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University of Minnesota, USA

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University of Ulster at Coleraine, UK

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University of Liverpool, UK

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University of Minnesota, USA

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University of Minnesota, USA

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book Historic Papers


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Symposion Publishing

ISSN 1434-4599

Harry Benjamin, M.D.

51 Male Transsexuals and the Results of their Operations next

Operative data

By the end of 1964, a total of 249 male transvestites were observed in my offices, either in New York or in San Francisco. Of these, 152 were diagnosed as transsexuals. This figure, however, may actually be higher as some transvestites do not reveal their true intentions during the first few interviews. In some others, an apparent transvestism may gradually seem to progress into transsexualism with or (more likely) without any treatment and patients originally diagnosed as transvestites (of the II or III type in the S.O.S.) are actually transsexuals (V or VI on the S.O.S.). A few of them are among the 51 cases operated upon.

These patients were, in the earlier years, mostly operated upon in Denmark, Holland, or Sweden, and a few in Mexico. Then, Dr. Elmer Belt in California performed a series of such operations. In approximately half of them I could observe the results. Dr. Belt discontinued this type of surgery a few years ago, largely for personal reasons. During the last three or four years, most conversion operations among patients I know were done in Casablanca, Marokko, by a French surgeon, Dr. Georges Burou. Reports have reached me of operations being done occasionally, rather secretly, in the United States, rather freely in Japan, occasionally in Mexico,and a few in Italy.

In the three northern European countries, the operations are still being performed but only on their own citizens, not on foreigners, because too great an influx of patients from other countries, especially the United States, is feared, patients who would want to take advantage of the more enlightened attitudes in matters of sex in Denmark, Holland, and Sweden.

The technique employed by the different surgeons undoubtedly varied from time to time and according to the patient, particularly concerning the formation of the vagina. In the majority of the 51 cases of operation in this country, the vaginal canal was lined with skin taken from the thigh, while in all those operated upon in Casablanca the inverted skin of the penis was utilized. In two patients that I know of, a short piece of gut (ileal loop) was removed and used to form the vagina. This technique naturally constitutes a more extensive operation as it involves the opening of the abdominal cavity. In four of my 51 patients, the technique is unknown.

As far as pain and discomfort after the operation are concerned, the reports that I received varied greatly, probably in accordance with the constitutional pain threshold of the individual, his psychological state, the atmosphere in the hospital, the operative technique, and the way the surgeon and his staff acted.

From "It was rough," "I had dreadful pain, especially the first few days," to "It was really nothing," "I had very little discomfort," all kinds of descriptions were related to me. It seems that the most frequent complaint was about painful, early, and sometimes forcible dilatation of the newly created vagina with an instrument or with the surgeon's fingers.

The fees reported to me by patients ranged in the majority from $2,000 to $4,000, usually including a three- to four-week stay in the hospital. It was disheartening to some patients to be prepared to pay the reported fee of $2,ooo or even $3,000 to a particular surgeon, only to find out when they tried to make a definite appointment that the price had gone up $5oo to $1,ooo in only a few months' time. The surgeon, however, is said to have operated anyhow, allowing the patient credit for the balance of the fee.

Personal data

The ages of the 51 patients at the time of their operations were as follows:

23 in their 20's
14 in their 30's
11 in their 40's
3 in their 50's

The youngest patient was twenty years old. The oldest was fifty-eight. The average age was 33.02 years.

The social (educational) level of these patients was as follows:

Upper 6
Middle 37
Lower 8

At the time of their operation, the patients stated the following occupations:

Occupation Number
Office work 10
Salesperson 3
Musician 1
Store proprietor 3
Hairdresser 6
Housewife 5
Stockbroker 1
Show business (acting) 10
Domestic 1
Office manager 1
Prostitute 3
Teaching 2
Practical nurse or companion 2
Photography 1
Retired 1
Unknown 1

Hypogonadism, that is to say, a more or less distinct sexual underdevelopment, existed in twenty patients (39.2 per cent).

There are nine only children among the 51. This amounts to approximately 17.6 per cent, which is higher than in the general population at a given time (Maximum 10%).

First evidence of transsexualism among these 51 patients was reported as follows (this would refer to the patient "feeling" like a girl, dressing in mother's or sister's clothing, etc.):

Early childhood 43
Puberty 2
Unknown 6

Evidence of childhood conditioning was as follows:

Positive conditioning 12
No evidence 28
Doubtful evidence 10
Early history unknown 1


In perhaps twenty-three patients, the sexual motive appeared to be dominant. The gender motive seemed to prevail in twenty-eight cases. A sharp separation is not possible. As explained previously, the legal motive exists in all cases and the social motive has to be thought of in only a minority.

