa Littman described in 2018, based on parent questionnaires, a pattern she called 'rapid-onset gender dysphoria'; she presents this as a hypothesis, and the journal stressed in a correction that it is not a formal diagnosis (source). See also Cass Review, ROGD cohort.