There are a number of theories which attempt to explain the practice of cross-dressing, none of which is even remotely conclusive despite the undoubted credentials of their respective proponents.

Even Harry Benjamin, a doyen amongst “sexologists” and founder of the Harry Benjamin International Dysphoria Association has stated in his book The Transsexual Phenomenon (1996) that:-

     “...psychoanalytic theories are something like a cult, if not a religion, and are often quite incomprehensible to ordinary clinicians. To them, their explanations and analyses many times appear far-fetched, even absurd, in spite of their often intriguing and sometimes poetic quality…These psychoanalytic concepts have been accepted variously as important scientific discoveries, or as ingenious theories, but have also been criticised and rejected as merely intellectual "games," a sophisticated voodoo, if not as plain nonsense and balderdash...The prominent psychiatrists and university professors Buerger-Prinz, Giese, and Albrecht in an important German monograph [Zur Phenomenologie des Transvestismus bei Maennern.(1953)] call some psychoanalytic theories "think possibilities without evidence in clinical observation" (phenomenology).”

 Nevertheless, this did not stop Benjamin from devising his own theories, which he encapsulated in his “Sexual Orientation Scale” for transvestites and transsexuals, which is set-out, with modifications, on my CD Types page.

Before having a look at some of these theories in more detail, it would be wise to define exactly what is meant by the cross-dressing, especially since the issue is not as clear-cut as one might imagine.

On my Definitions page I discuss in some detail the various definitions that have been offered for the descriptor “cross-dressing” whilst demonstrating the inconsistencies between them, so I will not reiterate those issues here. Suffice to say that when I refer to cross-dressing, I mean someone dressing in clothing which society at large considers inappropriate for that person’s assigned gender, irrespective of whether there is an erotic component or not and regardless of whether the cross-dresser is distressed by the experience.  It should be noted that my definition neither pathologises cross-dressing  per se, nor requires it to be regarded as a paraphilia.

Before looking at the various theories which attempt to explain the aetiology of cross-dressing, it may be useful to mention that they can be divided rather artificially into one of the two arbitrary classifications much beloved by psychologists and other so-called “social scientists”, namely whether cross-dressing is caused by an aberration of “nature”, i.e., physiological, or “nurture”, i.e., psychological, though there is arguably some crossover and obfuscation involved in making  these rather artificial distinctions.

Briefly, however, the psychoanalytical theories tend to fall into the nurture camp, whilst the “hormonal bath” and other physiological explanations such as that of “epileptiform EEG abnormalities” or “chemical abuse fall into the nature camp, but it is more likely that cross-dressing can be more accurately attributed to an amalgam of both nature and nurture, for some of us at least, and that any explanation which attributes cross-dressing to only one causal factor is probably as irrelevant as it is likely to be worthless. However, social scientists have never been ones to let rigorous scientific inquiry, concrete evidence and sound methodology interfere with their pet theories, so the debate continues unabated between their respective proponents and is no nearer reaching a comprehensive explanation for the phenomenon of cross-dressing.

There is no one single valid explanation  for cross-dressing per se, despite superficial similarities between many cross-dressers’ histories.

Whilst I think that the search for a comprehensive explanation as to why certain people cross-dress makes for an interesting academic or intellectual exercise, I do not see it as either a particularly useful or worthwhile human endeavour unless its sole purpose is to be better able to help cross-dressers who regard their cross-dressing as ego-dystonic and who are seeking professional help to resolve their misperceptions.

 It must also be appreciated that the traditional sexual paradigm promoted by religion, psychology and psychiatry, not to mention popular opinion, asserts that procreation is the most important biological function of all sexual activity. Thus, any form of sexual expression which diverges from that paradigm is indicative of a “problem” which needs to be “cured”, hence the pathologising by the psychoanalytical profession of any sexual activity which does not fit with their model.  This explains why, until comparatively recently, the psychiatric profession treated homosexuality as both a pathology  and a paraphilia per se, but had to rapidly revise their manuals once the gay-rights movement became a sociological and political force to be reckoned with.

Apart from questioning the utility of the various theories bandied about to explain cross-dressing, I know that many cross-dressers find them upalatable, to say the least, for it is disconcerting and hurtful to learn that some so-called expert has written one off as some kind of freak, deviant, or pervert on the basis of unscientific investigations supported by unsound methodological practices and little real evidence.

