Benjamin, 1966
Private Practice, New York, NY, USA

This first monograph about transsexualism became, especially among US (American) patients, a well-read text. The author reports about his increased sample (comp. Benjamin 1964a, b, c). In the appendix of the book there is an article by Lal about the complimentary of genders and by Green a text about the mythological, historical and transcultural aspects of transsexualism and by Masters an article about autobiographies of transsexuals.

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

Study Methods
Interviews and physical examinations were done. Also the correspondence with patients and information by general physicians, friends or relatives were considered.

Evaluation Fields and Criteria
Evaluation fields and criteria are explicitly defined only for females. The physical and mental health, social situation, family relations and sexual functioning were evaluated. The evaluation was done mostly analogous as in Benjamin (1964a, b) to the mentioned ratings with the only divergence that the best rating category was not "excellent" anymore, but "good." (comp. Benjamin 1964c).

Results
Females: In the overall rating the results were 17 (33.3%) of the females considered as good, 27 (52.9%) considered as satisfactory, five (9.8%) as doubtful; and one (1.9%) was considered in each of the categories unsatisfactory, resp., unknown. The question if they would undergo surgery again was answered in the affirmative by the majority. One was hesitant and two were undecided. The inclination of one or two was toward the answer "no" because they had so much pain and difficulties and that the results, especially because of sexual difficulties, were not satisfactory. More than half of the females had orgasms from sex. Not having orgasms was only considered by a few females as problematic. Major corrective surgery was done for eight females, minor surgery for seven. After surgery, 12 females married and 23 had sexual relationships.

Males: Hormonal treatment and/or surgery had increased the general satisfaction of patients. With the exception of one male who reverted into the female role, all patients were improved in the overall rating. Six males married.

Case Studies
As an example from the females, an unsatisfactory and a satisfactory result are quoted. With males, some very short cases were also quoted.

Role Re-reversal
One female whose result was rated as unsatisfactory had the intention to live as a male again. After unsuccessfully trying to live in the role of a male, one male returned to the female role and had a surgical breast augmentation done after the original breasts had been removed. "But she is not unhappy and has no regrets" (p. 158).

Follow-up Studies Mentioned
Benjamin 1964a, b; Hamburger et al., 1953; Hertz et al., 1961

Authors' Conclusion
"My observations have forced upon me the conclusion that most patients operated upon, no matter how disturbed they still may be, are better off afterward than they were before: some subjectively, some objectively, some both ways. I have become convinced from what I have seen that a miserable, unhappy male transsexual can, with the help of surgery and endocrinology, attain a happier future as a woman. In this way, the individual as well as society can be served. The rejection of the operation and/or treatment as a matter of principle is therefore not justified" (p. 135).

Remarks
Based on the heterosexual/homosexual evaluation scale by Kinsey and his co-workers (Kinsey et al., 1948), the author developed a Sex Orientation Scale (S.O.S.), by which the transitions from transvestism to transsexualism could be categorized. In some later follow-up studies, this scale was used for the descriptions of the samples. Overall this scale found little dispersion in the scientific literature.