Case Reports - Female

Case 31. to Case 43.

CASE 31.
Female. Two older brothers and one older sister. There was much strife in the home; the child welfare bureau complained to the parents; the parents divorced when the patient was 2. The mother kept the patient; she did not remarry. One sister was put in a special class at school.
The patient was born in hospital, weighing 3470 g. She had a high fever in connection with measles.
She spent all her school life in a special class, and after finishing she worked for short spells at various kinds of unskilled work, mostly in factories. At 20 she received a suspended sentence of six months for car thefts and fraud. A few years later she was again found guilty of fraud and put in an institution for a period. After she came out, she went on committing various forms of minor crime.
She was strongly attached to her mother and the younger of her brothers, who apparently acted as a father-substitute.
She always felt like a boy. She played boys' games. She was embarrassed during the gymnastic lessons at school. At 15, when she entered puberty, she began to abhor all the signs she showed of belonging to the female sex. She longed to get rid of her breasts and have her menstruation stopped. At first she wore clothes of neutral character, but at 18 she changed over to wearing men's clothing entirely. She had a moderate libido. She was erotically attracted to girls. She had occasional heterosexual contacts, each time when she was under the influence of alcohol, but none gave her any feeling of satisfaction. She finally had mostly homosexual contacts. She said she had never masturbated.
Examination at 22 revealed: Syntonic personality; IQ 84. Ordinary build; large hands; normal pubic and axillary hair; normal breasts; no signs of gynecologic abnormality; hormone titers normal; EEG abnormal.
After this examination she began getting androgen treatment and the same year her breasts were removed. At 24 she got her name changed. The result was better social adjustment and subjective improvement. She now lives as a man.

CASE 32.
Female. One older sister. One paternal aunt had a reactive depression for which she was hospitalized for a short time.
The patient was born at home.
After finishing school, she worked mainly as a man.
She had had a happy childhood. She said that her parents were kind and warmhearted; she did not prefer one to the other.
As young, she always felt like a boy. She played boys' games and was embarrassed when she had to undress in front of girls. At 17 she entered puberty. Her menses, which were sparse and infrequent, were a source of torment to her, and likewise her breasts. She was erotically attracted to girls. She denied having had any sexual activity or masturbated. Her libido was moderate. From the age of 10 on, she dressed consistently in male clothing. She wanted to have her breasts removed and her name changed.
Examination at 21 revealed: Calm, balanced woman with good insight; predominantly syntonic personality; IQ 103. Normal build: normal gynecologic state; normal breasts; normal pubic and axillary hair; no hair on body otherwise; hormone titers normal; normal EEG.
At 22 she got her name changed, androgen treatment was begun and her breasts were amputated. Too short a time has elapsed to be sure about the result, but she appears to be much more contented.

CASE 33.
Female. Three older brothers, two older sisters and two younger sisters and one younger brother. Mother operated on for tuberculosis of the kidney. Father had back troubles. One paternal uncle was an alcoholic addict and committed suicide.
The patient was born in hospital, weighing 3860 g.
She was irritable and aggressive as a girl, and stammered. She wet her bed.
After leaving school with average marks she started doing various kinds of masculine work. She showed a slightly antisocial attitude, later interpreted as being caused by an attempt to be accepted as a male.
She said that she had had a comparatively happy childhood, and that neither of her parents was particularly dominant. She preferred her father.
She always felt like a boy. She played boys' games when she was small, and was embarrassed at having to undress for gymnastics. She entered puberty at 12, and was revolted by her menses and her secondary sex characteristics, She stopped wearing female clothing at the age of 10. At 17 she was taken to a department of child psychiatry because of her transsexualism; the records from that time say that she appeared to have attacks of petit mal. She was erotically attracted to girls, Her libido was weak, and she denied having had any sexual experience. It is not certain how often she masturbated, but probably not often. At 17 androgen treatment was started. She longed intensely for a change of name and to have her breasts removed.
Examination at 18 revealed: A quiet and reticent girt, unsure of herself; great asthenia: cerebrolesional syndrome; IQ 94. Normal build; normal gynecologic state; normal breasts; normal amount of body hair; normal pubic and axillary hair; hormone titers (before hormone therapy) normal; EEG at 17 abnormal, and photostimulation produced grand mal attack: at 18, EEG still abnormal.
At 19 she had her breasts removed and application was made for a change of name. At 20 she looked much more like a man, she had become more even-tempered, and was well adjusted to life.

