_Why would I?_ In the English of my youth, "gender" (as a single word, rather than part of the phrase "gender role") was understood as a euphemism for _sex_ for people who were squeamish about the potential ambiguity between _sex_-as-in-biological-sex and _sex_-as-in-intercourse. (Judging by this blog's domain name, I'm not immune to this, either.) In that language, my "gender"—my sex—is male. Not because I'm necessarily happy about it (and I [used to](/2017/Jan/the-erotic-target-location-gift/) be pointedly insistent that I wasn't), but as an observable biological fact that, whatever my beautiful pure sacred self-identity feelings, _I am not delusional about_.
-Okay, so trans people aren't delusional about their [developmental sex](/2019/Sep/terminology-proposal-developmental-sex/); the claim is that their internal sense of their own gender is in some way more relevant, and should take precedence. So where does that leave me? In ["Sexual Dimorphism ..."](/2021/May/sexual-dimorphism-in-the-sequences-in-relation-to-my-gender-problems/), I wrote about my _own_ experiences, and not anyone else's (which I obviously don't have access to). I _mentioned_ transgenderedness a number of times, but I tried to cast it as explanation that one might be tempted to apply to my case, but which I don't think fits. Everything I said is _consistent_ with a world in which Ray Blanchard was being dumb and wrong when he coined "autogynephilia" as the obvious and perfect word for my thing while studying actual transsexuals—a world where my idiosyncratic weird sex perversion and associated beautiful pure sacred self-identity feelings are taxonomically and etiologically distinct from whatever brain-intersex condition causes _actual_ trans women. That's the world I _thought_ I lived in for ten years after [encountering the obvious and perfect word](/2017/Feb/a-beacon-through-the-darkness-or-getting-it-right-the-first-time/).
+Okay, so trans people aren't delusional about their [developmental sex](/2019/Sep/terminology-proposal-developmental-sex/); the claim is that their internal sense of their own gender is in some way more relevant, and should take precedence. So where does that leave me? In ["Sexual Dimorphism ..."](/2021/May/sexual-dimorphism-in-the-sequences-in-relation-to-my-gender-problems/), I wrote about my _own_ experiences, and not anyone else's (which I obviously don't have access to). I _mentioned_ transgenderedness a number of times, but I tried to cast it as explanation that one might be tempted to apply to my case, but which I don't think fits. Everything I said is _consistent_ with a world in which Ray Blanchard was being dumb and wrong when he coined "autogynephilia" (which is sometimes abbreviated as _AGP_) as the obvious and perfect word for my thing while studying actual transsexuals—a world where my idiosyncratic weird sex perversion and associated beautiful pure sacred self-identity feelings are taxonomically and etiologically distinct from whatever brain-intersex condition causes _actual_ trans women. That's the world I _thought_ I lived in for ten years after [encountering the obvious and perfect word](/2017/Feb/a-beacon-through-the-darkness-or-getting-it-right-the-first-time/).
My first clue that I wasn't living in that world came from—Eliezer Yudkowsky. (Well, not my first _clue_. In retrospect, there were lots of _clues_. My first wake-up call.) In [a 26 March 2016 Facebook post](https://www.facebook.com/yudkowsky/posts/10154078468809228), he wrote—
Indeed—here we are over seven years later, and _I am panicking_.[^panic] (As 2007–9 Sequences-era Yudkowsky [taught me](https://www.yudkowsky.net/other/fiction/the-sword-of-good), and 2016 Facebook-shitposting-era Yudkowsky seemed to ignore, the thing that makes a moral panic _really_ interesting is how hard it is to know you're on the right side of it—and the importance of [panicking](https://www.lesswrong.com/posts/erGipespbbzdG5zYb/the-third-alternative) [sideways](https://www.overcomingbias.com/2007/05/policy_tugowar.html) when the "maximize the number of trans people" and "minimize the number of trans people" coalitions are both wrong.)
-[^panic]: Or rather, I _did_ panic from mid-2016 to mid-2021, and this and the following posts are the retrospective accounting of that panic, a memoir written in the ashes of my defeat.
