May 19, 2014

Anne Vitale on Crossdreaming in Middle Age

What happens to gender dysphoric crossdreamers when they enter middle age?
Illustration photo by Volodina

The psychotherapist Anne Vitale has written a very interesting book on various transgender conditions -- including various shades of crossdreamer -- called The Gendered Self.

I am taking the liberty of quoting the book liberally, as I think the book contains an important discussion of the gender identity struggles of adult crossdreamers, crossdressers and transgender.

Gender expression deprivation anxiety

Vitale points out that mid-life brings up new challenges for what I call crossdreamers -- especially the gender dysphoric ones (i.e. those that suffer from what Vitale calls "gender expression deprivation anxiety").

"Decades of trying to overcome their increasing gender expression deprivation anxiety begins to weigh heavily on the individual. Family and career are now as deeply rooted as they will ever be. The idea of starting over as a different sex seems impossible."

These persons often show up in therapy offices with symptoms mimicking depersonalization disorder, depression or generalized anxiety disorder, Vitale points out. They complain of panic attacks, irritability, sleeping disorder, inability to concentrate and weight loss.

Some disconnect from their families emotionally. Others find it hard to keep up their job performance. Some get suicidal at this stage.

The problem is that the feeling of dissonance does not go away as you get older. It might just as well get stronger.

The life of John

Vitale tells the story about John, a 51 year old male assigned medical research scientist, married for over 20 years and with three children, who came to her after a severe panic attack.

Vitale reports:

"He said that he was 'gender dysphoric' and that he was 'desperate'. Feelings that were once 'controllable through sheer force of will' had increased to where he was now having protracted periods where he would close his office door, lie in the corner on the floor and weep quietly while curled up in the fetal position, holding his genitals in pain.

"Other than intrusive and repeated fantasies of being female, he had refused to allow himself any overt form of female gender expression. The only other form of temporary relief came through masturbating. He reported feeling that if he was to cross-dress and be caught, he would dishonor his wife and family. Having attained international recognition for his work, he was also concerned about his professional reputation."

The invisible transgender

To the extent the fates of persons like John are mentioned at all in the transgender debate, it is normally as examples of perverts afraid of losing their "male privilege". To me that make no sense at all. If this had only been about a sexual kink, John would not face this kind of severe emotional pain. This is a clear case of gender dysphoria, if I ever saw one.

And I fear there are many like him out there. Indeed, I can recognize a part of my own story in his. These are the "dark transgender", the invisible ones, the ones that do not show up in government statistics.

I must admit that this case has made a strong impression on me, as it documents how far we have to go before we are able to alleviate all this suffering. At the moment it seems too many, both sexist scientists and transgender separatists,  are trying to make it worse.

John makes a choice

What happened to John?

Vitale says that they worked together for three years by way of individual, group and family psychotherapy, plus estrogen replacement therapy. John has now taken a female name and is living full time as a woman.

Vitale does not reflect on what would have happened to her if she had not gone down that road.

In denial

Vitale argues that what she calls "group three" (the category of MTF transgender that are most similar to the majority of transgender people reading this blog, I guess) may end up i John's position because they have spent so much time trying to rid themselves of their dysphoria:

"Being largely heterosexual, they often marry and have children, hold advanced educational degrees and are involved in high levels of corporate and academic cultures. These are the invisible or cloistered gender dysphorics. They develop an aura of deep secrecy based on shame and risk of ridicule and their secret desire to be the opposite sex is protected at all cost...

"The irony is that gender dysphoric symptoms appear to worsen in direct proportion to their self-enforced entrenchment in the gendered world they do not identify with. The further an individual gets from believing he or she can ever live as a member of the opposite sex, the more acute and disruptive his or her dysphoria becomes."

The lives of the non-dysphoric

Vitale does not say that this applies to all crossdressers, mind you:

"If the individual's gender dysphoria is a relatively minor one, cross-gender lifestyle changes in dressing and behaviors may be all that person needs to ease the anxiety. However, if the individual's dysphoria is profound, a simple life style change may be insufficient. In the latter case, the need for more authentic gender expression moves from a life-style problem to a life-threatening imperative."

Feel free to share your own experience as a comment!

The introduction to Vitale's book is available for free.


  1. Jack

    My life has been just like that. I had to make a choice in my early forties to face my dysphoria as it was getting worse and desperately required I address it.

    My gender expression deprivation anxiety was at a boiling point and what has saved me is to openly express my desire to be female in a public and open fashion. I have no plans to transition and will resist the idea with all the power I can muster as I am not convinced that my life would be better even as I know that I would be able to cope living as a female.

    Thank you for pointing to Anne's good work as I have been a fan of hers for some time and have featured her writing in my blog.


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  3. I would not put too much emphasis on the "perverts afraid of losing their male privilege" either. This is just a ruse used by some deeply frustrated transsexuals to discredit others.

    Gender dysphoria and how one deals with it is the focus and for me it has been no picnic to manage throughout my life.

    Fortunately people like Anne Vitale who, like Harry Benjamin, has treated well over 500 patients very well understands the complexity of the condition and how it varies in intensity from person to person.

