Case Reports - Male

Case 11. to Case 20.

CASE 11.
Male. Only child. Parents divorced when patient was 2. Mother, who remarried when he was 13, was said to be nervous and to drink too much. No data forthcoming on father.
The patient was born in hospital, weighing 3650 g. He bit his nails and had nightmares when he was small and during puberty he began suffering from anancasms. At 12 he had tonsillitis, and an organic heart defect was discovered. At 15 he had acute pericarditis, but had no more heart trouble afterwards. At 16 his personality changed: he began to keep to himself, brood, and have attacks of anxiety. A child psychiatrist was consulted and he was hospitalized with the diagnosis of transvestism (schizophrenia?). He stayed several times at a mental hospital after this, the diagnosis there being "character disorder (transvestism)". The last time was when he was 23.
After finishing school, where he got good marks, he worked in offices and factories. He was considered a good worker, but from the age of 20 on he only took temporary jobs.
He said that he had not felt secure as a child, that he never got on well with his domineering stepfather. Nor did he care much for his mother, whom he said was nervous and unstable.
Until puberty at the age of 16 he was normally interested in girls, though not in a sexual sense, he said. After this he began to become more and more convinced that he belonged to the opposite sex, and eventually he came to hate his own genitals. At the same time lie also became sexually attracted to men, and from then on he was mainly interested in the male sex. He had a strong sexual libido, but said that he had never had any sexual activity. He masturbated often, and then imagined himself in the female role. At 16 his breasts began to ache, and he thought that they began to swell as well. He shaved all the hair off his body, and rubbed himself all over with hormone ointments. At 20, he began to long to be castrated. He cross-dressed periodically from the age of 16 on. He was often depressed and often threatened to commit suicide. He also threatened to castrate himself.
Between 21 and 23 he received supportive psychotherapy. At 23, estrogen treatment was started, but he was dissatisfied with the result and demanded sex-changing surgery.
Examination at 23 revealed: Psychoinfantile, asthenic, syntonic, hysteroid and schizothyrnic personality; ideas of persecution; cerebrolesional syndrome; no signs of psychosis; IQ 108. Normal build; estrogen-induced bilateral gynecomastia; normal penis, testicles and prostate; pubic hair shaved off; axillary and facial hair normal; EEG normal; roentgenograms of skull showed suggestion of hyperostosis frontalis interna.

CASE 12.
Male. Born out of wedlock and never legitimized. Two older half-sisters and half-brothers, all well.
The patient was born in hospital, weighing 3850 g.
Neither his mother nor stepfather was dominant, and he liked them equally well.
After leaving school, where he repeated his second year, lie did various kinds of work, and is presently working as a "female" shop assistant.
He always preferred girls' games and was embarrassed when others saw his body in the gymnastics lessons. From the time he was small, he felt that he belonged to the opposite sex, and this grew worse when he entered puberty at 14. He was often mistaken for a girl when he was young. He was erotically attracted to males. He never had any heterosexual intercourse, but had frequent and satisfying homosexual relations. He masturbated without any accompanying fantasies. He had a moderately strong libido. At 17 he began to cross-dress now and then, and at 23 he changed over to wearing feminine clothing all the time. He wanted a sex-changing operation and to have his name changed. At 22 he began getting estrogens.
Examination at 22 revealed: A mild, gentle man with a hysteroid, asthenic, psychoinfantile personality; IQ 81. Normal build; normal penis, testicles, prostate; normal pubic and axillary hair, but shaving only necessary once a week: normal hormone values; EEG abnormal.

