The DSM-5 states that adolescent and adult males with late-onset gender dysphoria "frequently engage in<unk>  behavior with sexual excitement." "Habitual fetishistic<unk> m developing into autogynephilia" is given as a risk factor for gender dysphoria to develop. According to DSM-IV, this fetishism was limited to heterosexual men; however, the DSM-5 does not have this restriction, and opens it to women and men with this interest, regardless of their sexual orientation. It is, however, usually documented in males. There are two key criteria before a psychiatric diagnosis of<unk> " is made: # Individuals must be sexually aroused by the act of cross-dressing. # Individuals must experience significant distress or impairment – socially or occupationally – because of their behavior.
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