Hore, Nicolle & Celnan, 1975
University Hospital of South Manchester; Withington Hospital, West Didsbury, Manchester; Royal Post-graduate Medical School and Hammersmith Hospital, London, UK

This study is to be counted about the follow-up studies only with limitations. Mostly a sample is described that was already treated surgically with very bad results. However, this work is informative and interesting because it describes how frequent and severe surgical complications and undesired consequences are with sex reassignments (comp. Jayaram et al., 1970a).

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

Study Methods
The authors who participated in the treatment evaluated the pre-surgical situation based on the hospital files; the research method for the post-surgical situations is not mentioned.

Evaluation Fields and Criteria
The pre-surgical situation was analyzed with regard to the following criteria: family history, infant development and sexual orientation, education and profession, psychiatric history and social stability. Post-surgically the physical result and the mental constitution were evaluated globally.

Results
About the physical results the authors report that the urethrastenosis caused by procedures done somewhere else could be removed. Four females had recto-vaginal fistulae caused by the new surgery that could be corrected three months later for three. Two had urethra fistulae, of which one was closed at the examination time and the other could be cured a little later. Infections in the surgical area were observed in one patient. Two patients developed a deep vein trombosis, one with a subsequent lung embolism. Two patients' vaginas were too narrow, in one case the authors attributed it to the lacking cooperation of the patient.
The mental results are summarized by the authors as follows: "Eleven consider themselves to have definitely benefited from the operation in terms of feeling more female and having increased confidence in their new role both emotionally and sexually" (p. 86). Two females had married and one who pre-surgically had lived in a male role had successfully assumed the female role. Dissatisfaction was mentioned by five females, three because of surgical complications and two because they did not feel "fully female" (p. 87). One of these females did not go out on the street pre-surgically for fear of being recognized. The surgery did not change anything in this regard.

Authors' Conclusion
The results are to be interpreted cautiously in the opinion of the authors because the sample size is small and the follow-up study time period relatively short. In summary, they said that the results "would seem to be encouraging, 11 of 17 patients appearing subjectively and objectively to benefit and two patients dissatisfied" (p. 87).

Follow-up Studies Mentioned
Benjamin, 1966; Hoenig et al., 1970a, b; Pauly, 1965; Randell, 1969

Remarks
Even though this is a psychiatric-surgical joint publication, the pre-surgical situation of patients is described very imprecisely and does not regard the indicated evaluation fields and criteria. Also the preceding psychiatric diagnostic for the indication for surgery is not described, as well as psychiatric and psychotherapeutic treatment and hormonal treatment of patients. As the only differential diagnostic criterion for the indication, the "fixed conviction of incorrect assignment of several years duration" (p. 82) is mentioned. It seems alarming that not all patients had lived as females pre-surgically. Methodically this publication is poor, so that one has to ask how it could pass the peer review procedure in the journal where it was published - for example, the division of the sample in accordance with The Kinsey Scale of Sexual Orientation are different between text and in tables and, as so, are useless.