CASE 34.
Female. The patient was born out of wedlock and she knew nothing about her real father. She had one older sister and two older brothers. Her mother died when she was 10 and she was placed in a foster-home.
She was born at home. She said she was very prone to infection when she was small, but otherwise healthy.
After leaving school with average marks she worked chiefly on farms. She grew up in poor and slightly insecure circumstances, but on the whole she said that her childhood was not unhappy.
When she was a child she played mostly with boys and at boys' games. She always felt that she belonged to the opposite sex, and this feeling grew worse when she entered puberty, when she was revolted by her menses and breasts. She had not had any sexual activity either with boys or girls, but she felt more attracted erotically to girls than to boys, She said she had never masturbated and had a weak libido. She had worn neutral clothes since her early years at school and after 13-14 wore only male clothing, and she afterwards worked as a "man". She had occasional periods of depression and thoughts of suicide. She wanted an operation to make her body more masculine.
Examination at 22 revealed: Syntonic and psychoinfantile personality; tendency to depressive reactions; IQ 99. Normal build: normal gynecologic state; normal breasts; normal hair for female; normal hormone titers; normal EEG.

CASE 35.
Female. Three older sisters and one older brother. Mother died when patient was 14.
The patient was born in hospital (impossible to get record of delivery).
After leaving school with good marks, she trained for an occupation in which she is now a "male" executive.
She said that she was brought up in a happy home, that neither parent was more dominant than the other, and that she liked her father best.
As far back as she could remember she felt that she was born into the wrong sex.
She played boys' games when she was small. She was not embarrassed about her body when she went to school. After puberty the feeling of belonging to the opposite sex increased, and she was disgusted at her own menstruation. She began to have frequent periods of depression. She was erotically attracted to women, and had some homosexual activity. She had a moderately strong libido. From the age of 30 on she lived as a "man".
At 31 hormone treatment was begun. At 37 her breasts were amputated, and at 43 she got her name changed. The results were excellent: she became extremely well adjusted and had no more attacks, of depression.
Examination at 42 revealed: Hysteroid, syntonic traits; good insight; IQ 112. Before androgen treatment, she was said to have had the physical characteristics of a normal woman; now after many years of taking androgens, she showed great virilism; EEG normal.

CASE 36.
Female. Two younger sisters. Father drank, and parents quarrelled often. They divorced when the patient was 16. She was sometimes placed in foster-homes when she was small. The mother was "unstable and nervous" but had not been hospitalized for this reason.
The patient was born in hospital, weighing 2950 g. At 2 months she had dyspepsia and anemia.
After finishing school with average marks she did various kinds of work on farms, in factories and in offices. During the last few years she had worked as a foreman in a large factory, and was considered to be an excellent worker.
She did not think that either of her parents was particularly dominant. She was most attached to her mother as a girl.
When young, she always felt like a boy. She always played boys' games and kept company with boys. She disliked gymnastics and was embarrassed at having to change in front of girls. She began menstruating at 13; she had painful menses and suffered from premenstrual tension. She was revolted by her menses and the other signs of femininity she showed. She began cross-dressing now and then at the age of 10, and at 16 changed over to male clothing completely. She was erotically attracted by girls, was never interested in boys and never had heterosexual intercourse. But she obtained full satisfaction from sexual activity with girls. She had a moderate libido. She has now been engaged to a girl for several years. She had frequent attacks of depression.
At 22 she had her name changed, at 24 androgen treatment was started, and at 25 her breasts were removed. She became more adjusted to life, had fewer attacks of depression and grew more contented.
Examination at 24 (before amputation of breasts) revealed: A frank, accessible and intelligent person with a sober and realistic attitude to her problems; no distinct signs of depression at the time; predominantly syntonic personality; IQ 97. Ordinary female build; no gynecologic abnormality; normal breasts; normal pubic and axillary hair; normal hormone titers; nonnal EEG.

CASE 37.
Female. One older and one younger sister. Father died when patient was 13. Mother described as "nervous", of solitary nature, and with a tendency to paranoid ideas. The older sister died while young from some unknown cause. The child welfare bureau had complained about the conditions in the home, and the patient was put in a foster-home for a time. One maternal aunt committed suicide.
The patient was born in a cottage hospital (no record of birth obtainable). After leaving school with average marks, she did various kinds of male types of work.
She said that she had had a happy childhood on the whole, except for the times her mother's peculiar nature had led to discord. She was more attached to her father.
She had heard that her parents had wanted a boy instead of her, but her parents had not reared her as a boy. When young she felt that she was a boy. She played mostly boys' games. She was embarrassed when she had to undress for gymnastics. She began to menstruate at the age of 15, and at this her feeling of belonging to the opposite sex increased, and she was revolted by all the characteristics of femininity she showed. She wore neutral clothing until she was 17, and then changed completely to male attire. She was erotically attracted to girls. She had made herself have heterosexual intercourse to see if it helped, but she had not enjoyed it. She became pregnant after one of her heterosexual relationships, and while she was pregnant, she still felt that she belonged to the other sex. She bore her child, but left it to the care of others. She had not had any homosexual contacts, and denied having masturbated. Her sexual libido was classed as weak. She had several attacks of depression.
Examination at 20 revealed: Quiet, shy manner; good insight; asthenic, syntonic and schizothymic traits; IQ 103. Slender build; no gynecologic abnormality; infantile breasts and hair around the nipples; male pubic hair; normal axillary hair; normal hormone titers; normal EEG.
At 21 androgen treatment was started.

