CASE 1.
Male. One younger brother, Mother, said to have had St. Vitus' dance as a girl, had been married once before she married the patient's father at 30; the father was an aggressive man, and the conditions in the patient's home were reported several times to the child welfare authorities, and he was put in foster-homes on several occasions.
He was born in hospital, weighing 3050 g; the amniotic fluid was discolored. At 14 months he was hospitalized under the diagnosis of hydrocephalus (had tonsillitis at time) and examination showed: nystagmus; pale optic discs; reduced vision; no testes palpable. At 13 he began getting hormones for the cryptorchidism. At 15 he was operated for bilateral cryptorchidism and atrophy of testes. He kept on taking androgens until the time of the present study. At 17-18 his voice broke and hair began growing on his Pubes. He had never had any erection or ejaculation.
He was an irritable child, quick-tempered and lacking in self-control; his parents took him to a child psychiatrist for this. After leaving school with good marks he attended commercial college and afterwards did mostly office-work. At 29, he began studying again for a higher degree.
He said that he had felt insecure as a child, that he hated his domineering father and was warmly attached to his kinder and more understanding mother.
As a boy he played mostly with girls; people teased him for being a sissy; he was embarrassed about his own body. At 12, he began to feel uncertain about his sex role; he felt as if he were "neutral"; after a time he began to feel as if he belonged to the opposite sex, and this feeling grew stronger shortly before he entered puberty, at which time he also began to be disgusted at the sight of his own body. At 26 he began to have periods of gradually mounting desire to cross-dress, ending in continual crossdressing for a time. He was erotically aroused by men and had a few homosexual contacts; he never showed any interest in girls. He had a weak libido, and said that he had never masturbated. He tried to conquer his anomaly by marrying, but this only made matters worse; he got frequent attacks of depression and at 26 was admitted to a psychiatric department, but after five years of supportive psychotherapy, he was no better. He wanted to have his name changed and to be operated on.
Examination at 29 revealed: Psychoinfantile, asthenic, hysteroid and syntonic traits; cerebrolesional symptoms; tendency to depression; IQ 123. Dysplastic build; kyphoscoliosis; bilateral nystagmus; reduced vision in left eye; shrunken penis; small scrotum and no palpable testes; no prostate; masculine pubic hair; sparse axillary hair; no beard; hormones: slightly low FSH value; BMR-23 per cent; EEG normal.
CASE 2.
Male. One younger sister. The father drank a little too much, but on the whole the family atmosphere was pleasant.
The patient was born in hospital, weighing 3650 g. At about 10 he was said to have got concussion, but he was not hospitalized, and he had no postconcussional disorders. At 28 he was operated on for phimosis, and thyroid treatment was started for hypothyroidism; he stopped taking the drugs of his own accord and showed no signs of hypornetabolism at the time of consultation.
He took a university degree and advanced to a high social standing.
He said that he had felt insecure as a child; his father was colorless and submissive, and his mother domineering; he did not prefer one to the other.
Up to the age of 10 he was like an ordinary boy, and good at gymnastics. At 10 he began to get a feeling of belonging to the opposite sex; the feeling grew stronger with time and became combined with aversion for his own body, and he finally determined to have an operation done. He plucked out the hairs on his face. To begin with he was erotically aroused by the opposite sex, but in the end only by members of his own sex. He married twice and had children in both marriages; his first marriage broke up because of his anomaly and he did not enjoy sexual intercourse with his second wife either. He became more and more attracted to men, and finally could not even bear the idea of having sexual intercourse with women. His masturbatory fantasies were of males, and had a slightly masochistic coloring. He cross-dressed now and then until about 19, when the desire to do so began coming on in periods, He had several attacks of depression and had attempted to commit suicide.
Examination at 31 revealed: Formal, cultured manner; syntonic, hysteroid, schizothymic personality; tendency to depression, IQ 125. Normal build; normal pubic and axillary hair; normal penis and testes; normal beard; normal hormone titers; normal EEG.
CASE 3.
Male. One sister and one younger half-sister. Parents divorced when patient was 9, and father remarried. Mother often hospitalized in psychiatric institutions for anancastic syndrome; she had asked for a legal abortion when she was expecting the patient, but was refused; she got a psychotic reaction after delivering the patient, and was hospitalized. Because of the mother's ill-health the patient often stayed in foster-homes.
He was born in hospital, weighing 3920 g. At 17 he had a short spell of concussion.
His parents consulted a child psychiatrist because of his behavior and sleep disorders. He got average marks at school, and went on to an agricultural school. Afterwards he worked as a postman and a factory hand.
He said that his father was strict and authoritative and his mother gentle and submissive; he did not prefer one to the other.
As a boy he played mostly with girls and at girls' games. He was embarrassed when he had to undress for gymnastics at school. He began to feel as if he belonged to the opposite sex when he was very young-before puberty. After entering puberty at 13-14, he began also to be disgusted at the sight of his own genitals and to want to have them removed. He was sexually attracted to boys, and never interested in girls. He had a weak libido, and no sexual experience up to the time of consultation. His masturbatory fantasies were of males, He started cross-dressing during puberty, and did so more and more with time, but never continuously. He urinated in the female position. He was often depressed and often contemplated suicide.
Examination at 19 revealed: Syntonic and psychoinfantile personality; IQ 105. Leptosomatic build; sparse axillary hair and feminine pubic hair; too little facial hair to need shaving; normal penis, testicles and prostate; hormone analysis, suspiciously high total gonadotropins and fractionated estrogens for age; normal EEG.
Case 4.
Male. Two -older brothers and one older sister. Parents quarrelled; father drank and committed suicide when the patient was 9. One uncle was an alcoholic addict. Three cousins on father's side committed suicide.
The patient was born at home. He went through secondary school and has since done various kinds of qualified work.
He was strongly attached to his mother as a child.
At 10 he began to feel that he belonged to the opposite sex and to be repelled by the male characteristics of his body. At about the same time he began to cross-dress now and then. People often called him "Miss" when he was young. At 40 he changed over completely to being a "woman". He was erotically stimulated by men, and liked men as sex partners. He had a strong sexual urge and wanted sex-changing surgery chiefly for sexual reasons. He had several attacks of depression when he contemplated suicide. When he was refused a conversion operation, he got ideas of persecution.
At 37 he was put on estrogens.
Examination at 40 revealed: Hysteroid, syntonic, schizothymic, psychoinfantile personality; tendency to ideas of persecution; IQ 122. Normal build; estrogen-induced gynecomastia; little beard because of electrocoagulation; normal pubic and axillary hair; normal penis, testicles and prostate; no data forthcoming on previous hormone analysis; abnormal EEG.
At 43, he got plastic breast implants, and a conversion operation. Since then he has been more stable and is more content with life.
Case 5.
Male. One younger sister, Mother, who had migraine, died when the patient was 27. The father drank and caused trouble in the home.
The patient was born at home. At 10 he began having migraine. He had several attacks of kidney stones.
After finishing school with average marks, he went from one job to another, running errands, in shops, in restaurants and in factories. During the six months before he came to us, he had worked as a "housewife" for another man, doing no outside work.
He did not think that either of his parents had been particularly dominant, though his father got very aggressive when he drank. He felt nothing at all for his father, but was strongly attached to his mother.
