More about the real roots of fetishistic cross-dressing  from someone who healed himself of the behavior:

In my own case the sexual adventures, which I have recounted in vivid detail in my book, “Bipolar Bare”, were associated both with both mania and depression. A depressed rage would come over me, where I sought out high risk behavior in bathhouses. I wished to kill myself through contracting AIDS. I would go into periods where I thought my life worthless, and vile. The more I sought out sex in gay bathhouses the worse I felt about myself, but I hid this behind a façade of normality. I acted and dressed like a professional during the day, and at night during those times of extreme depression I would go out looking for sex. I didn’t do this when I was not depressed. I acted like a heterosexual male dating women and loving their company. But I could never get into a meaningful relationship because I had this secret life which occurred during my depressions. I was addicted to marijuana at this time. Stoned it was easy to overcome my inhibitions about homosexuality so that as my cyclical depressions arose I could operate on my hidden fantasies. Gay sex was the behavior I loved and hated at the same time.Later after I had given up marijuana and became a Buddhist meditator, I abandoned this secret life for eight years. I still had depressions and manic episodes, but they were not as severe and I could handle them. I stopped hating life and frequenting bathhouses. I got married and embarked on a productive professional career as an architect, but this period of tranquility did not last. After a few years the stresses in my life especially the problems of keeping an architectural practice flourishing lead me back into severe manic-depression and addiction. The drug I became addicted to was far more powerful than marijuana. I found crack cocaine and immediately began to abuse it. Crack is rocket fuel to mania. I loved this high, which at first and actually for a fairly long time diminished my depression. I was self-medicating. The drug however released all my inhibitions, and I found what I most wanted to do was cross-dress and seek out sex in clubs and bars. I did this secretly for a long time. I had a studio separate from my home, where I would go ostensibly to work on my art, which I did some of the time, but much of the time I spent getting dressed up as my alter-ego Carlotta. She would prowl the streets of downtown Los Angeles with the other transvestites looking for johns. She also carried in her purse and eight inch ice pick for protection -she said- but in reality she hoped to come across some poor smuck who would challenge her and she could skewer. Luckily this never happened. It was all about risk and dichotomy.

The risk of this behavior was more than merely exciting, I was euphoric. Once I had a rough homeless man hanging onto my open car door as I tried to speed away from a drug deal gone bad. I was trying to push him off the door at the same time negotiating the steering wheel. He eventually let go and tumbled into the street. I should have been terrified by this event. I wasn’t. I was trilled. It was everything I wanted: the adrenalin rush, the exhibitionist behavior – I was dressed in full drag, and the act on the cusp of illegality. I could not get enough of this activity. I like Dr. Jekyll could not and did not want to stop becoming Mrs. Hyde.

The dichotomy was a full expression of my manic self. There was Carl, the professional architect doing his job each day looking normal -at least normal at first, the more my addiction grew the less balance and reliable I became. People in my office later remarked to me that they did not know what Carl would show up on any given day. One day I would be cute and loving, the next I could be cutting and hateful. Then there was Carlotta, black dressed bitch with orange red hair, who raced around town from transvestite bar to gay bar or walked the streets of skid row. These two selves were diametrically opposed to one another. One was the daytime loving husband and father; the other, the queen of the night.

I have recovered from my addiction and my cross-dressing with the help of therapy and medication. I have come to see my desire to become a woman as a manifestation of my illness that had its roots in childhood. When I was five or six before my young life was torn apart by the nasty divorce of my mother and father. My happiest days were dressing up in an attic closet with my older sister in our grandmother’s old clothes and shoes. We would put on slips- they dragged far behind us, high heels that were twice as big as our little feet, and wrap our necks with feather boas. These days with my sister that ended in our separation after the divorce stayed with me and influenced my future relationship to my sex. Sex is deeply ingrained, be it be sexual identity or sexual proclivity. I believe it comes out in mental illness in some form or the other, perhaps influenced by personal history or just plain biology. Perversion of sex can be seen in many of the bipolar disordered.”