Results of the conversion operation

In assessing the over-all results of the operation (to which estrogen treatment has to be added in practically all cases), several factors have to be considered: the physical and mental health, the emotional state, the social status, as compared to that before the change; the attitude of the family, the position in society, and last but by no means least, the sex life, largely dependent upon the adequacy of the newly created female genitalia, especially the vagina.

As to the period of postoperative observation, the longest period was thirteen years, the shortest period three months, with an average period of five to six years.

The descriptions of the results are based on personal interviews and examinations in forty-six cases. Otherwise, or supplementing the examinations, was correspondence, sometimes with the patient's doctor as well as with relatives or friends.

In describing the total result as good (including those that could be called excellent), satisfactory, doubtful, or unsatisfactory, conscious conservatism was attempted. In some cases, major or minor corrective surgery in the genitourinary region had already been performed when the estimation was made. In others, such operations may still have to be done and if successful, may then alter the estimation upward. The same could be said of later cosmetic procedures, especially breast surgery.

The impression of the total result was judged with the inclusion of the sex life, provided it played any part for this particular patient. This was not always the case. The results were:

Result Number Percentage
Good 17 33.3
Satisfactory 27 52.9
Doubtful 5 9.8
Unsatisfactory 1 1.9
Unknown 1 1.9

To be assessed good, the total life situation bad to be successful as well as the sex life. A good integration into the world of women with acceptance by society and by their families was essential.

Regarding the sex life, more will have to be said later. Here it should only be noted that an absence of an orgasm, if unimportant to the patient, did not necessarily exclude her from the good classification. If this defect, however, was sorely missed by the patient, the result was not considered good.

If the result was distinctly lacking in any of the above areas but otherwise fulfilled the patient's wishes, it was termed satisfactory.

Whenever I was uncertain whether to judge the result good or satisfactory, the latter designation was chosen.

Cases were considered doubtful whenever only insufficient or contradictory information was available, or whenever the genital status (appearance) and sex functions were unsatisfactory, yet the relief from gender unhappiness was present and the patient had no regrets.

Considered unsatisfactory was the case of a "woman" now sixty-four years old, of Latin extraction, operated upon in Europe in 1955 without my consent. She was the only one who expressed regret over the decision to be sex changed. The operation, incidentally, did not include the formation of a vagina. This patient, in his former male role, was reasonably prosperous, having always held a well-paying position in the business world. As a woman, he was never able to make a satisfactory living and was always in financial difficulties, although fully acceptable as a women in appearance and manner. She had insisted on conducting her own mail-order business in which she had no experience. Her command of the Spanish language was hoped to be a great asset. Alas, it did not prove to be so.

Her general health had also failed, perhaps owing to psychosomatic influences (lack of a sex life?) and a return to the male status is now being considered and most likely advisable.

In this case, the sex motive had probably played an equal part with the gender and legal motives when the operation was decided upon at the age of fifty-six. Emotional frustration, however, compounded by economic failure and the aging process, probably led to the present unsatisfactory state which, as may be hoped, can be improved under a new life pattern.

Here, the outcome of his venture into the female world was considered unsatisfactory by the patient himself. Such selfassessment, I feel, is necessary to justify an unfavorable diagnosis. I found no other similar example among the 51 patients.

In one other instance too, the outcome could be considered "unsatisfactory," although this patient never actually said so or expressed the wish to return to male status. Here again was economic failure as a female and with it, failure in the social status, so that the present "woman" cannot be compared to the former man. In addition, there is no satisfactory sex life. Yet female dress and female occupation (factory work) were considered preferable to the previous well-paying male job (architect). Here a satisfied gender motive evidently acted as a compensatory factor.

Three of the 51 TSs operated upon unfortunately have died. One was successfully married as a woman for six years, a house wife and clubwoman, a charming, intelligent lady who succumbed to a fatal heart attack at the age of 50.[1]

The second died a "narcotic death," according to the medical examiner's office (see page 68 in Chapter 4).

The third died in her 51st year. Her "sex change" dated back to 1954 when she was operated upon in Holland but without the formation of a vagina. This was first attempted later in the same year in the United States, but unsuccessfully. The vagina was reconstructed in the United States in 1958 but a vaginorectal fistula developed. It was repaired successfully the following year.

