Case Reports - Male

Case 1. to Case 10.

CASE 1.
Male. One younger brother, Mother, said to have had St. Vitus' dance as a girl, had been married once before she married the patient's father at 30; the father was an aggressive man, and the conditions in the patient's home were reported several times to the child welfare authorities, and he was put in foster-homes on several occasions.
He was born in hospital, weighing 3050 g; the amniotic fluid was discolored. At 14 months he was hospitalized under the diagnosis of hydrocephalus (had tonsillitis at time) and examination showed: nystagmus; pale optic discs; reduced vision; no testes palpable. At 13 he began getting hormones for the cryptorchidism. At 15 he was operated for bilateral cryptorchidism and atrophy of testes. He kept on taking androgens until the time of the present study. At 17-18 his voice broke and hair began growing on his Pubes. He had never had any erection or ejaculation.
He was an irritable child, quick-tempered and lacking in self-control; his parents took him to a child psychiatrist for this. After leaving school with good marks he attended commercial college and afterwards did mostly office-work. At 29, he began studying again for a higher degree.
He said that he had felt insecure as a child, that he hated his domineering father and was warmly attached to his kinder and more understanding mother.
As a boy he played mostly with girls; people teased him for being a sissy; he was embarrassed about his own body. At 12, he began to feel uncertain about his sex role; he felt as if he were "neutral"; after a time he began to feel as if he belonged to the opposite sex, and this feeling grew stronger shortly before he entered puberty, at which time he also began to be disgusted at the sight of his own body. At 26 he began to have periods of gradually mounting desire to cross-dress, ending in continual crossdressing for a time. He was erotically aroused by men and had a few homosexual contacts; he never showed any interest in girls. He had a weak libido, and said that he had never masturbated. He tried to conquer his anomaly by marrying, but this only made matters worse; he got frequent attacks of depression and at 26 was admitted to a psychiatric department, but after five years of supportive psychotherapy, he was no better. He wanted to have his name changed and to be operated on.
Examination at 29 revealed: Psychoinfantile, asthenic, hysteroid and syntonic traits; cerebrolesional symptoms; tendency to depression; IQ 123. Dysplastic build; kyphoscoliosis; bilateral nystagmus; reduced vision in left eye; shrunken penis; small scrotum and no palpable testes; no prostate; masculine pubic hair; sparse axillary hair; no beard; hormones: slightly low FSH value; BMR-23 per cent; EEG normal.

CASE 2.
Male. One younger sister. The father drank a little too much, but on the whole the family atmosphere was pleasant.
The patient was born in hospital, weighing 3650 g. At about 10 he was said to have got concussion, but he was not hospitalized, and he had no postconcussional disorders. At 28 he was operated on for phimosis, and thyroid treatment was started for hypothyroidism; he stopped taking the drugs of his own accord and showed no signs of hypornetabolism at the time of consultation.
He took a university degree and advanced to a high social standing.
He said that he had felt insecure as a child; his father was colorless and submissive, and his mother domineering; he did not prefer one to the other.
Up to the age of 10 he was like an ordinary boy, and good at gymnastics. At 10 he began to get a feeling of belonging to the opposite sex; the feeling grew stronger with time and became combined with aversion for his own body, and he finally determined to have an operation done. He plucked out the hairs on his face. To begin with he was erotically aroused by the opposite sex, but in the end only by members of his own sex. He married twice and had children in both marriages; his first marriage broke up because of his anomaly and he did not enjoy sexual intercourse with his second wife either. He became more and more attracted to men, and finally could not even bear the idea of having sexual intercourse with women. His masturbatory fantasies were of males, and had a slightly masochistic coloring. He cross-dressed now and then until about 19, when the desire to do so began coming on in periods, He had several attacks of depression and had attempted to commit suicide.
Examination at 31 revealed: Formal, cultured manner; syntonic, hysteroid, schizothymic personality; tendency to depression, IQ 125. Normal build; normal pubic and axillary hair; normal penis and testes; normal beard; normal hormone titers; normal EEG.

