Treatment for transvestism

This is a more academic article about the treatment for transvestism – here.  Overall, it shows us the power of crossdressing and how most psychological help for crossdressers has done nothing for them.  For most crossdressers, they considered it a waste of time.  This is surely a difficult problem to tackle, but surely not impossible.

I thought this paragraph interesting – Pomeroy (1975) reassured his transvestite patients that their cross-dressing was “benign” and that their problems were social in nature. He believed that the most important therapeutic task was to develop self-acceptance for transvestic behavior, which would ultimately lead to both greater control over the behavior and a diminished drive to cross-dress. He cautioned that an initial period of 6-24 months of increased cross-dressing activity would sometimes be observed after a transvestite informed his spouse of his cross-dressing behavior and she expressed tolerance or acceptance of his behavior. Later, however, the transvestite’s realization that he now had greater freedom to cross-dress with the full knowledge of a supportive individual (e.g., therapist, spouse) often resulted in self-limiting of cross-dressing, as it no longer represented a forbidden activity (Pomeroy 1975).

So according to this, many crossdressers give into the behavior partly because it is forbidden fruit.  There is an element of it that is wanting to do something forbidden, sinful, of wanting to break the laws, the boundaries of gender.  This certainly was part of the motivation for me, not all of it, but at least a small part of it.  Obviously this notion in itself doesn’t prove that crossdressing is wrong.  But perhaps it helps to illustrate it.  If it was not wrong, why would it be a forbidden fruit to crossdressers?  Why wouldn’t they crossdress even more once it was accepted unless they felt inside that it is still wrong?

There is also an interesting examination of medication used to treat transvestism and crossdressing in the article.  It seems like they were successful in that by limiting anxiety, people lost the motive to crossdress.  This supports the theory that we crossdress as a way to escape the difficulties of life and deal with our anxiety, perhaps as a connection to our childhood, or to our mother, or to the subconscious view that women and girls have easier carefree lives.  I would advocate that instead of medication, we should learn to deal with our anxiety in healthy ways besides crossdressing.

The article also noted that certain drugs, that are helpful for those with OCD, did not help those struggling with crossdressing.  Which means that those who think addictive crossdressing is just a form of OCD, are mistaken.

12 comments on “Treatment for transvestism

  1. Eric says:

    I had problems finding the pharmaceutical info in the article, but it’s probably because I’m tired.

    I’ve heard the opposite about OCD medicine and cross dressing. It was explained to me that CD’s get stuck thinking about cross dressing. The OCD meds help release them from that endless mental loop.

    I understand reluctance to use medicine, but sometimes it’s not as easy as trying something else to relieve anxiety. If I was giving someone advice on CD, I’d tell them to get a full psych profile. Then take whatever medicine or actions necessary to fix the issues identified (depression, anxiety, OCD, ADD, Bipolar, or whatever). Once those issues are resolved, then see what happened to the CD impulse. Did it go away too?

  2. thorin25 says:

    Yeah that sounds like the best advice Eric, I’d vote for that too.

  3. Ralph says:

    Thorin, you asked:
    >> If it was not wrong, why would it be a forbidden fruit to crossdressers?
    (Sorry, I can’t seem to get formatting options here)

    Anyway… to paraphrase a famous comedian, “I guess that all depends on what your definition of forbidden is”. Leaving aside the theological aspect to that question for a moment — since this applies to believers and non-believers alike — my understanding is that it’s forbidden in the sense that *society* condemns crossdressing, but (speaking from the POV of a hypothetical crossdresser) society is wrong. So it’s not wrong, yet it’s still forbidden by way of suffering societal repercussions.

    Now having said that, I think the shrinks are way off here. I have an accepting wife; I work from home so I can stay dressed however I want just about 24×7 except for the few times a week I go out in public. If they were correct, I’d have been satiated decades ago but instead I fidget in discomfort every time I have to wear pants and cotton shirts.

  4. thorin25 says:

    That’s right Ralph, certainly in your case and many others it doesn’t function that way. The approval doesn’t do anything to diminish your desire for CD. But perhaps you never did it with that motivation? Perhaps it’s only for those that do it because it’s a forbidden fruit, who lose desire for it once it’s no longer forbidden.