  4. I've learned something new today, gender expression deprivation anxiety. I think I might need to read Anne's book to understand the more intricate details of what it entails. But at a surface level, it seems relatively easy to understand: it's when the overwhelming desire to express a different gender starts impairing your normal routine, your work, your relationships, etc.

    That obviously rings a bell. I tend to classify myself as a 'failed transexual'. Because I'm a coward and unable to start from scratch as a woman, and almost all of my interesting years have gone (sure, we can enjoy ourselves as females until our last day, but I guess we can agree that it's much more fun being a woman with 20 to 40 years), transition is something that has to be deliberately put on the backburner. It's something that I will never achieve on this life.

    So, there is still crossdressing to relieve the anxiety — but my trouble is that I don't think my anxiety is 'strong enough' to ever be taken seriously by a psychologist. Sure, I think about crossdressing all the time — and about how happy I'd be if I were a woman — and obviously I dream about surgery (and nice dresses that fit!).

    But is that really 'anxiety' or merely 'obsession'? Hard to say! The truth is, once I fully assumed to myself that there would never be 'more than that' (meaning: no transition, just regular crossdressing), there was, on one hand, a slight decrease of the anxiety about transition (no point in worrying about something that will never happen), a substantial increase in all things related to crossdressing (including accessory things like making the decision to do laser hair removal, growing the fingernails and keeping them trim, doing some waist training with a corset, etc.), and a subtle change of goals in my life. In my late 20s, my goal was to make enough money so that I could live out of the interest, because it would be unlikely to get a job as a transexual. I actually accomplished that goal, but lost all the money shortly afterwards (long story), and, with time, I realized that this 'goal' was nothing more than just 'wishful thinking'. So I wondered about the purpose of my life, which, for all effects, lacked a goal. I live with my wife (she tolerates my crossdressing but doesn't encourage it), we cannot have kids, and without a goal, I have little interest in 'slaving away' for money. Instead, everything except crossdressing became secondary. No, I don't live in perpetual apathy, and still work to survive on a tiny salary, while simultaneously struggle to improve my education to get more career opportunities — so there is no 'depression' here — but the goal is just merely 'survival' and nothing else. I might aim for a bigger house with more room to fully express myself through crossdressing, but even that is not a powerful magnet in my life — after all, I can already crossdress with some regularity today, and a better paying job also means less time free for crossdressing, so internally I'm not so keen in that either.

  5. My life has become just a struggle for survival and the constant dream of the next crossdressing session, which fills all my conscious thoughts and dreams. But there is nothing more than that. On the positive side, I most definitely don't share the levels of anxiety and depression of 'John', or of many others whose stories and case studies I have read about. To me, not to become a woman is not 'a case of life or death'. I can see that my enthusiasm about work has lessened, and, to a degree, I view negatively all obstructions to my crossdressing (from mandatory house chores to attending social events or visiting family and friends), but they're a 'nuisance', not a source of intense stress, anxiety, or depression.

    Still, there are many forms of depression. I have hesitated for many months if I shouldn't just visit a transgender-friendly psychologist and tell them about my urges and how I deal with them, and how they are never satisfactory, but I accept that with resignation. That, in itself, might be a very light form of 'gender expression deprivation anxiety', which is not at the stage of 'anxiety' yet, but merely 'frustration'.

    Maybe Anne's book explains the several degrees of this form of anxiety. Maybe I should watch carefully for tell-tale signs that might point to a more acute case of gender expression deprivation anxiety in the future, and deal with them now, while the impulse is far from overwhelming but still very manageable.

    In any case, a very provoking article and links. Thank you for posting!

  6. @Joanna,

    Vitale's point too is that expressing the female side alleviate the dysphoria. For some occasional crossdressing is enough (although I suspect there is more suffering among them than we tend to believe. For the more intensely dysphoric, more is needed.

    You seem to have found a middle way that works well for you, and who also give you some of the recognition your inner self demands and deserves.

    I like that!


    You write: "but my trouble is that I don't think my anxiety is 'strong enough' to ever be taken seriously by a psychologist. Sure, I think about crossdressing all the time — and about how happy I'd be if I were a woman — and obviously I dream about surgery (and nice dresses that fit!)."

    This reminds me of a comment I found over at tumblr:

    "If you wonder if you are transgender [in the broad sense of the word], you are most likely trans, because cis people don't have worries like that."

    A relevant variant would be:

    "If you think about transitioning all the time, there is probably more to this than an innocent kink."

    I am pretty sure the reason i have spent all this energy on this blog and in other relevant arenas, is because there is a part of me that demands to be accepted and expressed. It is definitely dysphoria.

    Still, for many years I believed this was a kind of depression caused by other factors.

  7. I agree with jack in that most people never ever question their gender. Sandra you may not be a type V or VI but you may be a type IV which makes you a strong enough gender dysphoric to require treatment. Transition is NOT the only treatment for gender dysphoria and perhsps regular cross gender expression may work for you.

    Doubts on your part should be explored to see what might be behind them.