In the meantime, the patient had lived in reasonable comfort as a woman, held a clerical position with a large business concern for ten years, and was fully accepted as a woman. She enjoyed several "sex affairs" after the final operation on her vagina.

The patient died late in 1964 of a complication of illnesses requiring repeated operations. Several large liver cysts were removed. (There was a history of hepatitis in the late forties.) Part of a benign pancreatic tumor was excised. Later a "dormant" carcinoma of the pancreas was discovered. She was also operated upon for stomach ulcers, developed diabetes and hypertension, but the immediate cause of death was a pulmonary embolism.



If an example was given above in some detail of an unsatisfactory outcome of the operation, at least one history should in fairness be related where a good (if not excellent) designation is justified.

Jonathan, usually called Johnny, was twenty-four years old when I saw him first. He was a miserable, unhappy young man of rather short stature, slightly overweight and moderately underdeveloped sexually, a transsexual of the VI type in the S.O.S. He worked in a restaurant as a checker. One of the headwaiters was homosexual and gave our patient a bad time with his unwanted propositions. While Johnny was attracted to men, he disliked homosexuals. "They want another man," he said, "but I feel I am a girl."

Finally Johnny had saved enough money, his family was understanding, and a psychiatrist to whom I had sent him definitely recommended surgery. One year later, he went to Europe (in 1955) and, in those earlier years, had only a castration and penectomy done. An American surgeon, two years later, fashioned a well-functioning vagina.

Then Johnny (now Joanna), met a man a few years older than he (now she) when she was working as a receptionist in a dentist's office. He was and still is a reasonably successful salesman. He fell in love with Joanna and married her. He knows only that Joanna as a child had to undergo an operation which prevented her from ever menstruating or having children. They have had a distinctly happy marriage now for seven years. Joanna no longer works but keeps house and they lead the lives of normal, middleclass people. To compare the Johnny I knew with Joanna of today is like comparing a dreary day of rain and mist with a beautiful spring morning or a funeral march with a victory song. The old life in the original (male) sex is all but forgotten and is actually unpleasant to be recalled.

This "John to Joanna" transformation is not unique. It could be duplicated perhaps a dozen times among my own patients, naturally with all kinds of variations.

Yet these successful outcomes should not deceive us as to the risks involved. While most transsexuals who underwent the operation were decidedly better off afterward than before, they did not become models of emotional stability and mental adequacy. A few do remain more or less disturbed, insecure, in precarious emotional balance, problem personalities who could perhaps be helped by psychiatric guidance. Alas, too few seek it and that may be another reason why some drift occasionally into reactive depressions or into promiscuity, prostitution, and addictions. The salvaging of transsexuals does not always end with the operation, though without it there would have been no hope.

Changes following the conversion

Physical Changes
The physical changes soon after the operation were few. It takes time for them to develop. They can generally be described as demasculinization, but actual feminization is probably due more to the continuing estrogen medication than to the surgery (see Chapter 6). If the technique included castration, it is conceivable that a reduction of androgen production aided the estrogen effect, unless one adheres to the theory that the testicles of transsexuals always produce a considerable amount of estrogen. As yet, this has not been proved, although one may suspect it at least in some cases from evidence so far inconclusive.

The regular loss of weight during hospitalization is soon recovered and a moderate gain in weight (owing to estrogen, especially Enovid medication?) soon takes place. Estrogen medication occasionally seems more effective, even with smaller doses, after the operation than before, which may be psychological, but could also be endocrine provided the testicles had been removed. Actual castration symptoms were rarely observed, undoubtedly on account of the continuing estrogen therapy.

The "female form"
Breast development, necessary for an emotional relief in all transsexuals, may respond a little better to estrogen after the operation (with castration), but, to repeat, I still feel that this particular response is more dependent upon constitutional, hereditary factors than to any particular form of therapy. Sometimes small doses are more effective than large and sometimes it is the other way around. Therefore, breast surgery, with implants of various types, is often chosen as a surer, quicker, although more risky way to acquire the All-American "May West-Jayne Mansfield" bosom. The sometimes exaggerated and unnatural results, the usual hard, marblelike structure, seems no deterrent and can please just the same.

In several cases, I saw infections develop that necessitated the removal of the implant. Silicone injections into the breast tissue, wich some plastic surgeons prefer, yielded a satisfactory result in one case and rather negative results in two or three others.