  5. John says:

    Thorin,

    I think the drive to behave compulsively, in this case crossdress, in a non supportive relationship or environment has more to do with the stress and anxiety of not being able to do it out in the open than being motivated to do something forbidden. At least for me, I’ve felt driven many times to crossdress when I lived in places where it was difficult. I also did look for opportunities where there was a period of perceived unlimited freedom.

    Now, I’m free to do it almost anytime I want and I am able to refrain and have for 2+ years. Now of course I want to refrain but I think my compulsion would be stronger if I were sharing my home with a partner who did not approve. Obviously it is just a guess but I think at some level it is a matter of feeling somewhat in control. I’ll think about it some more and post if anything else comes up but for now this is some food for thought and discussion.

  6. Vivienne says:

    I found the article about treatment for crossdressing very interesting. As someone for whom evidence-based medicine is a way of life, the scientific content of it is very low. It is quite a wide-ranging review of the medical literature, but much of the source material presented is over 20 years old, which makes it pretty obsolete.
    Here’s what you would need to do to find out if there were a treatment for crossdressing. First, you would need to define what it is: do guys who (like me) do it a couple of times a year in the privacy of their homes count? Or is it only guys who go to buy groceries in a tutu? Next, you need to define an intervention: a treatment of some kind. This could be a medication, surgery, or a cognitive or psychological intervention such as counselling. Next you need to define an outcome: is it permanent cure? Temporary cessation? A general reduction in crossdressing behaviour?
    Next, you need a large sample of people with your condition, and you need to randomise them into two (ideally three) groups, without telling anyone. Group 1 gets your intervention. Group 2 gets a sham intervention or placebo. Group 3 (if you have one) gets no treatment at all (so that you can study what happens if you do nothing at all). Nobody knows who is in which group: not the investigators, not the subjects, not the people asking the questions, until after the study is over (this is called double-blinding).
    Then you need to follow up all your groups for a predetermined time interval and see what happens. Some people in groups 2 and 3 will improve: that’s just how life is. Some people in group 1 will get worse: ditto. You need to apply statistical analysis (in itself no mean feat) to your groups to say how likely it is that your intervention helps.
    And you can never be sure. Not ever. You can only say how confident you are that your results are not purely due to random chance.
    So, on surveying the world medical literature, how many studies of this kind have been perfomed on crossdressers? None! Not a single one. Not even something close. (Don’t get me started on how FEW trials of this kind are done on things which are much more common and serious, like diabetes, asthma, or arthritis, let alone psychological disorders like depression).
    What that means is that your guess is (literally) as good as mine (or that of the author of this review)about what works to treat crossdressing. The evidence presented is little better than a collection of anecdotes.

  7. Vivienne says:

    All of that said, let’s take a look at what they do say. For me, the most resonant phrase was this one:

    “Although he may ask the psychiatrist to cure him of the transvestism, what he is really asking is to be cured of his pain. He generally does not consider his transvestism as painful. Quite the contrary, it is most enjoyable; what it stirs up in others is what leads to pain. (Stoller 1968, p. 62)” Yep. Right with you there.

    “Earlier treatments included psychoanalysis (Bak 1953), faradic (Marks and Gelder 1967) or chemical aversion (Pearce 1963), and electroconvulsive therapy (ECT) (Liebman 1944).” And none of them worked: you can’t talk people out of it; you can’t electrocute people out of it; you can’t poison or punish people out of it, and you can’t scramble people’s brains enough that they stop wanting to do it. The article correctly alludes to the phenomenon that the subject pretends they are cured just enough to escape from the treatment, before going back to it. This paragraph resonates with my personal experience in talking to crossdressers who underwent aversion (read “punishment”) “therapy”, which succeeded in brutalising them without “curing” them.

    “The effectiveness of psychotherapy in either curing transvestism or alleviating the desire to cross-dress has never been demonstrated.” Yep. It doesn’t work.

    “Based on ethically permissible treatments, the number of reported successfully treated cases of transvestism (where success is defined as suppression of cross-dressing behaviors and fantasies) is small, and therapeutic nihilism regarding this goal is commonplace.” Yep. Patients don’t think they can be cured, and neither do their doctors.

