Letters to the Editor

Dear Sir:

Dr. Siomopoulos tackles a very important problem, the etiology of transsexualism ( J. Am. Acad. Psychoanal. Dyn. Psychiatr.,  2 (3):  201-214↗). I cannot follow him in his conclusion that transsexualism is a form of paranoia. As Dr. Siomopoulos is endangering the treatment of these patients, I feel obliged to put my objections into writing. I disagree with Dr. Siomopoulos on two main points.

Dr. Siomopoulos bases his diagnosis of transsexualism as a thought disorder on ascribing to the patient “a particular type of thinking which allows his inclusion into the class ‘females’ on the basis of the single characteristic of feminine—sexual and other—interests” (italics mine). The classical transsexual presents a long history, usually from very early childhood on, of opposite-sex role behavior which pervades all areas of the child's life including toy preferences, game preferences, sex roles in fantasy games, activity level, fighting behavior, sex preference in peer relationships, cross dressing, and so on. These behavioral features do not show up only in overt behavior but also in dreams and fantasies. It is certainly not appropriate to call such pervasive behavior patterns a “single characteristic.” It is well known in child psychology, that children of preschool age classify the sexes primarily by external appearance of hairdo, clothing, and behavior whereas classification on the basis of genitalia develops considerably later in childhood when the gender identity disorders have long been established in most cases. Thus, in comparing his behaviors, interests, feelings to those of other children, the gender-disordered child shows realistic thinking rather than a thought disorder when he sees himself on the cross-gender side.

My second objection concerns Dr. Siomopoulos' conclusions regarding treatment. He refers to the “potentially dangerous surgical-hormonal treatment whose beneficial effects in the long run,…, has not yet been ascertained,” and condemns it as restin