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A Further Assessment of Blanchard’s Typology of Homosexual
Versus Non-Homosexual or Autogynephilic Gender Dysphoria
Larry Nuttbrock,
National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY
10010, USA Nuttbrock@ndri.org
Walter Bockting,
Program in Human Sexuality, Department of Family Medicine and Community Health, University
of Minnesota, Minneapolis, MN, USA
Mona Mason,
National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY
10010, USA
Sel Hwahng,
National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY
10010, USA
Andrew Rosenblum,
National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY
10010, USA
Monica Macri, and
National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY
10010, USA
Jeffrey Becker
National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY
10010, USA
Abstract
In a series of important but now highly controversial articles, Blanchard examined associations of
sexual orientation and transvestic fetishism among male-to-female (MTF) transgender persons in
Toronto, Canada. Transvestic fetishism was rare among the homosexuals but prevalent among the
non-homosexuals. Subtypes of non-homosexual MTFs (heterosexual, bisexual, and asexual) were
consistently high with regard to transvestic fetishism. Non-linear associations of a continuous
measurement of sexual attraction to women (gynephilia) and transvestic fetishism were interpreted
in terms of an etiological hypothesis in which transvestic fetishism interferes with the early
development of heterosexuality. Blanchard concluded that homosexual versus non-homosexual
sexual orientation is a dominant and etiologically significant axis for evaluating and understanding
this population. We further assessed these findings among 571 MTFs from the New York City
metropolitan area. Using the Life Chart Interview, multiple measurements of transvestic fetishism
were obtained and classified as lifetime, lifecourse persistent, adolescent limited, and adult onset.
Large (but not deterministic) differences in lifetime, lifecourse persistent, and adolescent limited
transvestic fetishism were found between the homosexuals and non-homosexuals. Contrary to
© Springer Science+Business Media, LLC 2009
Correspondence to: Larry Nuttbrock.
NIH Public Access
Author Manuscript
Arch Sex Behav. Author manuscript; available in PMC 2012 April 1.
Published in final edited form as:
Arch Sex Behav
. 2011 April ; 40(2): 247–257. doi:10.1007/s10508-009-9579-2.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
Blanchard, differences in transvestic fetishism were observed across subtypes of the non-
homosexuals, and linear (not curvilinear) associations were found along a continuous
measurement of gynephilia and transvestic fetishism. Age and ethnicity, in addition to sexual
orientation, were found to be statistically significant predictors of transvestic fetishism. The
clinical, etiological, and sociopolitical implications of these findings are discussed.
Keywords
Gender identity disorder; Transsexualism; Sexual orientation; Transvestic fetishism;
Autogynephilia
Introduction
The Classification of Male-to-Female Transgender Persons
Individuals born with a penis who later develop a sense of themselves as “female” or
partially “female” in certain situations or roles—male-to-female transgender persons (Bolin,
1998; Whitlock, 1996)—are a unique yet highly heterogeneous population, and several
attempts have been made over the years to classify them into subgroups (Bullough &
Bullough, 1997; Cole, Denny, Eyler, & Samons, 2000). One approach to this classification,
exemplified in the pioneering work of Hirschfeld (1910) and some later writers (Ellis, 1936),
is sexual orientation as defined in terms of the traditional binary gender system. A basic
divide in this approach, also reflected in the DSM, is between MTFs who are sexually
attracted only to biological males as compared to those who are not so attracted (American
Psychiatric Association, 2000). The latter subgroup includes MTFs attracted to females
(heterosexuals), both males and females (bisexuals), and neither males or females (asexuals)
(Smith, van Goozen, Kuiper, & Cohen-Kettenis, 2005). Since the 1960s, several studies
have found that homosexual MTFs are seldom (if ever) sexually aroused by dressing in the
female role (termed transvestic fetishism) while all three subtypes of non-homosexual MTFs
are typically so aroused (Buhrich&McConaghy, 1977; Doorn, Poortinga,& Verschoor, 1994;
Freund, Steiner,& Chan, 1982).
Blanchard’s Typology of Homosexual Versus Non-Homosexual or Autogynephilic Gender
Dysphoria
In a series of scientifically important articles, Blanchard interpreted and further analyzed the
association between sexual orientation and transvestic fetishism among MTFs in terms of a
broader concept called autogynephilia (Blanchard, 1985a, 1988). Following Hirschfeld
(1910), transvestic fetishism was conceptualized as one manifestation of a misdirected
development of heterosexuality in which non-homosexual MTFs become sexually aroused,
not by the thought or image of actual sexual partners, but by the thought or image of “the
woman within.” Case studies of this MTF subgroup suggested that dressing in the female
role (“cross dressing”) elicited sexual arousal because of this self imagery of femininity; that
this self imagery may be linked to stereotyped feminine activities (such as knitting) and may
be sexual arousing as a result; and that sexual activity (including masturbation and sexual
intercourse) in this MTF subgroup is sexually satisfying (orgasmic) if it is associated with a
self imagery of femininity. Autogynephilia, in one manifestation or another, came to be
regarded as a universal, albeit abnormal, aspect of development among non-homosexual
MTFs. Autogynephilia among homosexual MTFs, because of largely unspecified aspects of
their development (see Ovesey & Person, 1976), was presumed to be extremely rare or
nonexistent. These individuals were said to be sexually aroused, not by the thought or image
of the “woman within,” but by actual physical characteristics of other biological males
(Blanchard, 1991).
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Beyond these clinical descriptions, Blanchard’s view of the association between sexual
orientation and transvestic fetishism among MTFs, conceptualized as autogynephilia, has
been supported by an important series of empirical studies conducted among gender
dysphoric biological males who registered at a gender identity clinic in Toronto, Canada,
during the 1980s. Participants included in Blanchard’s analysis were screened for some
degree of “wanting to be a female” (MTF using the above definition), with an average age of
40–45 (in the 1980s) and an unspecified ethnicity (presumably mostly white) (Blanchard,
1985a). Participants were assigned to one of the four types of sexual orientation (indicated
above) based on a cluster analysis of their scores on multiple items related to sexual
orientation. The analysis was predetermined to generate four clusters presumed to indicate
the four subtypes of sexual orientation. Transvestic fetishism was measured as a global
lifetime report of sexual arousal associated with wearing women’s apparel (Blanchard,
1989).