He had felt like a girl as long as he could remember and he played with dolls when he was small. He did not mind undressing in front of others for gymnastics at school. He was often teased for being a sissy at school. He entered puberty at 13-14 and was afterwards erotically attracted to members of his own sex. He had a moderately strong sexual urge. He had frequent and satisfying homosexual activity, and his masturbatory fantasies were of males. He was disgusted by his own male sex characteristics, and wanted a sex-changing operation. He urinated in the sitting position. At 15 he began cross-dressing periodically; at 33 he changed over completely to women's clothing. At 20, an operation was discussed but was not done, mainly because his mother was against it.
Examination at 35 revealed: Psychoinfantile, hysteroid and syntonic personality; IQ 97. Slight obesity, but normal build and heavy bones; normal penis, testicles and prostate; normal axillary, pubic and facial hair; hormone analysis at age of 20 had shown nothing abnormal; normal EEG.
At 35, estrogen treatment was begun, and with this he became more content with life, and more stable mentally.
Case 6.
Male. One older brother.
The patient was born in hospital, weighing 3550 g. He was slow in developing, both physically and mentally. He said that he had injured his back at the age of 2 and his bead at the age of 5, but that he recovered completely; this could not be confirmed. At 21, his left breast began to swell and ache, and he lost 8-10 kg in weight, and began to get attacks of stabbing pain in his epigastrium.
He stayed at a children's home for some undiscoverable reason when he was about one year old. Otherwise he had had a happy childhood on the whole. His father was slightly unstable and quick-tempered; his mother was more sensitive and warmhearted, and the patient was more attached to her.
After leaving school, where he repeated one year, he did unskilled work of various kinds, often in restaurants, where he often worked as a "woman". He had frequent attacks of depression.
He liked to dress as a girl when he was small, and his mother sometimes gave in and let him do it. He played mostly with girls. He was not embarrassed by having to undress in front of others. He became more and more envious of the clothes girls wore. At 12-13 he began to be erotically stimulated by boys. He never had heterosexual intercourse, but he had many and satisfying homosexual contacts. He said that he never masturbated but that be often had spontaneous erections combined with homosexual fantasies. At 18 he began cross-dressing periodically. He always felt confused about his sex role, though he felt more female than male; he felt more female in some periods than others, apparently even before puberty, and the contrary sex feeling grew particularly strong while the gynecomastia was developing, at which time lie also grew to abhor his own genitals and to long intensely for a sex-changing operation.
Examination at 21 revealed: Asthenic, syntonic, hysteroid and schizothymic personality; tendency to feel persecuted, cerebrolesional signs and symptoms; IQ 104. Normal build; swollen left breast; normal penis and testicles; normal axillary hair but sparse beard (had not yet shaved); hormones: abnormally high pregnanediol values on two occasions; endocrinologic analysis failed to show cause for the gynecomastia; PBI and liver function values normal; normal EEG.
Case 7.
Male. Three older sisters, one older brother and six younger brothers. The mother was said to be backward, and the father was a criminal. One brother (IQ 58-70) and one sister (IQ 66) were in hospitals for antisocial retarded, Complaints were made to authorities about conditions in home, and the patient was put in a foster-home when he was an infant.
He was born in hospital, weighing 4200 g. He bit his nails as a child.
He got poor marks at school and had to attend special classes the last years he was there. A child psychiatrist was consulted. After leaving school, he did various odd jobs of unskilled nature, often working as a "woman". He was charged with crimes when he was 19 and 24, and underwent psychiatric examination on the order or the court; mental abnormality of nonpsychotic nature was diagnosed.
He said that he had felt insecure as a child-that he had no one to lean on. He felt like a girl from the beginning, and played girls' games when he was a child. He was embarrassed whenever he had to undress in front of others, and he abhorred his genitals from the time he was very young, and at 15 this got worse. He began cross-dressing as a young boy, and two years before consultation he changed over to wearing women's clothing continually. He was erotically attracted to men, had male partners for most of his sexual activity, and imagined himself in the female role when he masturbated. He had a strong libido. After his second sentence at 24 he did not come into conflict with the law again.
Examination at 27 revealed: Hysteroid, syntonic, psychoinfantile, asthenic personality; cerebrolesional symptoms; IQ 96. Normal build; normal penis, testicles and prostate; shaved legs and pubic hair to give feminine appearance; normal axillary and facial hair; low total gonadotropin level for age; abnormal EEG.
At 27 he received estrogens and at 28 he got his name changed. It was easier for him to adjust afterwards, but he still longed for a conversion operation.
Case 8.
Male. Two younger sisters and one younger brother.
The patient was born in a private nursing-home, weighing 3560 g. At 2, he was suspected to have poliomyelitis as his legs seemed to be paralyzed, but he was apparently not hospitalized for this.
As a child he sometimes had nightmares. Around puberty he began to bite his nails.
His father was strict and dictatorial; his mother was tolerant, understanding and yielding, and the patient was more attached to her.
After leaving school with average marks, he took a year's course in office-work. At 18 he started studying at a painting academy.
Ever since lie could remember he felt as if he were a girl, but he played equally often with both sexes when he was small. He was poor at gymnastics and felt embarrassed when he had to undress in front of boys. He entered puberty at 13 and afterwards his feeling of belonging to the other sex got stronger, and his body began to feel unpleasant; it felt foreign, as if his mind and body did not agree. He was erotically attracted to boys, never to girls. At the time of consultation, at 18, he had not had any sexual experience. When he masturbated he imagined himself as a female. He had a moderate libido. At about puberty he began cross-dressing at times. He longed for sex-changing surgery. He complained that he felt under intense strain, and that he had had repeated attacks of depression when he contemplated suicide.
Examination at 18 revealed: Quiet, shy young man with an asthenic and slightly psychoinfantile personality; slight depression; IQ 96. Normal build; normal pubic and axillary hair but shaving only necessary every other day; normal penis, testicles and prostate; normal hormone values; normal EEG.
Case 9.
Male. One older sister. Cousin on father's side said to be retarded. Maternal aunt had been in mental hospital for "nervousness".
The patient was born in hospital, weighing 3860 g. He had eczema and asthma up to the age of 10. At 11, he began to suffer from anancasms, which were said to begin after high fever following vaccination for smallpox.
He took a university degree, and now worked as a civil servant.
His father was the dominant member of the family. He did not particularly prefer one parent to the other.
He had a happy childhood. He played only with boys and boys' games. He felt ernbarrassed during gymnastics- always had the feeling that he was different from others. At about 12, his body began to feel foreign and he began to cross-dress now and then. At 21, he began to cross-dress more, but only when he was not working; at the same time he began to shave his pubic hair to make it look feminine. His feeling of belonging to the other sex grew and grew, and was firmly entrenched at the time of consultation. He had tried to castrate himself, and had frequent attacks of depression combined with thoughts of suicide. He had had no sexual experience. He was mentally stimulated by his own sex. He had a weak libido. His masturbatory fantasies were of men.
At 30 he went to a psychiatric department asking for recommendation for castration, and it was decided to put him on estrogens.
Examination at 33 revealed: Asthenic, syntonic, schizothymic, psychoinfantile personality; clear reactive depression; cerebrolesional syndrome; anancasms; IQ 106. Estrogen-induced gynecomastia; small atrophic testicles; small prostate; sparse facial hair; male pubic hair; normal axillary hair; before estrogen treatment started, genitals and hormone values said to be normal; normal EEG.
CASE 11.
Male. Only child. Parents divorced when patient was 2. Mother, who remarried when he was 13, was said to be nervous and to drink too much. No data forthcoming on father.