CASE 3.
Male. One sister and one younger half-sister. Parents divorced when patient was 9, and father remarried. Mother often hospitalized in psychiatric institutions for anancastic syndrome; she had asked for a legal abortion when she was expecting the patient, but was refused; she got a psychotic reaction after delivering the patient, and was hospitalized. Because of the mother's ill-health the patient often stayed in foster-homes.
He was born in hospital, weighing 3920 g. At 17 he had a short spell of concussion.
His parents consulted a child psychiatrist because of his behavior and sleep disorders. He got average marks at school, and went on to an agricultural school. Afterwards he worked as a postman and a factory hand.
He said that his father was strict and authoritative and his mother gentle and submissive; he did not prefer one to the other.
As a boy he played mostly with girls and at girls' games. He was embarrassed when he had to undress for gymnastics at school. He began to feel as if he belonged to the opposite sex when he was very young-before puberty. After entering puberty at 13-14, he began also to be disgusted at the sight of his own genitals and to want to have them removed. He was sexually attracted to boys, and never interested in girls. He had a weak libido, and no sexual experience up to the time of consultation. His masturbatory fantasies were of males, He started cross-dressing during puberty, and did so more and more with time, but never continuously. He urinated in the female position. He was often depressed and often contemplated suicide.
Examination at 19 revealed: Syntonic and psychoinfantile personality; IQ 105. Leptosomatic build; sparse axillary hair and feminine pubic hair; too little facial hair to need shaving; normal penis, testicles and prostate; hormone analysis, suspiciously high total gonadotropins and fractionated estrogens for age; normal EEG.

CASE 4.
Male. Two -older brothers and one older sister. Parents quarrelled; father drank and committed suicide when the patient was 9. One uncle was an alcoholic addict. Three cousins on father's side committed suicide.
The patient was born at home. He went through secondary school and has since done various kinds of qualified work.
He was strongly attached to his mother as a child.
At 10 he began to feel that he belonged to the opposite sex and to be repelled by the male characteristics of his body. At about the same time he began to cross-dress now and then. People often called him "Miss" when he was young. At 40 he changed over completely to being a "woman". He was erotically stimulated by men, and liked men as sex partners. He had a strong sexual urge and wanted sex-changing surgery chiefly for sexual reasons. He had several attacks of depression when he contemplated suicide. When he was refused a conversion operation, he got ideas of persecution.
At 37 he was put on estrogens.
Examination at 40 revealed: Hysteroid, syntonic, schizothymic, psychoinfantile personality; tendency to ideas of persecution; IQ 122. Normal build; estrogen-induced gynecomastia; little beard because of electrocoagulation; normal pubic and axillary hair; normal penis, testicles and prostate; no data forthcoming on previous hormone analysis; abnormal EEG.
At 43, he got plastic breast implants, and a conversion operation. Since then he has been more stable and is more content with life.

CASE 5.
Male. One younger sister, Mother, who had migraine, died when the patient was 27. The father drank and caused trouble in the home.
The patient was born at home. At 10 he began having migraine. He had several attacks of kidney stones.
After finishing school with average marks, he went from one job to another, running errands, in shops, in restaurants and in factories. During the six months before he came to us, he had worked as a "housewife" for another man, doing no outside work.
He did not think that either of his parents had been particularly dominant, though his father got very aggressive when he drank. He felt nothing at all for his father, but was strongly attached to his mother.
He had felt like a girl as long as he could remember and he played with dolls when he was small. He did not mind undressing in front of others for gymnastics at school. He was often teased for being a sissy at school. He entered puberty at 13-14 and was afterwards erotically attracted to members of his own sex. He had a moderately strong sexual urge. He had frequent and satisfying homosexual activity, and his masturbatory fantasies were of males. He was disgusted by his own male sex characteristics, and wanted a sex-changing operation. He urinated in the sitting position. At 15 he began cross-dressing periodically; at 33 he changed over completely to women's clothing. At 20, an operation was discussed but was not done, mainly because his mother was against it.
Examination at 35 revealed: Psychoinfantile, hysteroid and syntonic personality; IQ 97. Slight obesity, but normal build and heavy bones; normal penis, testicles and prostate; normal axillary, pubic and facial hair; hormone analysis at age of 20 had shown nothing abnormal; normal EEG.
At 35, estrogen treatment was begun, and with this he became more content with life, and more stable mentally.