CASE 13.
Male. One older brother. Whole family alive and well.
The patient was born in hospital, weighing 3000 g; the amniotic fluid was discolored. At the age of 2 he had concussion and was hospitalized for a short time. At 7 he was again hospitalized for concussion and a small cranial fracture; afterwards speech disorders developed. At 18 he was operated on for a gastric ulcer. At 21, diabetes mellitus was discovered.
After leaving school he did various kinds of work, first as a male, but at 21 he began working as a female.
He said that he had had a happy childhood. His father was the dominant parent; he was more attached to his warm-hearted mother.
As long as he could remember he had felt as if he were a girl. He played girls' games when he was a child. He was embarrassed when he had to undress in front of his schoolmates. He entered puberty at about 15, and then became disgusted at the sight of his body. He was mentally aroused by the male sex, and had chiefly homosexual contacts. A few attempts at heterosexual intercourse were all a failure. He imagined himself in the female role while he was masturbating. He had a moderate libido. He began cross-dressing during puberty, first only occasionally, but at 19 he began wearing women's clothes all the time, and eventually he adopted a completely feminine role, both at home and at work.
He had several periods of mental trouble when he grew up, but none very profound or long-lasting.
Examination at 21 revealed: Good balance and good insight; hysteroid and syntonic traits; IQ 96. Normal build; slight paralysis of left abducens nerve; normal penis, testicles and prostate, and male pubic hair; shaved armpits; needed to shave every other day; abnormal EEG.
At 21 estrogen treatment was started and at 23 he got his name changed. This made it possible for him to get better and more permanent work, and he became more stable mentally.

CASE 14.
Male. The patient was illegitimate and never saw his father. His mother, said to have been 42 when he was born, had three girls in an earlier marriage, two of whom died for some unknown reason; she herself died at 57 for an unknown reason.
The patient said that he was born at home. At 24 he had lung tuberculosis, and was discharged from hospital recovered after one year. He bit his nails as a boy.
After finishing school, where he was an average pupil, he first worked in factories, and then in restaurants, where he had worked as a woman during recent years.
When he was small he liked to play girls' games, and to associate with girls. He felt like a girl, and it was extremely hard for him to undress in front of boys at school. While he was going to school, he began to sit down to urinate. From his very earliest years he hated his genitals, At 12 he entered puberty and with this his feeling of belonging to the opposite sex increased. He was erotically attracted to the male sex, and had several homosexual relationships. He had a moderately strong libido and said that he never masturbated. He started cross-dressing now and then when he was a child and continued doing so until he was 28 when he began wearing women's clothing all the time. He was periodically depressed, and had once attempted to take his life. He longed for a conversion operation and a change of name, and at 30 the operation was done.
Examination at 27 revealed: Hysteroid, syntonic, psychoinfantile personality; cerebrolesional syndrome; tendency to depression; normal intelligence (IQ not measured because of linguistic difficulties). Athletic build; penis, testicles and prostate normal; inale pubic, axillary and facial hair; normal EEG.

CASE 15.
Male. One older sister, two older and two younger brothers.
The patient was born at home. At 12 he hit his head, but did not faint. At 17 he apparently had poliomyelitis but he was not hospitalized and the disorder disappeared without a trace. At 18 he fell while ski-jumping and lost consciousness for a long time; no skull fracture could be seen. The next year he fell again ski-jumping, and dislocated his shoulder and broke off some of his teeth. He had many attacks of gastritis, kidney stones, and prostatitis.
As a child lie was anxious and easily upset, and he bit his nails so much that his parents sent him to a child psychiatrist.
He got average marks at school. After finishing there and doing his military service, he first worked for a time in the forests, and finally became a truck-driver.
He said that lie had been brought up in a happy home atmosphere on the whole. His father was slightly more dominating than his mother, but he did not prefer one parent more than the other.
Up to the age of 22-23 he developed normally and had normal and satisfying sexual relations with women. In his 23rd year he began to feel that he was being transformed into a woman, and started dressing in women's clothes now and then. At 24 he married, and lie was very fond of his wife, with whom he had two children, but she gradually lost her sexual attraction for him. His feeling of belonging to the other sex grew and grew, and lie began to shave his pubic hair and to do other things to make himself took like a woman, and he cross-dressed more and more often. At 29 his wife threatened to leave him. He consulted a doctor who advised him to consult us at the mental hospital, and we admitted him. It was found that he had an abnormal EEG, and as an experiment he was given phenantoin, without any suggestion being used; three weeks later his transsexualism vanished. The drug had to be stopped because of its side effects, and with this the transsexualism reappeared. Other anticonvulsants tried also had to be stopped because of side effects. At 30 the patient was a full-fledged transsexual, his wife divorced him and he started making plans to adopt a female role entirely. According to his last report to us, when he was 31, the transsexualism had diminished for a time but was now back in full force, and he felt he could no longer go on working as a man.
Examination at 29 revealed: Hysteroid, asthenic personality; tendency to ideas of persecution; cerebrolesional syndrome; IQ 104-110 (measured during military service). Normal build; normal penis, testicles and prostate; pubic hair shaved to look female; eyebrows and facial hair plucked; hormone values normal; EEG abnormal.