A clue to the fact that the theories offered to explain cross-dressing are basically just so much useless verbiage can be found in the Diagnostic and Statistical Manual of Mental Disorders-IV-TR itself, for it states in the paragraph entitled “Etiology(sic)” of “transvestic fetishism”, or cross-dressing if you will, that:

    “There are different theories related to this disorder, many stemming from the psychoanalytic camp. They suggest that childhood trauma (e.g., sexual abuse, or other significant sexual experience) or significant childhood experiences can manifest itself in exhibitionistic behavior (sic)(emboldening added)”.

 Nevertheless, a trawl of the professional literature on the US National Institutes of Health digital archives, academic libraries and reputable sources elsewhere suggests that the suggestions referred to in the DSM-IV-TR to explain cross-dressing have little or no foundation in concrete fact and more to do with (a) the attitudes of the psychoanalysts conducting the so-called research, and (b) the psychological problems that were specific to those whom they interviewed as part of that research rather than with either scientific methodology or objective evidence per se.

In short, cause and effect were not proven in a sufficiently representative number of cases to make the findings generally applicable, which makes the theories advanced so far of highly questionable merit and worthy of little value except for padding the curriculum vitae of their respective authors.

Before one can categorise any particular form of behaviour as deviant, one has to define what one means by “normal behaviour”. In this connection, one has to acknowledge that the word normal is open to two interpretations:-

    (a) in the statistical sense, describing the frequency and prevalence of various forms of   behaviour in a specific society at a specific time, and

    (b) the moralistic sense, describing what an individual or host society considers to be acceptable behaviour at a specific time.

Consequently, it is probably correct to say that cross-dressing is currently not normal, in either sense of that word. In a strict sense, therefore, it is currently deviant. However, that is not said in a pejorative or denigratory way, nor is it meant to imply that cross-dressing is pathological per se, but it is simply an acknowledgement of the ineluctable facts: male-to-female cross-dressing is neither statistically normal, nor is it generally considered to be societally acceptable at the present moment, apart from in certain sanctioned, limited and specific circumstances, but see also the extracts from Agner Fog’s paper below.

Nevertheless, it is a fact that cross-dressing has been a ubiquitous phenomenon which has existed since males and females adopted sex-differentiated clothing and symbols, whilst the mythology of most cultures includes instances of gods or goddesses impersonating the opposite sex and even of some actually changing their sex. Similarly, mortals had their sex changed by the gods or for some reason impersonated the opposite sex. Many societies have institutionalised a supernumerary gender or third sex to allow certain people to live outside the gender norms of the culture.

Whilst cross-dressing may not be pathological per se, it is generally acknowledged and most certainly true to say that strongly felt, ego-dystonic sexual practices can be a significant cause of suffering and can have a deleterious effect upon the mental health of the practitioner. It is equally true to say that many cross-dressers appear to be ego-dystonic, i.e. they perceive their cross-dressing as self-repugnant, alien, discordant, or otherwise inconsistent with their total personality.

As  Richard von Krafft-Ebing said in his Psychopathia Sexualis (1886):-

     “[The case-histories of  sexual deviants] reveal sufferings of the soul in comparison to which all the other afflictions dealt out by Fate appear as trifles.”

 Implicit in Krafft-Ebing’s dicta is that deviancy per se should be  treated and “cured”, epitomising the medical approach to something which is regarded as being an illness, rather like diptheria or tuberculosis. A better approach would have been to address the issue of the why the perceptions per se of the sufferer caused them so much distress, but that approach requires psychoanalysts to question their own perceptions as well as those of the society in which they live. Much easier simply to claim that the patient’s suffering is caused directly by the deviancy per se. Thus, if the deviancy is cauterised, amputated, or vomited, metaphorically speaking so to speak, then the suffering will disappear as if by magic.

Not unnaturally, perhaps, the psychiatric profession is not keen to investigate its own double-standards, especially in those cases where demonstrating more integrity on their part  would bring them into conflict with a large sector of the society in which they live. I refer, of course, to their refusal to classify religious belief as a mental disorder per se , despite the fact that belief in a supernatural deity who is credited with all sorts of magical powers is indistinguishable from the diagnosis of many of the other psychotic disorders described in the DSM-IV-TR (see here), since it involves, at the very least, delusions on the part of the theistic “believer” - (see the page entitled Parallels & Similarities for a further discussion of this point).

In short, the DSM-IV-TR promulgates dual standards when it comes to cross-dressing, since it limits the diagnosis to heterosexual males. Curiously, women and gay men are free to wear whatever clothing they chose without a label of mental illness. This criterion serves to enforce a stricter standard of conformity for straight males than women or gay men. Its dual standard not only reflects the social privilege of heterosexual males in both American culture and all patriarchal societies, but actually promotes it. One implication is that biological males who emulate women, with their lower social status, are presumed irrational and mentally disordered, while biological females who emulate males are not.