CASE 6.
Male. One older brother.
The patient was born in hospital, weighing 3550 g. He was slow in developing, both physically and mentally. He said that he had injured his back at the age of 2 and his bead at the age of 5, but that he recovered completely; this could not be confirmed. At 21, his left breast began to swell and ache, and he lost 8-10 kg in weight, and began to get attacks of stabbing pain in his epigastrium.
He stayed at a children's home for some undiscoverable reason when he was about one year old. Otherwise he had had a happy childhood on the whole. His father was slightly unstable and quick-tempered; his mother was more sensitive and warmhearted, and the patient was more attached to her.
After leaving school, where he repeated one year, he did unskilled work of various kinds, often in restaurants, where he often worked as a "woman". He had frequent attacks of depression.
He liked to dress as a girl when he was small, and his mother sometimes gave in and let him do it. He played mostly with girls. He was not embarrassed by having to undress in front of others. He became more and more envious of the clothes girls wore. At 12-13 he began to be erotically stimulated by boys. He never had heterosexual intercourse, but he had many and satisfying homosexual contacts. He said that he never masturbated but that be often had spontaneous erections combined with homosexual fantasies. At 18 he began cross-dressing periodically. He always felt confused about his sex role, though he felt more female than male; he felt more female in some periods than others, apparently even before puberty, and the contrary sex feeling grew particularly strong while the gynecomastia was developing, at which time lie also grew to abhor his own genitals and to long intensely for a sex-changing operation.
Examination at 21 revealed: Asthenic, syntonic, hysteroid and schizothymic personality; tendency to feel persecuted, cerebrolesional signs and symptoms; IQ 104. Normal build; swollen left breast; normal penis and testicles; normal axillary hair but sparse beard (had not yet shaved); hormones: abnormally high pregnanediol values on two occasions; endocrinologic analysis failed to show cause for the gynecomastia; PBI and liver function values normal; normal EEG.

CASE 7.
Male. Three older sisters, one older brother and six younger brothers. The mother was said to be backward, and the father was a criminal. One brother (IQ 58-70) and one sister (IQ 66) were in hospitals for antisocial retarded, Complaints were made to authorities about conditions in home, and the patient was put in a foster-home when he was an infant.
He was born in hospital, weighing 4200 g. He bit his nails as a child.
He got poor marks at school and had to attend special classes the last years he was there. A child psychiatrist was consulted. After leaving school, he did various odd jobs of unskilled nature, often working as a "woman". He was charged with crimes when he was 19 and 24, and underwent psychiatric examination on the order or the court; mental abnormality of nonpsychotic nature was diagnosed.
He said that he had felt insecure as a child-that he had no one to lean on. He felt like a girl from the beginning, and played girls' games when he was a child. He was embarrassed whenever he had to undress in front of others, and he abhorred his genitals from the time he was very young, and at 15 this got worse. He began cross-dressing as a young boy, and two years before consultation he changed over to wearing women's clothing continually. He was erotically attracted to men, had male partners for most of his sexual activity, and imagined himself in the female role when he masturbated. He had a strong libido. After his second sentence at 24 he did not come into conflict with the law again.
Examination at 27 revealed: Hysteroid, syntonic, psychoinfantile, asthenic personality; cerebrolesional symptoms; IQ 96. Normal build; normal penis, testicles and prostate; shaved legs and pubic hair to give feminine appearance; normal axillary and facial hair; low total gonadotropin level for age; abnormal EEG.
At 27 he received estrogens and at 28 he got his name changed. It was easier for him to adjust afterwards, but he still longed for a conversion operation.