+[^panic]: Or rather, I _did_ panic from mid-2016 to mid-2021, and this and the following posts are the retrospective accounting of that panic, a memoir telling the Whole Dumb Story, written in the ashes of my defeat.
But at the time, this was merely _very confusing_. I left [a careful comment in the Facebook thread](/images/facebook_etle_comment.png) (with the obligatory "speaking only for myself; I obviously know that I can't say anything about anyone else's experience" [disclaimer](https://www.overcomingbias.com/2008/06/against-disclai.html)), quietly puzzled at what Yudkowsky could _possibly_ be thinking.
(With the caveated understanding that psychology is complicated and there's [a lot to be said about what "as a first approximation" is even supposed to mean](/2022/Jul/the-two-type-taxonomy-is-a-useful-approximation-for-a-more-detailed-causal-model/), but I need a few paragraphs to first talk about the _simple_ version of the theory that makes _pretty good_ predictions on _average_, as a prerequisite for more complicated theories that might make even better predictions including on cases that diverge from average.)
-The theory was put forth by Blanchard in a series of journal articles in the late 'eighties and early 'nineties, but notably popularized [(to some controversy)](https://en.wikipedia.org/wiki/The_Man_Who_Would_Be_Queen#Negative_reactions) by J. Michael Bailey in the popular-level book _The Man Who Would be Queen_ in 'aught-three. The idea is that male-to-female transsexualism isn't actually one phenomenon; it's two completely different phenomena that don't actually have anything to do with each other, except for the (perhaps) indicated treatments of hormone therapy, surgery, and social transition. (Compare to how different medical conditions might happen to respond to the same drug.)
+The theory was put forth by Blanchard in a series of journal articles in the late 'eighties and early 'nineties, but notably popularized [(to some controversy)](https://en.wikipedia.org/wiki/The_Man_Who_Would_Be_Queen#Negative_reactions) by J. Michael Bailey in the popular-level book _The Man Who Would Be Queen_ in 'aught-three. The idea is that male-to-female transsexualism isn't actually one phenomenon; it's two completely different phenomena that don't actually have anything to do with each other, except for the (perhaps) indicated treatments of hormone therapy, surgery, and social transition. (Compare to how different medical conditions might happen to respond to the same drug.)
-In one taxon, the "early-onset" type, you have same-sex-attracted males who have just been extremely feminine (in social behavior, interests, _&c._) their entire lives going back to early childhood, in a way that's salient to other people and causes big social problems for them—the far tail of effeminate gay men who end up fitting into Society better as straight women. _That's_ where the "woman trapped inside a man's body" trope comes from. [This one probably _is_ a brain-intersex condition.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3180619/)
+In one taxon, the "early-onset" type, you have same-sex-attracted males who have just been extremely feminine (in social behavior, interests, _&c._) their entire lives going back to early childhood, in a way that's salient to other people and causes big social problems for them—the far tail of effeminate gay men who end up fitting into Society better as straight women. (Blanchard called them "homosexual transsexuals", which is sometimes abbreviated as _HSTS_.) _That's_ where the "woman trapped inside a man's body" trope comes from. [This one probably _is_ a brain-intersex condition.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3180619/)
That story is pretty intuitive. Were an alien AI to be informed of the fact that, among humans, some fraction of males elect to undergo medical interventions to resemble females and be perceived as females socially, "brain-intersex condition such that they already behave like females" would probably be its top hypothesis for the cause of such a phenomenon, just on priors.
Certainly, 82% is not 100%! (But 82% is evidence for my claim that a _substantial majority_ of trans women under modern conditions in Western countries are essentially guys like me.) Certainly, you could argue that Reddit has a sampling bias such that poll results and karma scores from /r/MtF fail to match the distribution of opinion among real-world MtFs. But if you don't take the gender-identity story as a _axiom_ and [_actually look_](https://www.lesswrong.com/posts/SA79JMXKWke32A3hG/original-seeing) at the _details_ of what people say and do, these kinds of observations are _not hard to find_. You could [fill an entire subreddit with them](https://archive.is/ezENv) (and then move it to [independent](https://ovarit.com/o/ItsAFetish/) [platforms](https://saidit.net/s/itsafetish/) when the original gets [banned for "promoting hate"](https://www.reddit.com/r/itsafetish/)).