After a recent survey [2] conducted in this country, the American Society of Plastic and Reconstructing Surgery came out against breast implants or similar devices used in women; thirteen out of twenty-three doctors had discontinued this technique after finding it unsatisfactory. "Stick to falsies," they said.

Mental changes
The mental changes were invariably more pronounced than any physical ones, as is to be expected. The great satisfaction that goes with a final accomplishment of a difficult and long-sought-for mission was strikingly evident. Occasionally, however, it was marred by an unsatisfactory genital (and sexual) state and the necessity of further corrective surgery.

"How do you feel now, after it is all over?" was my regular question. The answers ranged from "In seventh heaven," and "Oh, so wonderful," to the more cautious "Okay, I'm glad it's all over." My "Would you do it again?" was answered in the great majority of cases with an emphatic "Yes." A few were hesitant; two said: "I don't know" and one or two inclined toward "No," because there had been too much pain and discomfort and the result, because of sexual difficulties or frustrations, not sufficiently rewarding, at least at the moment (see also remarks on page 120 in this chapter).

Handicaps and disappointments
Invariably, disappointments had to do with the sexual functions. If the surgical result was satisfactory, the sex motive for the operation later on requires the proper sex partner in the form of a husband or lover. Even an attractive girl may find it difficult to meet her Prince Charming. If she feels that time may be running out, it could easily cause much feeling of insecurity, dissatisfaction and depression, in spite of the attainment of her life's ambition, and still leave her with unsolved problems.

The physical state of the vaginal canal is, however, paramount for all those whom the sex motive led to the conversion. To repeat: unless proper, skillful dilatation of the vagina is resorted to from the very beginning, the vagina may contract through scar formation, even years later, and eventually close up entirely. This would necessitate a new and major correction, possibly with the formation of a new canal, lined with skin from the thigh or even a loop of intestine.

Minor scar formation or insufficient depth or (rarely) a retention of a small penile stump can more easily be corrected. In three of four cases a widening of the urethral opening was necessary and in one case, unsightly and disturbing long scrotal folds had to be shortened to resemble the labia majora.

The immediate postoperative period is fraught with the possibility of complications. Constitutional factors, the surgeon's skill and experience, and scrupulous aftercare seem to be vital factors in avoiding disappointments and securing ultimate success.

In a smaller group of patients the gender motive outweighed the sexual. Thus the state of the genital region was of minor importance as was their entire sex life. 

The inability to achieve orgasm was a handicap for only a few. Pleasurable sensation and satisfaction were repeatedly claimed even without an actual climax. However, definite orgasmic ability with a more or less distinct ejaculation from the urethra was described by more than half of these 51 patients, although the orgasm did not take place on every occasion (which is the case in normal relationships too). The explanation for the orgasm without a clitoris and a natural vagina is probably twofold. First, the psychological effect of, at last, being able to take the longed-for female role in the sex act. Second, the possible retention of sensory nerve ends in the scrotal (now labial) fold and also in the penal (now vaginal) tissue, provided this particular surgical technique was used. Occasionally it took several months, and of course the right partner, before the first orgasm was achieved. But even without it, they were satisfied with their ability to be a normal sex partner (in a face-to face position) to their husband or lover. Ejaculation even with orgasm does not persist for long. It usually disappears, in all probability, with the gradual atrophy mainly of the prostate gland.

Corrective surgery
Among the 51 cases, major corrective surgery was required in eight instances, minor in seven. The major consisted of the formation of a new vagina with a lining different from the one originally used. Minor ones were usually the removal of scar tissue and surgical dilatation of the vagina or urethra with prescription for molds or dilating objects for the former.

Additional surgical corrections were required in twelve of those (among the 51) whose vagina was lined with body skin. It was necessary in three who were operated upon with the use of penile skin.

The male transsexual's life after conversion

Postoperatively, it is a great delight right away for the true TS to view his (now her) own genitals in the mirror, thus having visual proof of femininity. To show the female genitals to doctors or intimate friends likewise gives great satisfaction.

My secretary told me she once entered the waiting room unexpectedly and saw a newly operated upon TS with uplifted skirt, proudly and quite unconcernedly exhibiting her "female" genitals to two other TS patients. But aside from the appearance, the attainment of a sex life as a woman is the most essential part of the future life, with marriage and the possible adoption of children as the dearest wish.

The sex life is less essential or altogether immaterial if the gender motive was the driving force for the operation.

