The Doctor is not confused at all, he enjoys wearing women's clothing and promiscuous sex with either gender. It's not complicated.
This. It's a perfectly delightful tragedy (in perfect classical form, where the hero makes a mistake that eventually brings about his downfall and costs him his life)/comedy (in substance)/action film (with genuine B movie special effects) that doesn't take itself too seriously, and while it may be a musical it at least has great music. And for those like me who get bored with musicals, Little Nell complete with obligatory nip slip and Susan Sarandon's, um, talents in (nearly) all their glory. Plus it has Tim Curry who is awesome in everything. If we are to teach tragedies in schools, this would be far, far better than that Shakespeare crap I had to sit through. I never found the behavior of the Bard's tragic heroes to be remotely logical or believable, but I can certainly understand a dude indulging his every sexual passion and whim until it eventually kills him. That's human nature NOW.
I was cleaning my AMX one day in maybe '80 or '81 in the apartment parking lot with that cassette playing. Just as a neighbor pulled up and stopped to talk, Tim Curry began belting out "I'm just a sweet transvestite from Transexual Transylvania". Dude froze, mouth open, then after a moment turned his head and drove on without saying a word. Just as well, when he finally deigned to talk to me again he was trying to trade his freakin' Vega coupe for my '70 AMX.
It's worth pointing out that of all the world's problems, none of them come from transvestites.