Ray Blanchard, semi-retired researcher in human sexuality who spent fifteen years screening applicants for sex-reassignment surgery at a gender identity clinic and another fifteen years assessing paraphilic interests in sex offenders, recounts the clinical realities of transsexualism before its political reframing. In the 1970s through mid-1990s, clinics treated transsexualism as a mental disorder requiring rigorous gatekeeping: patients underwent multi-year real-life tests living and working full-time as the opposite sex before any surgical approval, and numbers remained extremely low. Blanchard contrasts that era with the present, when activism recast the condition as a matter of identity and social justice rather than psychopathology, attracting different patients and clinicians while expanding presentations to include non-binary and rapid-onset cases. He defends the concept of autogynephilia as central to many male-to-female transitions and criticises purely sociopolitical explanations that evade clinical reality. Blanchard predicts that, to preserve insurance coverage, transsexualism will be redefined as a “wrong-body” disorder rather than removed from diagnostic manuals, and notes the internet’s unprecedented role in allowing individuals with rare conditions to form reinforcing echo chambers.