CASE 16.
Male. Only child. Parents divorced when patient was 4. Mother, who Temarried, was said to have Basedow's disease.
The patient was born in hospital, weighing 3480 g. He was a "delicate child". Diabetes mellitus was discovered when he was 3 and beginning with his early years he had many attacks of coma. He had ichthyosis from the time he was young.
After finishing his compulsory school training he went to a trade school, and afterwards did various kinds of work, mainly in restaurants.
He was aggressive, irritable and maladjusted as a boy, and was taken to a department for child psychiatry on two occasions, when he was 14 and 17, where the diagnosis both times was "puberty neurosis and diabetes mellitus".
He said that he had felt insecure as a child, that his domineering step-father did not understand him, and that he preferred his more submissive mother.
He was apparently not interested in the clothes of the opposite sex when he was a boy, and he was not embarrassed during gymnastic lessons. But already at 6 or 7 he began to feel that he was not fitted to play a masculine role. Shortly before puberty he began to feel intensely that he really belonged to the opposite sex, and to become more and more repelled by his own body. He had occasional heterosexual contacts when he was young, but he was always erotically attracted to his own sex. He got engaged twice in attempt to be like other men, but both times it was a failure. He had a moderate libido. He masturbated without any specific form of fantasies. He began to cross-dress periodically when he was a boy, and at 23 he changed over to wearing women's clothing all the time. He had many attacks of depression and had attempted to commit suicide. The last few years he had had an overwhelming desire for conversion surgery and a change of name.
Examination at 24 revealed: Good verbal ability; hysteroid, asthenic, schizothymic, psychoinfantile personality; cerebrolesional syndrome; IQ 104. Normal build; ichthyosis; normal penis, testicles and prostate; male pubic, axillary and facial hair; low total gonadotropin value for age; abnormal EEG.

CASE 17.
Male. One younger brother and one sister. Mother "delicate" and "nervous" though she never consulted a physician for it.
The patient was born in hospital, weighing 2400 g. At 9 he broke his thigh-bone in a traffic accident, and suffered from concussion and confusion for about two days afterwards. At 14 he began having bronchial asthma. At 25 he was examined for dizziness, and an EEG taken was normal.
After finishing school he went to a commercial college and was now a salesman.
He said that he had not got the tenderness he longed for as a child. His mother was the dominant member of the family, and he liked his father better.
He said that he had heard his mother say that she had wanted a girl instead of him, but this was not verified, and he was not reared like a girl. As a boy he preferred girls' games. Beginning at about the age of 4, he started to feel that he belonged to the opposite sex, and he was considered to be a sissy at school. At 14, when he entered puberty, the contrary sex feeling grew more intense and he began to detest his own body, especially his genitals. He began periodical cross-dressing at about the age of 25, and at about the same time began shaving his legs and his pubic hair to make himself look feminine, and also to have his beard removed by electrolysis. He had occasional heterosexual contacts, but they had not given him any satisfaction. He was erotically aroused by men, but he had not had any homosexual contacts. He had a moderately strong libido. He had frequent attacks of depression, and was prepared to give up everything for a conversion operation and change of name. Estrogen treatment, started when he was 3~1 made him calm down a little, but only for a time.
Examination at 34 revealed: Hysteroid, asthenic, schizothymic, psychoinfantile personality; cerebrolesional syndrome; IQ 103. Slight dbtsity; heavy bone structure; male pubic and axillary hair; normal perils, testicles and prostate; normal EEG.

