What is Accurate Diagnosis, Application of Theory, and Potential Treatment for Frankie?

Frankie (He/Him) has sought out a therapist because he is feeling frustrated and worried because he thinks his wife is going to leave him due to his sexual interests. During the intake, Frankie divulged that he fantasies of wearing his wife's lingerie while having sex with her. Frankie reports feeling aroused and excited when he wears his wife's pantsuits and dresses, and that for the last year, he typically wears some article of female clothing when he masturbates. Frankie is now feeling nervous and having trouble focusing on work and interacting with his wife because, a few weeks ago, she told him that him wearing her clothing while they had sex was making her uncomfortable and she told him she thinks he might be transgender. He feels embarrassed about his fantasies and that he is aroused by this. He indicates that he has always felt like he is manly and says his friends would describe him as masculine. He does not think his wife is correct in thinking that he is transgender, but he does worry that something is "wrong" with him because of how intense his cross-dressing fantasies are.

Additional, Relevant Details:

• Frankie reports experiencing erections as a teenager when he tried on his sister's clothing but has never found himself to be attracted to other men and describes himself as heterosexual.
• Frankie reports that he and his wife are supportive of the LGBTQ+ community.
• Frankie is dressed in a suit and tie (corporate attire).