Using this sample and measurement protocol, three interrelated sets of findings were
produced. Extending the studies reviewed above, transvestic fetishism was much higher
among the non-homosexuals (82.6%) compared to the homosexuals (9.6%). Deviations of
these percentages from100% among the non-homosexuals and 0% among the homosexuals,
indicative of developmental universals distinguishing these subgroups (as implied in his
theory), were interpreted as resulting from measurement error and response bias (see
Blanchard, Clemmensen, & Steiner, 1985).
The second finding also bears on the validity of a dichotomous classification of MTF based
on sexual orientation: the three subtypes of non-homosexuals consistently reported high
levels of transvestic fetishism that were found to be very similar. The differences in
transvestic fetishism across these three groups (from 68% to 85%) were not statistically
significant and interpreted as measurement error (Blanchard, 1989).
The third finding bears, somewhat inferentially, on the more etiological proposition that
transvestic fetishism (interpreted as autogynephilia) interferes with normal heterosexual
development among the non-homosexual MTFs (Blanchard, 1992). This theoretical
proposition was empirically evaluated by observing levels of transvestic fetishism and other
aspects of autogynephilia along three gradations of a continuous measurement of gynephilia.
MTFs with extremely low (or nonexistent) gynephilia were presumed to be homosexual. As
such (consistent with the above findings), they were predicted to report low transvestic
fetishism. MTFs with an intermediate level of gynephilia were predicted to report high
transvestic fetishism; those with the highest level of gynephilia were also predicted to report
low transvestic fetishism. The predicted down-turn in levels of transvestic fetishism from the
second (intermediate) to the third (high) gradations of gynephilia reflects the assumption
that transvestic fetishism and gynephilia are competing motives (or orientations or
behaviors) (i.e., if one is high. the other must be low). The overall form of the association
between transvestic fetishism and levels of gynephilia was predicted to be an inverted U (∩).
These predictions were supported by plotting mean values of transvestic fetishism(and other
measures of autogynephilia) across levels of gynephilia. The non-monotonic or curvilinear
(inverted U) form of these associations was confirmed using curvilinear regression analysis
(Blanchard, 1992).
Blanchard’s studies, for the most part conducted more than two decades ago, have
fundamental implications for the psychiatric diagnoses of gender-related disorders in DSM,
the etiology of gender-related disorders, and the worldwide transgender movement. His
theoretical formulation of autogynephilia has been introduced into DSM-IV-TR. His
deterministic typology of MTFs as either homosexual or non-homosexual is consistent with
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DSM-IV protocols for Transvestic Fetishism and the subtyping of Gender Identity Disorder
by sexual orientation (Bower, 2001).
The Current Controversy Surrounding Blanchard’s Findings
The etiological implications of Blanchard’s findings point to basic mechanisms underlying
the development of transvestic fetishism and heterosexuality that are presumably
independent of sociocultural factors and historical change. As such, his work is framed
within an essentialist as compared to a social constructionist paradigm of sexuality (Bem,
1993). His findings have sociopolitical implications far beyond scientific circles because
they directly contradict basic tenets of the worldwide transgender movement: sex and gender
are deemed to be separate, socially constructed dimensions of personal identity
characterized by individual variation and social diversity (Bolin, 1998; Bornstein, 1994;
Boswell, 1998; Rothblatt, 1994).
A recent highly polemic book by Bailey (2003) set out to better understand the differences
between homosexual and non-homosexual MTFs, and further inflamed transgender activists
around the world. A central proposition of Bailey’s work is that homosexual MTFs are
effeminate biological males who “cross dress” and pursue a transgender lifestyle as a
strategy to maximize sexual partners. In these and other ways, transgenderism was
essentially reduced to sexuality. The ensuing storm of controversy has prompted world-wide
scrutiny (albeit little research) regarding the validity of classifying MTFs as either
homosexual or non-homosexual, and the concept of autogynephilia more generally.
Blanchard’s highly specialized articles on autogynephilia, after two decades of relative
obscurity, are now at the front stage of scientific and public debate (Dreger, 2008).
A Further Assessment of Blanchard’s Findings
The significance and broad implications of Blanchard’s findings, combined with the fact that
there is surprisingly little scientific data directly bearing on them, prompted us to investigate
whether or not his findings could be replicated in a community-based sample of 571 MTFs
from the New York City metropolitan area (Nuttbrock et al., 2009). Our analysis included
multiple measurements of sexual orientation (categorical and continuous), multiple
measurements of transvestic fetishism that reflect potentially significant life course variation
in its persistence, and two potentially critical sociodemographic variables that (as detailed
below) are highly intertwined with both sexual orientation and transvestic fetishism among
MTFs—age (age cohort) and ethnicity.
Date of birth is a potentially significant factor underlying virtually all aspects of the
transgender phenomenon (including transvestic fetishism). MTFs born between 1950 and
1969,with a current age of 40–59, were adolescents at a time when professional and social
knowledge about transgenderism was limited and identification as transgender was,
presumably as a result, comparatively unlikely (Bolin, 1998). MTFs born between 1970 and
1989, with a current age of 19–39, were adolescents at a time when professional and social
knowledge about transgenderism was broadly disseminated, different types of transgender
identity proliferated, and identification as transgender was, presumably as a result of this,
more likely (Bolin, 1998). Both generations of MTFs grew up as a sexual minority in an
“often hostile social environment” (Cole et al., 2000), but the younger generation developed
a gender identity at a time when transgenderism was rapidly losing its secretive and exotic
character (Bolin, 1998). We examined the specific hypothesis that the younger generation
has lower levels of transvestic fetishism than the older generation.