The patient was born in hospital, weighing 3650 g. He bit his nails and had nightmares when he was small and during puberty he began suffering from anancasms. At 12 he had tonsillitis, and an organic heart defect was discovered. At 15 he had acute pericarditis, but had no more heart trouble afterwards. At 16 his personality changed: he began to keep to himself, brood, and have attacks of anxiety. A child psychiatrist was consulted and he was hospitalized with the diagnosis of transvestism (schizophrenia?). He stayed several times at a mental hospital after this, the diagnosis there being "character disorder (transvestism)". The last time was when he was 23.
After finishing school, where he got good marks, he worked in offices and factories. He was considered a good worker, but from the age of 20 on he only took temporary jobs.
He said that he had not felt secure as a child, that he never got on well with his domineering stepfather. Nor did he care much for his mother, whom he said was nervous and unstable.
Until puberty at the age of 16 he was normally interested in girls, though not in a sexual sense, he said. After this he began to become more and more convinced that he belonged to the opposite sex, and eventually he came to hate his own genitals. At the same time lie also became sexually attracted to men, and from then on he was mainly interested in the male sex. He had a strong sexual libido, but said that he had never had any sexual activity. He masturbated often, and then imagined himself in the female role. At 16 his breasts began to ache, and he thought that they began to swell as well. He shaved all the hair off his body, and rubbed himself all over with hormone ointments. At 20, he began to long to be castrated. He cross-dressed periodically from the age of 16 on. He was often depressed and often threatened to commit suicide. He also threatened to castrate himself.
Between 21 and 23 he received supportive psychotherapy. At 23, estrogen treatment was started, but he was dissatisfied with the result and demanded sex-changing surgery.
Examination at 23 revealed: Psychoinfantile, asthenic, syntonic, hysteroid and schizothyrnic personality; ideas of persecution; cerebrolesional syndrome; no signs of psychosis; IQ 108. Normal build; estrogen-induced bilateral gynecomastia; normal penis, testicles and prostate; pubic hair shaved off; axillary and facial hair normal; EEG normal; roentgenograms of skull showed suggestion of hyperostosis frontalis interna.
CASE 12.
Male. Born out of wedlock and never legitimized. Two older half-sisters and half-brothers, all well.
The patient was born in hospital, weighing 3850 g.
Neither his mother nor stepfather was dominant, and he liked them equally well.
After leaving school, where he repeated his second year, lie did various kinds of work, and is presently working as a "female" shop assistant.
He always preferred girls' games and was embarrassed when others saw his body in the gymnastics lessons. From the time he was small, he felt that he belonged to the opposite sex, and this grew worse when he entered puberty at 14. He was often mistaken for a girl when he was young. He was erotically attracted to males. He never had any heterosexual intercourse, but had frequent and satisfying homosexual relations. He masturbated without any accompanying fantasies. He had a moderately strong libido. At 17 he began to cross-dress now and then, and at 23 he changed over to wearing feminine clothing all the time. He wanted a sex-changing operation and to have his name changed. At 22 he began getting estrogens.
Examination at 22 revealed: A mild, gentle man with a hysteroid, asthenic, psychoinfantile personality; IQ 81. Normal build; normal penis, testicles, prostate; normal pubic and axillary hair, but shaving only necessary once a week: normal hormone values; EEG abnormal.
CASE 13.
Male. One older brother. Whole family alive and well.
The patient was born in hospital, weighing 3000 g; the amniotic fluid was discolored. At the age of 2 he had concussion and was hospitalized for a short time. At 7 he was again hospitalized for concussion and a small cranial fracture; afterwards speech disorders developed. At 18 he was operated on for a gastric ulcer. At 21, diabetes mellitus was discovered.
After leaving school he did various kinds of work, first as a male, but at 21 he began working as a female.
He said that he had had a happy childhood. His father was the dominant parent; he was more attached to his warm-hearted mother.
As long as he could remember he had felt as if he were a girl. He played girls' games when he was a child. He was embarrassed when he had to undress in front of his schoolmates. He entered puberty at about 15, and then became disgusted at the sight of his body. He was mentally aroused by the male sex, and had chiefly homosexual contacts. A few attempts at heterosexual intercourse were all a failure. He imagined himself in the female role while he was masturbating. He had a moderate libido. He began cross-dressing during puberty, first only occasionally, but at 19 he began wearing women's clothes all the time, and eventually he adopted a completely feminine role, both at home and at work.
He had several periods of mental trouble when he grew up, but none very profound or long-lasting.
Examination at 21 revealed: Good balance and good insight; hysteroid and syntonic traits; IQ 96. Normal build; slight paralysis of left abducens nerve; normal penis, testicles and prostate, and male pubic hair; shaved armpits; needed to shave every other day; abnormal EEG.
At 21 estrogen treatment was started and at 23 he got his name changed. This made it possible for him to get better and more permanent work, and he became more stable mentally.
CASE 14.
Male. The patient was illegitimate and never saw his father. His mother, said to have been 42 when he was born, had three girls in an earlier marriage, two of whom died for some unknown reason; she herself died at 57 for an unknown reason.
The patient said that he was born at home. At 24 he had lung tuberculosis, and was discharged from hospital recovered after one year. He bit his nails as a boy.
After finishing school, where he was an average pupil, he first worked in factories, and then in restaurants, where he had worked as a woman during recent years.
When he was small he liked to play girls' games, and to associate with girls. He felt like a girl, and it was extremely hard for him to undress in front of boys at school. While he was going to school, he began to sit down to urinate. From his very earliest years he hated his genitals, At 12 he entered puberty and with this his feeling of belonging to the opposite sex increased. He was erotically attracted to the male sex, and had several homosexual relationships. He had a moderately strong libido and said that he never masturbated. He started cross-dressing now and then when he was a child and continued doing so until he was 28 when he began wearing women's clothing all the time. He was periodically depressed, and had once attempted to take his life. He longed for a conversion operation and a change of name, and at 30 the operation was done.
Examination at 27 revealed: Hysteroid, syntonic, psychoinfantile personality; cerebrolesional syndrome; tendency to depression; normal intelligence (IQ not measured because of linguistic difficulties). Athletic build; penis, testicles and prostate normal; inale pubic, axillary and facial hair; normal EEG.
CASE 15.
Male. One older sister, two older and two younger brothers.
The patient was born at home. At 12 he hit his head, but did not faint. At 17 he apparently had poliomyelitis but he was not hospitalized and the disorder disappeared without a trace. At 18 he fell while ski-jumping and lost consciousness for a long time; no skull fracture could be seen. The next year he fell again ski-jumping, and dislocated his shoulder and broke off some of his teeth. He had many attacks of gastritis, kidney stones, and prostatitis.
As a child lie was anxious and easily upset, and he bit his nails so much that his parents sent him to a child psychiatrist.
He got average marks at school. After finishing there and doing his military service, he first worked for a time in the forests, and finally became a truck-driver.
He said that lie had been brought up in a happy home atmosphere on the whole. His father was slightly more dominating than his mother, but he did not prefer one parent more than the other.
Up to the age of 22-23 he developed normally and had normal and satisfying sexual relations with women. In his 23rd year he began to feel that he was being transformed into a woman, and started dressing in women's clothes now and then. At 24 he married, and lie was very fond of his wife, with whom he had two children, but she gradually lost her sexual attraction for him. His feeling of belonging to the other sex grew and grew, and lie began to shave his pubic hair and to do other things to make himself took like a woman, and he cross-dressed more and more often. At 29 his wife threatened to leave him. He consulted a doctor who advised him to consult us at the mental hospital, and we admitted him. It was found that he had an abnormal EEG, and as an experiment he was given phenantoin, without any suggestion being used; three weeks later his transsexualism vanished. The drug had to be stopped because of its side effects, and with this the transsexualism reappeared. Other anticonvulsants tried also had to be stopped because of side effects. At 30 the patient was a full-fledged transsexual, his wife divorced him and he started making plans to adopt a female role entirely. According to his last report to us, when he was 31, the transsexualism had diminished for a time but was now back in full force, and he felt he could no longer go on working as a man.