Of these 51 patients, twelve married as women. Also, twelve were married previously as men. Five have experienced married life from both sex angles (as a male, unsuccessful, some not even consummated); five were divorced [3] as females and three remarried one or more times.

Of the 39 unmarried, twenty-three reported sex relations. Of these, nine are part or full-time prostitutes, at least at this time of writing.

The unfortunate fact that a number of patients went into prostitutional activities right after their operations has turned some doctors against its acceptance as a legitimate therapy.

As one urologist expressed it: "I don't want a respectable doctor's clinic to be turned into a whorehouse."

Behind this exaggeration is not necessarily a puritanical mentality alone. It may have very practical reasons (loss of other patients?) or spring from the idea that a doctor is not only there to protect or restore his patient's health but also his morals.

A physician with such a concept may enjoy the feeling of being on the side of the angels but he scarcely has ethics or logic for support. Should a physician refuse to heal the injured right hand of a pickpocket because he may return to his profession and perhaps forge checks besides? Should a urologist - for argument's sake - decline to treat sexual impotence because a cure may induce the patient to start an illicit love affair or, if married, lead him to adultery?

A doctor could hardly be held responsible, and should not hold himself responsible, for what a patient will do with his regained health. That is none of his business. Such an attitude could lead to endless absurdities as the above examples show. 

The medical literature on the conversion operation

Scientific reports as to the result of the operation are so far meager indeed but will most likely increase in the near future. Several reports in the past dealt with only one case, successful or unsuccessful. In 1961, an article appeared in Acta Psychiatrica Scandinavica [4] written by John Hertz, Karl-Gunnar Tillinger, and Axel Westman, dealing with five cases. Here is their summary:

The authors give a report on five cases of Transvestitism, two males and three females. After a thorough examination, including endocrinological and psychiatric exploration, they were all treated hormonally and surgically. In the males a surgical demasculinization, i.e., extirpation of the penis and scrotum with its contents, was followed by administration of oestrogens while in the females a defeminizing procedure, i.e., extirpation of the ovaries, tubes, and uterus as well as extirpation of the breasts, was followed by treatment with androgens. Postoperative follow-ups for 3½ to 16 years revealed that the final outcome in three of the cases could be characterized as satisfactory and in one case as definitely good. In the fifth case the outcome was satisfactory until an unsuccessful attempt to form an artifical vagina induced rather deep depression.

Dr. Leo Wollman, noted gynecologist and student of hypnotism, who had occasion to examine and treat a considerable number of transsexuals after their operation, has this to say: [5]

"Before irrevocable surgery makes the transition from male to female physically permanent, it is essential that a psychiatric evaluation and a psychological examination be done. This is indicated for the protection of the physician as well as the patient. Also a period of observation under estrogen therapy to reduce libido and tension is recommended.

It is suggested, as an avant garde technique, that hypnotic progression might be an important asset in the true evaluation of the transsexual's needs and aspirations. This projection into the future may, in some cases, dispel certain faulty attitudes and provide the faltering future female with second thoughts before definitive surgery.

Following the preparatory estrogen hormone therapy to provide breast tissue and decrease the male libidinous feelings, the transsexual embarks upon a new life immediately after the surgical removal of the external male sexual apparatus and the creation of a functional vaginal sheath. Many varying surgical procedures have been divised and are being carried out with equivocal results. However, in those cases where medicine and surgery have sucessfully created a phenotypic female, the "gynecological" problems of the male-to-female individual merit special attention.

For this patient, patient understanding and gentle treatment are necessary. The most frequent complaint after the operation, excluding the painful convalescence, is urinary frequency usually due to a urethro-cystitis. Antibiotic treatment will effect a rapid surcease from the disquieting urinary signs and symptoms.

A rather unusual urinary complaint is the control of the direction of the urine stream flowing from the os urethrae. If the urethral opening remains high, the flow will run over the rim of the toilet seat. This messy condition may be prevented by adjusting the tilt of the pelvis to permit the urine to flow into the bowl.

Another common complaint is the inability of the transsexual (now a female) to consummate sexual intercourse. This may be due to many factors. Notable among these are 1) an atretic vagina, 2) a narrow introitus, 3) a thin vaginorectal septum, 4) an insufficiently lubricated vaginal canal, 5) vaginal bleeding from the apex of the freshly scarred vaginal pouch after vigorous coitus.

