What causes the urge to crossdress or to change one's sex?

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There is a great deal of debate in the medical community as to what causes transsexualism and transvestitism. Transsexualism is thought by some to be caused by a area in the brain called the "sexually dimorphic nucleus". Others claim that it is caused by a hormonal imbalance during pregnancy. Some types of transsexualism (e.g. xxy syndrome) are genetic. The two main types of transsexuality are called "primary" and "secondary" transsexualism. Primary transsexalism occurs in young adults who are gender dysphoric from a young age. Secondary transsexualism occurs in middle-aged people who have not had very strong transgender urges in their earlier lives. This type of transsexualism is thought to be linked to hormonal changes in the body at that time. There are also cases where people are forced into alternative sex roles due to religious, social, or family pressures. Some men dress as women to avoid draft or get out of the army.
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