A second implication stereotypically associates femininity and cross-dressing with male homosexuality and serves to punish straight males who transgress this stereotype with all the more severity now that, since 1973, the psychiatric profession could no longer treat homosexuality as a “mental illness” per se, though many psychiatrists still operate on the basis that it is, apparently. Strangely enough, those are the ones who often quote scripture to justify their beliefs, whilst failing to recognise that there is no qualitative difference between religious belief and delusional disorder per se, despite the weasel-words of the DSM-IV-TR specifically excluding the former from the diagnosis of the latter - see my Parallels & Similarities page for more on this subject.

Furthermore, in the supporting text of the “transvestic fetishism” diagnosis, behaviour which would be ordinary or even exemplary for genetic women are presented as symptomatic of mental disorder if genetic men do them. This includes collecting and wearing female clothes or undergarments, dressing entirely as females, wearing makeup, expressing feminine mannerisms and "body habitus," and appearing publicly in a feminine role (DSM-IV-TR p. 574). It is not clear how this behaviour can be pathological per se for one group of people and not for another.

Most disturbing, the DSM lists "involvement in a transvestic subculture" among symptomatic "transvestic phenomena." Psychiatric diagnosis on the basis of social, cultural or political affiliation evokes the darkest memories of medical abuse in modern history. For example, women suffragettes who demanded the right to vote in the early 1900s were diagnosed and institutionalised with a label of "hysteria" whilst immigrants, Bolsheviks and labour organizers of the same era were labelled as socially deviant and mentally defective by prominent psychiatric eugenicists, such as Dr. Charles Kirk Clarke, founder of the Clarke Institute of Psychiatry in Toronto, Ontario (Dowbiggin, I.  Keeping America Sane: Psychiatry and Eugenics in the United States and Canada, 1880-1940.(1997) pps. 133-177).

Amazingly, psychiatrists have displayed a remarkable inability over the last 120 years or so to discern that their approach to so-called paraphilias simply does not work. Perhaps even more amazing is the fact that the psychiatric profession appears to be blind to it’s own shortcomings in the foregoing regard. That is particularly strange, is it not, when such an obvious and important disconnect and lack of insight in a patient would likely be pathologized by the very same psychiatric profession.

In truth, transgender support organisations world-wide are the primary source of support, education and civil rights advocacy for gender variant people, families, friends and allies. Their necessity is a consequence of social intolerance, and psychiatric stigmatisation, not of mental deviancy per se on the part of cross-dressers.

In the circumstances where cross-dressing is fetishistic (defined below), it is maintained by some psychoanalysts that the donning of a garment is not an attempt to identify oneself as a member of the morphologically opposite sex, but simply an attempt to possess more fully the fetish object, and by extension, the person with whom the object is more conventionally associated. In other words, all of you like me who started cross-dressing in your early childhood are really trying to possess your mother without the inconvenience of having to murder your father, unlike poor Oedipus. If this view is correct, then fetishistic transvestism has similar primal psychological roots to those  that give rise to sympathetic or imitative magic (for a discussion on the roots of sympathetic magic, see Sir James Frazer’s The Golden Bough, Chapter 3 (1922)).

Furthermore, since religious belief also owes its existence to those same  primal psychological roots, what valid justification can psychiatrists offer for pathologising “transvestic fetishism” whilst not pathologising the “religious belief” in the alleged transubstantiation in the Eucharist of bread and wine into the flesh and blood of the so-called “Christ”? None, that’s what. And then we come to the alleged “virgin birth” by Mary, not to mention all the other delusional claims made by religions over the millennia, but enough has been said to illustrate my point: the psychiatric profession as a body is not only remarkably selective in the forms of human behaviour it decides to pathologise, but it demonstrates little by way of integrity, logical analysis, scientific rigour, or consistency in many of its promulgations, and has been roundly criticised for this by a growing number of its own members.

Incidentally, fetishism is defined in the psychoanalytical literature as a paraphilia, whilst a fetish is defined as an inanimate object to which a pathologicial sexual attachment is formed, or by extension a person who is the object of an obsessive fixation.  Etymologically the antecedent of the word fetish is the Portuguese word “feitišo”, which means “magic”, which seems highly relevant to me.

 Where cross-dressing is a fetishistic activity it can obstruct the formation of interpersonal sexual relationships, but that is not to say that it must be disruptive either to the formation of these relationships, or their satisfactory continuation. Whilst, in cases where the cross-dressing is associated with a high level of compulsion, it can, but need not necessarily, interfere with work and other daily activities. However, irrespective of whether there is disruption or interference with other aspects of the cross-dresser’s life, if he feels that his cross-dressing is ego-dystonic per se, then it represents a problem which needs addressing.