CASE 38.
Female. Only child. The parents quarrelled, probably because of the problems the patient created. The child welfare bureau intervened mostly because of the way the father treated her, and she was placed in foster-homes for a number of periods.
She was born in hospital, weighing 2915 g. The mother had previously had many spontaneous abortions, but she was not threatened with miscarriage while she was pregnant with the patient.
The patient was an irritable and aggressive child, and she was admitted to a department for child psychiatry before the age of 15 because of the difficulties she caused and because she insisted on identifying herself with the male sex. She began menstruating at 14, and in connection with this had a number of depressive and anancastic reactions.
She said that her mother was the dominant member of the family. She did not prefer either one of her parents particularly.
She always felt like a boy when she was small, -that she was "born into the wrong sex". She played boys' games and with boys. She was strongly repelled by all the characteristics she showed of the female sex. After 14 she wore only male clothes. When she finished school she did various kinds of work, always as a "man". She was erotically attracted to girls, but denied having had any sexual activity with either sex, or ever having masturbated. Her sexual libido was classed as moderately strong. Her transsexualism had made it extremely hard for her to adjust, and she had frequent attacks of depression.
Examination at 23 revealed.: A rather secretive and untalkative nature, though she discussed her problems frankly; schizothymic traits; mild but distinct cerebrolesional syndrome; IQ 112. Ordinary build; normal axillary and pubic hair; no gynecologic abnormality; low total gonadotropin titer for age; abnormal EEG.
At 23 she got her name changed and androgen treatment was begun.

CASE 39.
Female. Three older brothers and four older sisters. Two sisters, twins, died shortly after birth. The mother died from thrombosis when the patient was 24. Father remarried.
The patient was born at home.
After finishing school she took jobs in different forms of masculine work, and was considered a good worker.
She said that she had an insecure family background because of her father's domineering and brutal treatment of his family. Her mother was submissive and warmhearted, and she was strongly attached to her.
Since as far back as she could remember she was only interested in masculine pursuits, never in anything typical of females. She was embarrassed by her body during gymnastics, and was repelled by her breasts and menstruation when she entered puberty at the age of 17. She acted like a boy, and the-family called her "sonny". She was erotically attracted to women. She tried to overcome her difficulty by getting engaged, but the result was a failure., She thought that heterosexual coitus was unpleasant. After her engagement broke off, she had homosexual contacts, and was satisfied by them. She had a moderately strong libido. When she masturbated she thought of herself in the male role. She dressed in neutral clothes until about the age of 37 when she changed over to living as a "man". She had frequent attacks of depression when she contemplated suicide.
Examination at 38 revealed: A frank, sensible attitude, and good insight; apparently normal intelligence, but IQ 82. Normal build; no gynecologic abnormality; pubic hair of slightly masculine distribution; no abnormal amount of hair on body; hormone titers normal; normal EEG.
At 39 androgen treatment was begun, and later the same year she had her breasts removed and her name changed. She became much more content with life afterwards, and got along well in her masculine role.

CASE 40.
Female. Six older sisters and three older brothers. Parents died when patient was adult.
The patient was born at home.
After leaving school she worked mainly in shops. She was extremely well adjusted.
She said that she had had a happy childhood, that neither of her parents was particularly dominant, and that she liked them equally well.
As a child she liked to play boys' games. At 11 she became conscious of a feeling of belonging to the opposite sex, and this became accentuated at puberty, which she entered at about 14. She could not bear her own body. She began cross-dressing occasionally already before puberty, otherwise wore neutral clothing when she was a girl. At 23 she changed to being a "man". She was erotically attracted to women and had homosexual contacts. She had a moderate sexual libido and her masturbatory fantasies were of females.
At 27 she started taking androgens, at 28 she had her breasts amputated, at 33 her uterus was curetted and radium implanted, and she had her name changed, and at 36 she was officially registered as a male. The results of treatment were extremely good. She was now contented with life, had a good working capacity, and was happily married.
Examination at 35 revealed; Mainly syntonic, slightly schizothyrnic personality; objective, intelligent attitude to her problem; IQ not measured. The many years of taking androgens had led to strong virilism. The EEG was not recorded.

