(See also Overview of Paraphilic Disorders.)
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 months.
"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.
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 months.
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, a substance use disorder, or depression.
Social and support groups for men who cross-dress are often very helpful.
No drugs are reliably effective, although selective serotonin reuptake inhibitors have been tried and occasionally are beneficial in patients with a substantial obsessive-compulsive component to their presentation.
Psychotherapy, when indicated, is aimed at self-acceptance, family therapy, 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.
Most cross-dressers do not meet the clinical criteria for transvestic disorder.
Diagnose transvestic disorder only if cross-dressing causes significant distress or impairs functioning, and the condition has been present for ≥ 6 months.
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.