Pathologising cross-dressing and writing it off as a paraphilia is not addressing the problem, however.

As Agner Fog said in his paper Paraphilias and Therapy, (Nordisk Sexologi, vol. 10, no. 4, 1992, pps. 236-242):-

      The least explored area of research [into sexuality] is the phylogenetic paradigm, comprising sociobiology and ethology. It explains general phenomena by the evolutionary history of the human species. It has been shown by ethologists that non-procreative sexual behaviour is common among non-human primates. Behaviours such as "homosexuality" and "paedophilia" are functional among apes, and probably among humans as well. When such behaviours occur among humans they may violate moral norms, but not biological laws.

    The reason why paraphilias are difficult to understand in the traditional sexological paradigm is that this paradigm assumes that sexuality has only one ultimate biological function: procreation. The phylogenetic paradigm discloses, however, that sexuality has many functions, and the sociogenetic paradigm tells us that many of these functions are suppressed in our culture but not in certain other cultures. The integration of all three paradigms is necessary for a full understanding.

     It is evident that the choice of paradigm influences the scientific results. It also influences the way we look at puzzling phenomena. Take exhibitionism as an example. An ontogenetically oriented scientist [i.e. where the investigation is based on psychology and psychiatry which tends to look at the individual only, and seeks the causes of any problem in the life history of the individual] would ask: "Why can’t this man keep his pants on?" The sociologist would ask: "Why do people get scared and hysteric when they see a naked man?" And the phylogenetic scientist would discuss the function of visual sexual communication in the lives of our ancestors.

 I consider that Fog’s paper Paraphilias and Therapy, contains a number of interesting insights, so I make no apologies for continuing to quote from it at length. His introduction, definition and aetiology of the what he calls the “isolated minority syndrome” is, in many respects, relevant, even if Fog does make some sweeping generalisations which I find quite unpalatable, for a number of reasons that I will not go into here. First, Fog defines the  “isolated minority syndrome” as the situation of a person whose sexual peculiarities (his word, not mine) are suppressed by the surrounding society, then, according to him:-

     “The cause of this syndrome is a lack of identification model. The so called "pervert" has no knowledge of any appropriate script for the paraphilic behaviour that would satisfy him. He has no contact with experienced paraphiliacs who could teach him the most appropriate way to act out his wishes and the pitfalls to avoid. He does not even have an understanding of his own identity. And he tries to suppress his paraphilic fantasies because he does not accept them himself.

     The symptoms are an extremely stereotypic, inflexible and uncontrolled sexual behaviour that is hardly satisfying to himself and certainly not to his partner (if he has any). He repeats the same stereotypic fantasy over and over again with hardly any variation. He regards his partner as an object. He has very unrealistic ideas about the ideal partner that would satisfy him and he has no chance of finding a partner who would match these ideas.

     The lack of identification model may lead him into a permanent search for information about his paraphilia...If he is in therapy, he will most certainly try to get information from his therapist. He will read the therapists model or script for paraphilic behaviour out of the questions the therapist asks. And he is likely to internalise the therapist’s script for paraphilic behaviour. This means that he is likely to fulfil all the therapist’s expectations concerning deviant behaviour. He will even talk the therapist’s language. Any theory about the paraphilia that the therapist may come up with will be a self-fulfilling prophecy. (emboldening added)

     The social symptoms in the isolated minority syndrome can best be explained by the theory of deviancy amplification . One type of deviance leads to other deviances. The sexual frustration, low self-esteem, social stigmatisation and isolation may often lead to substance abuse, social deroute, non-sexual crimes, political extremism and suicide.

     The psychological defence mechanisms include suppression and repression of the deviant impulses, projection of the deviant impulses on other persons, and violence against the sexual object. The paraphiliac may even kill the sexual object (e.g. children) in a symbolic attempt to kill his deviant impulses [the typical cross-dressers’ cycle of behaviour involving the “purging” of their feminine apparel is a directly relevant example of this].

