Hertz, Tillinger & Westmann, 1961
Psychiatric University Clinic (Karolinska Sjukhuset), Stockholm, Sweden

This is the first follow-up study that we could find in which a group of at least five operated transsexuals are described. From today's point of view it is remarkable how the authors presumed that it is self-explanatory that there was no psychiatric therapy possibility for these patients. Because of this premise, it is understandable that in the cases almost no pre-treatment of patients were documented and that patients were in no pre-operative continuous treatment.

• Sample
• Study Methods
• Evaluation Fields and Criteria
• Results
• Case Studies
• Role Re-reversal
• Follow-up Studies Mentioned
• Authors' Conclusion
• Remarks

Study Methods
The authors who participated in the treatment had some unstructured interviews in regular intervals that are not defined.

Evaluation Fields and Criteria
In the case studies many contextual evaluation areas are regarded. A systematic representation was not done. Two global conclusions are given in tabular form for every patient: First, the result was placed in the categories "better," "good" or "worse" immediately post-surgically. Second, for the follow-up study time it was differentiated into categories "very satisfactory," "satisfactory" and "not satisfactory."

Results
Females: Immediately post-surgically the results were good for one of the females and long-term satisfactory. This woman was depressed at times and, because she did not have a vagina, considered herself only "half woman." The conclusion for the other female for the post-surgical period was better, and long-term satisfactory (see below).
Males: Of the males, two were evaluated post-surgically as better and one as good. In the follow-up studies the global evaluation for two was satisfactory. Subjectively all three males were happy with their situation, even though no phalloplasty was done. Post-surgically, all five patients were able to change their name and sex legally.

Case Studies
All courses are clearly documented.

Role Re-reversal
Five years after the first surgery (orchidectomy and penectomy), one female, who felt notably better than before, had a vagina constructed at her insistence. Because of the scars, the result was, particularly from a functional viewpoint, unsatisfactory. This patient was increasingly depressed and finally developed a psychosis and, four years after this surgery, lived again as a male.

Follow-up Studies Mentioned
Hamburger et al., 1953

Authors' Conclusion
The authors remark that their experience is very limited and "permits no definite conclusions concerning the value of surgical intervention in transvestitism" (p. 292). Long-term studies with larger groups are necessary to make assertive statements.

Remarks
The sceptical conclusion of the authors regarding psychiatric treatment possibilities was frequently cited in the affirmative until the end of the 1970s and after that, in many other more general works regarding the theme, were criticized just as frequently.