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There has been a great deal of discussion about the transsexual syndrome.1-16 Much of this discussion has been in an attempt to identify those persons who have the greatest likelihood of benefiting from sex reassignment surgery while also identifying those persons not likely to benefit or indeed likely to be psychologically harmed by surgery. Newman and Stoller16 report that the prognosis for transsexual surgery is best for those individuals who meet the following criteria: evidence of lifelong femininity, inability to live in one's assigned biological gender role, and the capacity to pass effortlessly and continuously in society as a member of the opposite sex. The prognosis is thought to be less favorable if one or more of these criteria is absent. Similarly, alternate, less adequate reasons for desiring surgery have been noted. Some homosexual males seek sex reassignment surgery in order to become more appealing to those male homosexuals attracted to feminized men. Some individuals with fetishistic, transvestitic interests may also seek transsexual surgery. Some seek this surgery while in the midst of an acute schizophrenic episode. The advisability of surgery under these circumstances is greatly diminished.
Psychodynamically, true male transsexuals have been described6, 7, 14, as persons who had weak, passive, and/or physically absent fathers; and as persons who had continuous close physical contact and a symbiotic relationship with their mothers during the first three years of life.
Following up on this previous work and in an attempt to further explore possible dynamic reasons for the seeking of sex reassignment surgery by males, we will present information about the following 30-year-old biological male who came to our attention through his request for evaluation for surgery. He is interesting because he does not meet all of Stoller's criteria for surgery, yet he does not evidence those types of psychopathology and/or sexual orientations which contraindicate se