Ethnicity is a second, fundamentally significant factor associated with the transgender
experience (and transvestic fetishism) (Lippa & Tan, 2001; Nanda, 1994; O’Kobe et al.,
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2008; Tsoi, 1988). The association between sexual orientation and transvestite fetishism is
complicated by the fact that homosexuality may vary across ethnic groups (Lawrence,
2008). Compared to White MTFs, Blacks and Hispanic MTFs are more likely to report sex
with biological males and endorse a homosexual identity (Hwahng&Nuttbrock,
2007).Whatever their sexual orientation, compared to White MTFs, Black and Hispanic
MTFs are more socially expressive about their sexuality and gender. Black and Hispanic
MTFs in New York City, and perhaps other areas as well, belong to MTF ethno-cultural
communities in which expressions of femininity and dressing in the female role are socially
accepted and encouraged. In New York City, the younger generation of Black and Hispanic
MTFs, in particular, live in a social context where transgenderism has almost completely
lost its secretive and exotic character.
Finally, to better characterize the current sample of MTFs and provide data bearing on the
validity of the findings regarding sexual orientation and transvestic fetishism, measurements
of lifetime hormone therapy (HT) were obtained and incorporated in some of the analysis.
The use of hormones in conjunction with sex reassignment surgery (SRS) or to promote
amore feminized appearance (with or without SRS) has historically been regarded as an
indicator of transsexualism, defined as the commitment to live as a woman on a permanent
basis (Pauly, 1990). Since the early writings of Benjamin (1966), the degree of commitment
to a female role, as revealed by actual (or intended) HT or SRS, has been an additional axis
for subclassifying MTFs (in addition to sexual orientation). It was long assumed that
transsexuals were a distinct subgroup of MTFs because they typically did not experience
sexual arousal associated with dressing in the female role. The negative association between
transsexualism and transvestic fetishism, while intuitively compelling, is statistically weak
(Blanchard & Clemmensen, 1988;Wise & Meyer, 1980).
Method
Participants
A total of 571 MTFs were recruited for the baseline component of a large cross-sectional/
longitudinal study of MTFs in the New York City metropolitan area (The New York
Transgender Project). All study participants were assigned as male at birth but subsequently
did not regard themselves as completely male in all situations or roles (transgender identity).
In addition to transgender identity, eligibility for inclusion in the study included age of 19 or
older and the absence of psychotic ideation (two were screened out). Study participants were
broadly recruited from the streets, clubs, newspaper advertisements, transgender
organizations (e.g., TRIESS, Cross Dressers International, and the Mid Hudson Valley
Transgender Association), the Internet, and referrals of other transgender persons by study
participants.
Participants ranged in age from 19 to 59 with a mean of 37 years. A total of 333 were
between 19 and 39; 238 were between 40 and 59. Hispanic identification was 43.9%, with
26.8%, 21.6%, and 7.6% identifying, respectively, as non-Hispanic White, non-Hispanic
Black, or some other Non-Hispanic ethnic category. These groups will be referred to as
Hispanics, Blacks, Whites, and Others. About one fourth (27.7%) indicated no hormone
therapy (HT); 29.9% started HT before the age of 19 (adolescence); and 42.4% started HT at
the age of 19 or later (adult).
The participants were compensated $30 as a token payment for their time and effort.
Transgender or gender variant individuals were actively involved in all aspects and phases
of the research design. The Institutional Review Board of the National Development and
Research Institutes approved all of the research protocols.
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Measures and Procedure
Face-to-face interviews, which typically lasted about 90 min, were conducted in conjunction
with the Life Review of Transgender Experiences (LRTE) (available from the first author).
The interview was designed specifically for an MTF population and included a broad range
of social, behavioral, economic, and psychiatric assessments. The first section contained
items about sociodemographic factors (including age and ethnicity), sexual orientation, and
current living arrangements. Subsequent sections contained structured and semi-structured
items about economic factors, interpersonal relationships, and transgender experiences that
occurred during five stages of the life course. For all participants, early adolescence was age
10 thru 14; late adolescence was age 15 thru 19 (for all participants). For younger
participants currently between the ages of 19–39,early adulthood was age 20 thru 24; young
adulthood was age 25 thru 29; and early middle age was age 30 thru 39. For older
participants currently between the ages of 40 and 59, early/young adulthood was age 20 thru
29; early middle age was age 30 thru 39; and later middle age was age 40 thru 59.
Following the methodology and administration protocols of the Life Chart Interview (LCI)
(Lyketsos, Nestadt, Cwi, Heithoff, & Eaton, 1994), sets of personal and social memory cues
or anchors were utilized to define and personally characterize each age period. Calendar
years and (as appropriate) levels of education bounding the life stages were elicited and
recorded. Salient personal and social events occurring within these time frames were also
elicited and recorded. To facilitate memory, the life stage boundaries, and the personally
meaningful events occurring during them, were periodically repeated during the course of
the LRTE interview. The interview proceeded in a time-sequential manner. All items were
asked with reference to the first time period (early adolescence) followed, in sequence, by
asking these same questions with regard to later time periods. As the interview progressed,
participants were reminded about their responses to items during earlier life stages.
Current age was coded as both a continuous (19 thru 59) and a dichotomous variable (19–
39=0; 40–59=1). The two groups of current age were interpreted as age cohorts. Four
categories of ethnicity were classified as Hispanic, Non-Hispanic Black, Non-Hispanic
White, or some other classification. Each of these categories was dummy coded as 1
(identification with a given category) or 0 (identification with any of the remaining three
categories). White versus non-White will be used in the regression modeling below.
The LRTE section pertaining to sexual orientation began with an open-ended question
asking participants to “describe how you view your sexual orientation.” After so introducing
this line of inquiry, participants were given a card describing seven types of potential sex
partners (non-transgender females; non-transgender males; male-to-female transgender
(MTF); female-to-male transgender (FTM); male-to-female transsexual; female-to-male
transsexual; and inter-sex). This comprehensive listing of potential sex partners was used to
encompass the full range of sexual partners that may potentially be found in a transgender
population. The coding for this report was based solely on the first two types of listed
potential sex partners (non-transgender females and non-transgender males). The
participants were asked to indicate all of the types of listed partners with whom they: (1)
“currently have sexwith”; (2)“are sexually attracted to”; (3)“have sexual fantasies”; and(4)
“canfall in love with.”