    The pharmacology section is interesting. It’s ironic that many (but not all) crossdressers respond to feminising hormones (oestrogens, progestogens, anti-androgens) with suppression of their crossdressing, implying that the reason that we do it is something to do with testosterone. This is actually very interesting. FWIW, I believe this finding is true, or mostly true. What I am not sure is what it tells us about crossdressing.

    Antidepressants don’t work because crossdressing isn’t depression. Anxiolytics don’t work because crossdressing isn’t anxiety (though it can cause a great deal of both of those things, they are symptoms, not the problem itself).

    My own belief is that crossdressing cannot be “cured”. I think that it can be effectively suppressed using behavioural or even pharmacological techniques, and I think these do have a role in some people who want them. I am wholeheartedly in agreement with the statement that informed consent should be obtained before pharmacology is used. I am also quite in accord with the therapeutic angle that crossdressing isn’t so bad in itself: what upsets people is the revulsion in others, and the guilt and self-loathing they feel. Rightly, homosexuality has emerged out of that place in the last couple of decades, and perhaps crossdressing should too.

    But I don’t think that doctors can make it go away. I think it’s innate, like any aspect of personality, and therefore cannot be changed by any treatment or experience. But remember, there isn’t an ounce of scientific evidence to back me up, so that’s just my opinion!

  8. thorin25 says:

    Hi Vivienne thanks for the comments. On your first one, I have to agree, there has been no study done like the one you described and it would be nice if they could do so. But really, that seems highly impossible, really for any type of aberrant behavior you would want to study. It’s just too hard to get the participants and so on…. I totally agree with you that much of what is presented in this article is just a collection of anecdotes and the article quotes many different people with varying views. Hence, I can look at the article from my perspective and find statements and people that I agree with that fit my view about crossdressing, and you can find statements and people in the article that fit your view that crossdressing cannot be cured. So maybe this article isn’t really that helpful in general. Oh well, still interesting to read.

    You said you talked to crossdressers who had aversion therapy? I’m interesting to hear more about your conversations with them and what they actually went through, on whose initiative, how the process worked, what they felt about it afterward, etc.

  9. Flynn Rider says:

    There is nothing in the bible that states crossdressing is a sin. My wife supports me being feminine. I put on nail polish, a little makeup, thigh-high stockings and pink underwear sometimes too. I asked my pastor if this is wrong and he said it’s perfectly acceptable and God and Jesus still love me. Just wanted to share my thoughts. God bless you all.

  10. thorin25 says:

    Flynn thanks for the comment. You are wrong however in that the Bible does speak about crossdressing. Deuteronomy 22:5, and 1 Corinthians 11 at the least. Here is what I have written about other biblical passages concerning this issue – http://healingcd.wordpress.com/category/bible/

    This is why I think it is sinful in summary form – http://healingcd.wordpress.com/2013/07/08/summary-of-why-crossdressing-is-sinfulharmful/

    Pastors are people too, and sometimes they make mistakes. Likely your pastor has no idea what crossdressing addiction is really all about, and in his ignorance he has said it is okay. But for him to say that, it does not mean it is okay.

  11. Flynn Rider says:

    Thank you Thorin25. I have prayed about Deuteronomy 22:5, it’s pretty clear to me what I’m doing is not pleasant in the eyes of the lord, and my pastor is most likely wrong. I feel so bad however that I need to stop doing what really made me happy for years. It will be something that will be on my mind everyday and I know my anxiety will increase, especially the nail polish and makeup. It was very difficult for people in the public to notice these, as it was clear nail polish and just foundation on the face to even things out. Despite all this, I want to please our Christian fellowship, lord Jesus and his father God in Heaven, thus I will stop immediately. Thank you for your guidance Thorin25, I’ll let you know how things come along.

  12. thorin25 says:

    Flynn that is great! It is not an easy path you have chosen. Might want to read this post for some help on how to stop – http://healingcd.wordpress.com/2012/03/18/12-steps-to-stop-crossdressing/

    And if you want our group support in stopping you are welcome to join this group – http://healingcd.wordpress.com/email-prayer-chain/

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