Vogt, 1968
Aker Sykehus, Dept. of Internal Medicine, Oslo, Norway

The author provides an extensive account of the courses of treatment of five patients treated by him. He has taken on these patients as an endocrinologist and has seen them over years.

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

Study Methods
Clinical interviews as well as somatic examinations.

Evaluation Fields and Criteria
Background and courses of treatment are extensively represented in case descriptions. The post-surgical situation is not researched systematically. Evaluation fields and criteria are not given.

Results
The results are represented exclusively in case histories. Resuming the author thinks that all -- with the exception of one man -- are socially well integrated after surgery.

Case Studies
The case studies extensively represent the familial background, the medical and social anamnesis and the course of treatment of every patient. We refer only to the treatment results in note form:

A. About one year after surgery, this male started to increasingly develop conversion neurotic symptoms that were treated with low doses of Librium. Three years after surgery, he did not seem to be depressed and was happy with his decision. According to the opinion of the psychiatrist, he was integrated into the male role in a stable fashion. In connection with several deaths in his immediate environment, he was treated psychiatrically five years after surgery in short-term stationary care.

B. The second male had stable employment after surgery. He lived with a female and two children for whom he took over the paternal role. As well as his own family, the family of the female were in favor of the relationship.

C. This male had social fears that, according to the opinion of the psychiatrist, were reduced about one year after starting the hormone treatment - even though they never receded completely. After half-a-year after the surgical breast reduction, he was admitted short-term to a clinic for being alcohol addicted. After having difficulties at the beginning to find employment, he found a stable job two years after surgery and his self-esteem increased.

D. The male had finished his education and was socially well adapted. He had a permanent relationship with a female whom he had met on vacation.

E. About this male it is only reported that he had a permanent relationship with a female and wanted to marry her.

Follow-up Studies Mentioned
Benjamin, 1966; Hamburger et al., 1963; Hertz et al., 1961

Author's Conclusions
Hormone treatment, the suppression of the menstrual bleeding, breast reduction and official first name change were helpful for the five described males. The treatment was only started after repeated psychiatric treatment remained without results. A stable family background furthers good results, but additional neurotic symptoms reduces success. Elementary for success seems to be that treatment is planned long term.

Remarks
The author describes how -- shortly after a speech by Hamburger in Oslo in the year 1954 -- he met the first patients with transsexual symptoms. While the MFTs were transferred to Per Anchersen, the director of the psychiatric male station, evidently nobody was interested in the FMTs and the author, who is an internist and endocrinologist, treated them. His impression was that the psychiatric diagnostic and treatment failed for them and was convinced that they did not only need psychiatric and endocrinologic help, but also surgical. As a rule he started -- as soon as his patients were of legal age -- relatively fast with a (mostly underdosed) hormone treatment. He delayed surgical procedures, but he aided very much the legal recognition of the gender role of his patients. In the sense of a systematic follow-up study this report is not very fruitful, but very interesting in the sense of a clinical description because the author not only describes linear courses but also the crises of the patients.