Transvestites who present for treatment are likely to be a minority of heterosexual cross-dressers (Docter 1988; Prince and Bentler 1972; Wise 1990). For example, a range of 17%-49% of members of transvestite social clubs have reported being evaluated or treated by mental health practitioners (17%, G. R. Brown 1994; 44%, Buhrich 1981; 49%, Croughan et al. 1981). The proportion of transvestites who cross-dress only in secrecy and never present for evaluation or treatment is unknown, although 76% of 504 transvestites responding to a 1972 mail-in survey had never sought treatment (Prince and Bentler 1972), compared with only 55% in 1997 (Docter and Prince 1997). Motivations for seeking treatment include those listed in

Table 70-2.

A majority of transvestites (54%, as reported by Docter [1988]) indicate that cross-dressing had had little or no negative consequences in their lives. However, about 25% of those polled by Docter (1988) indicated that their transvestism had had clearly harmful social, occupational, or personal consequences. A minority of spouses of transvestites (32% of 107) polled by G. R. Brown (1994) reported that they had seriously considered divorce or separation after learning of their mates’ cross-dressing. Transvestites who present for treatment, however, describe losses of relationships with spouses and family members, destroyed military careers (G. R. Brown 1988b), chronic guilt and shame (Wysocki 1993), depressed mood, and episodic gender dysphoria (Wise 1990). Although transvestites who are seen in clinical settings may have a high rate of alcohol dependence, there is no evidence to suggest that men who cross-dress are more likely to become alcohol dependent than are age- and race-matched American men in the community (G. R. Brown 1994; Docter 1988).

It should also be mentioned that the majority of men who cross-dress and who respond to research surveys describe their transvestic activities as one of the most fulfilling and enriching aspects of their adult lives (Brooks and Brown 1994). In Docter’s (1988) survey, 56% of the respondents reported that cross-dressing was “highly pleasurable” or “extremely pleasurable.” An additional 17% endorsed the statement, “Cross-dressing is a super-pleasure for me. No other activity gives me as much delight.” Most men who report such ego-syntonic enjoyment of transvestism struggled for years with their desire to cross-dress and came to accept themselves as transvestites only later in life. This was sometimes in the context of psychotherapy, often with a skilled therapist who had no special knowledge about the topic until beginning to work with his or her first cross-dressing patient. Self-acceptance is often obtained through involvement with one of the many social and support groups for transgendered people and their families (e.g., Tri-Ess, Boulton and Park Society, International Foundation for Gender Education, Seahorse Club, CrossPort, Beaumont Society, Phoenix Transgender Support, and Tennessee Vals [Buhrich 1976; G. R. Brown et al. 1996]). A typical case presentation is that of “Anthony”:

Susan, a 52-year-old woman who had been married for 28 years, came home unexpectedly one afternoon to find her recently retired 63-year-old husband, Anthony, wearing her clothing and high heels, sporting a blond wig, and sitting in front of the television sipping tea from a small teacup. She was shocked and amazed to discover that Anthony had been borrowing her clothes throughout their marriage and that he had cross-dressed privately during his military career and later as a civilian while away on business trips. She became confused and later depressed about this discovery and was too embarrassed to discuss her feelings with friends. Anthony had been through a number of “purges” of clothing, shoes, and wigs over the years and constantly struggled with his desire to dress as a woman. In an attempt to console his wife, he vowed never to cross-dress again. However, he then began to drink excessively, alone and at social gatherings, causing additional pain in their relationship. They began to quarrel about “little things,” and for the first time, Susan began to contemplate her life without him. Finally, fearing he would lose her, Anthony agreed to see a psychiatrist “if she thought it would help.”