CASE 18.
Male. Only child. The father, who drank, left home shortly after his son was born, and died three years later.
The patient was born in hospital, weighing 3220 g. He was prone to infection as a small child. At 4 he began having facial tics, which gradually disappeared. At 10, when he was examined for a defect in the frontal bone, the EEG showed a focus, but this had gone in a record taken later.
He kept to himself as a child. After finishing school, where he was an average pupil, he did various kinds of work.
He said that he had had a happy childhood on the whole. He was greatly attached to his mother.
From early childhood on, he felt that he was really a girl. He played girls' games, and his schoolmates called him "girlie". He was extremely embarrased whenever he bad to dress and undress in front of his schoolmates. After puberty, at 14, he began to abhor his own body, especially his genitals. He was sexually attracted to males, and had occasional homosexual contacts, but never any heterosexual relationships. He masturbated but said he had no masturbatory fantasies. He had a moderate libido. He often had attacks of depression. Beginning at the age of 15, he cross-dressed every time he got the chance and at 20 he changed over to wearing women's clothing all the time. From then on he was consumed by a desire for a conversion operation and a change of name.
Examination at 22 revealed: A quiet, modest and gentle manner; hysteroid, asthenic, Syntonic traits; IQ 94. Normal build; slender bones; normal penis, testicles and prostate; male pubic, axillary and facial hair; hormones normal; EEG normal.
At 23, after a period of estrogen medication, a conversion operation was performed. At 24 he got his name changed and breast implants. The results so far have been very satisfactory. He is much happier and more stable than he used to be.

CASE 19.
Male. The patient, an only child, was born in hospital, weighing 3200 g. At 7 he had polyserositis which healed without complication. As a child he suffered from night terrors and nightmares. At 5 he began biting his nails.
He was an average pupil, and after finishing school went into office work.
He felt insecure as a child because his parents quarrelled a great deal. His father was the dominant parent. He was very fond of his mother.
He always felt like a girl when he was small, and he played girls' games. At 7 the contrary sex feeling grew stronger and he began to dislike the sight of his own body, and disliked it still more, especially his genitals, after he entered puberty at 15. He was erotically attracted to men, and never had any heterosexual contacts, but several homosexual relationships. He had a moderate libido. His masturbatory fantasies were of males. Beginning as a schoolboy, he began to cross-dress now and then. At 19-20 be began to feel an intense desire for a conversion operation; every sign of his male anatomic sex became abhorrent. He bad several attacks of depression when he contemplated suicide.
Examination at 20 revealed: Shy andreserved manner; asthenic syntonic and psychoinfantile personality; slight depression; IQ 87. Normal build; normal penis, testicles, and prostate; male pubic, axillary and facial hair; low total gonadotropin value for age; abnormal EEG.
At 22, he began taking estrogens. The result has been greater mental stability and less tendency to depression.

CASE 20.
Male. Three older brothers, one younger brother and sister. Whole family said to be "nervous", but none had been hospitalized for it.
The patient was born in hospital, weighing 2710 g. As a child he tended to keep to himself, and was shy and reserved, and a child psychiatrist was consulted.
After finishing school lie worked in restaurants, from the age of 24 on as a "woman".
He said that lie had had an unhappy childhood mostly because of his aggressive, domineering father. He preferred his mother, who was more submissive.
As a child he always felt like a girl. He was embarrassed at having to undress for gymnastics. fie had little to do with other boys, and was called a sissy. When he entered puberty at 15, lie began to abhor his body, especially his genitals, and he envied the way the bodies of his female playmates were developing. At this age he also became firmly convinced that he belonged to the opposite sex. He was attracted erotically only to males. After one unsuccessful attempt at heterosexual intercourse, he had only homosexual contacts, which always satisfied him. His masturbatory fantasies were of males. He had a moderate libido. Beginning as a boy, he crossdressed now and then, and at 24 he changed over to wearing women's clothing all the time. He wanted to have a conversion operation and a change of name. At 24 estrogen treatment was begun, but he has not yet noticeably improved.
Examination at 24 revealed: A shy, vague, evasive man with asthenic and syntonic traits; IQ 96. Normal build, normal penis, testicles and prostate; normal male pubic, axillary and facial hair; hormone titers normal; normal EEG.