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The authors examined a group of five male transsexuals who had undergone sexual reassignment and who were unhappy or repentent and compared this group of "unfavorable results" with a group of nine patients who had a favorable outcome. They derived a group of factors which could be considered prior to surgery that would serve as indicators of poor prognoses. The major factors were: (1) an unstable personality, (2) criminality, (3) inadequate support from family,
(4) inadequate self-support (inability to hold a job), (5) inappropriate physical build (heavy bone structure, large hands, athletic muscle development, coarse features and profuse body hair), (6) heterosexual experience indicating the subject had at some time achieved full coitus. An additional major factor that was present in those who had an unfavorable outcome involved the age at the time of the request for intervention—the older the patient at the time of intervention, the more unfavorable the outcome. Other factors that have been mentioned by these authors as well as by others is the poor prognosis in those patients who have had a psychotic reaction or those who have mental retardation, alcoholism, and/or drug addiction.