Case Reports - Male

Case 21. to Case 30.

CASE 21.
Male. Three older brothers and one younger sister. Father had gone through a period of excessive drinking. One brother epileptic.
The patient was born in hospital, weighing 3300 g. At 10 he got concussion but he was apparently not hospitalized. At about the same age he had a short spell of albuminuria.
After leaving school, where he was an average pupil, he worked in restaurants for the most part, as a "woman" from the age of 24 on. Apparently because of the difficulties his anomaly caused him, he started drinking too much and to take too much of various forms of drugs. He stole, and after a few suspended sentences, was exempted from legal punishment. He was admitted several times to a mental hospital.
He thought that his childhood had been a happy one on the whole. His father was the dominant parent, and he preferred his mother.
From as far back as lie could remember he was convinced that he was a female. He preferred girls' games and to play with girls. He gradually began to dislike his own body, and began to do so even more when he entered puberty at 14-15. He -crossdressed now and then from the time he was a boy until he was 24, when he changed over to wearing women's clothing all the time. He was erotically attracted to men, and had only homosexual activity. His masturbatory fantasies were of males. He had a strong libido. He often had attacks of depression and thought of suicide.
Examination at 26 revealed: Hysteroid and syntonic traits; tendency to feel persecuted; IQ 94. Normal build; normal penis, testicles and prostate; normal pubic, axillary and facial hair; normal EEG.
At 28 he had a conversion operation, after a period of estrogen medication, and the same year he got his name changed. After this he appeared to become better adjusted and to show less inclination to crime. He himself felt more at peace with the world and said that he did not become depressed so often as before.

CASE 22.
Male. One older brother and one younger sister. Parents happily married. One maternal uncle committed suicide, and another was treated at a psychiatric institution for transient "nervous trouble."
The patient was born in hospital, weighing 4080 g. Apart from a slight attack of rickets, his early physical history was normal.
He took a university degree and worked as a teacher.
He said his father was slightly more dominant than his mother, who was more warm-hearted and to whom he was much more attached.
As a child he always played girls' games, and he had felt like a girl ever since he could remember. He did not act like other boys and he was embarrassed when he had to change clothes for gymnastics. He got more and more the feeling that he was "born in the wrong sex". At 14-15, when he entered puberty, he began to abhor his own genitals, and to long to have them operated upon so that he would look female. When he became conscious of his sexual urge, he was attracted to males, never to females, He had frequent homosexual contacts, which satisfied him immensely, and never any heterosexual intercourse. His masturbatory fantasies were of males. He had a moderate libido. He was often depressed and thought of suicide, but never attempted to take his life. Because of his social position he had never been able to cross-dress.
Examination at 33 revealed: An extremely frank, accessible and intelligent man, with good insight; hysteroid, syntonic traits; IQ 121. Normal build; normal penis, testicles and prostate; normal pubic and axillary hair; slightly sparse beard (partly plucked out); normal hormone titers; normal EEG.

CASE 23.
Male. One older sister. Parents divorced when patient was about 7. His mother, who was appointed his guardian, never remarried; she had rheumatism, and was "nervous"; she gave the impression of being slightly retarded.
The patient was born in hospital, weighing 4740 g. When he was a child he often felt worried, and had attacks of the anxiety type, and he bit his nails intensely. Because of this he was taken to a child psychiatrist.
After finishing school, where he repeated one grade, he did unskilled factory work.
He said he had been unhappy as a child "because I could not be a girl". He preferred his mother to his father; neither was particularly dominant.
As far back as he could remember he felt that he was a girl. He played only girls' games, never boys'. He liked gymnastics, but thought it was hard to change in front of the other boys. At 7 he began to sit down for urinating. At this age he also began to dislike his own genitals, and this feeling grew more intense after puberty. He envied girls their bodies. He had no sexual activity, though he had a strong libido. He was erotically attracted to the male sex, and his masturbatory fantasies were of males. At 14-15 he began to cross-dress on occasion. He had repeated attacks of depression; he threatened again and again to commit suicide, and attempted to do so on at least two occasions. He tried to get a surgical change of sex and became greatly upset when this was denied him.
Examination at 19 revealed. Asthenic, hysteroid, syntonic, psychoinfantile traits; strong tendency to depression; distinct cerebro)esional syndrome; IQ 81. Normal build; heavy bones; penis, testicles and prostate normal; normal male pubic, axillary and facial hair; normal hormone titers; normal EEG.
Estrogen treatment was started when he was 19, but it is too early yet to be able to say anything about the result. He is now working as a "woman".