Examination at 29 revealed: Hysteroid, asthenic personality; tendency to ideas of persecution; cerebrolesional syndrome; IQ 104-110 (measured during military service). Normal build; normal penis, testicles and prostate; pubic hair shaved to look female; eyebrows and facial hair plucked; hormone values normal; EEG abnormal.
CASE 16.
Male. Only child. Parents divorced when patient was 4. Mother, who Temarried, was said to have Basedow's disease.
The patient was born in hospital, weighing 3480 g. He was a "delicate child". Diabetes mellitus was discovered when he was 3 and beginning with his early years he had many attacks of coma. He had ichthyosis from the time he was young.
After finishing his compulsory school training he went to a trade school, and afterwards did various kinds of work, mainly in restaurants.
He was aggressive, irritable and maladjusted as a boy, and was taken to a department for child psychiatry on two occasions, when he was 14 and 17, where the diagnosis both times was "puberty neurosis and diabetes mellitus".
He said that he had felt insecure as a child, that his domineering step-father did not understand him, and that he preferred his more submissive mother.
He was apparently not interested in the clothes of the opposite sex when he was a boy, and he was not embarrassed during gymnastic lessons. But already at 6 or 7 he began to feel that he was not fitted to play a masculine role. Shortly before puberty he began to feel intensely that he really belonged to the opposite sex, and to become more and more repelled by his own body. He had occasional heterosexual contacts when he was young, but he was always erotically attracted to his own sex. He got engaged twice in attempt to be like other men, but both times it was a failure. He had a moderate libido. He masturbated without any specific form of fantasies. He began to cross-dress periodically when he was a boy, and at 23 he changed over to wearing women's clothing all the time. He had many attacks of depression and had attempted to commit suicide. The last few years he had had an overwhelming desire for conversion surgery and a change of name.
Examination at 24 revealed: Good verbal ability; hysteroid, asthenic, schizothymic, psychoinfantile personality; cerebrolesional syndrome; IQ 104. Normal build; ichthyosis; normal penis, testicles and prostate; male pubic, axillary and facial hair; low total gonadotropin value for age; abnormal EEG.
CASE 17.
Male. One younger brother and one sister. Mother "delicate" and "nervous" though she never consulted a physician for it.
The patient was born in hospital, weighing 2400 g. At 9 he broke his thigh-bone in a traffic accident, and suffered from concussion and confusion for about two days afterwards. At 14 he began having bronchial asthma. At 25 he was examined for dizziness, and an EEG taken was normal.
After finishing school he went to a commercial college and was now a salesman.
He said that he had not got the tenderness he longed for as a child. His mother was the dominant member of the family, and he liked his father better.
He said that he had heard his mother say that she had wanted a girl instead of him, but this was not verified, and he was not reared like a girl. As a boy he preferred girls' games. Beginning at about the age of 4, he started to feel that he belonged to the opposite sex, and he was considered to be a sissy at school. At 14, when he entered puberty, the contrary sex feeling grew more intense and he began to detest his own body, especially his genitals. He began periodical cross-dressing at about the age of 25, and at about the same time began shaving his legs and his pubic hair to make himself look feminine, and also to have his beard removed by electrolysis. He had occasional heterosexual contacts, but they had not given him any satisfaction. He was erotically aroused by men, but he had not had any homosexual contacts. He had a moderately strong libido. He had frequent attacks of depression, and was prepared to give up everything for a conversion operation and change of name. Estrogen treatment, started when he was 3~1 made him calm down a little, but only for a time.
Examination at 34 revealed: Hysteroid, asthenic, schizothymic, psychoinfantile personality; cerebrolesional syndrome; IQ 103. Slight dbtsity; heavy bone structure; male pubic and axillary hair; normal perils, testicles and prostate; normal EEG.
CASE 18.
Male. Only child. The father, who drank, left home shortly after his son was born, and died three years later.
The patient was born in hospital, weighing 3220 g. He was prone to infection as a small child. At 4 he began having facial tics, which gradually disappeared. At 10, when he was examined for a defect in the frontal bone, the EEG showed a focus, but this had gone in a record taken later.
He kept to himself as a child. After finishing school, where he was an average pupil, he did various kinds of work.
He said that he had had a happy childhood on the whole. He was greatly attached to his mother.
From early childhood on, he felt that he was really a girl. He played girls' games, and his schoolmates called him "girlie". He was extremely embarrased whenever he bad to dress and undress in front of his schoolmates. After puberty, at 14, he began to abhor his own body, especially his genitals. He was sexually attracted to males, and had occasional homosexual contacts, but never any heterosexual relationships. He masturbated but said he had no masturbatory fantasies. He had a moderate libido. He often had attacks of depression. Beginning at the age of 15, he cross-dressed every time he got the chance and at 20 he changed over to wearing women's clothing all the time. From then on he was consumed by a desire for a conversion operation and a change of name.
Examination at 22 revealed: A quiet, modest and gentle manner; hysteroid, asthenic, Syntonic traits; IQ 94. Normal build; slender bones; normal penis, testicles and prostate; male pubic, axillary and facial hair; hormones normal; EEG normal.
At 23, after a period of estrogen medication, a conversion operation was performed. At 24 he got his name changed and breast implants. The results so far have been very satisfactory. He is much happier and more stable than he used to be.
CASE 19.
Male. The patient, an only child, was born in hospital, weighing 3200 g. At 7 he had polyserositis which healed without complication. As a child he suffered from night terrors and nightmares. At 5 he began biting his nails.
He was an average pupil, and after finishing school went into office work.
He felt insecure as a child because his parents quarrelled a great deal. His father was the dominant parent. He was very fond of his mother.
He always felt like a girl when he was small, and he played girls' games. At 7 the contrary sex feeling grew stronger and he began to dislike the sight of his own body, and disliked it still more, especially his genitals, after he entered puberty at 15. He was erotically attracted to men, and never had any heterosexual contacts, but several homosexual relationships. He had a moderate libido. His masturbatory fantasies were of males. Beginning as a schoolboy, he began to cross-dress now and then. At 19-20 be began to feel an intense desire for a conversion operation; every sign of his male anatomic sex became abhorrent. He bad several attacks of depression when he contemplated suicide.
Examination at 20 revealed: Shy andreserved manner; asthenic syntonic and psychoinfantile personality; slight depression; IQ 87. Normal build; normal penis, testicles, and prostate; male pubic, axillary and facial hair; low total gonadotropin value for age; abnormal EEG.
At 22, he began taking estrogens. The result has been greater mental stability and less tendency to depression.
CASE 20.
Male. Three older brothers, one younger brother and sister. Whole family said to be "nervous", but none had been hospitalized for it.
The patient was born in hospital, weighing 2710 g. As a child he tended to keep to himself, and was shy and reserved, and a child psychiatrist was consulted.
After finishing school lie worked in restaurants, from the age of 24 on as a "woman".
He said that lie had had an unhappy childhood mostly because of his aggressive, domineering father. He preferred his mother, who was more submissive.
