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TRANSVESTISM: INCIDENCE, ETIOLOGY, DIAGNOSIS

on April 7th, 2009 by admin

Incidence

The incidence of transvestism is unknown. There are no public health statistics, nor are there satisfactory statistics of transvestites arrested by the police, nor of those seen by psychiatrists. There are some transvestite organizations with their own magazines or newsletters. The syndrome is probably more frequent than is generally assumed.

Etiology

The precise etiology of transvestism cannot be formulated on the basis of today’s knowledge. Most evidence points to the early years when gender identity/role is being differentiated as critical to the beginnings of transvestism. A few transvestites recall being dressed in girls’ clothes as a punishment—the so-called petticoat punishment of the older literature.

Diagnosis

The diagnosis is made primarily from the patient’s account of his chief complaint and its history. As in the case of transexualism, it is necessary to get corroborative evidence from family members or others and from available records. The physical examination is a routine necessity, even though it can generally be counted on as being noncontributory.

Differential Diagnosis

The diagnoses to be ruled out parallel those for transexualism. There may be some confusion with transexualism in the case of the patient who wears women’s clothes, but with a full unshaven beard, with or without taking estrogen, and with no demand whatsoever for genital surgery. Until the last few years this variant of transvestism was unknown, through lack of public disclosure. A corresponding female condition is that of the woman who wears men’s clothes and who requests only a mastectomy, but no other treatment.

A tricky problem of differential diagnosis occurs in those cases of transvestic transexualism that sit on the fence, so to speak, of both diagnoses. Typically the patient is fortyish, and has been a covert transvestite throughout adulthood. Finally the compulsion for public appearance as a woman and for total sex change demands expression, despite personal commitments to wife and family. Without a real-life test of two years or longer, such a patient cannot get his affairs in order and himself rehabilitated. Some of them, however, are past masters at clinic shopping. They maneuver from one doctor to another, editing the information given to each, until they finally implement their plans, despite contradictory advice. Some of them become adequately rehabilitated. The burden imposed on their dependents may be excessive.

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