CASE 8.
Male. Two younger sisters and one younger brother.
The patient was born in a private nursing-home, weighing 3560 g. At 2, he was suspected to have poliomyelitis as his legs seemed to be paralyzed, but he was apparently not hospitalized for this.
As a child he sometimes had nightmares. Around puberty he began to bite his nails.
His father was strict and dictatorial; his mother was tolerant, understanding and yielding, and the patient was more attached to her.
After leaving school with average marks, he took a year's course in office-work. At 18 he started studying at a painting academy.
Ever since lie could remember he felt as if he were a girl, but he played equally often with both sexes when he was small. He was poor at gymnastics and felt embarrassed when he had to undress in front of boys. He entered puberty at 13 and afterwards his feeling of belonging to the other sex got stronger, and his body began to feel unpleasant; it felt foreign, as if his mind and body did not agree. He was erotically attracted to boys, never to girls. At the time of consultation, at 18, he had not had any sexual experience. When he masturbated he imagined himself as a female. He had a moderate libido. At about puberty he began cross-dressing at times. He longed for sex-changing surgery. He complained that he felt under intense strain, and that he had had repeated attacks of depression when he contemplated suicide.
Examination at 18 revealed: Quiet, shy young man with an asthenic and slightly psychoinfantile personality; slight depression; IQ 96. Normal build; normal pubic and axillary hair but shaving only necessary every other day; normal penis, testicles and prostate; normal hormone values; normal EEG.

CASE 9.
Male. One older sister. Cousin on father's side said to be retarded. Maternal aunt had been in mental hospital for "nervousness".
The patient was born in hospital, weighing 3860 g. He had eczema and asthma up to the age of 10. At 11, he began to suffer from anancasms, which were said to begin after high fever following vaccination for smallpox.
He took a university degree, and now worked as a civil servant.
His father was the dominant member of the family. He did not particularly prefer one parent to the other.
He had a happy childhood. He played only with boys and boys' games. He felt ernbarrassed during gymnastics- always had the feeling that he was different from others. At about 12, his body began to feel foreign and he began to cross-dress now and then. At 21, he began to cross-dress more, but only when he was not working; at the same time he began to shave his pubic hair to make it look feminine. His feeling of belonging to the other sex grew and grew, and was firmly entrenched at the time of consultation. He had tried to castrate himself, and had frequent attacks of depression combined with thoughts of suicide. He had had no sexual experience. He was mentally stimulated by his own sex. He had a weak libido. His masturbatory fantasies were of men.
At 30 he went to a psychiatric department asking for recommendation for castration, and it was decided to put him on estrogens.
Examination at 33 revealed: Asthenic, syntonic, schizothymic, psychoinfantile personality; clear reactive depression; cerebrolesional syndrome; anancasms; IQ 106. Estrogen-induced gynecomastia; small atrophic testicles; small prostate; sparse facial hair; male pubic hair; normal axillary hair; before estrogen treatment started, genitals and hormone values said to be normal; normal EEG.

CASE 10.
Male. One older sister. Parents divorced when patient 8, the father being appointed guardian for the patient and the mother for the girl. The father remarried when the patient was 15.
He was born in hospital, weighing 3600 g. After leaving school, where he repeated one year, he worked in factories and offices and was apparently a good worker. He was once reported for drunken misconduct. At 24 he married, and now has two children, but his marriage is not happy on account of his transsexualism.
He said that he had had a normal childhood, that neither of his parents was dominant, and that he did not prefer one to the other.
As far back as he could remember he had wanted to be a female, and the feeling of belonging to the other sex grew and grew, and became even more intense during puberty, when he became revolted at the signs he showed of belonging to the male sex, especially his genitals. He was always mentally aroused by his own sex, but he had not had any homosexual activity. He had a weak libido, and said that he had never masturbated. He began to cross-dress now and then when he was a child, and at 28 he changed to women's clothing every evening when he got home. He had many attacks of depression and often thought of suicide. He longed for a conversion operation.
Examination at 34 revealed: A cool and detached man, asthenic traits, clearly depressed; IQ 88. Ordinary build; female pubic hair; normal axillary and facial hair; normal penis, testicles and prostate; low gonadotropin value for age; normal EEG