Planning a demonstration of per-case reimbursement for inpatient physician services under Medicare Book

The importance of a book is measured in how it encourages people to think about and discuss, even if they don’t agree… maybe especially if they don’t agree… on its thesis.

The main thesis of TMWWBQ is that homosexuality and gender atypicality are highly correlated. Most of the book is about the scientific research that has shown that the folk-wisdom (sounds better said that way than “stereotype”) that gay men were usually notably “sissy” or “effeminate” as boys and that most “sissy” boys grow up to be gay men. Of course, also as part of this thesis, is that there is a continuum of femininity, and that the most feminine of such “homosexual” males grow up to live as women, to seek out hormone and surgical interventions to feminize their bodies to match their feminine personalities and natural manners. But to explain who he meant, he also had to describe and delineate those who were not on that continuum, but are often conflated and confused with them, namely, autogynephiles, especially, autogynephilic transsexuals (AGP).

This set off a firestorm that quickly became a witch-hunt against Bailey, led by several noted transwomen. I needn’t explore that episode, as it was well documented by Alice Dreger in 2008. She also published a book that touched in on the topic in 2015. Instead, I want to explore how the science regarding transsexuality that Bailey touched upon has evolved since then, in part because of TMWWBQ and the fuss that those transwomen made, and continue to make.

But first, I should point out that it is very likely that Bailey understood that his book might upset some in the AGP transsexual community, as in his closing notes on suggested further reading made clear, “For an article that angered many autogynephiles – but which provides a sympathetic portrayal of both cross-dressers and their wives – See Amy Bloom’s “Conservative men in Conservative Dresses, “… ” or when he suggests reading Anne Lawrence’s website,

“Anne Lawrence maintains an awesome website for transsexuals, Transsexual Women’s Resources, (www.annelawrence.com/twr), and one section of her site is devoted to autogynephilia. … Not only does she have clear explanations of autogynephilia, but she also includes testimonials of transsexuals who have visited her site and read about the concept. Most of them are thankful that someone is finally talking about the sexual side of transsexualism.. Some say that the finally understand themselves. A few are angry with Anne for embracing Blanchard’s “wrongheaded” ideas. … “

But Bailey could not foresee that he would be vilified and deliberately defamed as he was in the aftermath of the book’s publication. Many of the people who continue to do so have never read his book, even though they can read the key chapter regarding AGP transsexual women online, or even know that Bailey was sympathetic to transfolk, speaking warmly and openly, that they should be respected and supported. For example, after quoting Paul McHugh, the &^%$#@! (expletive deleted) who shut down the Gender Clinic at John Hopkins, “[The focus on surgery] has distracted effort from genuine investigations attempting to find out just what has gone wrong for these people – what has, by their own testimony, given them years of torment and psychological distress and prompted them to accept these grim and disfiguring surgical procedures.” Bailey rebukes McHugh,

“One problem with McHugh’s analysis is that we simply have no idea how to make gender dysphoria go away. I suspect that both autogynephilic and homosexual gender dysphoria result from early and irreversible developmental processes in the brain. If so, learning more about the origins of transsexualism will not get us much closer to curing it. Given our present state of knowledge, saying that we should focus on removing transsexual’s desire to change sex is equivalent to saying that it is better that they should suffer permanently from gender dysphoria than they should obtain sex reassignment surgery.”

Bailey is being too polite, but basically spells it out, McHugh has no sympathy for transfolk, saying to us instead that we should suck it up and be men, or more colorfully, that we should “eat $#!+ and die”. I doubt it would surprise many of my readers to learn that McHugh is a conservative observant Catholic, who substitutes religious intolerance for pragmatic palliative medicine. It astounds me that Bailey, friend as he was to the trans-community, should be vilified and hounded, while the likes of McHugh are barely noticed. But then, I think an observation made by one of the original 2004 authors of the transkids.us website explains it all, it wasn’t that Bailey was wrong, but that he was too right.

When Bailey wrote his book, Blanchard’s papers were the latest thing in transsexual research. It summed up and explained the confusion of the past researcher’s work, most notably Person & Oversey, Stoller, and Meyer. It brought together and explicated, in a concise way, what had been coming together already, but slowly, and sadly, under the burden of psycho-analysis. Blanchard swept away the unscientific notions and put the study of transsexuality on a firm scientific foundation. But, as all will admit, much of his original research had yet to be properly replicated.

Ironically, I believe that the transsexual community’s violent objections to Bailey’s book, and by extension, his defense of Blanchard’s work, inspired others to replicate his research. Most of the key data showing that there are two (and likely only two) types of MTF transsexual have been very convincingly replicated by Lawrence, Smith, and Nuttbrock. The only paper that no one has attempted to replicate yet has been the one where Blanchard tested “non-homosexual” transwomen who denied being aroused by autogynephilic ideation on whether that was really true. His paper showed that they did become sexually aroused by listening to spoken narratives of cross-dressing, while control (non-AGP) men did not. I sincerely hope that this study is replicated, as it would answer the only remaining possible question as whether there was a “third” type of transsexual as some claim.


