NATURE AND MANAGEMENT OF TRANSVESTISM

From: THE LANCET

10/23/71

I am a physiologist who, for the past thirty-three years, has been a male transvestite.

In my own thinking about the cause of the transvestite state based on my own experiences and on reading The Transsexual Phenomenon by Dr. H. Benja- min, The Transvestite and his Wife by Dr. Virginia Prince, and Sex and Gender by Dr. R.J. Stol- ler, it is clear that many factors must be involved. One factor, however, has been largely ignor- ed. A developing personality re- acts with and adapts to its psy- chological and social environ- ment-all the time learning to be- have in ways that will enable it to preserve its own sense of iden- tity and integrity. Elements of this idea are present in psychoan- alytic and conditioning theories of behavioural and emotional development, but the idea of a reacting, dynamic entity, always seeking for a way of living that lowers tension and conflict, is perhaps best expressed in the 'personal construct" theory of the late George A. Kelly.

There is little evidence of a role for hormonal imbalance in male transvestism. It has been suggested that excess estrogen might be present, or that the cells in the hypothamus that mediate sexual behaviour are hy- persensitive to the normal estro- gen content of the blood. Both should lead to a reduction in tes- ticular Leydig cell activity through the hypothalamus-pitui- tary mechanism, with a resultant loss of libido. But in the trans- vestite state the heterosexual e- motional drive is usually normal:

loss of libido, when it does hap- pen, is a secondary effect due to the intense anxiety set up by the failure to satisfy the transvestite drive. Other similar mechanisms to this hormonal one belong to the realm of speculation.

FULLY DEVELOPED STATE

Clinically, transvestism is a compul- sive state; to its sufferers the most dis- tressing aspect is the build-up of anxi. ety and tension that occurs when the compulsion cannot be satisfied, and the intensity of the drive varies from case to case and from time to time. "Unisex" clothes have no appeal to the transvestite, nor did the gorgeous clothes and wigs worn by all men in the 17th and 18th centuries. The ob- session forces the transvestite across a clearly defined line into the apparel of the opposite gender. I don't want a frilly or patterned shirt from a men's store, I want a lady's blouse, and there is no doubt about it. Although there may be a fetishist aspect to the state, this is not invariable. Many established transvestites—and I myself have found this-report that the fetishist or erotic stimulation on "dressing” fades as the compulsion is satisfied, being replaced with a feeling of relief at the freedom from anxiety. Almost all, whether dressed or in men's clothes, feel the normal heterosexual attractions to- wards women. The persistence of the normal heterosexual drive disting- uishes "normal" transvestism from both homosexuality and transsexual- ism. Homosexuals may cross-dress to attract other men. The transsexual, on the other hand, really believes himself to be "a woman's mind trapped in a man's body", and so woman's clothes are the only right ones for him: he wishes to go further and have his ex- ternal genitalia refashioned, so repu- diating his biological sex.

CASE - HISTORY

My mother was of Puritan stock. Her first husband was a doctor who died only 10 weeks after the marriage, - 26.

which was never consummated. She married my father 12 years later. His background was in farming, school teaching, and the Church. He was a "Harvard intellectual" who had decid- ed to do medicine, but had stopped short and made a career for himself in physiology. My mother was the dom- inant partner, having much physical energy and a vigorous emotional tem- perament: my father was quiet, intel- lectual, and artistic. I was the young. est of three sons, and it was early de- cided that, since I alone showed an in- terest in biology, I should become a doctor. Our family was very close- knit; we didn't have much to do with our neighbours.

For me to become a doctor was part of the family's mental structure, built in some years before. In my thir- teenth year, I first had transvestite fan- tasies.In a geography lesson on Holland I heard of the island community of Mar- ken which kept boys in girls' dresses and long hair until they were fourteen. I can still clearly feel the excitement and envy with which I heard this.

At the age of twenty-five, I began unaccountably failing in my medical examinations. I was sent to a psychia- trist, and had two years of anlytical psychotherapy. One significant fantasy that emerged during this time was of a female patient, of my mother's build and age, who attempted to seduce me while I was conducting a physical ex- amination on her. I was so anxious a- bout the consequences of medical qualification that my analyst suggested that I forget medicine and pursue a career in physiology.

Within the context of this family milium and neurotic breakdown, the development of my transvestism could be explained as follows: I imagined (or construed) my mother as wanting me to replace her first husband by becom- ing first a doctor and then her lover. In this she was threatening my self-reali- sation by choosing my career for me and this in a partnership in which she would clearly be the demanding and dominant member. My reaction, in or- der to maintain integrity and to avoid this sexual relationship, was to try to escape by disguising myself as a girl.