Wyler, 1978
Psychiatric Cantonsspital Basel, Basel, Switzerland

This medical dissertation is a descriptive analysis of the patients treated at the Psychiatric University Clinic in Basel between October 1969 and April 1976 with transsexual symptoms. The compiled representation of the most important results is easier accessible in the article by Wyler et al. (1979).

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

Study Methods
The publication is based on the evaluation of patient records. Four patients were interviewed by the author within the outclinic routine; six answered a questionnaire, the content of which is not at all shared.

Evaluation Fields and Criteria
Subjective well-being, sexuality, partnership, ability to work, marital status. The evaluation criteria are not operationalized.

Results
Females: Seven of the eight females felt post-surgically subjectively better. One female who had already four suicide attempts in her history became depressed after losing the partner. Two each lived in a constant relationship with males, resp., females. Almost all were unhappy with the dysfunctional surgical results. Only one female was capable of having sexual intercourse. Pre-surgically, four patients were not employed and two only sometimes. Post-surgically, four females were in training programs or cross-training; two were unemployable; one lived as a housewife and only one worked in the previous profession. All females who participated in the katamnesis were German citizens. Only one could, in a matter of speaking, obtain (under the table) a new birth certificate, in which she was classified as a female.
Males: Surgical complications did not happen for males. Subjectively, both males experienced their situation in comparison to before surgery as better, even though it was not good. Regarding sexuality, there are no statements. Regarding partnership, work situation and legal sex questions, one male said he was satisfied, the other unsatisfied.

Suicide Attempts
Pre-surgically five MFTs attempted suicide; of these, four twice each and one four times. Further, two each had suicidal thoughts or attempted self-mutilation. Post-surgically -- within the frame of a partnership crisis -- a depressive reaction without suicide attempt was observed in the patient who had attempted suicide four times previously. Of the FMTs pre-surgically one patient attempted suicide twice. She elected not to have the intended sex reassignment performed. Two others had threatened suicide if it was not possible to live as males.

Follow-up Studies Mentioned
Benjamin, 1966; Hamburger et al., 1953; Money & Ehrhardt, 1970; Pauly, 1965; Stürup, 1976; Walser, 1968

Authors' Conclusion
"Despite all these limitations, it seems to us that these surgical measures are justified because they give the individuals a certain self-assuredness. The question of the evaluation of the results ... is difficult ... We hope that we can decide this question fundamentally with all other transsexuals who will come to our clinic" (p. 81).

Indication Recommendations
"Corresponding to the experience of Money & Ehrhardt (1970) of the Johns Hopkins University in Baltimore, we have made the indication for 'sex-changing' surgery; only then if the individual demonstrated a certain ego strength, they mentioned for over one year constantly the wish for such surgery, they were ready to take on extensive psychiatric, hormonal, genetic and surgical examinations and a hormone treatment (hormones of other sex) to be taken for at least one year. All patients had to live for a minimum of one year in the desired gender role" (Wyler et al., 1979, p. 50).

Remarks
The dissertation contains many anamnestic details regarding the situation of the described patients before the surgical procedures that are not mentioned in more detail here. They are compiled relatively short and overviewable in the publication of Wyler et al. (1979). Regarding the follow-up study aspect of this publication, it is weak and rather anecdotal. As is frequent in dissertations, it is attempted to clarify the theme transsexualism -- including all causal aspects -- without the available data actually making it possible. Instead of the dissertation, to read the shortened version is more adequate, in which smoothing-over has been performed and sometimes diverging figures are given without explanation.
For the treatment situation of the 1960s this publication is fair. Much data was taken of the patients by which the causal studies were to be determined; it is still unclear what was offered as treatment for the psychiatric and psychotherapeutical part. It seems that, at least on the part of the Psychiatric University Polyclinic, it was nothing. "The age at time of surgery was mostly the same as at the time of the first consultation because most patients were transferred by other physicians after a long observation time in those practices. Shortly after the examination by us the patients could be operated" (p. 51).