The syndrome of male transsexualism is characterized by a life-long preference for the feminine role, predicated on the conviction of belonging to the female sex. This conviction is held and persists despite the painfully obvious fact of normal male anatomy and genitalia, before and after puberty, and in the absence of delusional ideation or psychosis in the majority of transsexuals studied. He is disgusted with the development of his primary and secondary sexual characteristics, to the point where the male transsexual frequently contemplates and occasionally performs self-mutilation of his genitalia. He prefers normal, heterosexual men as sexual partners, and rejects homosexual men or the idea that his sexual activity is homosexual. Feeling he belongs to the female gender, he considers it appropriate to have a love relationship with a man, and he feels “unnatural” in a relationship with a woman, considering this “homosexual.” There is some evidence that sex or overt sexual activity, whether it be considered homosexual or heterosexual, plays a minor or secondary role. The transsexual may decide to pass and become accepted as a female, either before or after sex reassignment surgery, depending upon individual circumstances.
The postoperative results of 121 male transsexuals who have obtained sex reassignment surgery are reviewed. A satisfactory outcome, as indicated by improved social and emotional adjustment, is 10 times more likely than an unsatisfacory result. Improvement is enhanced if the transsexual has functional use of an artificial vagina, obtains a legal change of gender status and freely passes in society as a member of the opposite sex. At the present time one is impressed with the lack of success in attempting to alter gender identity, once established, by traditional psychotherapy. This fact, together with the apparent success of sex reassignment surgery, compels one to accept the surgical treatment of transsexualism on an experimental basis until the initial results can be verified or contradicted or until alternative treatment procedures prove successful.
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