- ‘Transvesticism’ – Magnus Hirschfeld, 1910 – more or less introduced this term
into clinical work. He used the term to denote any instance of psychologically
motivated cross-dressing (got away from biological roots). In every day language,
there are many terms used to denote transvestitism (drag queen, gender blender,
- in the DSM 4 there is a term known as transvestic Fetishism. It is limited to
heterosexual males. In is clear within the psychiatric nomenclature that it is
clearly there for heterosexuals. Why is this? Are there homosexual cross dressers?
It is clear that some individuals who cross-dress do have gender dysphoria. Others
are not, however, and this raises the question of whether this is a continuum, etc.
- Working on definition of transvesticism:
o Psychological motivated cross dressing which probably at least one point
in the individuals life was associated with sexual arousal. If you talk to
older cross dressers, their arousability goes down to cross dress at older
ages. Is this just because of growing older?
o Three principal dimensions to the cross dressing experience:
Fetish component, cross gender identity, sexual orientation
- Historical references:
o Sardanopoulos – King of Assyria: according to biblical references, it is
quite clear that sardanopolous cross-dressed in his court, and invited
everyone to do it with him. Everyone was accepting of him cross-dressing
as king, until there was a revolution in Assyria – when he went to war, he
stopped cross dressing. He fought in the war as a male.
o Statues of hatshepshut – ruler of Egypt because her brothers were not. If
you look at the statues, although she was a woman she was often portrayed
with a beard and in male clothing.
o Biblical references state that this is prohibited and unacceptable.
- Basic questions:
o Is cross dressing a normal variation or psychiatric problem?
Female impersonator vs. transvestitic fetishist
o What are the causes?
Why are they almost always males?
o How is cross dressing related to gender identity?
- Characteristics of Male Transvestites: studies are flawed, as cross-dressing is not
necessarily societally acceptable. The access to individuals, and therefore the
research, is quite limited. We often find out about cross-dressers in odd ways.
Epidemiology of Gender Dysphoria
- Swedish Register (Landen 1998)
Possible Gender Dysphoria Continua
- Typology is important because the phenomena we call transsexuality and gender dysphoria are not uniform. There are many individual differences. Within even a
presumed category, there are differences in intensity that have suggested to people
that maybe it is classifiable or differential.
o The basic reason that this has occurred are clinical patterns that appear to
be different in these individuals who claim gender
o Major divide is between homosexual and non-homosexual gender
- Non-Homosexual Gender Dysphoria: called this because the term heterosexual
does not seem to apply. There is no correct term to denote what describes these
individuals, but the term autogynophilic seems to describe the majority of these
individuals in terms of their sexual arousal.
- Patterns of Gender Dysphoria:
o Biological Males
o Non-homosexual (autogynephilia)
Seems to very much resemble male cross-dressers. They are
indistinguishable from other ‘normal boys’. It is hidden and you
would never know – they seem like very average men.
In adulthood, there is a clinical idea – the interpretation of men
who work in male dominated spheres realize that they are different
and they tend to ‘overcompensate’ by going into very male kinds
of things. Clinically this has been remarked on.
If you look at these individuals up until the age of 25 or 30, they
look very average – they tend to get families, get married, etc. do
the same thing as the general population.
They cross dress in secret often to sexual arousal and autogyephilic
types of arousal.
Typical around the mid 30s, these individuals become dissatisfied
with their bodies. They become dissatisfied with their gender and
no longer are happy to be seen as males. This creates a major
conflict. The cross dressing might increase in frequency and they
feel they want to do something about it. This varies upon the
This conflict is a serious one, and leads individuals to seek help,
but the degree is unpredictable. Sometimes it is transient, however,
this creates a major life change.
o Homosexual Males
Are effeminate from childhood. Don’t like boys activities, they
tend to be called ‘sissy’s’, not competitive boys and hang out with
girls and identified as such are often ostracized.
The cross dressing is not as frequent, although it does occur in
these individuals. It is not associated with sexual arousal.
Homosexual gender dysphorics are not as prevalent in adulthood
as the non-homosexual ones. Their gender dysphoria or
incongruence goes as far as its going to go by the mid 20s. There is variability of what they will do with it, but by age 20-25 it is pretty
One of the cardinal characteristics is the sexual arousal to clothing
– which seems to be one of the markers.
o Biological Females
Transpose anything about the male homosexual to the female
These are tomboyish girls. Stereotypically tomboyish.
As far as we know, they do not exist. Transvestite heterosexual
women are few and far between and no one really knows what to
make of it.
In principle if things were equal, they should be there but they are
- If you look at childhood as predictor of adulthood, there is an interesting
o If you look at it from the point of view of childhood of highly effeminate
male children. The life-course of those children is over 90% of them will
become gay adults. Some of those children will as kids identify with the
other gender. At that point, in childhood, it is very hard to know if these
kids are truly gender dysphoric or not. Most of them will become gay in
adulthood but not gender dysphoric. This creates a management problem
for what to do with these children. If you ask them as adults what they are
like, virtually all homosexuals will say they were effeminate. The reason
this is important is that there is a strong tendency to take child gender
dysphorics and do things early – surgery early, etc. This is to prevent the
pain or difficulties with the social mal-comfort that will exist later. The
problem is, you cant predict who will stay gender dysphoric or who will
be gay. The difficulty is if you make a mistake, it is a huge mistake.
Treatment – Do we treat this?
- Do we need to treat?