“The transvestitic urge (fetishistic or transsexual) contains an element of addiction. Larger "doses" may be required for certain individuals as time goes on. Therein may lie a ‘progressive’ nature of TVism in some instances. If untreated and uncontrolled, ‘dressing’ may be desired more and more frequently and even the idea of physical changes through hormone treatment or through an operation may be gaining ground, particularly in unfavorable - that is to say, constantly stimulating - surroundings. Here psychotherapy and proper guidance at the right time may help, provided a transsexual tendency is not too deep-seated. Such seemingly progressive aggravation of transvestism was rarely noticed under treatment, although it did apparently occur in a few cases. However, later on, these patients proved to be initially unrecognized transsexuals. The opposite was more frequently observed: under estrogen medication, the desire to ‘dress’ became often less demanding and less sexual and the inability to indulge grew somewhat less frustrating. The explanation probably is that the libido was reduced in its intensity through estrogen and since the transvestitic urge is part of the libido, it was likewise lowered. But I am anticipating a later discussion. The foregoing ... (if repetition may be permitted) apply chiefly to that form of transvestism that is its own purpose, which is to say that it is not the chief symptom of transsexualism. As soon as physical changes are desired, it ceases to be true transvestism, and inclines toward transsexualism (Type IV). The full and complete transsexual (S.O.S. V and VI) finds only temporary and partial relief through ‘dressing.’ I have even met transsexuals who would not ‘dress’ at all.” What good is it?" they said; "it does not make me a woman. I am not interested in her clothes; I am only interested in being a woman." That is the true transsexual sentiment.” p113-4/52-3
This is sometimes the hardest part to understand about where you fit.
If you, like me, fall into this grey zone of being a type III or IV it makes you second guess yourself. Being in the middle is challenging because the lower echelons don’t want to be a woman while the upper ones very much do and feel themselves to be hence they transition.
My search for self-understanding has taken a little longer in part because I seem to be right in the middle.
Benjamin even sometimes got the original diagnosis wrong as witnessed by the following excerpt from his book:
"By the end of 1964, a total of 249 male transvestites were observed in my offices, either in New York or in San Francisco. Of these, 152 were diagnosed as transsexuals. This figure, however, may actually be higher as some transvestites do not reveal their true intentions during the first few interviews. In some others, an apparent transvestism may gradually seem to progress into transsexualism with or (more likely) without any treatment and patients originally diagnosed as transvestites (of the II or III type in the S.O.S.) are actually transsexuals (V or VI on the S.O.S.). A few of them are among the 51 cases operated upon."
Hardly the stuff of exact science.