Four categorical measurements of sexual orientation were classified as sexual attraction
(item 2) to non-transgender males but not non-transgender females (homosexual); non-
transgender females but not non-transgender males (heterosexual); both non-transgender
females and non-transgender females (bisexual); or neither non-transgender females or non-
transgender males (asexual). In some of the analysis below, these four mutually exclusive
types of sexual orientation were measured as a dichotomy: homosexual versus non-
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homosexual. Non-homosexual participants included heterosexuals, bisexuals, and asexuals
(with asexuals excluded from some of the analysis because of the low numbers).
Continuous measurements of sexual orientation reflected gradations of attraction to non-
transgender females (gynephilia) and non-transgender males (androphilia) using all four of
the item listed above. Separate continuous scales of androphilia and gynephilia reflected the
total number of the four indicators of attraction endorsed for non-transgender females and
non-transgender males, respectively. Low levels of gynephilia and androphilia (scored as 0)
indicated that none of the four attraction indicators were endorsed; intermediate levels of
gynephilia or androphilia (scored as 1) indicated that 1 thru 3 of the attraction indicators
were endorsed; high levels of gynephilia or androphilia (scored as 2) indicated that all of the
attraction indicators had been endorsed.
The LRTE section pertaining to transvestic fetishism was introduced as follows: “Let’s
continue to think about this particular period of your life and recall the types of feminine
attire that you may have worn during this time and whether or not wearing this feminine
attire was sexually arousing.” [Interviewer reminder of salient and boundary events
previously determined to define this stage of life.] “During this stage of your life, how much
of the time did you wear (1) feminine under apparel in public [repeated: in private]; (2)
feminine outer apparel in public [repeated: in private]; (3) jewelry in public [repeated: in
private]; and (4) make-up in public [repeated: in private]? The participants were given a card
listing amounts of time (response categories) as 0 (none of the time); 1 (almost none of the
time);2 (some of the time);3 (most of the time); 4 (almost all of the time); 5 (all of the time).
If participants reported any public or private feminine dressing for any amount of time, they
were further queried as to whether or not this feminine dressings as “sexually arousing” at
this time in their life. [The above measurement protocols were repeated as above for the
other four stages of life.] These items for the assessment of transvestic fetishism were
adapted from Blanchard’s (1985b) Cross-Gender Fetishism scale (assessed here during
specific stages of the life course).
Transvestic fetishism during a given stage of life was coded as 0 (no sexual arousal from
any type of feminine dressing either in public or in private) or 1 (sexual arousal from one or
more types of feminine dressing either in public or in private). Measurements of the patterns
of transvestic fetishism across the life course were constructed from the life course specific
assessments. Participants who reported that any of these four types of feminine dressing was
“sexually arousing” in private or in public, during any stage of their life, were coded with
lifetime transvestic fetishism (0=no; 1=yes). Additional dimensions of transvestic fetishism
were coded by determining whether sexual arousal was associated with feminine dressing
during particular phases of the life course. Following Moffitt (1993), life-course specified
transvestic fetishism was assessed as lifecourse persistent (scored if transvestic fetishism
was indicated during both adolescence and post-adolescence); adolescent limited (scored if
transvestic fetishism was indicated during adolescence only); or adult onset (scored if
transvestic fetishism was indicated after adolescence only).
Participants were asked if they ever “used hormones for either sex reassignment or to
enhance their gender presentation.” Lifetime hormone therapy (HT)was scored as never
used, starting during adolescence, or starting after adolescence.
Results
Measured categorically, 68.5%, 12.4%, 16.8%, and 2.1% of the 571 MTFs were classified as
homosexual, heterosexual, bisexual, or asexual, respectively. Measured along the continuous
scale of androphilia, 8.6%were low,19.1%were intermediate, and 71.8% were high.
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Measured along the continuous scale of gynephilia, 63.7% were low, 20.8% were
intermediate, and 14.7% were high.
About two-fifths (38.7%) of the participants reported lifetime transvestic fetishism; 25.0%
reported lifecourse persistent transvestic fetishism; 9.3% reported adolescent limited
transvestic fetishism; and 4.0% reported adult onset transvestic fetishism.
The percentages of lifetime and lifecourse specified transvestic fetishism across categories
of sexual orientation and other variables are shown in Table 1. Twenty three percent of the
homosexuals reported lifetime transvestic fetishism compared to 81.7%, 67.7%, and 66.7%
among the heterosexual, bisexuals, and asexuals, respectively. The overall difference
between the homosexuals (23.0%) and the non-homosexuals as a group (73.2%) was
significant, χ2=130.2, df=3, p= .001. Among the non-homosexuals, the higher level of
transvestic fetishism among the heterosexuals (81.7%) compared to the bisexuals (67.7%)
was also significant, χ2=4.4; df=3; p=.05.
Twelve percent of the homosexuals reported lifecourse persistent transvestic fetishism
compared to 69.0%, 44.8%, and 33.3% among the heterosexuals, bisexuals, and asexuals,
respectively. The overall difference between the homosexuals (12.0%) and the non-
homosexuals as a group (53.6%) was significant, χ2=68.2; df=3; p=.01. Among the non-
homosexuals, the higher level of lifecourse persistent transvestic fetishism among the
heterosexuals (69.0%) compared to the bisexuals (44.8%) was also significant,χ2=9.7;
df=3;p=.01.
Eight (7.7%) of the homosexuals reported adolescent limited transvestic fetishism as
compared to 5.6%, 17.7%, and 33.3% among the heterosexuals, bisexuals, and asexuals,
respectively. The overall difference between the homosexuals (7.7%) and the non-
homosexuals as a group (14.0%) was significant (χ2=5.7; df=3; p=.01). Among the non-
homosexuals, the higher level of adolescent limited transvestic fetishism among the
heterosexuals (17.7%) compared to the bisexuals (5.6%)was also significant, χ2=5.4; df=3;
p=.01.
About three percent (3.3%) of the homosexuals reported adult onset transvestic fetishism
compared to 7.0%, 5.2%, and 0.0%among the heterosexuals, bisexuals, and asexuals,
respectively. None of the differences between sexual orientation and this dimension of
transvestic fetishism were significant. The above patterns of associations among
categorically measured sexual orientation and measurements of transvestic fetishism were
generally observed with the continuous measurements of sexual orientation.
