To understand transgendered persons (transvestites, cross-dressers, and transsexuals), it is necessary to define some terms:

Gender Identity - A person's internal sense of being a man or a woman.

Gender Role - A person's behaviors that define him or her to society as a man or woman.

Sex - The physical state of being male or female. There are many different aspects, e.g., genital, chromosomal, hormonal, and reproductive. Not all of these match in everybody.

Sexual Partner Choice - This is a person's choice of the same or other sex for personal interactions.

It is critical to understand that it is possible to find any combination of the four categories listed above. With these simplified definitions, it is possible to describe various forms of transgender behavior. I am excluding all persons who have a measurable or identifiable biological problem, such as hermaphrodites and those who suffer from chromosomal or hormonal abnormalities.

Transvestism is primarily found in males. Clinically, a transvestite is a man who likes to wear clothing socially reserved for women. It has been estimated that 0.1% to 1% of the male population has this behavior to some degree, but there are no observable physical or hormonal irregularities that could account for this behavior. The average male crossdresser is heterosexual and presents a masculine gender role except when he is crossdressed. His gender identity is mostly to exclusively masculine; however, when crossdressed, he may say he "feels female." In the beginning crossdressing often has a strongly erotic component. Later the erotic feelings may diminish and crossdressing becomes a way to temporarily escape from the masculine role. The thought is, "If I am dressed as a woman, then I no longer have my masculine responsibilities."

Women who are transvestites or crossdressers would have the same psychological characteristics as described above for men. Women who wear masculine-style clothing but who are "obviously" women do not fall into this category. Crossdressing is a gender statement with erotic overtones, not a fashion statement. I estimate that the number of women who fit this definition is vanishingly small, perhaps one ten-thousandth of a percent of the female population.

There are many other reasons for adopting the clothing of the other gender. For example, theatrical productions may use crossdressing for comedic or more sinister effects. Some Like It Hot and Psycho are two classic films that employ this technique. Also, there are female impersonators for whom cross-dressing is an integral part of their act. Sometimes cross-dressing is used as a disguise to commit a crime or hide from the law. Lastly, there are gay males who use "drag" as a way to attract sexual partners. None of these examples fit the clinical definition of crossdressing.

Gender dysphoria usually only defines a severe clinical dislocation of a person's gender identity. Many people who crossdress are not gender dysphoric in that sense. Anecdotal data suggest that there are a large number of male transvestites who never have felt the need to go to a clinician, or who have gone once and found that the average clinician is unable to help. For example, the obsessive nature of transvestism can be very disruptive in their life and relationships. Generally those who come to clinical settings do so because of the problems that crossdressing causes in their life.

Neither transsexualism nor the desire to crossdress has been eliminated by any clinical approach, so one might theorize that there is some biological basis. This idea is further strengthened by the observation that such behaviors are reported throughout history and in a wide variety of cultures. The higher incidence of transgendered males may be caused, in part, by the fact that all fetuses will develop as female unless there are appropriate hormonal actions that both defeminize and masculinize the male fetus. If one assumes that in some cases these processes do not go to completion during the gestation period, one could hypothesize that there is a partial female construct in the brain that is activated by social factors.

Most male crossdressers seem to come from middle- and upper-middle-class environments. They generally have some education beyond high school. A large percentage have professional vocations--doctors, lawyers, engineers, stock brokers, clergy, etc. Minorities are under-represented in the various social organizations that support crossdressers. Whether this is economic or social is difficult to determine. All age ranges seem to be represented with the exception of the under-20 population. My own observations suggest that this is primarily an economic phenomenon. Most organizations hold their meetings at locations that require a car for access. Further, there is an emphasis on "doing it right" which costs much money for clothing, wigs, and make-up. [The cost of attending] conventions, while held all over the country, [are high]. Also, there needs to be sufficient freedom to be away from their job for some time. Few of these conditions exist for the younger crossdresser and may be a reason why the professional man is over-represented in the crossdressing culture.

The "typical" male crossdresser is strongly heterosexual [and] married. He [also] may often have engaged in hyper-masculine activities in an attempt to prove his masculinity and- and-or to submerge the crossdressing feelings. A large percentage probably have some guilt over their desire to cross-dress; but many have come to terms with their feelings. Unfortunately, many crossdressers are very self-centered, which interferes with personal relationships.

While some may have been abused as children and-or have had a substance-abusing parent, the majority seem to have had a relatively normal childhood. There is some very sketchy information that found transgender and-or homosexual behavior in several members of one family, but the numbers are so small as to be inconclusive. If one asks the average crossdresser, the most common reason [given for crossdressing] would probably be forced crossdressing as a child or some other sociological effect. Some might link it to the erotic component. John Money and his description of "lovemaps" would probably support this latter explanation.

Within the B&D; culture, the dominant may use crossdressing on a male as a means of emphasizing a submissive role. I have not heard of the reverse, [i.e.], a female submissive being dressed in masculine clothing. I suspect that the male submissive who participates in "forced" crossdressing is usually a willing partner.

