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 type 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.
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. This behavior 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, 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. In response to these feelings, these men often purge their wardrobe of female clothing.
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..