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Blanchard typology: two empirically validated routes, ideologically forbidden

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. Forty years of empirical substantiation, replicated in dozens of cohorts, clinically unmistakable. And yet ideologically forbidden: anyone who names the typology is silenced and branded as hateful. Not refuted — canceled.

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".

Empirical substantiation — four decades, multiple countries

• Blanchard himself (1985, 1989, 1991, 2005) — repeatedly replicated in his own Toronto cohort.
• Lawrence (2005, 2017) — confirmation in American cohorts, plus clinical descriptions by someone who belongs to this category himself.
• Smith et al. (Netherlands, 2005) — confirmation in the Amsterdam cohort of the VUmc itself.
• Nuttbrock et al. (2011) — confirmation in New York population.
• Veale et al. (2008, 2012) — confirmation in Australian and Canadian cohorts.

This is not a marginal hypothesis. It is one of the best-replicated findings in the entire gender care literature — and is dismissed for ideological reasons.

Why this is clinically indispensable

The two routes have different development trajectories, different motivations, different risks, and different medical transition outcomes. By merging them under a single label "trans woman," clinically indispensable information is lost. It makes meaningful research into care outcomes practically impossible—which could explain why regret rates and outcome data remain so vague. Those who look away do not know. That is not science; that is dogma.

The attack on the researchers

Trans activists reject the typology because AGP undermines the inner-identity claim. Substantive refutation is lacking — only political attacks on Blanchard, Bailey, and Lawrence personally. Bailey's book The Man Who Would Be Queen (2003) became the target of a multi-year intimidation campaign, meticulously documented by Alice Dreger (2008). Criticism was framed as hate, knowledge as violence, and replicable data as dangerous ideology. This is no longer science; it is an ideological defense campaign against empirical findings that do not fit. See publication bias and intimidation .

Implications for current gender care

Dutch gender care (VUmc, Gender Care Network) treats HSTS and AGP as a single category. This is methodologically indefensible. The Cass Review explicitly identifies the lack of differential diagnosis as a problem. Moreover, for minors, the ROGD cohort has been added—girls with socially distributed dysphoria—which has a fundamentally different profile. One label, three different clinical populations, one protocol: that is not medicine; that is ideological belief disguised as care.