CASE 41.
Female. Parents still living, over 80 years of age. The patient was the 4th of 6 sibs. One brother died in infancy; the rest are still living.
She did not know if she was born in hospital or at home.
She did well at school and took a university degree. Though she was brought up strictly, she thought that she had had a happy childhood. Her father was the dominant member of the family and she was most attached to him.
Ever since she was a child she had felt as though she belonged to the opposite sex, and she was often taken for a boy. She began menstruating at 12-13 and was repelled both by her menses and her breasts. She responded erotically to members of her own sex. She had not had much sexual activity, and then mainly of homosexual type. She had a moderately strong sexual libido. Her masturbatory fantasies were of females. She had tried marriage, but it had ended in failure. She cross-dressed occasionally from the age of 8 on otherwise wore mostly neutral clothes. She periodically worked and lived as a man. She had had several attacks of severe depression leading to hospitalization. She wanted to have something done to make her a man, for she felt she could not go on any longer as she was- "I am a man, though I have a female body".
Examination at 45 revealed; Hysteroid, syntonic, schizothymic traits; intelligent attitude to problem (IQ not measured); slightly hypomanic at time of examination; signs of a cerebrolesional syndrome; no signs of psychosis. Thin, normal build; powerful muscles; infantile breasts; hair on sternal region; male pubic hair; normal axillary hair; no gynecologic abnormality; hormone titers normal; EEG normal.

CASE 42.
Female. Born out of wedlock and not legitimized. Two younger sisters. At age of 2 sent to foster-parents.
The patient was born in hospital, weighing 3710 g. At 22 she had meningo-encephalitis from which she recovered completely.
After leaving school she took a job in a masculine occupation and was a good worker.
She said that she had had a happy childhood; neither of her foster-parents was particularly dominant. She liked her foster-father best.
When small, she always felt like a boy and she did what boys did. She was repelled by her menstruation and the other feminine characteristics that developed when she entered puberty at 15. She wore neutral clothing until she was 18, when she changed over to a completely male role. She was erotically attracted to women. She had occasional heterosexual contacts when she was young. She had a moderately strong sexual libido. Her masturbatory fantasies were of females. Before treatment she had had several attacks of depression.
At 30 salpingo-oophorectomy was performed and she started taking androgens.
At 31 she got her name changed. At 32 she had her breasts removed, and she was officially registered as a male. She improved greatly after this, and was now happily married. She no longer had any attacks of depression.
Examination at 38 revealed: A hysteroid and syntonic personality, and an intelligent and realistic attitude to her problem; IQ 114. Before androgen treatment was started, she 1ad small but not infantile breasts, normal pubic and axillary hair, no abnormal amount of body hair, and normal hormone titers. At 38, her EEG was abnormal.

CASE 43.
Female. Born out of wedlock, and sent directly from hospital to foster-parents. Three older and two younger children in foster family. At 18 she was adopted.
She was born in hospital, weighing 3340 g. She wet her bed until the age of 12, and suffered from nightmares as a child.
After leaving school she continued her education with a correspondence course, and she then took jobs in masculine types of work, such as in motorcar repair shops. At 16 she began to turn criminal, and during the next few years she was charged with fraud, forgery, drunken driving, and other forms of antisocial conduct. The courts ordered a psychiatric examination on two occasions, and both times it was recommended that she be given psychiatric treatment, and concluded that her criminal behavior was secondary to her wish to be accepted as a male.
The foster-mother was the dominant member of the family. The foster-father was more evasive and passive. The patient seemed to have preferred him slightly to her foster-mother.
She always felt like a boy, and played boys' games when she was small. She began cross-dressing occasionally when she was small and at about 21 she changed over completely to male clothing. She was disgusted at all the signs she showed of belonging to the female sex, and her menses, starting when she was about 14, were a source of great torment. At 16 she began to drink and take drugs, and once when she was drunk she had heterosexual intercourse and became pregnant. She married the child's father, and delivered the child, but the marriage soon broke up, and the child is now living with foster-parents. Her feeling of belonging to the opposite sex only increased while she was pregnant. She was always erotically attracted to girls, and after her divorce had only homosexual activity. She had a moderate sexual libido, and masturbated to a moderate extent, imagining herself in the male role. She had repeated attacks of depression and during one of thern she attempted to commit suicide.
At 23 she added a male name to the female names she already had. At 25 she began taking androgens, but it is too early yet to be able to tell the result.
Examination at 24 revealed; Strongly hysteroid and psychoinfantile personality and cerebrolesional symptoms; IQ 100. Normal build; gynecologic condition normal; low total gonadotropins for age; normal pubic and axillary hair; normal EEG.