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Transvestism

(Transvestic Disorder)

By George R. Brown, MD, Chief of Psychiatry;Professor and Associate Chairman, Department of Psychiatry, Mountain home VAMC, Johnson City, TN;East Tennessee State University

Transvestism involves recurrent, intense sexual arousal from cross-dressing. Transvestic disorder is transvestism that causes significant distress or substantially interferes with daily functioning.

  • Most cross-dressers do not have transvestic disorder.

  • Doctors diagnose transvestic disorder when people are greatly distressed by or cannot function well because of their desire to cross-dress.

  • No drugs are reliably effective, but psychotherapy, when needed, may help people accept themselves and control behaviors that could cause problems in their life.

Transvestism is a form of fetishism (the clothing is the fetish), which is a type of paraphilia. In transvestism (cross-dressing), men prefer to wear women’s clothing, or, far less commonly, women prefer to wear men's clothing. However, they do not wish to change their sex, as transsexuals do. Also, most of them do not have an inner sense of belonging to the opposite sex as people with gender dysphoria do. However, men who cross-dress may have feelings of gender dysphoria when they are under stress or experience a loss.

The term cross-dressers is usually used to refer to people with transvestism. Transvestite is a less acceptable term.

Heterosexual males who dress in women’s clothing typically begin such behavior in late childhood. This behavior is associated, at least initially, with intense sexual arousal.

Cross-dressers may cross-dress for reasons other than sexual stimulation—for example, to reduce anxiety, to relax, or, in the case of male cross-dressers, to experiment with the feminine side of their otherwise male personalities.

Later in life (sometimes in their 50s or 60s), some men who were cross-dressers only in their teens and twenties develop gender dysphoria. They may seek to change their body through hormones and genital (sex-reassignment) surgery.

When a partner is cooperative, cross-dressing may not hurt a couple’s sexual relationship. In such cases, cross-dressing men may engage in sexual activity in partial or full feminine attire.

When a partner is not cooperative, cross-dressers may feel anxious, depressed, guilty, and ashamed about their desire to cross-dress. In response to these feelings, these men often purge their wardrobe of female clothing. This purging may be followed by additional cycles of accumulating female clothes, wigs, and makeup, with more feelings of guilt and shame, followed by more purges.

Diagnosis

  • A doctor's evaluation, based on specific criteria

Doctors diagnose transvestic disorder when

  • People have been repeatedly and intensely aroused by cross-dressing, and the arousal has been expressed in fantasies, intense urges, or behaviors.

  • As a result, people feel greatly distressed or become less able to function well (at work, in their family, or in interactions with friends).

  • They have had the condition for 6 months or more.

Most cross-dressers do not have transvestic disorder.

Treatment

  • Social and support groups

  • Sometimes psychotherapy

Transvestism is considered a disorder and thus requires treatment only if it causes distress, interferes with functioning, or leads to behavior likely to result in injury, loss of a job, or imprisonment.

Only a few people with transvestism seek medical care. Those who do may be motivated by an unhappy spouse or by worry about how the cross-dressing is affecting their social life and work. Or they may be referred by courts for treatment. Some seek medical care for other problems, such as substance abuse or depression.

Social and support groups for men who cross-dress are often very helpful.

Psychotherapy, when needed, is focused on helping people accept themselves and control behaviors that could cause problems.

No drugs are reliably effective.