     A paraphiliac who has contact with similarly disposed persons and who accepts his own feelings does not show these symptoms. His sexual behaviour is more flexible and controlled by rational thinking. If for any reason he chooses not to have sex, he can refrain from that and still preserve his mental health and self-control despite the sexual frustrations.(emboldening added)

     The isolated minority syndrome may be seen in paedophiles, exhibitionists, bisexuals, sadomasochists, fetishists, transvestites, transsexuals, etc. The symptoms mentioned above are often believed to be characteristic of paraphilias per se, but they are in fact secondary symptoms of the social suppression. It is not possible to change the sexual orientation, but it is possible to cure the isolated minority syndrome, thereby improving the client’s psychological and social well-being. The client will gain self-control which means that the uncontrolled, aggressive and perhaps dangerous sexual acts will be replaced by more harmless and well-controlled acts...If, however, the person has internalised society’s condemnation and tries to suppress not only the paraphilic behaviour but also the paraphilic fantasies, in other words: if he suffers from the isolated minority syndrome, then the safety valve is closed and [he] will explode in an outburst of uncontrollable sexuality.(emboldening added)

    Traditional studies of paraphiliacs are based on psychiatric and forensic populations. The vast majority of these populations suffer from the isolated minority syndrome to various degrees. This has created an image in the psychiatric literature of paraphilias as uncontrollable and dangerous compulsions. Members of sexual minority organisations, however, suffer only slightly or not at all from the isolated minority syndrome and they do not match the image presented by psychiatrists. Sociological studies based on populations from sexual minority organizations give a totally different image.(emboldening added)

It will be noted from the above quotes that Fog uses the word paraphilia and its variations in the way that it is defined in the DSM-IV, but his implication is clear: cross-dressing need not be a paraphilia any more than it need be ego-dystonic, as in the case of someone who is sufficiently composed to be able to recognise that their “deviant” behaviour is not a problem per se, but simply the misperception of those who define it as one. However, the traditional psychoanalytical response to a cross-dresser who has sufficient ”ego-strength” to regard his cross-dressing as ego-syntonic, i.e. the cross-dresser regards it as consistent and harmonious with his total personality, is to persuade the cross-dresser that they should feel ego-dystonic about their cross-dressing. Where that persuasion fails, the cross-dresser is simply re-diagnosed as suffering from an additional pathological condition with an even more unfavourable prognosis.

In other words, the aim of most psychiatry is to enforce social conformity, consequently many clinicians simply try to convince people who present for treatment that the generally held views of the host society are the correct ones they should be adhering to ( more on the societal attitudes towards cross-dressing is on my Sociological page). Pity help anyone who presents to a healthcare professional who is not persuaded by their arguments. At best, the subject is treated with disdain and written up in even more pejorative language; at worst, they are  labelled a danger to others and locked up.

A caveat is in order here. Ideally a cross-dresser will come to see his cross-dressing as ego-syntonic, but one of the things he must bear in mind is the effect that his cross-dressing may have on his female partner, if he has one. Many partners and wives see cross-dressing as a threat to their own feminine image and regard themselves as failures sexually. Some even acknowledge that having sex with their man when he is partially or fully en femme makes them feel like a lesbian, which they either resent or are otherwise uncomfortable with. They are also fearful of exposure and of the effect on children, if any. Certainly cross-dressers who are married and want to remain married have to work out agreements with their spouses on the limits of their cross-dressing activities. See also my Spouses & Partners page for more on this issue.

Whilst on the subject of cross-dressers with partners who accept their cross-dressing, albeit with conditions, even those women have not escaped excoriation and denigration in the psychoanalytic literature. As long ago as 1967, Robert Stoller was writing them off in an article entitled Transvestite's Women (American Journal of Psychiatry, Vol. 124, pps. 333-339), as willing to succour transvestism in their male partner only because they  held a burning, pathological anger towards “normal”  or “competent” males. As always, however, Stoller provided absolutely no evidence for his claims, but then he was never a man who let such a nicety interfere with his opinions and hypotheses. Frankly, Stoller’s writings over the years suggest to me that he was guilty of what Stephen Purcell refers to as “perverse countertransferences”, i.e. that Stoller  had a vested, and perverted, reason for pathologising, labelling and otherwise vicariously enjoying his patients’ problems, some of which were undoubtedly iatrogenic and introduced entirely by Stoller himself (see also here).

Further references to the way in which the partners of cross-dressers have been maligned in the psychiatric literature are provided on my Spouses & Partners page.

Nevertheless, despite the plethora of theories that have been produced by clinicians since Krafft-Ebbing in the latter part of the 19th Century, many are still currently held by proponents of one theoretical persuasion or another. These are examined briefly on the pages Psychological and Physiological, each of which have a number of relevant child-pages to which you are referred, respectively. Some of the sociological theories are also referred to, rather unsurprisingly, in the Sociological page.

The child pages for my Psychological page are  Autogynephilia, PerversionThe Five Steps and CD Types respectively; those of my Physiological page are Epiletiform EEG Abnormalities , Hormonal Bath and the Chemical Abuse theory  TO BE COMPLETED.