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To the Editor:—
In your questions and answers column (197:599,1966) your correspondent Donald W. Hastings, MD, writes, "Transsexualism can be considered as a more complete role reversal than transvestism," implying that transsexualism and transvestism are part of one and the same continuum, with transsexualism as the more severe form.In my experience, transsexualism and transvestism are completely separate clinical and possibly pyschopathological entities. I explained this distinction (Brit J Psychiat11:268, 1965): "In transsexualism the male patient both desires to be a woman and believes that he is one. To this end he may masquerade more or less continuously as a female." In transsexualism, unlike transvestism, "the process of dressing in female costume does not in itself provoke sexual excitation, but merely facilitates feminine disguise." It would seem that transvestism and fetishism (in which there is pathological sexual attachment to an object or objects other than the normal
Barker JC. Transsexualism and Transvestism. JAMA. 1966;198(4):488. doi:10.1001/jama.1966.03110170200040