The authors present an interesting and genetically well-documented paper. It traces the development of a thirty-three-year-old male through stages of feminine identification, homosexuality, and transsexualism, leading to an attempt at surgical resolution. It also contains an eighteen-month follow-up of the patient's current adjustment. The dynamic family configuration presents some variations from Stoller's formulation of such cases: a bisexual mother keeps her son too close to her body too long, creating an unending symbiosis, and a psychologically absent father fails to interrupt the process. The authors' central hypothesis is the regressive diffusion of the patient's fragile gender identity into primitive 'as if' and 'fusions of self and object' modes of infantile identification. The presentation is rich in concrete and human clinical details.