This paper touches on two issues that have been disputed by child analysts: the genesis of the transsexual symptom complex, and the question of transference neurosis in child analysis. My observation, as reported previously (Loeb and Shane, 1980) and shown in the present case, is that the transsexual symptom complex can develop out of intrapsychic conflict and can be resolved in a fully developed transference neurosis. In the analysis of a four-and-a-half-year-old boy with transsexual symptoms, I was abstinent—not benevolent or supportive—and both positive and negative transference feelings developed into a full-blown transference neurosis. Then, as I interpreted its elements, we worked through his conflicts, which manifested themselves as acting out of his identification with his aggressive, seductive, and castrating grandmother. As he came to understand his conflicts, the boy's transsexual symptoms vanished.