The term transvestite is sometimes confused with cross-dresser, but the two identities are distinct. Unlike transgender people, cross-dressers have a consistent gender identity and only dress for sexual pleasure or arousal.
For example, men who dress as women are considered cross-dressers but not transvestites. Male impersonators known as drag queens or drag kings are also cross-dressers but not transvestites.
Definition
Transvestite, transgender, and transexual all get used interchangeably, which can lead to confusion. However, it is important to understand the nuance differences between these terms.
The term transvestite describes a person who dresses in clothes traditionally associated with the opposite sex. This is not a mental health condition, but can be a form of gender expression. It is different from cross-dressing, which is a fetish wherein someone dresses as the other sex for sexual gratification or to allay the anxiety caused by obsessive thoughts.
It is also not the same as a drag queen, who is a man who dresses in women’s clothing to entertain an audience. It is best to use these terms on a case-by-case basis, and avoid using them in a derogatory manner. The word transvestite is now considered outdated, and it’s better to use the more contemporary terms transgender or cross-dresser. These describe more accurately what a person is — a trans man who lives as a woman, or a trans woman who lives as a man.
Symptoms
In most cases, the desire to cross-dress does not cause distress or social impairment. Rather, it is a personal hobby that many people keep secret.
A key symptom is recurrent sexual arousal from clothing or fabrics worn by someone of a different sex. The urges must be repeated over at least six months to meet the criteria for a diagnosis. In some cases, a person with transvestism may also have other paraphilias, such as fetishism (in which a man is sexually aroused by the feeling of female shoes or undergarments) or autogynephilia (in which a man is sexually arouse by thoughts or images of himself as a woman).
Psychiatrists are trained to evaluate for recurrent transvestism and can use a variety of tools, including a medical history, situational assessments and psychotherapy. Psychotherapy often helps individuals who have this condition cope with their feelings and learn to control their behavior. This may include psychoeducation, such as teaching skills for self-control and managing triggers, and cognitive behavioral therapy.
Treatment
When you hear the word transvestite, you may think it has a sexual connotation. In reality, cross-dressing is not a mental illness and most people who wear women’s clothing do so for reasons other than to gain sexual gratification. Unlike the drag queen, many people who dress in women’s clothes want to subvert gender norms and explore their own sexual identity. However, only if men’s desire to dress in women’s clothing is accompanied by guilt or shame and their urges are compulsive, can transvestism be considered a medical condition.
You should avoid using the terms drag queen and drag king to describe people who dress in clothing associated with the opposite sex, as these are more generally used to describe performers. You should also be careful to use the term transgender correctly, as this can cause confusion. A person who identifies as a male at birth but prefers to dress as a woman should be called a transgender man, not a transvestite.
Prevention
Transgender people have a high prevalence of HIV and other STIs. Preventive health interventions should target these populations, especially abstinence from sexual activity and use of barrier methods (internal condoms or dental dams) with every sexual encounter. It is also important to address systemic issues such as routine transphobia, which manifests as stigma, discrimination and violence in a variety of global contexts and increases risk for HIV/STI transmission and other health problems by restricting access to healthcare, lowering the acceptability of HIV prevention services and contributing to economic marginalization and poor mental health.7,8
Developing preventive health strategies that address the multiple needs and risks of this population requires an integrative approach based on Frieden’s Health Impact Pyramid.