-Reddit isn't "scientific" enough for you? Fine. The scientific literature says the same thing. [Blanchard 1985](/papers/blanchard-typology_of_mtf_transsexualism.pdf): 73% of non-exclusively-androphilic transsexuals acknowledged some history of erotic cross-dressing. (Unfortunately, a lot of the classic studies specifically asked about cross-_dressing_, but the underlying desire isn't about clothes.) [Lawrence 2005](/papers/lawrence-sexuality_before_and_after_mtf_srs.pdf): of trans women who had female partners before sexual reassignment surgery, 90% reported a history of autogynephilic arousal. [Smith _et al._ 2005](/papers/smith_et_al-transsexual_subtypes_clinical_and_theoretical_significance.pdf): 64% of non-homosexual MtFs (excluding the "missing" and "N/A" responses) reported arousal while cross-dressing during adolescence. (A lot of the classic literature says "non-homosexual", which is with respect to natal sex; the idea is that self-identified bisexuals are still in the late-onset taxon.) [Nuttbrock _et al._ 2011](/papers/nuttbrock_et_al-a_further_assessment.pdf): lifetime prevalence of transvestic fetishism among non-homosexual MtFs was 69%. (For a more detailed literature review, see [Kay Brown's blog](https://sillyolme.wordpress.com/faq-on-the-science/) or the first two chapters of [Anne Lawrence's _Men Trapped in Men's Bodies: Narratives of Autogynephilic Transsexualism_](https://surveyanon.files.wordpress.com/2017/07/men-trapped-in-mens-bodies_book.pdf).)
+Reddit isn't "scientific" enough for you? Fine. The scientific literature says the same thing. [Blanchard 1985](/papers/blanchard-typology_of_mtf_transsexualism.pdf): 73% of non-exclusively-androphilic transsexuals acknowledged some history of erotic cross-dressing. (Unfortunately, a lot of the classic studies specifically asked about cross-_dressing_, but the underlying desire isn't about clothes; Jack Molay coined the term [_crossdreaming_](https://www.crossdreamers.com/), which seems more apt.) [Lawrence 2005](/papers/lawrence-sexuality_before_and_after_mtf_srs.pdf): of trans women who had female partners before sexual reassignment surgery, 90% reported a history of autogynephilic arousal. [Smith _et al._ 2005](/papers/smith_et_al-transsexual_subtypes_clinical_and_theoretical_significance.pdf): 64% of non-homosexual MtFs (excluding the "missing" and "N/A" responses) reported arousal while cross-dressing during adolescence. (A lot of the classic literature says "non-homosexual", which is with respect to natal sex; the idea is that self-identified bisexuals are still in the late-onset taxon.) [Nuttbrock _et al._ 2011](/papers/nuttbrock_et_al-a_further_assessment.pdf): lifetime prevalence of transvestic fetishism among non-homosexual MtFs was 69%. (For a more detailed literature review, see [Kay Brown's blog](https://sillyolme.wordpress.com/faq-on-the-science/) or the first two chapters of [Anne Lawrence's _Men Trapped in Men's Bodies: Narratives of Autogynephilic Transsexualism_](https://surveyanon.files.wordpress.com/2017/07/men-trapped-in-mens-bodies_book.pdf).)
Peer-reviewed scientific papers aren't enough for you? (They could be cherry-picked; there are lots of scientific journals, and no doubt a lot of bad science slips through the cracks of the review process.) Want something more indicative of a consensus among practitioners? Fine. The [_Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition_](https://en.wikipedia.org/wiki/DSM-5) (the definitive taxonomic handbook of the American Psychiatric Association) [says the same thing](https://sillyolme.wordpress.com/2021/02/06/american-psychiatric-association-supports-the-two-type-transsexual-taxonomy/) in [its section on gender dysphoria](/papers/DSM-V-gender_dysphoria_section.pdf) ([ICD-10-CM codes](https://en.wikipedia.org/wiki/ICD-10-CM) F64.1 and F64.2):
My shift in belief, from thinking the standard narrative is true about other people but not me, to thinking that the narrative is just a lie, happened gradually over the course of 2016 as the evidence kept piling up—from my reading, from correspondence with the aforementioned [Kay Brown](https://sillyolme.wordpress.com/)—and also as I kept initiating conversations with local trans women to try to figure out what was going on.