A strong association was observed between respondent’s current age and lifetime transvestic
fetishism, χ2=52.2; df= 3; p=.01. Older participants were roughly twice as likely to report all
measurements of transvestic fetishism. A strong association was also observed between
ethnicity (measured as White versus non-White) and lifetime transvestic fetishism, χ2=61.3;
df=3; p=.01. Whites were about twice as likely as non-Whites to report all measurements of
transvestic fetishism.
Hormone therapy (HT) was inversely associated with all measurement of transvestic
fetishism. Those who started HT during adolescence were especially unlikely to report any
measurement of transvestic fetishism.
As shown in Table 2, sexual orientation was highly intertwined with age, ethnicity, and HT.
[Note that a small number of asexual participants were excluded in this analysis and in the
analysis below.] The younger and non-white participants were significantly more likely to
be classified as homosexual (measured categorically). Participants starting HT during
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adolescence were significantly more likely to be classified as homosexual (measured
categorically).
Results of a multiple logistic regression modeling of sexual orientation and other variables
on transvestic fetishism are summarized in Table 3. Model 1 is a prediction of lifetime
transvestic fetishism. Models 2a thru 2c are predictions of lifecourse persistent, adolescent
limited, and adult onset transvestic fetishism. In each of these models, the outcome variable
represents a particular measurement of lifecourse specified transvestic fetishism (as
compared to no transvestic fetishism), with participants representing the remaining two
types of lifecourse specified transvestic fetishism excluded. The bivariate analysis predicted
the measurements of transvestic fetishism separately from three measurements of sexual
orientation (categorically measured as non-homosexual versus homosexual and continuously
measured as gynephilia and androphilia), a continuous measurement of age, a dummy
coding of White ethnicity and a design coding for HT (starting HT before or after age of 18
with never used as a reference category). The multivariate analysis predicted the
measurements of transvestic fetishism collectively from a continuous measurement of sexual
orientation (gynephilia), continuous age, a dummy coding of White ethnicity, and a dummy
coding of HT (ever used versus never used). Because of the high correlation between
androphilia and gynephilia (and the statistical problems associated with estimating their
independent effects) gynephilia was used as the sole predictor of transvestic fetishism.
In the bivariate analysis of Model 1, the three measurements of sexual orientation were each
strongly associated with lifetime transvestic fetishism (reflecting the differences in
percentages shown in Table 2). Age, measured from 19 thru 59, and White ethnicity were
also strongly associated with lifetime transvestic fetishism (also reflecting the differences in
percentages shown in Table 2. In the multivariate analysis of Model 1, gynephilia, age,
White ethnicity, and hormone use were each independently associated with lifetime
transvestic fetishism. The effect sizes of all of the included predictors were reduced by about
50% in the multivariate analysis. The estimates associated with Model 2a were similar to
Model 1. All of the predictors were each strongly associated with lifecourse persistent
transvestic fetishism in the bivariate analysis. Effect sizes of the included predictors were
again reduced by about 50% in the multivariate analysis.
In the bivariate analysis of Model 2b, all of the predictors were separately associated with
adolescent limited transvestic fetishism but the effect sizes were about 50% less than the
corresponding effects computed for lifecourse persistent transvestic fetishism. These
bivariate associations were further reduced in the multivariate modeling with the effects of
age no longer statistically significant.
In the bivariate analysis of Model 2c, all of the predictors (except HT) were separately
associated with adult onset transvestic fetishism. In the multivariate modeling, the effects of
age and ethnicity, but not gynephilia, remained statistically significant (HT was not included
in this model because of the low numbers).
Results of a multiple linear regression (linear probability) modeling of three measurement of
sexual orientation and other variables on transvestic fetishism are summarized in Table 4.
The principle aim of this analysis was to provide estimates of the explanatory power of
sexual orientation compared to age and ethnicity as predictors of transvestic fetishism. HT,
included for descriptive purposes in the above models, was not included here. The estimates
produced from the logistic and linear regression analyses were generally similar. In all of the
regression models, sexual orientation, age, and ethnicity were independently associated with
transvestic fetishism.
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The robustness of these findings was further examined using a categorical coding for age
(19 to 39 versus 40 thru 59) and multivariate modeling that included different measurements
of sexual orientation (dummy variables of non-homosexual versus homosexual and a
continuous variable of androphilia). The parameters estimated in Table 3 and Table 4 were
not significantly altered as a result of this revised coding and analysis (data available from
the first author).
Discussion
We examined associations among sexual orientation and transvestic fetishism in a sample of
571MTFs recruited from the New York City metropolitan area. Distinctive features of the
study, in addition to the large and community-based sample, included a broadly focused
interviewing protocol in which inquires about sexuality were made in the context of a broad
set of social and life style factors (which may have reduced responses biases), multiple
measurements of sexual orientation (categorical and continuous), and multiple
measurements of transvestic fetishism (lifetime and lifecourse specified). Our analysis
centered on whether or not Blanchard’s important findings about sexual orientation and
transvestic fetishism, observed in a narrowly defined sample of MTFs in Toronto during the
1980s, could be replicated in a community-based sample of MTFs from a different
geographical area a quarter century later.
Consistent with Blanchard, we observed strong associations between three measurements of
sexual orientation and different measurements of transvestic fetishism. The lifetime
prevalence of transvestic fetishism was approximately three times higher among the non-
homosexuals (69%) as compared to the homosexuals (23%) and significant differences
across sexual orientation were also observed for lifecourse specified transvestic fetishism.
These associations were strong but clearly not deterministic, however. Significant numbers
of participants reported transvestic fetishism at odds with Blanchard’s predictions (23% of
the homosexuals reported transvestic fetishism; 27% of the non-homosexuals did not report
transvestic fetishism).
Statistically significant and substantive differences were observed between heterosexual and
bisexual participants in two respects. The heterosexuals reported comparatively higher levels
of lifetime and lifecourse persistent transvestic fetishism; the bisexuals reported
comparatively higher levels of adolescent limited transvestic fetishism. During adolescence,
and puberty in particular, bisexual MTFs may have broadly defined experiences of
sexuality, including different types of partners and transvestic fetishism, which diminish and
become better clarified as they mature into adulthood (Garber, 2000; Rossi, 1994).