As well as being Blanchard’s “Bulldog”, Bailey also speculated about the nature and behavior of the two types of transwomen. The most disturbing to me was on the relative paucity of marriages or even just long term relationships among “homosexual” (feminine androphilic / MTF transkid) transsexuals. Bailey reports,

Do transsexuals find partners? Certainly, homosexual transsexuals find sex partners after their surgery, but do they find steady partners? Do they get married? I have already mentioned my impression that homosexual transsexuals are not very successful at finding desirable men willing to commit to them. In part, this reflects the difficulty that men have with the notion of coupling with women who used to be men (no matter how attractive such women may be), as well as the difficulty most transsexuals have keeping their secret.”

So far, I could agree totally with Bailey. It is difficult, but not impossible, as Richard Green, M.D. documented decades before him. However, he goes on,

“But it also reflects the choices that homosexual transsexuals are prone to make. My impression is that they would rather have a relatively uncommitted relationship with a very attractive man than a committed relationship with a less desirable partner. Although the homosexual transsexuals I have met are all searching for “Mr. Right,” perhaps in vain, their sex lives have all clearly improved after surgery. They can hide their past identities for a while, at least, and no longer have to worry about how to respond to attractive men who hit on them in bars.”

Here, I suspect that Bailey means, that MTF transkids would rather have a physically attractive partner… but he does understand the reality that those men who are most likely to want a transsexual wife are themselves transgendered, closeted cross-dressers, who transkids rarely find truly desirable. So, he is partly right, but massively wrong. He goes on to admit that he has only known street transkids, the type who work as “escorts”. Thus, he has the classic issue of a “sampling bias” in that at the time he wrote the book, he had never had contact with the more respectable, “invisible transsexual” population of transkids who had managed to stay off of the street, and out of bars. It is important to note that two thirds of transkids have never been ‘escorts’. (Elsewhere in his book, Bailey notes that although common, around half of the transkids in one of his studies were never prostitutes.) For this, less street wise population, their difficulty in finding husbands is not related to any putative desire to continue to date other handsome men when they already have a fine man in hand.

“When I asked Jaunita […] about the best, and worst, reactions she had had from lovers after she revealed that she used to be a a man, she replied, “I have really never had a good experience. The men always leave.” … All the homosexual transsexuals I have talked to say that they wish they could find a man they could tell and who would love them anyway, but they all worry that such a man does not exist. And they are all deeply suspicious of men who prefer transsexual to real women. (These men have something similar to “sexual interest in she-males” and transsexuals find them weird.) There is little incentive for the postoperative homosexual transsexual to be honest.”

Bailey’s book, because he fully understands and acknowledges that transkids are different than AGP, is one of the few books that really discusses the the problems that MTF transkids face. It was refreshing… and at the same time… very disturbing and sad, to read what is essentially a tour guide to the life and many of my past transkid friends and acquaintances.

“They [HSTS] are outcasts as children because of their extreme femininity. They mostly come from poor, broken families, and family rejection is common. … They have, in fact, had to cope with rejection and disapproval since childhood, because of their extreme femininity. And they have not had the advantages that tend to instill respect in the social order. The early chaotic backgrounds of so many homosexual transsexuals might help explain why they do not defeminize the way that most very feminine boys do. A feminine boy from a middle-class or upper-middle-class family has more motivation to “hang in there” until he normalizes his gender role behavior, because he has a good chance at a conventionally successful future.”

Although I’m not at all convinced that Bailey is right, he is onto something, as it is likely that socio-economic status is one of the important factors in transkid decision making about whether to transition or not.

Bailey remarked upon the ethnic background of the transkids, noting that most of them were either Black or Latina, while the opposite is true of AGP transsexuals. He related some speculations from his transkid informants about why this might come about, which didn’t seem to satisfy him. Since the book was published, his observation has been confirmed in the Nuttbrock study of the trans-scene in New York City. But more importantly, Anne Lawrence M.D. has shown that the percentage of AGP transsexuals in a country is highly correlated with that country’s Hofstede Individuality Index. I wish to point out here that the Black and Latino/a communities are both subcultures in the US, which have much lower Individuality Index scores… and thus are less likely to have AGPs transition within them.

In writing about transkids and AGPs, Bailey found himself having to educate his readers about the differences between them. He wrote a somewhat tongue in cheek quiz which is useful in learning the differences.

Bailey remarked upon and speculated on the general intelligence of “homosexual” transsexuals, saying he thought that they were below average intelligence generally. As we now know, this is simply not true, as studies in the Netherlands show that as a group they have average IQ (98.86 to be exact, where 100 is by definition, average).

Thus, all in all, Bailey’s book has helped spur further research… and has largely been shown to have been prophetic and insightful. I recommend that this book should be read, carefully read, by transsexuals and their allies, with an open mind and heart. Don’t let a few unhappy, and very loud, individuals tell you what is “wrong” with Bailey’s book. Find out for yourself. I predict you won’t find that is it “wrong”, but “too right” for comfort.