As a child he always felt like a girl. He was embarrassed at having to undress for gymnastics. fie had little to do with other boys, and was called a sissy. When he entered puberty at 15, lie began to abhor his body, especially his genitals, and he envied the way the bodies of his female playmates were developing. At this age he also became firmly convinced that he belonged to the opposite sex. He was attracted erotically only to males. After one unsuccessful attempt at heterosexual intercourse, he had only homosexual contacts, which always satisfied him. His masturbatory fantasies were of males. He had a moderate libido. Beginning as a boy, he crossdressed now and then, and at 24 he changed over to wearing women's clothing all the time. He wanted to have a conversion operation and a change of name. At 24 estrogen treatment was begun, but he has not yet noticeably improved.
Examination at 24 revealed: A shy, vague, evasive man with asthenic and syntonic traits; IQ 96. Normal build, normal penis, testicles and prostate; normal male pubic, axillary and facial hair; hormone titers normal; normal EEG.
Case 21.
Male. Three older brothers and one younger sister. Father had gone through a period of excessive drinking. One brother epileptic.
The patient was born in hospital, weighing 3300 g. At 10 he got concussion but he was apparently not hospitalized. At about the same age he had a short spell of albuminuria.
After leaving school, where he was an average pupil, he worked in restaurants for the most part, as a "woman" from the age of 24 on. Apparently because of the difficulties his anomaly caused him, he started drinking too much and to take too much of various forms of drugs. He stole, and after a few suspended sentences, was exempted from legal punishment. He was admitted several times to a mental hospital.
He thought that his childhood had been a happy one on the whole. His father was the dominant parent, and he preferred his mother.
From as far back as lie could remember he was convinced that he was a female. He preferred girls' games and to play with girls. He gradually began to dislike his own body, and began to do so even more when he entered puberty at 14-15. He -crossdressed now and then from the time he was a boy until he was 24, when he changed over to wearing women's clothing all the time. He was erotically attracted to men, and had only homosexual activity. His masturbatory fantasies were of males. He had a strong libido. He often had attacks of depression and thought of suicide.
Examination at 26 revealed: Hysteroid and syntonic traits; tendency to feel persecuted; IQ 94. Normal build; normal penis, testicles and prostate; normal pubic, axillary and facial hair; normal EEG.
At 28 he had a conversion operation, after a period of estrogen medication, and the same year he got his name changed. After this he appeared to become better adjusted and to show less inclination to crime. He himself felt more at peace with the world and said that he did not become depressed so often as before.
Case 22.
Male. One older brother and one younger sister. Parents happily married. One maternal uncle committed suicide, and another was treated at a psychiatric institution for transient "nervous trouble."
The patient was born in hospital, weighing 4080 g. Apart from a slight attack of rickets, his early physical history was normal.
He took a university degree and worked as a teacher.
He said his father was slightly more dominant than his mother, who was more warm-hearted and to whom he was much more attached.
As a child he always played girls' games, and he had felt like a girl ever since he could remember. He did not act like other boys and he was embarrassed when he had to change clothes for gymnastics. He got more and more the feeling that he was "born in the wrong sex". At 14-15, when he entered puberty, he began to abhor his own genitals, and to long to have them operated upon so that he would look female. When he became conscious of his sexual urge, he was attracted to males, never to females, He had frequent homosexual contacts, which satisfied him immensely, and never any heterosexual intercourse. His masturbatory fantasies were of males. He had a moderate libido. He was often depressed and thought of suicide, but never attempted to take his life. Because of his social position he had never been able to cross-dress.
Examination at 33 revealed: An extremely frank, accessible and intelligent man, with good insight; hysteroid, syntonic traits; IQ 121. Normal build; normal penis, testicles and prostate; normal pubic and axillary hair; slightly sparse beard (partly plucked out); normal hormone titers; normal EEG.
Case 23.
Male. One older sister. Parents divorced when patient was about 7. His mother, who was appointed his guardian, never remarried; she had rheumatism, and was "nervous"; she gave the impression of being slightly retarded.
The patient was born in hospital, weighing 4740 g. When he was a child he often felt worried, and had attacks of the anxiety type, and he bit his nails intensely. Because of this he was taken to a child psychiatrist.
After finishing school, where he repeated one grade, he did unskilled factory work.
He said he had been unhappy as a child "because I could not be a girl". He preferred his mother to his father; neither was particularly dominant.
As far back as he could remember he felt that he was a girl. He played only girls' games, never boys'. He liked gymnastics, but thought it was hard to change in front of the other boys. At 7 he began to sit down for urinating. At this age he also began to dislike his own genitals, and this feeling grew more intense after puberty. He envied girls their bodies. He had no sexual activity, though he had a strong libido. He was erotically attracted to the male sex, and his masturbatory fantasies were of males. At 14-15 he began to cross-dress on occasion. He had repeated attacks of depression; he threatened again and again to commit suicide, and attempted to do so on at least two occasions. He tried to get a surgical change of sex and became greatly upset when this was denied him.
Examination at 19 revealed. Asthenic, hysteroid, syntonic, psychoinfantile traits; strong tendency to depression; distinct cerebro)esional syndrome; IQ 81. Normal build; heavy bones; penis, testicles and prostate normal; normal male pubic, axillary and facial hair; normal hormone titers; normal EEG.
Estrogen treatment was started when he was 19, but it is too early yet to be able to say anything about the result. He is now working as a "woman".
Case 24.
Male. Five younger sisters and four younger brothers. His family was poor, but there was a pleasant atmosphere in the home. One sister was treated in a mental hospital under the diagnosis of postinfectious psychosis; she died from lung tuberculosis.
The patient was born at home. After finishing rural school, he went to a people's high school. He then took a job in an office, and at the same time went on with his education by taking correspondence courses. During the last few years he has been working as a civil servant.
Neither parent was more dominant than the other and he liked them equally well.
He always felt like a female. When he was small he had had only feminine interests, and played mostly with girls. He was poor at gymnastics, but not particularly embarrassed when he had to undress in front of the other boys. At 14 he entered puberty and afterwards felt himself strongly attracted to boys. He had many homosexual contacts, which he enjoyed immensely. He once tried heterosexual intercourse but it was a failure. He had a moderate libido, and his masturbatory fantasies were of males. His feeling of belonging to the other sex became more and more accentuated after puberty, and at 25 he began to long to have a "sex-changing" operation. He never cross-dressed because of his social position and because he was afraid of getting into trouble, but he had often longed to do so. He had never said anything to a doctor about his troubles until he came to us.
Examination at 49 revealed: Asthenic, syntonic, schizothymic, psychoinfantile traits; average intelligence (IQ not measured). Normal build; normal penis, testicles and prostate; normal pubic, axillary and facial hair; normal EEG; low but not definitely abnormal total gonadotropin values for age.
Case 25.
Male. Besides a twin brother, apparently bi-ovular, he had four older brothers, two older sisters and two younger brothers. One paternal uncle was said to have had epilepsy and one sister had a son who was treated for a short time in a mental hospital, apparently for a depressive reaction.
The patient was born at home. At 8 he fainted in an accident, and afterwards suffered from headache, dizziness and difficulty in concentrating. At 14 he began to have attacks of epilepsy, mostly of the grand mal type. At 37 he was operated on for prognathism.
After finishing school he first worked in factories but from the age of 23 on he cooked in a restaurant.
