Does Blanchard’s typology have any value in a clinical context? Does it help the physician understand his patient and their condition better, and thus provide better care?

If, as is commonly believed, homosexual transsexuals are better adapted to transition, then knowledge of their being a ‘homosexual transsexual’ could help the clinician advise their patient better on whether to transition or not.

However, as common sense suggests, a successful transition is dependent on an enormous number of variables, including financial status, family support, personality, appearance, physical health, mental health… in fact, as our essay ‘should I transition?’ shows… there are dozens of variables. If a physician starts to work on simplified heuristics like ‘he’s a homosexual transsexual… and homosexual transsexuals transition better…therefore I will advise transition…” he risks gross simplification on all sides.

Treating transsexual patients requires a clear vision of the individual personality of the patient and their individual circumstances. If anything, pushing physicians towards a treatment based on taxonomies such as ‘homosexual’ or ‘non-homosexual’ blunts the fine tuning and eye for the individual a good physician needs in this context.

Now please, if someone with clinical experience can offer me examples to the contrary I will be happy to include them in the next version of this seminar, but right now I can see no clinical value in a physician looking at the patient and classifying him as homosexual or non homosexual. Yes, the two types may have distinct grey matter, they may have different sexual interests, they may be different heights, they may have different economic backgrounds… but transsexualism is transsexualism and marking the two groups as distinct does not change that.

What I can see is – something we are all familiar with in professional contexts – specific types of client who tend to have certain characteristics, and with whom we change our style accordingly. For example, sometimes I teach groups of young people and sometimes I teach groups of executives… each group requires a different style and teaching methodology… therefore, it is helpful among staff to indicate these types. It seems to me this is exactly the same in dealing with Blanchard’s two types of transsexual… they are different in some ways and it’s good for a gender therapist to know that… but does that mean we start proclaiming some kind of species style, biologically conditioned, intrinsic taxonomy of the transsexual?

…Of course not.

As I said, if a taxonomy has no clinical value it may well be very interesting… but in the end it’s like ‘yes… there’s homosexual and non-homosexual transsexuals… so what?” The treatment options for a gender identity crisis are the same… and the physician can not be swayed in choosing those options by whether the client is gay or not. The only professional for whom such a taxonomy might be useful is a travel agent selling gay cruises.

Point 5. The Blanchard taxonomy ‘homosexual’ and ‘non-homosexual transsexual’ brings no value to the clinician treating the transsexual patient.
(felix… no mention of cross gender arousal)

Part 4c. The social and cultural value of autogynephilia


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