Higher levels of attraction to women (gynephilia) were associated with monotonically
increasing levels of transvestic fetishism in this sample. Blanchard (1992) found a non-
monotonic association between transvestic fetishism and levels of gynephilia, in which
transvestic fetishism was highest at an intermediate level of gynephilia. This empirical
finding was interpreted as supporting an etiological hypothesis in which transvestic
fetishism interferes with the development of heterosexuality among non-androphilic MTFs.
This interesting and potentially significant finding could not be replicated. Higher levels of
gynephilia were associated with monotonically increasing levels of transvestic fetishism in
this sample.
Blanchard’s studies of sexual orientation and transvestic fetishism were conducted more
than two decades ago, with most participants then typically in their mid-40s, and little
reported variation in ethnicity (assumed to be mostly White). A central finding of this study
is that the very factors on which his sample can now be regarded as insufficiently diverse
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(age cohort and ethnicity) are, in fact, important and statistically independent predictors of
transvestic fetishism. Both age and ethnicity were strongly associated with both sexual
orientation and transvestic fetishism. Moreover, the effects of age and ethnicity on
transvestic fetishism were also observed with sexual orientation statistically controlled in the
analysis.
The differences in transvestic fetishism between homosexuals as compared to non-
homosexuals, observed by Blanchard and his predecessors and in this study as well, is an
important scientific finding that is worthy of further study. The hypothesis that transvestic
fetishism interferes with the development of heterosexuality in non-homosexual MTFs,
suggested by Hirschfeld and Blanchard, is an important hypothesis which needs to be further
studied in diverse populations. Our study poses an equally important, albeit highly
theoretical, hypothesis—that transvestic fetishism may be a historically fading phenomenon.
Blanchard’s fascinating finding of a non-monotonic association between transvestic
fetishism across levels of gynephilia was produced a generation ago (in a group of MTFs
roughly equivalent to the older participants in our study). A replication of this aspect of
Blanchard’s finding, in conjunction with a current generation of MTFs in Toronto, would be
an interesting and worthwhile analysis.
Transvestic fetishism is not only a generational phenomenon but a phenomenon
disproportionately experienced among Whites as compared to non-Whites (in North
America). For American white MTFs, the older generation in particular, the presentation of
their gender identity by dressing in the female role was frequently a highly secretive and
exotic phenomenon (Prince, 1976). The exotic nature of feminine dressing, experienced
more often by Whites as compared to the non-Whites in our sample, may largely account for
the higher levels of transvestic fetishism among the Whites.
Largely unknown developmental factors may partially account for transvestic fetishism, but
an adequate theory of this phenomenon must also account for the age cohort and ethnic
differences observed in this study. Bem’s (2000) exotic-becomes-erotic theory of sexual
orientation suggests that socially exotic behaviors and experiences may become eroticized
because they are associated with generalized states of emotional and physiological arousal
(Schachter& Singer, 1962). The older generation of White MTFs included in this study may
have developed transvestic fetishism, in part, because of the emotional arousal (and sexual
attributions) associated with their socially exotic presentations of gender (see Wolchik et al.,
1980).
This research had several limitations which should be considered in interpreting the findings
and drawing broader inferences about the MTF population. Broad conclusions about
autogynephilia in this population are constrained by the fact that we only included one
manifestation of this phenomenon (transvestic fetishism). Our sample of MTFs from the
New York City metropolitan area, while large and heterogeneous, may not adequately
represent MTFs from other geographic areas, and was not randomly obtained. Key
measurements included in this study, transvestic fetishism and sexual orientation, were
difficult to measure with a high degree of precision in an MTF population. These and all of
the measurements included in the analysis contained some degree of random and non-
random error which to some degree impacted the findings. Random measurement error on a
particular variable may have attenuated its impact on an analyzed outcome; non-random
measurement error on a particular variable may have biased its estimated impact on an
outcome variable. The multivariate modeling also contained predictor variables with a
moderate degree of co-linearity, which may have produced imprecision in estimating of the
independent effects of these variables on transvestic fetishism.
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These limitations notwithstanding, we nonetheless conclude that a classification of the MTF
population, based solely on sexual orientation, is fundamentally limited. An adequate
understanding of this population will only be achieved if social dimensions of the
transgender experience, as framed by age and ethnicity in particular, are fully considered.
Acknowledgments
Supported by a grant from the National Institute of Drug Abuse (NIDA) (1 R01 DA018080) (Larry Nuttbrock,
Principal Investigator).
References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed..
Washington, DC: Author; 2000. text revision
Bailey, JM. The man who would be queen:The science of gender-bending and transsexualism.
Washington, DC: Joseph Henry Press; 2003.
Bem, S. The lenses of gender: Transforming the debate on sexuality. New Haven: Yale University
Press; 1993.
Bem D. Exotic becomes erotic: Interpreting the biological correlates of sexual orientation. Archives of
Sexual Behavior 2000;29:531–548. [PubMed: 11100261]
Benjamin, H. The transsexual phenomenon. New York: Julian Press; 1966.
Blanchard R. Typology of male-to-female transsexualism. Archives of Sexual Behavior 1985a;
14:247–261. [PubMed: 4004548]
Blanchard, R. Research methods for the typological study of gender disorders in males. In: Steiner,
BW., editor. Gender dysphoria: Development, research, management. New York: Plenum Press;
1985b. p. 227-257.
Blanchard R. Nonhomosexual gender dysphoria. Journal of Sex Research 1988;24:188–193.
Blanchard R. The concept of autogynephilia and the typology of male gender dysphoria. Journal of
Nervous and Mental Disease 1989;177:616–623. [PubMed: 2794988]
Blanchard R. Clinical observations and systematic studies of autogynephilia. Journal of Sex and
Marital Therapy 1991;17:235–251. [PubMed: 1815090]
Blanchard R. Nonmonotonic relation of autogynephilia and heterosexual attraction. Journal of
Abnormal Psychology 1992;101:271–276. [PubMed: 1583219]
Blanchard R, Clemmensen LH. A test of the DSM-II-R’s implicit assumption that fetishistic arousal
and gender dysphoria are mutually exclusive. Journal of Sex Research 1988;25:426–432.