  8. Hello,

    I am Alexia, I also think I might fit into this section of Transgender confusion. In October I will turn 42. I have a Masters of Divinity in Christian Education and work primarily with Youth & Children in one of the most Judgmental of the Protestant Denominations. It should be apparent one reason I fear exposure of my wish to be female.

    I have struggled with writing something like this for a few months. I almost wrote an email to you Jack a dozen times just spilling my guts about everything. Sometimes when I read your Blog a great deal of it goes over my head. I get lost in the terms and the discussion. Still, I read because it is a small comfort to know that there is someone out there that is willing to accept a Non-Op Transgender like me and try to help us all figure out what is going on when we face this life.

    Thinking back I realize I had desires that were quietly shown. Living in the Rural South of America I never had a real clear ability to think about them. I did have loving parents that allowed for me to grow up in a way that has lead me to accepting my female nature. Its funny, my first real female role model was the Bionic woman. I would pretend to be her when I played. I even got her one Christmas and the pictures of me around 5 or 6 with her under the Christmas Tree reminds me of happier times.

    I played Jamie Summers in private. Being the Lone Ranger or another guy hero was always there as well, but somehow I liked the girls better. Thing is in some ways I also had a crush on her as well. I think this is what led me to confusion and ultimately shyness about women and the cause of my becoming physically ill when I tried to ask a girl out.

    I think I am Bi now, but really only when I can think of myself as a female. I would need to be at least passable to be with a guy in an intimate way I think. This part is still confusing to me. I guess part is because I have to make sure I am not perceived in any way as to endanger my life.

    One thing I do know is that my female nature comes out in my work. I feel a deeper sense of maternal feelings for the kids I am with. It comes through. I would even question my protectiveness that many discern as a male thing to be more female warrior instincts. This giving nature is also something that feeds my depression and anxiety.

    I am a virgin. I have never had a physical intimate relationship in my life. I give love but never get a great deal back. This leads to emptiness and loneliness. I just want to not exist sometimes. I am all those things listed above; irritable, trouble sleeping, wish for the weight loss. I have sleep apnea and am diabetic (by genetics). I sense that my anxiety affects my diabetes.

    I know many would look at the way I am sexually online and say I was a freak. The thing is that the ways I exist here became a release. I have even become a hermit here though. I am lucky enough to have a few online people that care enough to be around me. One has even allowed me to become her submissive and use hypnosis on me as my fetish is strong there. It is limited because of her work schedule, but I feel at peace when I can just relax and be hers.

    I know I have opened up my self for rejection and ridicule by anyone who is not nice that reads Jack's Blog, but I also know that some will understand how lonely and hurting my life feels.


  9. @Lady Alexia,

    You are no freak. In fact, your story is quite similar to mine and many other crossdreamers visiting this site and Crossdream Life.

    My role model was Supergirl. But she wasn't that different from the Bionic woman, I guess.

    I am convinced that your female identity is real. Add a conservative religious upbringing to an already introvert transgender soul, and you easily end up in the inner closet. That is a very lonely place.

    The question is what you can do about. It is not too late. There are women out there would love and appreciate someone like you, and they are not limited to the girlfags, either. There are also men who looks for a male bodied person with a feminine soul. You just have to keep looking.

    I see, however, that working for "one of the most judgmental of protestant denominations" does not give you much leeway. You might consider changing your place of work. With your background you should be able to find similar work elsewhere.

    You might also consider finding a liberal and open minded counselor, therapist or sexologist who could listen to your story and give you some advice. Yes, the chances are that he or she will recommend a more drastic change in your life, but it is up to you to decide whether you should follow that advice.

    I understand that you live in the countryside and that your local community may lack open minded helpers of that sort, but some therapists are willing to do distance counseling (via the phone or Skype) , combined with some face to face meetings. Anne Vitale, the therapist I refer to in this blog post, does so. She is transgender herself and will not judge you.

    But first: Write me at .

  10. Gosh, I don't even know where to start... I'm 56 now and had been crossdressing pretty regularly since my 30s, difference being I pad as well to fill out my figure. I was pretty good at it too as I went out in public many times with no negative experiences. I thought a few yrs back I could just pull back and stop..purged all mt clothes, shoes, make-up etc, and got married again(also 3 grown children)
    It was ok for awhile, 5 yrs to be exact, and now the feelings have returned. Thank GOD I found this site!
    I do not know what to do now and am thinking about revealing all this to my wife, whose very socially liberal, from San Fransisco in fact and had talked of the padding thing before. I of course kept silent.
    We are experiencing tough financial times now and maybe it wouldn't be a good time to tell her, but it's really getting to me.

  11. @Wanna,

    It is of course impossible for others to predict what will happen when you come out to the ones closest to you. Even you do not know.

    I ended outing myself to my wife by accident, which turned out to be a very good thing, indeed. She accepts me for who I am, and has given me a lot of support. That affirmation helps me a lot. I think the constant fear of losing her affected me more than I understood at the time.

    But it was the fear of losing her that stopped me from telling her.


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