Treatment for these aforementioned dyspereunic states will vary with the condition found. Simple hygienic measures, proper lubrication methods, new coital techniques, dilatation by means of a Kelly aluminum dilator or a bakelite Young's dilator or a solid plastic mold worn with a flattened superior surface to protect the urethral passage, and sensible advice usually meted out to newly-weds are some of the physical and psycho-physiological treatments found effective.

Above all, it is imperative for the gynecologist to regard his patient as a "female" - as "she" so rightly deserves to be considered after the lengthy and costly efforts to become a physical female. A great deal of research is indicated by the medical and psychological investigators before more consistent help can be offered to these male transsexuals, now ostensibly functioning females. The Harry Benjamin Foundation is now actively engaged in a research program of this type."

In a lecture before the American Psychiatric Association, on May 6, 1964 in Los Angeles, Ira B. Pauly, psychiatrist at the University of Oregon, carefully reviewed the international literature on transsexualism. I am quoting from the summary in his manuscript:

The transsexual attempts to deny and reverse his biological sex and pass into and maintain the opposite gender role identification. Claims of organic or genetic etiology have not been substantiated. The evidence from cases of transsexualism appears to complement the information from studies of human pseudo-hermaphrodites and stresses the significance of early learning and conditioning in the determination of gender role preference. The choice is made early and is difficult to reverse. Although psychosis is not frequent in the schizophrenic sense, in its most extreme form, transsexualism can be interpreted as an unusual paranoid state, characterized by a well-circumscribed delusional system in which the individual attempts to deny the physical reality of his body. The term Paranoia Transsexualis has been suggested as an appropriate descriptive term for this syndrome. Psychosexual inversion is seen as a spectrum of disorders, from mild effeminacy to homosexuality, transvestism, and finally transsexualism, each representing a more extreme form, and often including the previous manifestation. An attempt to approximate the female anatomical structure is the final step in this syndrome. At least 93 men and 22 women have obtained surgical intervention to some degree. Follow-up studies at the present time are inadequate to determine empirically the value of surgical treatment in this syndrome. An understanding of this syndrome may prove helpful to further our knowledge of psychosexual development in general, and hopefully reversible problems of psychosexual identity in particular.

Per Anchersen [6] writes as follows:

In treatises on these problems we find that the discussion has been characterized by strong emotional reactions and conventional points of view. Glaus (1952) mentions two male transvestites who were operated (castratio and ablatio penis) and who afterwards gained a feminine social position. He adds himself a third similar case.

In an extensive discussion in Psyche (1950), religious and ethical views were raised and disturbed the impression of more rational points of view (M. Boss, C. G. Jung, H. Kranz, and others). In Denmark Stürup and collaborators have maintained a sober humane point of view in order to manage to help these unhappy human beings to a better psycho-social adjustment.

Interpreting the result of a sex change operation is not as easy as that of a cataract or a gallbladder removal. Too many factors enter, psychological and physical, that may obscure the issue, and not the least, the observer's own attitude may color his reports. Much of it has been discussed in previous pages. Furthermore, the statements of patients who may still have their neurotic tendencies have to be employed as yardsticks much more often than measurable physical changes. There are also patients who want to please the doctor with their statements. Pauly calls transsexuals "unreliable historians." Furthermore, the results observed and reported by one investigator are not enough. They should be complemented and confirmed by others, working possibly in a different emotional atmosphere and with different medical criteria.

I have heard the operation condemned by a prominent internist who never saw a single case. He replaced knowledge with arrogance when uttering his prejudices. I have heard the results of the operation generally minimized by a surgeon and also by a psychiatrist who saw only those doubtful or temporarily unsatisfactory cases who came to them for further help. They did not see and therefore did not consider those who were well and satisfied and no longer in need of medical attention. It has been my endeavor to avoid these pitfalls.


My observations have forced upon me the conclusion that most patients operated upon, no matter how disturbed they still may be, are better off afterward than they were before: some subjectively, some objectively, some both ways. I have become convinced from what I have seen that a miserable, unhappy male transsexual can, with the help of surgery and endocrinology, attain a happier future as a woman. In this way, the individual as well as society can be served. The rejection of the operation and/or treatment as a matter of principle is therefore not justified.


[1] This patient bad not been castrated, therefore may have retained more androgenic activity.

[2] Quoted from Science Newsletter, Oct. 22., 1965, p. 264.

[3] Or marriage annulled.

[4] Vol. 37, Fas. 4, 1961, pp. 283-294.

[5] Personal communication.

[6] Per Anchersen, "Problems of Transvestism," Acta Psychiatrica et Neurologica, Supp. 106, 1956.

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