The theory of Autogynephilia was first proposed in 1989 by Ray Blanchard, as an attempt to explain male-to-female transsexuals who are sexually attracted to women. The theory claims that "all gender dysphoric males who are not sexually oriented toward men are instead sexually oriented toward the thought or image of themselves as women". Blanchard argues that in these cases gender dysphoria has its origins in sexual fetishism.

This theory is highly controversial, and a great many people reject it. Blanchard's theory has been questioned on the grounds that it does not account for the behavior and self-identification of a great many transsexuals, who are presumed under the theory to be mistaken about themselves. Some suggest that, since correlations do not establish causality, Blanchard may be mistaking a symptom of gender dysphoria for its primary cause. A lack of control groups in Blanchard’s work lead some to wonder how different bisexual and lesbian transsexual women are from other women. Most of Blanchard’s work on gender dysphoria focuses on what he calls autogynephilic transsexuals. This leads some to wonder how his theory might account for other transsexuals: female-to-male transsexuals and male-to-female transsexuals exclusively attracted to men.

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