-Someone I met at the Berkeley _Less Wrong_ meetup named Ziz[^ziz-privacy] denied experiencing autogynephilia at all, and I believe her—but it seems worth noting that Ziz was unusual along a lot of dimensions; again, I don't think a psychological theory needs to predict _every_ case in order to be broadly useful for understanding the world.
+Someone I met at the Berkeley _Less Wrong_ meetup who went by Ziz[^ziz-privacy] denied experiencing autogynephilia at all, and I believe her—but it seems worth noting that Ziz was unusual along a lot of dimensions; again, I don't think a psychological theory needs to predict _every_ case in order to be broadly useful for understanding the world.
[^ziz-privacy]: Ziz [wrote about her interactions with me in _her_ memoir](https://sinceriously.fyi/intersex-brains-and-conceptual-warfare/) and explicitly confirmed with me on 5 November 2019 that we weren't under any confidentiality agreements with each other, so it seems fine for me to name her here, in contrast to how I'm leaving other private individuals unnamed or assigning them pseudonyms.
I was happy to sit through the sessions as standard procedure rather than [going DIY](https://diytrans.wiki/How_to_Begin_HRT), but I was very preoccupied with the thing about how [_everyone had been lying to me about the most important thing in my life for fourteen years_](/2017/Jan/im-sick-of-being-lied-to/) and the professionals were _in on it_, and spent a lot of the sessions ranting about that. I gave the psychologist and one of the LCSWs a copy of _Men Trapped in Men's Bodies: Narratives of Autogynephilic Transsexualism_. (The psychologist said she wasn't allowed to accept gifts with a monetary value of over $25, so I didn't tell her that it actually cost $40.)
-I got the sense that the shrinks didn't quite know what to make of me. Years after the fact, I was grateful to discover that the notes from the appointments were later made available to me via the provider's website [(despite this practice introducing questionable incentives for the shrinks going forward)](https://old.reddit.com/r/slatestarcodex/comments/jia4ox/has_scott_written_about_this_im_curious_what_his/ga6vhke/); it's very amusing to read about (for example) one of the LCSWs discussing my case with the department director and "explor[ing] ways in which pt's [patient's] neurodiversity may be impacting his ability to think about desired gender changes and communicate to therapists".
+<a id="gender-clinic-notes"></a>I got the sense that the shrinks didn't quite know what to make of me. Years after the fact, I was grateful to discover that the notes from the appointments were later made available to me via the provider's website [(despite this practice introducing questionable incentives for the shrinks going forward)](https://old.reddit.com/r/slatestarcodex/comments/jia4ox/has_scott_written_about_this_im_curious_what_his/ga6vhke/); it's very amusing to read about (for example) one of the LCSWs discussing my case with the department director and "explor[ing] ways in which pt's [patient's] neurodiversity may be impacting his ability to think about desired gender changes and communicate to therapists".
The reality was actually worse than my hostile summary that everyone was lying, and the professionals were in on it. [In some ways, it would be _better_](/2016/new-clothes/) if the professionals secretly agreed with me about the typology and were cynically lying in order to rake in that sweet pharma cash. But they're not—lying. They just, have this whole paradigm of providing ["equitable" and "compassionate" "gender-affirming care"](https://thrive.kaiserpermanente.org/care-near-you/northern-california/eastbay/departments/gender-affirming-care/) which is transparently garbage-tier epistemology ([for a belief that needs to be affirmed is not a belief at all](/2020/Apr/peering-through-reverent-fingers/)), but is so pervasive within its adherents' milieu, that they're incapable of seeing someone not buying it, even when you state your objections very clearly.
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