At 38 he was treated three times in a mental hospital for mental confusion, once after heavy drinking; he was given the diagnosis of alcoholic psychosis and possibly epileptic psychosis. It was noted that he had convulsions when he was in hospital; he was put on phenantoin and then got fewer attacks. It seems that whenever he did not take enough of this medicine, he became confused again. Several routine EEG's were taken, but they were always normal.
He said that neither of his parents was particularly dominant. He preferred his mother.
As a child he always felt like a girt. He played girls' games and was embarrassed when he had to undress in front of boys. After puberty at about 15, he became erotically attracted to boys, and his homosexual preference grew more and more pronounced. He had heterosexual contacts but none had satisfied him. He had only a few homosexual contacts, however, and his libido was classed as weak. He masturbated occasionally, but without any particular type of fantasies. After puberty he began to abhor his own body, particularly his genitals, and to become more and more convinced that he belonged to the other sex. After puberty he also began crossdressing now and then. He longed for a conversion operation, but was afraid that this was impossible because of his age and his work and other social factors.
Examination at 42 revealed: Psychoinfantile, asthenic, hysteroid traits; tendency to feel persecuted; distinct cerebrolesional syndrome; IQ 72. Dysplastic build; penis, testes and prostate normal; normal axillary hair but female type of pubic hair and so little facial hair that he only needed to shave once a week; normal EEG.
Case 26.
Male. The patient was illegitimate and lived sometimes with his mother, sometimes with his mother's parents and sometimes in children's homes. His mother remarried when he was 12. He had no siblings.
He did not know whether he had been born at home or in hospital. He had many attacks of pneumonia as a child, though he apparently was never very sick.
After leaving school he worked in factories and in restaurants.
He said that he had grown up with a feeling that he did not belong anywhere.
He had heard that this mother had wanted him to be a girl, but this could not be confirmed. He had never felt like a male, but always like a female. He played girls' games as a child. He was embarrassed about his own body while he was growing up, and repelled at the sight of his male characteristics. These feelings and the feeling of belonging to the other sex increased after puberty at about 13. He was erotically attracted only to men and had many homosexual contacts. He had a moderately strong libido. He imagined himself to be female when he was masturbating. As a child he cross-dressed occasionally, and at 17 he changed over completely to women's clothing. He worked as a woman. He wanted a conversion operation and a change of name.
Examination at 21 revealed: Syntonic and schizothymic traits; good insight; apparently normal intelligence, low IQ of 72 being probably due to language difficulty. Athletic build; normal penis, testicles, and prostate; pubic hair shaved to look female; axillary and facial hair normal; hormone titers normal; EEG normal.
Case 27.
Male. One older sister. Parents divorced when patient was 3. Mother did not remarry. He was brought up away from home for long periods, sometimes at his maternal grandmother's and sometimes in children's homes. His mother had gynecologic and nervous troubles, and was treated in a mental hospital for a "neurotic-depressive reaction". She had also gone to a psychiatric department for nervous troubles and to obtain permission for a legal abortion (not for the patient).
The patient was born in hospital, weighing 3550 g.
He was an average student at school, but his transsexual feelings made him unhappy there, and he played truant and ran away from home, and was taken to a department for child psychiatry. After leaving school he had several jobs, usually only staying a short time at each, and he usually worked as a "woman". He had difficulty in adjusting, and had occasionally drunk too much and taken too many drugs.
He could not remember what his father was like. He described his childhood as insecure.
As a child, he always felt as if he were a girl. He played girls' games and liked to dress in his sister's clothes. He envied girls their bodies. After puberty at about 14, he became disgusted at his own body, and at his erections. At 15 he started wearing women's clothes all the time. He was erotically attracted to men, and had occasional homosexual contacts. He never had heterosexual intercourse. His libido was moderate. He imagined himself as a woman when he masturbated. After puberty, he determined to get a conversion operation and change of name. He had many periods of depression, and had been admitted to various forms of psychiatric institutions. He had attempted to commit suicide.
Examination at 18 revealed: Psychoinfantile, asthenic, hysteroid, syntonic traits; tendency to depression; IQ 96. Normal build; slender bone structure; female pubic hair; normal axillary and facial hair; normal penis, testicles and prostate; hormone titers normal; EEG normal.
At 18 he got his name changed, and estrogen treatment was started. He improved a little after this-did not get depressed so often. But he was still determined to get an operation.
Case 28.
Male. The patient was born out of wedlock and was sent to foster-parents at the age of I I months. He got along well in his foster family.
He was born in hospital, weighing 3370 g. At 7 he was said to have lost consciousness for a short while after a head injury. At 20 he fainted again after an injury during military service.
After finishing school he did office work and finally started his own firm.
He was "nervous" as a child, slept badly and walked in his sleep. When he grew older, he sometimes took alcohol and drugs to excess.
Neither of his foster-parents was more dominant than the other, and he liked them equally well.
As far back as he could remember he felt as if he belonged to the opposite sex. When he was small he played mostly girls' games, and he was always called a sissy. He was embarrassed during gymnastics and was exempted from participating. At 12 he began to use lipstick and powder. He became more and more disgusted at the sight of his genitals. At 25 he consulted an endocrinologist and then began taking estrogens. Two years later he began cross-dressing, at first only now and then, but at 27 he changed over entirely to women's clothes. At the same time he began to long for sex-changing surgery, and finally became convinced that he would not be able to go on without an operation. He had many periods of depression and once attempted to commit suicide. At 37 he got his name changed.
He was erotically attracted to men and had mainly homosexual contacts. His libido was moderate.
Examination at 35 revealed: Hysteroid, asthenic and syntonic personality: IQ 96. Estrogen-induced gynecomastia; atrophied testicles; normal male distribution of hair; normal EEG. Before the estrogen treatment he had a slender masculine build, and normal genitals and prostate.
Case 29.
Male. One older brother and one sister and three younger brothers and one younger sister. Mother, one brother and one sister mentally retarded. The brother showed behavior disorders and the sister had epilepsy. Some of the father's relatives were said to be retarded. The mother had consulted psychiatrists mainly for help in social conditions.
The patient was born in hospital, weighing 3100 g. At 2 he had severe scarlet fever and his hair fell out afterwards. He was late in learning to talk, and had difficulty at school, repeating the first year. Afterwards he worked in restaurants to begin with, and then as a "female" nurse's assistant.
He said that he had had a happy childhood on the whole. His father was the dominant member of the family. He did not prefer one parent to the other.
At the age of 12 at the latest, he began to feel that he belonged to the opposite sex. He was embarrassed in gymnastics, and was repelled by all the signs he showed of being a male. He began cross-dressing at 12 and at 18 he changed over completely to wearing women's clothes. He always had a weak sexual urge; he had no sexual contacts; he denied masturbating; and he was erotically attracted only to men. He started at an early age to urinate in the sitting position. He had several attacks of depression and thoughts of suicide.
Examination at 21 revealed: Psychoinfantile, asthenic, hysteroid, and syntonic traits; tendency to depression; cerebrolesional syndrome: IQ 72. Slender build; normal penis, testicles and prostate; feminine pubic hair; sparse beard of ordinary distribution; EEG abnormal.
At 23 he got his name changed, and at 24 he had a conversion operation. After this he felt better, got along better with others, and had fewer attacks of depression.
Case 30.
Male. The patient was born as the second of twins, the other twin being a girl. In addition, he had one older brother and three sisters. His father was hospitalized for an endogenous depression. The parents divorced when the patient was about 10, and the mother afterwards remarried. Before this there had been a great deal of strife in the home; the child welfare bureau had intervened, and placed the patient in foster-homes on several occasions.