The social challenge facing the crossdresser is acceptance by society at large--at least this is what they would like. Their fantasy of such acceptance is that they could decide, each day, which gender role they would like to present to the world and have the world accept that. However, until society places an equal value on masculinity and femininity and allows for behaviors that are a blend of the two, there is little chance of achieving this acceptance. The crossdresser moves between gender roles and so remains visible. This inability to make up his mind gains him the same censure as the bisexual who also "can't make up his-her mind".

As with crossdressers, transsexuals are found in all cultures, both past and present. Similarly, they find social acceptance is low. The transsexual, with or without genital surgery, will strive to be indistinguishable from the general population.

Transsexualism is found in both males and females, with various ratios reported. In primary transsexualism, gender identity is opposite to observable genital sex. There are no observable physical or hormonal anomalies that might explain these feelings. Transsexualism is often found at a much earlier age than transvestism, because the transsexual child will strongly assert that [he or she is] of the other gender.

Generally there are more males than females who exhibit this behavior. Compared with transvestism, it is a much rarer phenomenon with estimates of one in 40,000-50,000 births. There is little if any eroticism associated with wearing clothing of the other gender, because such clothing is seen as normal for their perceived gender identity. The best way to understand sexual-partner choice for transsexuals is to use their preferred gender identity as the guide rather than their sexual anatomy. Sexual-partner choice can be either heterosexual or homosexual, and, in male-to-female transsexuals, it appears that both forms are commonly found. For the female-to-male, it appears that there are more heterosexual than homosexual relationships. In some cases, the person avoids all sexual interactions, because there is too much psychological discomfort caused by the fact that their genitalia do not match their gender identity.

About 10% of transsexuals eventually undergo genital surgery ("sex change") and live full-time as members of the other gender. The balance are either unable to afford the procedures which may cost $50,000 or more, or are not suitable candidates due to other psychological or social problems. Even without such surgery, they may crosslive in the other gender role and would be called transgenderists. Anecdotal data also suggest that many, perhaps a majority, of transsexual persons will end up in a clinical setting looking for hormonal and surgical intervention. Probably the increased exposure by the media makes someone with a transsexual inclination aware of these remedies. Unfortunately, there are very few clinicians who have the experience to work effectively with such clients.

Transsexuals seem to come from lower- and middle-class environments. Education levels will often be less than for the crossdresser. Speculation suggests that the amount of gender discomfort they experience is so crippling that achievement in other social or educational spheres is very difficult. While all age ranges are represented, the transsexual found both in support groups and clinical settings tends to be younger, 20-30 years [old]. One might theorize that the emotional pain they feel causes them to seek help earlier. There is some evidence of the older transsexual, 50 plus years [old], in clinical settings. These people are generally males who have "done their duty" to family and children and now feel they can no longer live in the masculine gender role. A similar phenomenon is true for the female-to-male, who has often been married and had children before arriving at the clinic.

While there have been some clinical attempts to show primarily behavioral causation, e.g., Robert Stoller, such studies do not seem to represent the majority of transsexuals. The typical transsexual would probably state that the cause is biological, although this can not be proven. However, most transsexuals are not interested in reasons but simply want to move as quickly as possible to the preferred gender role.

The psychological problems facing the transsexual essentially stem from the need to unlearn one gender role and learn the other. Without accomplishing this switch, they can be socially unacceptable and uncomfortable in the chosen gender role. The primary therapist often has a key role in this learning process. Another source of assistance are the groups that support transsexuals. Generally, there is little guilt surrounding these feelings, [but] there can be anger or frustration at society's unwillingness to understand and support the need for transition.

The process of permanently changing gender roles should be guided by the Harry Benjamin International Gender Dysphoria Association's Standards of Care. In a clinical setting, it is crucial that the client be considered socially and emotionally ready for this switch. By this time, hormone therapy has sufficiently altered the person's body to permit a reasonable chance at passing in the other gender role. For the male-to-female, electrolysis for beard removal should be nearly complete. Changing to the other gender role brings its own problems; so other psychological or emotional problems should be resolved before proceeding. (a minimum of a year of full-time living and working in the chosen gender role is required by the Standards of Care before a recommendation for surgery will be made. The people who follow the Standards of Care and complete genital surgery do not regret the decision. The stories one hears about such regrets can usually be traced to situations where the Standards of Care have been either ignored or subverted.

Less than 50% of clients at a gender clinic will make it to the point of changing gender roles. A variety of factors, including cost, [account for] this reduction. Overall, less than 10% of those persons who enter a gender clinic will complete genital surgery; a few will crosslive without the surgery. Cost is a large factor, but some find that living full-time in the other gender role is not what they had expected.

In my opinion, transsexuals are less likely to engage in unusual sexual practices. Once living in the gender role of choice, they would be considered a typical "vanilla" member of that gender role. While there are certainly transsexuals who remain visible, they are the minority.

There is another segment of the gender community that is called transsexual: usually they are males who have used female hormones (often without medical supervision) to enlarge their breasts. They have not undergone surgery to change their genitalia to a feminine form and may still be capable of getting an erection. They are called transgenderists, which means somewhere in between crossdressers and transsexuals. These transgenderists are often seen in sexually oriented and X-rated videos. They act out whatever role is called for in the script. These can include S&M; or B&D; scenes, and the transgenderist may take either a dominant or submissive role.