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Transvestic Disorder

(Transvestism; Transvestic Fetishism)

By George R. Brown, MD, Professor and Associate Chairman of Psychiatry; Adjunct Professor of Psychiatry, East Tennessee State University; University of North Texas

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Transvestism involves recurrent and intense sexual arousal from cross-dressing, which may manifest as fantasies, urges, or behaviors. Transvestic disorder is transvestism that causes significant distress or significant functional impairment.

Transvestism is a form of paraphilia, but most cross-dressers do not meet the clinical criteria for a paraphilic disorder; these criteria require that the person's fantasies, intense urges, or behaviors cause distress, impair functioning, or harm others. The condition must also have been present for ≥ 6 mo.

Some scholars believe that transvestic fetishism should be removed from the International Classification of Diseases (ICD) at the next revision even though some men who cross-dress do so compulsively and are distressed and impaired by their behavior.

Cross-dresser is a more common and acceptable term than transvestite. Cross-dressing and transvestic disorder are extremely rare in birth-sex females.

Heterosexual males who dress in women’s clothing typically begin such behavior during late childhood. Up to 3% of men have cross-dressed and been sexually stimulated by it at least once, but far fewer report regular cross-dressing. Cross-dressing is associated, at least initially, with intense sexual arousal. Sexual arousal that is produced by the clothing itself is considered a form of fetishism and may occur with or independent of cross-dressing.

Personality profiles of cross-dressing men are generally similar to age- and race-matched norms.

When their partner is cooperative or willing to participate, cross-dressing men may engage in sexual activity in partial or full feminine attire. When their partner is not cooperative, they may feel anxiety, depression, guilt, and shame because of their desire to cross-dress and may experience sexual dysfunction in their relationship. 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 shame and guilt, followed by purges.


  • Specific Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria

Diagnosis of transvestic disorder requires the following:

  • Patients have been repeatedly and intensely aroused by cross-dressing; arousal is expressed in fantasies, intense urges, or behaviors.

  • These fantasies, intense urges, or behaviors cause significant distress or impair functioning at work, in social situations, or in other important areas.

  • The condition has been present for ≥ 6 mo.


  • Social and support groups

  • Sometimes psychotherapy

Most cross-dressers do not present for treatment. Those who do are usually brought in by an unhappy spouse, referred by courts, or self-referred out of concern about experiencing negative social and employment consequences. Some cross-dressers present for treatment of comorbid gender dysphoria, substance abuse, or depression.

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

No drugs are reliably effective.

Psychotherapy, when indicated, is aimed at self-acceptance and modulating risky behaviors.

Later in life, sometimes in their 50s or 60s, cross-dressing men may present for medical care because of gender dysphoria symptoms and may then meet diagnostic criteria for gender dysphoria.

Key Points

  • Most cross-dressers do not meet the clinical criteria for a transvestic disorder.

  • Diagnose transvestic disorder only if cross-dressing causes significant distress or impairs functioning, and the condition has been present for ≥ 6 mo.

  • Cross-dressers who present for treatment are usually brought in by an unhappy spouse, referred by courts, or self-referred out of concern about experiencing negative social and employment consequences of their behavior.

  • No drugs are reliably effective; psychotherapy and support groups may help.