transvestic drives are most likely to conflict  with performance in he terosexual intercourse
and desires to marry and start a family. Middle -age and older men with a history of trans-
vestism are less likely to present with transvestic disorder  than with gender dysphoria.
Functional Consequences of Transvestic Disorder
Engaging in transvestic behaviors can interfer e with, or detract from, heterosexual rela-
tionships. This can be a source of distress to  men who wish to maintain conventional mar-
riages or romantic partnerships with women.
Differential Diagnosis
Fetishistic disorder. This disorder may resemble transv estic disorder, in particular, in
men with fetishism who put on women’s unde rgarments while masturbating with them.
Distinguishing transvestic disorder depends on  the individual’s specific thoughts during
such activity (e.g., are there any ideas of be ing a woman, being like a woman, or being
dressed as a woman?) and on the presence of othe r fetishes (e.g., soft, silky fabrics, whether
these are used for garments or for something else). 
Gender dysphoria. Individuals with transvestic disorder do not report an incongruence be-
tween their experienced gender and assigned gender nor a desire to be of the other gender; and
they typically do not have a history of chil dhood cross-gender behaviors, which would be
present in individuals with gender dysphoria. Individuals with a presentation that meets full
criteria for transvestic disorder as well as ge nder dysphoria should be given both diagnoses.
Comorbidity
Transvestism (and thus transvestic disorder) is often found in associ ation with other para-
philias. The most frequently co-occurring paraphilias are fetishism and masochism. One