Blanchard R, Clemmensen LH, Steiner BW. Social desirability response set and systematic distortion
in the self-report of adult male gender patients. Archives of Sexual Behavior 1985;14:505–516.
[PubMed: 4084050]
Bolin, A. Transcending and transgendering: Male-to-female transsexuals, dichotomy and diversity. In:
Denny, D., editor. Current concepts in transgender identity. New York: Garland; 1998. p. 63-96.
Bornstein, D. Gender outlaw: On men, women and the rest of us. New York: Routledge; 1994.
Boswell, H. The transgender paradigm: Shift toward free expression. In: Denny, D., editor. Current
concepts in transgender identity. New York: Garland; 1998. p. 56-61.
Bower H. The gender identity disorders in DSM-IV classification: A critical evaluation. Australian and
New Zealand Journal of Psychiatry 2001;35:1–8. [PubMed: 11270443]
Buhrich N, McConaghy N. The discrete syndromes of transsexualism. Archives of Sexual Behavior
1977;6:483–495. [PubMed: 931625]
Bullough B, Bullough V. Are transvestites necessarily heterosexual? Archives of Sexual Behavior
1997;26:1–12. [PubMed: 9015576]
Cole, S.; Eyler, D.; Samons, S. Issues of transgender. In: Szuchman, L.; Muscarella, F., editors.
Psychological perspectives on human sexuality. New York: John Wiley; 2000. p. 149-168.
Doorn CD, Poortinga J, Verschoor AM. Cross-gender identity in transvestites and male transsexuals.
Archives of Sexual Behavior 1994;23:185–201. [PubMed: 8018022]
Nuttbrock et al. Page 12
Arch Sex Behav. Author manuscript; available in PMC 2012 April 1.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
Dreger AD. The controversy surrounding The Man Who Would be Queen: A case history of the
politics of science, identity, and sex in the Internet age. Archives of Sexual Behavior
2008;37:366–421. [PubMed: 18431641]
Ellis, H. Studies in the psychology of sex. New York: Random House; 1936.
Freund K, Steiner BW, Chan S. Two types of cross-gender identity. Archives of Sexual Behavior
1982;11:47–63.
Garber, M. Bisexuality and eroticism in everyday life. New York: Routledge; 2000.
Hirschfeld, M. Die Transvestiten. Berlin, Germany: Alfred Pulver Macher; 1910.
Hwahng SJ, Nuttbrock L. Sex workers, fem queens, and cross-dressers: Differential marginalizations
and HIV vulnerabilities among three ethnocultural male-to-female transgender communities in
New York City. Sex Research and Social Policy 2007;4:36–59.
Lawrence AA. Societal individualism predicts prevalence of nonhomosexual orientation in male-to-
female transsexualism. Archives of Sexual Behavior. 2008 doi:10.1007/s10508-008-9420-3.
Lippa RA, Tan FD. Does culture moderate the relationship between sexual orientation and gender-
related personality traits? Cross-Cultural Research 2001;36:65–87.
Lyketsos C, Nestadt G, Cwi J, Heithoff K, Eaton WW. The life chart interview: A standardized
method to describe the course of psychopathology. International Journal of Methods in Psychiatric
Research 1994;4:143–155.
Moffitt TE. Adolescent-limited and life-course persistent anti-social behavior: A developmental
taxonomy. Psychological Review 1993;100:674–701. [PubMed: 8255953]
Nanda, S. Hijras: An alternate sex and gender role in India. In: Herdt, G., editor. Third sex, third
gender: Beyond sexual dimorphism in culture and history. New York: Zone Books; 1994. p.
373-417.
Nuttbrock L, Hwahng S, Bockting W, Rosenblum A, Mason M, Macri M, et al. Psychiatric impact of
gender-related abuse across the life course of male-to-female transgender persons. Journal of Sex
Research. 2009 doi:10.1080/00224490903062258.
O’Kobe N, Sato T, Matsumota Y, Ido Y, Terado S, Kuroda S. Clinical characteristics of patients with
gender identity disorders at a Japanese gender identity clinic. Psychiatric Research 2008;157:315–
318.
Ovesey L, Person ES. Transvestism:Adisorder of the sense of self. International Journal of
Psychoanalytic Psychotherapy 1976;5:219–235. [PubMed: 955789]
Pauly I. Gender identity disorders: Evaluation and treatment. Journal of Sex Education and Therapy
1990;12:2–24.
Prince, V. Understanding cross dressing. Los Angeles: Argyle Books; 1976.
Rossi, A., editor. Sexuality across the life course. Chicago: University of Chicago Press; 1994.
Rothblatt, M. The apartheid of sex: A manifesto on the freedom of gender. New York: Crown
Publishing; 1994.
Schachter S, Singer JE. Cognitive, social, and physiological determinants of emotional state.
Psychological Review 1962;69:379–399. [PubMed: 14497895]
Smith YLS, van Goozen SHM, Kuiper AJ, Cohen-Kettenis PT. Transsexual subtypes: Clinical and
theoretical significance. Psychiatric Research 2005;137:1–16.
Tsoi WF. The prevalence of transsexualism in Singapore. Acta Psychiatrica Scandinavica
1988;78:501–504. [PubMed: 3265846]
Whitlock, K. The transgender outlook. San Francisco: Author; 1996.