CASE 24.
Male. Five younger sisters and four younger brothers. His family was poor, but there was a pleasant atmosphere in the home. One sister was treated in a mental hospital under the diagnosis of postinfectious psychosis; she died from lung tuberculosis.
The patient was born at home. After finishing rural school, he went to a people's high school. He then took a job in an office, and at the same time went on with his education by taking correspondence courses. During the last few years he has been working as a civil servant.
Neither parent was more dominant than the other and he liked them equally well.
He always felt like a female. When he was small he had had only feminine interests, and played mostly with girls. He was poor at gymnastics, but not particularly embarrassed when he had to undress in front of the other boys. At 14 he entered puberty and afterwards felt himself strongly attracted to boys. He had many homosexual contacts, which he enjoyed immensely. He once tried heterosexual intercourse but it was a failure. He had a moderate libido, and his masturbatory fantasies were of males. His feeling of belonging to the other sex became more and more accentuated after puberty, and at 25 he began to long to have a "sex-changing" operation. He never cross-dressed because of his social position and because he was afraid of getting into trouble, but he had often longed to do so. He had never said anything to a doctor about his troubles until he came to us.
Examination at 49 revealed: Asthenic, syntonic, schizothymic, psychoinfantile traits; average intelligence (IQ not measured). Normal build; normal penis, testicles and prostate; normal pubic, axillary and facial hair; normal EEG; low but not definitely abnormal total gonadotropin values for age.

CASE 25.
Male. Besides a twin brother, apparently bi-ovular, he had four older brothers, two older sisters and two younger brothers. One paternal uncle was said to have had epilepsy and one sister had a son who was treated for a short time in a mental hospital, apparently for a depressive reaction.
The patient was born at home. At 8 he fainted in an accident, and afterwards suffered from headache, dizziness and difficulty in concentrating. At 14 he began to have attacks of epilepsy, mostly of the grand mal type. At 37 he was operated on for prognathism.
After finishing school he first worked in factories but from the age of 23 on he cooked in a restaurant.
At 38 he was treated three times in a mental hospital for mental confusion, once after heavy drinking; he was given the diagnosis of alcoholic psychosis and possibly epileptic psychosis. It was noted that he had convulsions when he was in hospital; he was put on phenantoin and then got fewer attacks. It seems that whenever he did not take enough of this medicine, he became confused again. Several routine EEG's were taken, but they were always normal.
He said that neither of his parents was particularly dominant. He preferred his mother.
As a child he always felt like a girt. He played girls' games and was embarrassed when he had to undress in front of boys. After puberty at about 15, he became erotically attracted to boys, and his homosexual preference grew more and more pronounced. He had heterosexual contacts but none had satisfied him. He had only a few homosexual contacts, however, and his libido was classed as weak. He masturbated occasionally, but without any particular type of fantasies. After puberty he began to abhor his own body, particularly his genitals, and to become more and more convinced that he belonged to the other sex. After puberty he also began crossdressing now and then. He longed for a conversion operation, but was afraid that this was impossible because of his age and his work and other social factors.
Examination at 42 revealed: Psychoinfantile, asthenic, hysteroid traits; tendency to feel persecuted; distinct cerebrolesional syndrome; IQ 72. Dysplastic build; penis, testes and prostate normal; normal axillary hair but female type of pubic hair and so little facial hair that he only needed to shave once a week; normal EEG.