The patient was born at home.
Neither of his parents was particularly dominant. He was more attached to his mother.
He went to school both in Sweden and Denmark, where his mother moved when she remarried. After finishing school, he did various kinds of work on land and at sea, and lastly he began working in restaurants as a "woman".
He had felt that he belonged to the other sex as far back as he could remember. He was embarrassed at having to undress for gymnastics. His schoolmates called him by girls' names. At puberty his contrary sex feeling became accentuated and he began to despise his own body, and to want to have it operated on. He urinated in the sitting position. He was erotically attracted to men. He had occasional heterosexual contacts, but they did not satisfy him. Homosexual contacts, however, had given him complete satisfaction. He imagined himself a female when he masturbated.
Examination at 20 revealed: Hysteroid, syntonic traits; good insight; IQ I 11. Ordinary build; normal pubic and axillary hair; beard sparse, needing shaving only every other day; normal penis; testicles soft but normally sized; prostate normal; low total gonadotropins for age and high estrogen titer, but neither value definitely abnormal; normal EEG.
At 20 estrogen treatment was started.
Case 31.
Female. Two older brothers and one older sister. There was much strife in the home; the child welfare bureau complained to the parents; the parents divorced when the patient was 2. The mother kept the patient; she did not remarry. One sister was put in a special class at school.
The patient was born in hospital, weighing 3470 g. She had a high fever in connection with measles.
She spent all her school life in a special class, and after finishing she worked for short spells at various kinds of unskilled work, mostly in factories. At 20 she received a suspended sentence of six months for car thefts and fraud. A few years later she was again found guilty of fraud and put in an institution for a period. After she came out, she went on committing various forms of minor crime.
She was strongly attached to her mother and the younger of her brothers, who apparently acted as a father-substitute.
She always felt like a boy. She played boys' games. She was embarrassed during the gymnastic lessons at school. At 15, when she entered puberty, she began to abhor all the signs she showed of belonging to the female sex. She longed to get rid of her breasts and have her menstruation stopped. At first she wore clothes of neutral character, but at 18 she changed over to wearing men's clothing entirely. She had a moderate libido. She was erotically attracted to girls. She had occasional heterosexual contacts, each time when she was under the influence of alcohol, but none gave her any feeling of satisfaction. She finally had mostly homosexual contacts. She said she had never masturbated.
Examination at 22 revealed: Syntonic personality; IQ 84. Ordinary build; large hands; normal pubic and axillary hair; normal breasts; no signs of gynecologic abnormality; hormone titers normal; EEG abnormal.
After this examination she began getting androgen treatment and the same year her breasts were removed. At 24 she got her name changed. The result was better social adjustment and subjective improvement. She now lives as a man.
Case 32.
Female. One older sister. One paternal aunt had a reactive depression for which she was hospitalized for a short time.
The patient was born at home.
After finishing school, she worked mainly as a man.
She had had a happy childhood. She said that her parents were kind and warmhearted; she did not prefer one to the other.
As young, she always felt like a boy. She played boys' games and was embarrassed when she had to undress in front of girls. At 17 she entered puberty. Her menses, which were sparse and infrequent, were a source of torment to her, and likewise her breasts. She was erotically attracted to girls. She denied having had any sexual activity or masturbated. Her libido was moderate. From the age of 10 on, she dressed consistently in male clothing. She wanted to have her breasts removed and her name changed.
Examination at 21 revealed: Calm, balanced woman with good insight; predominantly syntonic personality; IQ 103. Normal build: normal gynecologic state; normal breasts; normal pubic and axillary hair; no hair on body otherwise; hormone titers normal; normal EEG.
At 22 she got her name changed, androgen treatment was begun and her breasts were amputated. Too short a time has elapsed to be sure about the result, but she appears to be much more contented.
Case 33.
Female. Three older brothers, two older sisters and two younger sisters and one younger brother. Mother operated on for tuberculosis of the kidney. Father had back troubles. One paternal uncle was an alcoholic addict and committed suicide.
The patient was born in hospital, weighing 3860 g.
She was irritable and aggressive as a girl, and stammered. She wet her bed.
After leaving school with average marks she started doing various kinds of masculine work. She showed a slightly antisocial attitude, later interpreted as being caused by an attempt to be accepted as a male.
She said that she had had a comparatively happy childhood, and that neither of her parents was particularly dominant. She preferred her father.
She always felt like a boy. She played boys' games when she was small, and was embarrassed at having to undress for gymnastics. She entered puberty at 12, and was revolted by her menses and her secondary sex characteristics, She stopped wearing female clothing at the age of 10. At 17 she was taken to a department of child psychiatry because of her transsexualism; the records from that time say that she appeared to have attacks of petit mal. She was erotically attracted to girls, Her libido was weak, and she denied having had any sexual experience. It is not certain how often she masturbated, but probably not often. At 17 androgen treatment was started. She longed intensely for a change of name and to have her breasts removed.
Examination at 18 revealed: A quiet and reticent girt, unsure of herself; great asthenia: cerebrolesional syndrome; IQ 94. Normal build; normal gynecologic state; normal breasts; normal amount of body hair; normal pubic and axillary hair; hormone titers (before hormone therapy) normal; EEG at 17 abnormal, and photostimulation produced grand mal attack: at 18, EEG still abnormal.
At 19 she had her breasts removed and application was made for a change of name. At 20 she looked much more like a man, she had become more even-tempered, and was well adjusted to life.
Case 34.
Female. The patient was born out of wedlock and she knew nothing about her real father. She had one older sister and two older brothers. Her mother died when she was 10 and she was placed in a foster-home.
She was born at home. She said she was very prone to infection when she was small, but otherwise healthy.
After leaving school with average marks she worked chiefly on farms. She grew up in poor and slightly insecure circumstances, but on the whole she said that her childhood was not unhappy.
When she was a child she played mostly with boys and at boys' games. She always felt that she belonged to the opposite sex, and this feeling grew worse when she entered puberty, when she was revolted by her menses and breasts. She had not had any sexual activity either with boys or girls, but she felt more attracted erotically to girls than to boys, She said she had never masturbated and had a weak libido. She had worn neutral clothes since her early years at school and after 13-14 wore only male clothing, and she afterwards worked as a "man". She had occasional periods of depression and thoughts of suicide. She wanted an operation to make her body more masculine.
Examination at 22 revealed: Syntonic and psychoinfantile personality; tendency to depressive reactions; IQ 99. Normal build: normal gynecologic state; normal breasts; normal hair for female; normal hormone titers; normal EEG.
Case 35.
Female. Three older sisters and one older brother. Mother died when patient was 14.
The patient was born in hospital (impossible to get record of delivery).
After leaving school with good marks, she trained for an occupation in which she is now a "male" executive.
She said that she was brought up in a happy home, that neither parent was more dominant than the other, and that she liked her father best.
As far back as she could remember she felt that she was born into the wrong sex.
She played boys' games when she was small. She was not embarrassed about her body when she went to school. After puberty the feeling of belonging to the opposite sex increased, and she was disgusted at her own menstruation. She began to have frequent periods of depression. She was erotically attracted to women, and had some homosexual activity. She had a moderately strong libido. From the age of 30 on she lived as a "man".
At 31 hormone treatment was begun. At 37 her breasts were amputated, and at 43 she got her name changed. The results were excellent: she became extremely well adjusted and had no more attacks, of depression.