Wise TM, Meyer JK. The border between transvestism and gender dysphoria: Transvestic applicants
for sex reassignment. Archives of Sexual Behavior 1980;9:327–342. [PubMed: 7416946]
Wolchik SA, Beggs BE, Wincze UP, Sakheim KD, Barlow DH, Mavissakalian M. The effect of
emotional arousal on subsequent sexual arousal in men. Journal of Abnormal Psychology
1980;38:595–598. [PubMed: 7400460]
Nuttbrock et al. Page 13
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Table 1
Lifetime and lifecourse specified transvestic fetishism by categorical and continuous measurements of sexual
orientation and selected other variables
Transvestic fetishism
Lifetime Lifecourse
persistent Adolescent
limited Adult onset
Sexual orientation
Categorical measurement
Homosexual (n=391) 23.0 12.0 7.7 3.3
Heterosexual (n=71) 81.7 69.0 5.6 7.0
Bisexual (n=96) 67.7 44.8 17.7 5.2
Asexual (n=12) 66.7 33.3 33.3 0.0
Continuous measurements
Androphilia
None (n=49) 75.5 61.2 6.1 8.2
Intermediate (n=109) 68.8 47.7 16.5 4.6
High (n=410) 26.3 14.6 8.3 3.4
Gynephilia
None (n=364) 22.3 11.8 6.9 3.6
Intermediate (n=119) 59.7 34.5 20.2 5.0
High (n=84) 81.0 69.0 7.1 4.8
Current age
19–39 (n=333) 26.4 14.7 9.0 2.7
40–59 (n=238) 55.9 39.5 10.5 5.9
Ethnicity
White (n=150) 78.7 58.0 14.0 6.7
Black (n=120) 23.1 11.6 7.4 4.1
Hispanic (n=246) 22.8 12.2 9.7 2.8
Other (n=54) 27.9 16.3 9.3 2.3
Hormone therapy
None (n=158) 59.5 44.3 11.4 3.8
Adolescent start (n=171) 14.0 8.2 5.8 0.0
Adult start (n=242) 42.6 24.4 11.2 7.0
Note: Overall base N of 571 with missing data less than 2%. Percentages of lifecourse specified transvestic fetishism are equal to the lifetime
estimate
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Table 2
Dichotomous measurement of sexual orientation by age, ethnicity, and hormone replacement therapy
(percentages)
Homosexual
(n=391) Heterosexual
(n=71) Bisexual
(n=96) χ2
Current age
19–39 (n=331) 81.6 5.7 12.7 56.2*
40–59 (n=227) 53.5 22.8 23.8
Ethnicity
White (n=141) 19.9 40.2 39.9 255.1*
Black (n=120) 90.0 2.5 7.5
Hispanic (n=244) 91.0 1.6 13.2
Other (n=53) 62.3 13.2 24.5
Hormone therapy
None (n=158) 54.2 25.5 20.2 70.9*
Adolescent start (n=171) 91.8 .6 7.6
Adult start (n=242) 64.5 13.2 22.2
Note: Overall base N of 558 with 13 asexuals excluded. Percentages may not total 100.0 due to rounding
*p=.01 (two-tailed)
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Table 3
Logistic regression modeling of three measurements of sexual orientation and selected variables with lifetime and lifecourse specified transvestic
fetishism
Scale range Model 1
Lifetime Model 2a
Lifecourse persistent Model 2b
Adolescent limited Model 2c
Adult onset
b SE OR b SE OR b SE OR b SE OR
Bivariate
Non-homosexual 0–1 2.23 .21 9.34** 2.59 .24 13.39** 1.56 .32 4.78** 1.07 .45 5.26**
Gynephilia 1–3 1.43 .14 4.22** 1.62 .16 5.08** 1.01 .22 2.76** .89 .29 2.42**
Androphilia 1–3 −1.39 .17 .25** −1.56 .18 .21** −.76 .28 .47** −1.07 .30 .34**
Age 19–59 .07 .01 1.07** .08 .01 1.09** .02 .01 1.02** .08 .02 1.09**
White ethnicity 0–1 2.49 .24 12.01** 2.84 .26 17.15** 1.70 .35 5.45** 2.12 .46 8.38**
Hormone therapy
None (reference)
Start before age 18 0–1 −2.17 .24 .11** −2.43 .32 .08** −1.32 .43 .27*−5.85 6.08 .15
Start age 18 or later 0–1 −.67 .21 .51** −.93 .23 .39 −.31 .35 .73 −.28 .50 .76
Multivariate
Gynephilia 1–3 .77 .18 2.15** .86 .20 2.35** .69 .25 1.99*.17 .36 1.18
Age 19–59 .01 .00 1.04** .05 .01 1.05** .00 .02 1.00 .06 .02 1.06**
White ethnicity 0–1 1.40 .29 4.07** 1.50 .34 4.50** 1.15 .43 3.14** 1.51 .57 4.53**
Any hormone use 0–1 −2.68 .45 .41** −1.18 .28 .31** −.75 .35 .47*– – –
Note: Base N of 558 with 13 asexuals excluded. Bivariate analysis includes the indicated predictor and one outcome measurement of transvestic fetishism. Multivariate analysis includes all of the indicated
predictors and one outcome measurement of transvestic fetishism. Model 1 is the full model of lifetime TF, with all cases included. In Model 2a, the outcome variable is life course persistent TF, with the
other two types ofTFexcluded. In Model 2b, the outcome variable is adolescent limited TF, with the other two types excluded. In Model 2c, the outcome variable is adult onset TF, with the other two types
excluded
*p=.05;
**p=.01 (two-tailed)
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Table 4
Multiple linear regression modeling of three measurements of sexual orientation and selected variables with lifetime and life course specified transvestic
fetishism
Model 1
Lifetime Model 2a
Lifecourse persistent Model 2b
Adolescent limited Model 2c
Adult onset
b SE Beta b SE Beta b SE Beta b SE Beta
Bivariate
Non-homosexual .51 .04 .48** 1.62 .12 .54** .23 .04 .26** .28 .07 .21**
Gynephilia .72 .06 .47** .98 .07 .54** .15 .03 .25** .15 .04 .17**
Androphilia −.50 .05 −.39
**
−.99 .09 −.45
**
−.11 .03 −.16
**
−.21 .05 −.21
**
Age .01 .01 .33** .05 .00 .39** .00 .00 .06 .01 .00 .21**
White ethnicity .55 .04 .49** 1.79 .12 .56** .27 .05 .26** .43 .08 .28**
Multivariate
Gynephilia .17 .03 .25** .52 .09 .29** .10 .03 .17** .04 .05 .05
Age .01 .01 .13** .02 .00 .16** .00 .00 1.00 .01 .00 .15**
White ethnicity .31 .05 .28** .97 .16 .30** .19 .06 .18** .33 .09 .21**
Note: Base N of 558 with 13 asexual participants excluded. Bivariate analysis includes the indicated predictor variable and one outcome measurement of transvestic fetishism. Multivariate analysis includes
all three predictor variables and one outcome measurement of transvestic fetishism. See Table 3 for specifications of the models
*p=.05;
**p=.01 (two-tailed)
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