+> In both adolescent and adult natal males, there are two broad trajectories for development of gender dysphoria: early onset and late onset. _Early-onset gender dysphoria_ starts in childhood and continues into adolescence and adulthood; or, there is an intermittent period in which the gender dysphoria desists and these individuals self-identify as gay or homosexual, followed by recurrence of gender dysphoria. _Late-onset gender dysphoria_ occurs around puberty or much later in life. Some of these individuals report having had a desire to be of the other gender in childhood that was not expressed verbally to others. Others do not recall any signs of childhood gender dysphoria. For adolescent males with late-onset gender dysphoria, parents often report surprise because they did not see signs of gender dysphoria in childhood. Adolescent and adult natal males with early-onset gender dysphoria are almost always sexually attracted to men (androphilic). Adolescents and adults with late-onset gender dysphoria **frequently engage in transvestic behavior with sexual excitement.**
+
+(Bolding mine.)
+
+Or consider Anne Vitale's ["The Gender Variant Phenomenon—A Developmental Review"](http://www.avitale.com/developmentalreview.htm), which makes the _same_ observations as Blanchard-and-friends and arrives at essentially the _same_ two-type taxonomy of MtF, but dressed up in socially-desirable language—
+
+> As sexual maturity advances, Group Three, cloistered gender dysphoric boys, often combine excessive masturbation (one individual reported masturbating up to 5 and even 6 times a day) with an increase in secret cross-dressing activity to release anxiety.
+
+Got that? They _often combine excessive masturbation_ with an _increase in secret cross-dressing activity_ to _release anxiety_—their terrible, terrible _gender expression deprivation anxiety!_
+
+Don't trust scientists or clinicians? Me neither! (Especially [not clinicians](/2017/Jun/memoirs-of-my-recent-madness-part-i-the-unanswerable-words/).) Want first-person accounts from trans women themselves? Me too! And there's lots!
+
+Consider this passage from Dierdre McCloskey's memoir _Crossing_, writing in the third person about her decades identifying as a heterosexual crossdresser before transitioning at age 53 (bolding mine):
+
+> He had been doing it ten times a month through four decades, whenever possible, though in the closet. The quantifying economist made the calculation: _About five thousand episodes_. [...] At fifty-two Donald accepted crossdressing as part of who he was. True, if before the realization that he could cross all the way someone had offered a pill to stop the occasional cross-dressing, he would have accepted, since it was mildly distracting—though hardly time consuming. **Until the spring of 1995 each of the five thousand episodes was associated with quick, male sex.**
+
+Or consider this passage from Julia Serano's _Whipping Girl_ (I know I [keep](/2017/Dec/lesser-known-demand-curves/) [referencing](/2020/Dec/crossing-the-line/) [this](/2021/May/sexual-dimorphism-in-the-sequences-in-relation-to-my-gender-problems/#whipping-girl) book, but it's _so representative_ of the dominant strain of trans activism, and I'm never going to get over the [Fridge Logic](https://tvtropes.org/pmwiki/pmwiki.php/Main/FridgeLogic) of the all [the blatant clues that I somehow missed in 2007](/2016/Sep/apophenia/))—
+
+> There was also a period of time when I embraced the word "pervert" and viewed my desire to be female as some sort of sexual kink. But after exploring that path, it became obvious that explanation could not account for the vast majority of instances when I thought about being female in a nonsexual context.
+
+"It became obvious that explanation could not account." I don't doubt Serano's reporting of her own phenomenal experiences, but "that explanation could not account" is _not an experience_; it's a _hypothesis_ about psychology, about the _causes_ of the experience.
+
+I could go on ... but do I need to? After having seen enough of these _laughable_ denials of autogynephilia, the main question in my mind has become not, _Is the two-type androphilic/autogynephilic taxonomy of MtF transsexualism approximately true?_ (answer: yes, obviously) and more, _How dumb do you (proponents of gender-identity theories) think we (the general public) are?_ (answer: very, but this assessment is accurate).
+
+An important caveat must be made: [different causal/etiological stories could be compatible with the same _descriptive_ taxonomy.](/2021/Feb/you-are-right-and-i-was-wrong-reply-to-tailcalled-on-causality/) You shouldn't confuse my mere ridicule with a serious and rigorous critique of the strongest possible case for "gender expression deprivation anxiety" as a theoretical entity, which would be more work. But hopefully I've shown _enough_ work here, that the reader can perhaps empathize with the temptation to resort to ridicule?
+
+Everyone's experience is different, but the human mind still has a _design_. If I hurt my ankle while running and I (knowing nothing of physiology or sports medicine) think it might be a stress fracture, a competent doctor (who's studied the literature and seen many more cases) is going to ask followup questions about my experiences to pin down whether it's stress fracture or a sprain. I can't be wrong about the fact _that_ my ankle hurts (that's a privileged first-person experience), but I can easily be wrong about my _theory about_ why my ankle hurts.
+
+Even if human brains vary more than human ankles, the basic epistemological principle applies to a mysterious desire to be female. The question is, do the trans women whose reports I'm considering have a relevantly _different_ psychological condition than me, or do we have "the same" condition, and (at least) one of us is misdiagnosing it?
+
+The _safe_ answer—the answer that preserves everyone's current stories about themselves without any need for modification—is "different." That's what I thought before 2016. I think a lot of trans activists would say "the same". And on _that_ much, we can agree.
+
+How weasely am I being with these "approximately true" and "as a first approximation" qualifiers and hedges? I claim: not _more_ weasely than anyone who tries to reason about psychology given the knowledge and methodology our civilization has managed to accumulate.
