Most cross-dressers do not have a psychiatric disorder. They may be said to have transvestism rather than transvestic disorder.
Doctors diagnose transvestic disorder only when people are greatly distressed by or cannot function well because of their desire to cross-dress or because of interference in other areas of their lives by the time and expense spent engaging in cross-dressing.
No medications 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 Fetishistic Disorder Fetishism is use of an inanimate object (the fetish) as the preferred way to produce sexual arousal. Fetishistic disorder occurs when recurrent, intense sexual arousal from using an inanimate... read more (the clothing is the fetish), which is a type of paraphilia Overview of Paraphilias and Paraphilic Disorders Paraphilias are frequent, intense, sexually arousing fantasies or behaviors that involve inanimate objects, children or nonconsenting adults, or suffering or humiliation of the person or a partner... read more in its most extreme forms. In transvestism (cross-dressing), men prefer to wear women’s clothing, or, far less commonly, women prefer to wear men's clothing. This may be because women have a broader range of clothing considered consistent with gender. However, they do not have an inner sense of belonging to the opposite sex or wish to change their sex, as do some people with severe gender dysphoria Gender Incongruence and Gender Dysphoria Gender incongruence is a marked and persistent experience of incompatibility between a person's gender identity and the gender expected based on sex at birth. Gender dysphoria is diagnosed when... read more . 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 and is considered offensive. Cross-dressing in and of itself is not considered a mental health disorder. Cross-dressing occurs in both heterosexual and homosexual men, and much more uncommonly in women. Nonbinary people who dress in clothing typically associated with a different birth sex are generally not engaging in "cross-dressing" for the purposes of sexual arousal.
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, however, 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 (gender-affirming) 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 with the consent of their partner.
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 of Transvestic Disorder
A doctor's evaluation, based on standard psychiatric diagnostic 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.
In making the diagnosis of transvestic disorder, the doctor specifies whether a person has a fetish Fetishistic Disorder Fetishism is use of an inanimate object (the fetish) as the preferred way to produce sexual arousal. Fetishistic disorder occurs when recurrent, intense sexual arousal from using an inanimate... read more or autogynephilia (a man's arousal by thoughts or images of himself as a woman).
Treatment of Transvestic Disorder
Social and support groups
Only a few people with transvestic disorder 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 a substance use disorder Overview of Substance-Related Disorders Medications and other substances, whether used for legitimate medical purposes, as a habit (for example, caffeine), or recreationally, are an integral part of everyday life for many people ... read more or depression Depression Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to interfere with functioning. It may follow a recent... read more .
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 medications are reliably effective, even if someone with transvestic disorder asks for such treatment..