Ihlenfeld, 1973
Private practice, New York, NY, USA

This congress report of the practice partner and successor of Harry Benjamin reports globally about patients with transsexual symptoms who were treated in the Benjamin practice. Mostly cumulative treatment figures are given, in which those of Benjamin (1964a, b, c, 1966, 1967) described samples are included.

• Sample
• Evaluation Fields and Criteria
• Results
• Suicide Attempts/Role Re-reversal
• Follow-up Studies Mentioned
• Authors' Conclusion
• Indication Recommendations
• Remarks

Evaluation Fields and Criteria
The main questions were: Is the patient now happier? Is he/she pleased with the surgical results? Is his/her outlook on life brighter than before? Are his/her interpersonal relationships better? Has he/she professional success? Is he/she accepted by family, friends and colleagues?

Results
There were hardly any expressions of regret. The reactions of the families were positive. Most patients had found satisfying work in their new gender role. In accordance to the clinical impression of the author, the results were positive.

Suicide Attempts/Role Re-reversal
Pre-surgically, resp., at treatment start, "some of these people were severely depressed or suicidal" (p. 232). One male who underwent surgery against the recommendation of the author, resp., Benjamin, committed suicide. Five females died of drug overdoses (p. 231, 233) without leaving suicide notes, where the author determined they were probably accidents and not suicides.

Follow-up Studies Mentioned
Benjamin, 1966; Pauly, 1968.

Authors' Conclusion
"The immediate result of selected sex reassignment for the adult transsexual is remarkably successful. Our patients appear happier and better adjusted socially, sexually and vocationally. Patients who were depressed and withdrawn usually appear brighter and better able to deal with life after reassignment" (p. 232). Also patients who were operated at older ages gained by the treatment. "These people (in their late 50's and 60's) have felt that the change was worthwhile, even at their older age, so that they might enjoy in their remaining years the peace and human fulfillment they missed in all the years before. It seems unlikely that these patients will become disappointed and depressed by the time they reach the long-term follow-up stage" (p. 232).

Indication Recommendations
This publication contains no indication recommendations, but contains the remark that advanced age is not a contra-indication (to surgery). Those who have not been operated have been divided into three groups by the author: (1) Persons with whom the urge for surgery is slight and who can live with a minimal hormone treatment; (2) Persons who could not afford the surgery and lived in constant fear of being discovered because they took hormones in the full amount and (3) Persons for whom the surgery would be indicated without question, but who cannot be operated because of the pressure from family or profession and who require regular hormone treatment and psychological counseling.

Remarks
This publication does not contain detailed data. It is to be regarded more as a plea for the approval of more research money to realize systematic follow-up studies. In the frame of private practice, these are not possible, because many patients are lost long-term. The author dreams of a national computerized general dysphoria register that always calculates the actual results. He remarks that such a register would not detract from the work with individual patients and that most of them probably would deny the collaboration in such a long follow-up study because they live as inconspicuous as possible in their new role and do not want to be reminded of their past.