https://pbs.twimg.com/media/E9Ul08UWUAs_Qmm?format=jpg&name=4096x4096

There's two entries in the DSM-V paraphilia section. One for not one of the eight specifically called out, and also one for "this person has a paraphilia that we don't have a name for."

Obviously I'm a proponent for Blanchard's larger-encompassing idea of autogynephilia replacing the transvestic entry. You can see how that's too narrow to encompass Shupe.

It's negligent of the clinicians Shupe was dealing with to only look at the eight. A cursory search of the Internet readily reveals the existence of more than eight paraphilias.

The specific call-outs have to do with frequency and use for the legal system. Listing every paraphilia would not be a worthwhile exercise. I think the clinicians probably just didn't give a damn.

Obviously Shupe is in the paraphilic disorder camp. From the interview, I agree with Shupe's assessment of treatment. Stabilization with sex-drive reducing medication, psychotherapy, with the goal of trying to reduce or eliminate the medical treatment due to the consequences of yanking the endrocrine system around. It's not good.

Shupe seems idealistic that he can eliminate the paraphilia with conversion therapy. The outlook on that, to me, is very grim. I think he's got a few options: orchiectomy, life-long sex-drive reduction, or psychotherapy that ideally would allow him to healthily integrate his sexuality into his life. Given the history, the latter does not seem viable.

Shupe is interesting. I need to look into him some more, why he had this "aha" moment wrt. autogynephilia. If you only look at the microcosm of the individual, well, there are transsexuals who don't believe in AGP and they're much happier than Shupe is. You'll never be able to disabuse Shupe of the concept of AGP at this point, and IMHO it would be highly unethical to do so. People who have been mislead, yanked around, lied to, etc., and think they discover the real truth (Shupe has) will never let go of it.

Shupe mentioned borderline personality disorder and this history screams BPD. I'd certainly treat for that. This is probably the comorbidity that's really kicking his ass. I view BPD as a contraindication to treating for "trans" but that's a whole new topic...

Ultimately, physicians and psychotherapists in the United States do not receive training in sex psychology. I regard this as a problem, on many accounts, not just paraphilia, and agree with Shupe.

This highlights an existing problem in the USA with medical care: doctors are more like technicians. They're punished for thinking on their own. They also think the training they receive in med school is sufficient for their entire career. This is a problem across many professions in the US.