The objective of this book is to propose a theory of transvestism and secondary transsexualism, and to provide information concerning these behaviors.  My view of these topics is much like that of Benjamin (1966) and nearly all other gender researchers.   It holds that a syndrome of similar behaviors can be identified, ranging from fetishism through transvestism, transgenderism, and secondary transsexualism.  But description is one thing and explanation of causes is another.  I agree with other gender researchers (e.g., Green & Money, 1969; Stoller, 1985) who have concluded that the causes of transvestism and transsexualism remain largely unknown.  But the fact that we cannot fully explain the origins of transvestism or secondary transsexualism does not mean that a comprehensive theory is impossible. . .

The approach I have adopted has the same scientific difficulties that confronted all of these previous workers.  For example, the ideal way to study these behaviors would be through long-term longitudinal observation starting in very early childhood, but that technique is not available to us for several reasons.  Our study is based on survey and test data from 110 heterosexual transvestites and some of their wives, together with follow-up correspondence with most of them over a 5-year period.  We have also had the opportunity to follow 40 TV's more closely during this time period, interviewing and observing them regularly, and attending many of their meetings in various parts of the nation.  Fifteen of these have participated with me in counseling activities, often together with their wives....

In brief, we propose the following theory about the process of transvestism: The management of the cross-gender identity by the self system is the determining factor in the stability, or, alternatively, the "progression" of transvestism into some other behavior pattern, such as transgenderism or secondary transsexualism.  In most cases of the transvestites who have been most extensively described - the club members - the cross-gender identity is gradually integrated into the self system and it functions there as an obedient, managed, reasonably responsible and subordinate component.   Only when cross dressed does the typical transvestite experience an intense sense of being in both the opposite gender role and of having a cross-gender identity.  It is in the rare cases wherein this process of integration and management of the cross-gender identity is not satisfactorily resolved that sustained conflict, anxiety, and ultimately for some, transsexual urges become intense.  Although this is rare, there appears to be increasing support for the view that much, if not most, transsexualism is secondary, and that such transsexualism follows an extensive career in either a transvestite or a homosexual form.

1. Introduction

Four Thematic Constructs

• Gender, Gender Identity, and Cross-Gender Identity
• The Complexity of Transvestism
• Transsexualism in History

2. The Spectrum of Cross Dressing

• Fetishism
• Fetishistic Transvestism
• Marginal Transvestism
• Transgenderism
• Primary and Secondary Transsexualism
• Drag Queens and Female Impersonators
• Outcomes of Transvestite and Transsexual Careers
• Summary

3. A Review of the Literature on Transvestism and Transsexualism

• Early Research and Clinical Description of Transvestism
• Contemporary Studies of Heterosexual Transvestites
• Treatment of Transvestism
• Personality Characteristics of Transvestites
• Childhood Origins of Transvestism
• Primary and Secondary Transsexualism
• Studies Differentiating Transvestites and Transsexuals
• Etiology of Transsexualism
• Follow-Up Studies of Sex Reassignment
• Summary

4. Self and Maturity

• The Concept of Self
• The Self-as-a-Theory
• Alternative Selves, Divided Consciousness, and Cross-Gender Identity
• Identity and Gender Identity
• Gender Identity in Transvestism and Transsexualism
• Summary

5. Sexual Excitement, Fetishism, and Pleasure

• Sexual Script Theory
• Innate Affective Systems and Script Formation
• Sexual Excitement
• Fetishistic Behavior
• Summary

6. Research Results

• Survey Procedures and Results
• Explanations for Cross Dressing
• Frequency of Cross Dressing during Early, Middle, and Late Stages
• Bem Sex-Role Inventory
• The Cross Dressing Inventory

7. Wives of Transvestites

• Survey Procedure and Results
• Problems as Seen by Wives
• Transvestism and Marital Sex
• Choice of Marital Partner: AN Hypothesis
• Patterns of Marital Adjustment
• Cessation or Frustration of Cross Dressing
• Survey Wives' Comments to Prospective Wives of Transvestites

8. A Theory of Heterosexual Transvestism and Secondary Transsexualism

• Foundations of a Theoretical Model
• Ideas Basic to Theory Development
• Definitions of Four Major Explanatory Constructs
• A Five-State Theory of Transvestism

9. Summary and Conclusions