Examination at 42 revealed: Hysteroid, syntonic traits; good insight; IQ 112. Before androgen treatment, she was said to have had the physical characteristics of a normal woman; now after many years of taking androgens, she showed great virilism; EEG normal.
Case 36.
Female. Two younger sisters. Father drank, and parents quarrelled often. They divorced when the patient was 16. She was sometimes placed in foster-homes when she was small. The mother was "unstable and nervous" but had not been hospitalized for this reason.
The patient was born in hospital, weighing 2950 g. At 2 months she had dyspepsia and anemia.
After finishing school with average marks she did various kinds of work on farms, in factories and in offices. During the last few years she had worked as a foreman in a large factory, and was considered to be an excellent worker.
She did not think that either of her parents was particularly dominant. She was most attached to her mother as a girl.
When young, she always felt like a boy. She always played boys' games and kept company with boys. She disliked gymnastics and was embarrassed at having to change in front of girls. She began menstruating at 13; she had painful menses and suffered from premenstrual tension. She was revolted by her menses and the other signs of femininity she showed. She began cross-dressing now and then at the age of 10, and at 16 changed over to male clothing completely. She was erotically attracted by girls, was never interested in boys and never had heterosexual intercourse. But she obtained full satisfaction from sexual activity with girls. She had a moderate libido. She has now been engaged to a girl for several years. She had frequent attacks of depression.
At 22 she had her name changed, at 24 androgen treatment was started, and at 25 her breasts were removed. She became more adjusted to life, had fewer attacks of depression and grew more contented.
Examination at 24 (before amputation of breasts) revealed: A frank, accessible and intelligent person with a sober and realistic attitude to her problems; no distinct signs of depression at the time; predominantly syntonic personality; IQ 97. Ordinary female build; no gynecologic abnormality; normal breasts; normal pubic and axillary hair; normal hormone titers; nonnal EEG.
Case 37.
Female. One older and one younger sister. Father died when patient was 13. Mother described as "nervous", of solitary nature, and with a tendency to paranoid ideas. The older sister died while young from some unknown cause. The child welfare bureau had complained about the conditions in the home, and the patient was put in a foster-home for a time. One maternal aunt committed suicide.
The patient was born in a cottage hospital (no record of birth obtainable). After leaving school with average marks, she did various kinds of male types of work.
She said that she had had a happy childhood on the whole, except for the times her mother's peculiar nature had led to discord. She was more attached to her father.
She had heard that her parents had wanted a boy instead of her, but her parents had not reared her as a boy. When young she felt that she was a boy. She played mostly boys' games. She was embarrassed when she had to undress for gymnastics. She began to menstruate at the age of 15, and at this her feeling of belonging to the opposite sex increased, and she was revolted by all the characteristics of femininity she showed. She wore neutral clothing until she was 17, and then changed completely to male attire. She was erotically attracted to girls. She had made herself have heterosexual intercourse to see if it helped, but she had not enjoyed it. She became pregnant after one of her heterosexual relationships, and while she was pregnant, she still felt that she belonged to the other sex. She bore her child, but left it to the care of others. She had not had any homosexual contacts, and denied having masturbated. Her sexual libido was classed as weak. She had several attacks of depression.
Examination at 20 revealed: Quiet, shy manner; good insight; asthenic, syntonic and schizothymic traits; IQ 103. Slender build; no gynecologic abnormality; infantile breasts and hair around the nipples; male pubic hair; normal axillary hair; normal hormone titers; normal EEG.
At 21 androgen treatment was started.
Case 38.
Female. Only child. The parents quarrelled, probably because of the problems the patient created. The child welfare bureau intervened mostly because of the way the father treated her, and she was placed in foster-homes for a number of periods.
She was born in hospital, weighing 2915 g. The mother had previously had many spontaneous abortions, but she was not threatened with miscarriage while she was pregnant with the patient.
The patient was an irritable and aggressive child, and she was admitted to a department for child psychiatry before the age of 15 because of the difficulties she caused and because she insisted on identifying herself with the male sex. She began menstruating at 14, and in connection with this had a number of depressive and anancastic reactions.
She said that her mother was the dominant member of the family. She did not prefer either one of her parents particularly.
She always felt like a boy when she was small, -that she was "born into the wrong sex". She played boys' games and with boys. She was strongly repelled by all the characteristics she showed of the female sex. After 14 she wore only male clothes. When she finished school she did various kinds of work, always as a "man". She was erotically attracted to girls, but denied having had any sexual activity with either sex, or ever having masturbated. Her sexual libido was classed as moderately strong. Her transsexualism had made it extremely hard for her to adjust, and she had frequent attacks of depression.
Examination at 23 revealed.: A rather secretive and untalkative nature, though she discussed her problems frankly; schizothymic traits; mild but distinct cerebrolesional syndrome; IQ 112. Ordinary build; normal axillary and pubic hair; no gynecologic abnormality; low total gonadotropin titer for age; abnormal EEG.
At 23 she got her name changed and androgen treatment was begun.
Case 39.
Female. Three older brothers and four older sisters. Two sisters, twins, died shortly after birth. The mother died from thrombosis when the patient was 24. Father remarried.
The patient was born at home.
After finishing school she took jobs in different forms of masculine work, and was considered a good worker.
She said that she had an insecure family background because of her father's domineering and brutal treatment of his family. Her mother was submissive and warmhearted, and she was strongly attached to her.
Since as far back as she could remember she was only interested in masculine pursuits, never in anything typical of females. She was embarrassed by her body during gymnastics, and was repelled by her breasts and menstruation when she entered puberty at the age of 17. She acted like a boy, and the-family called her "sonny". She was erotically attracted to women. She tried to overcome her difficulty by getting engaged, but the result was a failure., She thought that heterosexual coitus was unpleasant. After her engagement broke off, she had homosexual contacts, and was satisfied by them. She had a moderately strong libido. When she masturbated she thought of herself in the male role. She dressed in neutral clothes until about the age of 37 when she changed over to living as a "man". She had frequent attacks of depression when she contemplated suicide.
Examination at 38 revealed: A frank, sensible attitude, and good insight; apparently normal intelligence, but IQ 82. Normal build; no gynecologic abnormality; pubic hair of slightly masculine distribution; no abnormal amount of hair on body; hormone titers normal; normal EEG.
At 39 androgen treatment was begun, and later the same year she had her breasts removed and her name changed. She became much more content with life afterwards, and got along well in her masculine role.
Case 40.
Female. Six older sisters and three older brothers. Parents died when patient was adult.
The patient was born at home.
After leaving school she worked mainly in shops. She was extremely well adjusted.
She said that she had had a happy childhood, that neither of her parents was particularly dominant, and that she liked them equally well.
As a child she liked to play boys' games. At 11 she became conscious of a feeling of belonging to the opposite sex, and this became accentuated at puberty, which she entered at about 14. She could not bear her own body. She began cross-dressing occasionally already before puberty, otherwise wore neutral clothing when she was a girl. At 23 she changed to being a "man". She was erotically attracted to women and had homosexual contacts. She had a moderate sexual libido and her masturbatory fantasies were of females.
At 27 she started taking androgens, at 28 she had her breasts amputated, at 33 her uterus was curetted and radium implanted, and she had her name changed, and at 36 she was officially registered as a male. The results of treatment were extremely good. She was now contented with life, had a good working capacity, and was happily married.
Examination at 35 revealed; Mainly syntonic, slightly schizothyrnic personality; objective, intelligent attitude to her problem; IQ not measured. The many years of taking androgens had led to strong virilism. The EEG was not recorded.