The authors present a case report of a 47 year old man, married, with children, with cross-dressing. Although he has always lived as a man, the cross-dressing behaviour, secretly, became more and more frequent. He had fetishistic arousal to cross-dressing.

Even though he doesn’t seek the feminization of his body, he refers feeling like a woman, and when alone he assumes a female identity while cross-dressing. He has homosexual fantasies, and his sexual life with his wife is becoming more and more frustrating. In spite of all this, he doesn’t want to live like a woman or obtain feminization by hormones or surgical intervention.

Along with the case report, the authors also try to formulate a discussion on differential diagnosis between transvestism and transsexualism and to make some considerations about the categorization of fetishistic cross-dressing in discrete clinical types.