Transvestism involves recurrent and intense sexual arousal from cross-dressing, which may manifest as fantasies, urges, or behaviors. Transvestic disorder is transvestism that causes clinically significant distress or functional impairment in 1 or more important areas of life.
n the International Classification of Diseases, 11th revision (ICD-11), transvestic fetishism or transvestic disorder is not a specific diagnosis; it is subsumed under a more nonspecific category of paraphilic disorders involving solitary behavior or consenting individuals (1). If sexual arousal associated with cross-dressing causes significant distress or impairment, the paraphilic disorder can be diagnosed.
"Cross-dresser" is a more common and acceptable term than "transvestite." Cross-dressing in and of itself is not considered a psychiatric disorder. Cross-dressing occurs in both heterosexual and homosexual men. Cross-dressing is much less common among women, possibly because women are allowed a broader range of clothing options before they veer into what society considers gender-inappropriate styles. Nonbinary people who dress in clothing typically associated with a different birth sex are not generally assumed to be engaging in "cross-dressing." Some people who engage in cross-dressing do so for a variety of reasons that are not usually associated with sexual arousal (eg, costumes). However, for those cross-dressers who experience clinically significant distress or functional impairments based on their cross-dressing urges or behaviors, the diagnosis of transvestic disorder may be appropriate.
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 (2). Cross-dressing is associated, at least initially, with intense sexual arousal. Sexual arousal that is produced by the clothing itself (not by wearing the clothing) is considered a form of fetishism and may occur with or independent of cross-dressing.
The personality profiles of men who cross-dress appear generally similar to age- and race-matched norms (3). Gender dysphoria is more common in birth sex males with transvestic disorder. Such individuals may report arousal to wearing typically female clothing as teens that diminishes or disappears later in life, accompanied by a desire to live fully in the female gender. Some with transvestic disorder may also experience intermittent gender dysphoria associated with loss, grief, substance use, or depression.
When men who cross-dress have supportive partners, they may feel comfortable engaging in sexual activity in feminine attire. Conversely, if their partner is uncooperative, they may experience anxiety, depression, guilt, and shame related to their desire to cross-dress, potentially leading to sexual dysfunction in the relationship. These negative emotions can trigger cycles of repetitively purging their wardrobe of feminine clothing, followed by accumulating new items, and renewed feelings of shame; the cycle may thus continue.
General references
1. World Health Organization. (2019). 6D36 Paraphilic disorder involving solitary behaviour or consenting individuals. In International statistical classification of diseases and related health problems (11th ed). Accessed August 25, 2025.
2. Långström N, Zucker KZ. Transvestic fetishism in the general population: Prevalence and correlates. J Sex Marital Ther. 31(2):87-95, 2005. doi: 10.1080/00926230590477934
3. Brown GR, Wise TN, Costa PT Jr, Herbst JH, Fagan PJ, Schmidt CW Jr. Personality characteristics and sexual functioning of 188 cross-dressing men. J Nerv Ment Dis. 1996;184(5):265-273. doi:10.1097/00005053-199605000-00001
Diagnosis of Transvestic Disorder
Psychiatric assessment
Clinical criteria for diagnosis of transvestic disorder from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR) include the following (1):
Patients experience recurrent and intense arousal from cross-dressing as manifested by fantasies, intense urges, or behaviors.
These fantasies, intense sexual urges, or behaviors cause clinically significant distress or impair functioning at work, in social situations, or in other important areas of life.
The condition has been present for ≥ 6 months.
When making the diagnosis, the clinician must specify whether
Fetishism (sexual arousal by fabrics, materials, or garments) or autogynephilia (arousal by thoughts or images of self as a woman) are present.
The patient is living in a controlled environment (eg, institution) or in full remission (ie, at least 5 years without distress/impairment in an uncontrolled environment)
Diagnosis reference
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, Text Revision. American Psychiatric Association Publishing; 2022:798-800.
Treatment of Transvestic Disorder
Social and support groups
Sometimes psychotherapy
Most people who cross-dress do not experience significant distress related to it and may not voluntarily seek mental health treatment. Those who do seek evaluation or 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. Some people who cross-dress may present for the treatment of comorbid gender dysphoria, a substance use disorder, or depression.
Although there are no randomized trials, social and support groups, both in-person and on the internet, for men who cross-dress are often very helpful (1, 2).
Due to the lack of high-quality evidence, no medications have been found to be reliably effective, although selective serotonin reuptake inhibitors have been tried with occasional success in patients with a substantial obsessive-compulsive component to their clinical presentation (3). There is 1 case report of a patient with transvestic disorder benefiting from buspirone (). There is 1 case report of a patient with transvestic disorder benefiting from buspirone (4).
Psychotherapy, when indicated, is aimed at self-acceptance, family therapy, and modulating risky behaviors.
Later in life, sometimes in their 50s, 60s, or later men who cross-dress may present for medical care because of gender dysphoria symptoms and may then meet diagnostic criteria for gender dysphoria.
Treatment references
1. Newring K, Wheeler J, Draper C. Transvestic fetishism: Assessment and Treatment. In: Laws DR, Donohue WT, eds. Sexual Deviance: Theory, Assessment, and Treatment. Guilford Press; 2028: 285-304.
2. Moser C, Kleinplatz PJ. Transvestic fetishism: Psychopathology or iatrogenic artifact? NJ Psychologist. 52(2):16-17, 2002.
3. Balon Rez-Sierra D, Balgobin C, Wise TN. Treatment of paraphilic disorders. In: Balon R, ed. Practical Guide to Paraphilia and Paraphilic Disorders. Springer/Springer International Publishing AG; 2016:43-62.
4. Fedoroff JP. Buspirone hydrochloride in the treatment of transvestic fetishism. . Buspirone hydrochloride in the treatment of transvestic fetishism.J Clin Psychiatry. 1988;49(10):408-409.
Key Points
Most cross-dressers do not meet the clinical criteria for transvestic disorder and may not voluntarily seek treatment.
The diagnosis of transvestic disorder is made only if cross-dressing causes clinically significant distress or impairs functioning, and the condition has been present for ≥ 6 months.
No medications are reliably effective; psychotherapy and support groups may help.
Self-acceptance and harm reduction are the primary approaches in assisting those with transvestic disorder.
