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The analyst frequently encounters transvestite strivings and enactments in his analytic cases, but he may not often see the true transvestite. This paper presents a valuable, broad picture of the historical, medical, and legal aspects of extreme eonism. Reported incidence is higher in males, but the authors suspect a high incidence in women. Transvestite behavior is often interwoven with other sexual deviations. The transvestite may actively seek mutilation or removal of the sex organs in order to enhance both masquerade and fulfilment, and the surgeon who fulfils the patient's demands may face being charged with mayhem. The Moore test (skin biopsy to determine chromosomal sex difference in body cells) fails to show female morphology in the skins of a small series of true male transvestites, suggesting that no organically caused 'intersex' is involved. Nevertheless, sexual typing in human beings reveals a broad spectrum from strong to weak, with the probability that there is a subtle degree of intersexuality in man. The authors emphasize the prevailing conviction that treatment of the transvestite by any means, including psychotherapy, is unlikely to restore appropriate sexual identity and interests; there is no reported instance of such success. Mutilation has sometimes produced better adjustment, but the authors deplore the use of surgical alteration aimed at satisfying the transvestite's need to be more like the other sex. Rather they recommend intensive psychotherapy aimed at reducing tension and improving acceptance of the status quo.