+
+Reality has a single level (physics), but [our models of reality have multiple levels](https://www.lesswrong.com/posts/gRa5cWWBsZqdFvmqu/reductive-reference). To get maximally precise predictions about everything, you would have to model the underlying quarks, _&c._, which is impossible. (As [it is](https://www.lesswrong.com/posts/tPqQdLCuxanjhoaNs/reductionism) [written](https://www.lesswrong.com/posts/y5MxoeacRKKM3KQth/fallacies-of-compression): the map is not the territory, but you can't roll up the territory and put in your glove compartment.)
+
+Psychology is very complicated; every human is their own unique snowflake, but it would be impossible to navigate the world using the "every human is their own unique _maximum-entropy_ snowflake; you can't make _any_ probabilistic inferences about someone's mind based on your experiences with other humans" theory. Even if someone were to _verbally endorse_ something like that—and at age sixteen, I might have—their brain is still going to go on to make predictions inferences about people's minds using _some_ algorithm whose details aren't available to introspection. Much of this predictive machinery is going to be instinct bequeathed by natural selection (because predicting the behavior of conspecifics was very useful in the environment of evolutionary adaptedness), but some of it is the cultural accumulation of people's attempts to organize their experience into categories, clusters, diagnoses, taxons. (The cluster-learning capability is _also_ bequeathed by natural selection, of course, but it's worth distinguishing more "learned" from more "innate" content.)
+
+There could be situations in psychology where a good theory (not a perfect theory, but a good theory to the precision that our theories about engineering bridges are good) would be described by (say) a 70-node [causal graph](https://www.lesswrong.com/posts/hzuSDMx7pd2uxFc5w/causal-diagrams-and-causal-models), but it turns out that some of [the more "important" variables in the graph happen to anti-correlate with each other](https://surveyanon.wordpress.com/2019/10/27/the-mathematical-consequences-of-a-toy-model-of-gender-transition/), such that stupid humans who don't know how to discover the correct 70-node graph, do manage to pattern-match their way to a two-type typology that actually is better, as a first approximation, than pretending not to have a theory. No one matches any particular clinical-profile stereotype _exactly_, but [the world makes more sense when you have language for theoretical abstractions](https://astralcodexten.substack.com/p/ontology-of-psychiatric-conditions) like ["comas"](https://slatestarcodex.com/2014/08/11/does-the-glasgow-coma-scale-exist-do-comas/) or "depression" or "bipolar disorder"—or "autogynephilia".
+
+(In some sense it's a matter of "luck" when the relevant structure in the world happens to simplify so much; [friend of the blog](/tag/tailcalled/) Tailcalled argues that [there's no discrete typology for FtM](https://www.reddit.com/r/Blanchardianism/comments/jp9rmn/there_is_probably_no_ftm_typology/) as there is for the two types of MtF, because the various causes of gender problems in females vary more independently and aren't as stratified by age.)
+
+So, if some particular individual trans woman writes down her life story, and swears up and down that she doesn't match the feminine/early-onset type, but _also_ doesn't empathize at all with the experiences I've grouped under the concept of "autogynephilia", I don't have any definitive knockdown proof with which to accuse her of lying, because I don't _know_ her, and the true diversity of human psychology is no doubt richer and stranger than my fuzzy low-resolution model of it.
+
+But [the fuzzy low-resolution model is _way too good_](https://surveyanon.wordpress.com/2019/04/27/predictions-made-by-blanchards-typology/) not to be pointing to _some_ regularity in the real world, and I expect honest people who are exceptions that aren't well-predicted by the model, to at least notice how well it performs on all the _non_-exceptions. If you're a magical third type of trans woman (where, again, _magical_ is a term of art indicating phenomena not understood) who isn't super-feminine but whose identity definitely isn't ultimately rooted in a fetish, [you should be _confused_](https://www.lesswrong.com/posts/5JDkW4MYXit2CquLs/your-strength-as-a-rationalist) by the 230 upvotes on that /r/MtF comment about the "it's probably just a fetish" camp—if the person who wrote that comment has experiences like yours, why did they ever single out "it's probably just a fetish" [as a hypothesis to pay attention to in the first place](https://www.lesswrong.com/posts/X2AD2LgtKgkRNPj2a/privileging-the-hypothesis)? And there's allegedly a whole "camp" of these people? What could _that_ possibly be about?!
+
+I _do_ have a _lot_ of uncertainty about what the True Causal Graph looks like, even if it seems obvious that the two-type taxonomy coarsely approximates it. Gay femininity and autogynephilia are obviously very important nodes in the True Graph, but there's going to be more detail to the whole story: what _other_ factors influence people's decision to transition, including [incentives](/2017/Dec/lesser-known-demand-curves/) and cultural factors specific to a given place and time?
+
+Cultural attitudes towards men and maleness have shifted markedly in our feminist era. It feels gauche to say so, but ... as a result, conscientious boys taught to disdain the crimes of men may pick up an internalized misandry? I remember one night at the Univerity in Santa Cruz when I had the insight that it was possible to make generalizations about groups of people while allowing for exceptions (in contrast to my previous stance that generalizations about people were _always morally wrong_)—and immediately, eagerly proclaimed that _men are terrible_.
+
+Or consider computer scientist Scott Aaronson's account (in his infamous [Comment 171](https://www.scottaaronson.com/blog/?p=2091#comment-326664)) that his "recurring fantasy, through this period, was to have been born a woman, or a gay man [...] [a]nything, really, other than the curse of having been born a heterosexual male, which [...] meant being consumed by desires that one couldn't act on or even admit without running the risk of becoming an objectifier or a stalker or a harasser or some other creature of the darkness."