CASE 26.
Male. The patient was illegitimate and lived sometimes with his mother, sometimes with his mother's parents and sometimes in children's homes. His mother remarried when he was 12. He had no siblings.
He did not know whether he had been born at home or in hospital. He had many attacks of pneumonia as a child, though he apparently was never very sick.
After leaving school he worked in factories and in restaurants.
He said that he had grown up with a feeling that he did not belong anywhere.
He had heard that this mother had wanted him to be a girl, but this could not be confirmed. He had never felt like a male, but always like a female. He played girls' games as a child. He was embarrassed about his own body while he was growing up, and repelled at the sight of his male characteristics. These feelings and the feeling of belonging to the other sex increased after puberty at about 13. He was erotically attracted only to men and had many homosexual contacts. He had a moderately strong libido. He imagined himself to be female when he was masturbating. As a child he cross-dressed occasionally, and at 17 he changed over completely to women's clothing. He worked as a woman. He wanted a conversion operation and a change of name.
Examination at 21 revealed: Syntonic and schizothymic traits; good insight; apparently normal intelligence, low IQ of 72 being probably due to language difficulty. Athletic build; normal penis, testicles, and prostate; pubic hair shaved to look female; axillary and facial hair normal; hormone titers normal; EEG normal.

CASE 27.
Male. One older sister. Parents divorced when patient was 3. Mother did not remarry. He was brought up away from home for long periods, sometimes at his maternal grandmother's and sometimes in children's homes. His mother had gynecologic and nervous troubles, and was treated in a mental hospital for a "neurotic-depressive reaction". She had also gone to a psychiatric department for nervous troubles and to obtain permission for a legal abortion (not for the patient).
The patient was born in hospital, weighing 3550 g.
He was an average student at school, but his transsexual feelings made him unhappy there, and he played truant and ran away from home, and was taken to a department for child psychiatry. After leaving school he had several jobs, usually only staying a short time at each, and he usually worked as a "woman". He had difficulty in adjusting, and had occasionally drunk too much and taken too many drugs.
He could not remember what his father was like. He described his childhood as insecure.
As a child, he always felt as if he were a girl. He played girls' games and liked to dress in his sister's clothes. He envied girls their bodies. After puberty at about 14, he became disgusted at his own body, and at his erections. At 15 he started wearing women's clothes all the time. He was erotically attracted to men, and had occasional homosexual contacts. He never had heterosexual intercourse. His libido was moderate. He imagined himself as a woman when he masturbated. After puberty, he determined to get a conversion operation and change of name. He had many periods of depression, and had been admitted to various forms of psychiatric institutions. He had attempted to commit suicide.
Examination at 18 revealed: Psychoinfantile, asthenic, hysteroid, syntonic traits; tendency to depression; IQ 96. Normal build; slender bone structure; female pubic hair; normal axillary and facial hair; normal penis, testicles and prostate; hormone titers normal; EEG normal.
At 18 he got his name changed, and estrogen treatment was started. He improved a little after this-did not get depressed so often. But he was still determined to get an operation.

CASE 28.
Male. The patient was born out of wedlock and was sent to foster-parents at the age of I I months. He got along well in his foster family.
He was born in hospital, weighing 3370 g. At 7 he was said to have lost consciousness for a short while after a head injury. At 20 he fainted again after an injury during military service.
After finishing school he did office work and finally started his own firm.
He was "nervous" as a child, slept badly and walked in his sleep. When he grew older, he sometimes took alcohol and drugs to excess.
Neither of his foster-parents was more dominant than the other, and he liked them equally well.
As far back as he could remember he felt as if he belonged to the opposite sex. When he was small he played mostly girls' games, and he was always called a sissy. He was embarrassed during gymnastics and was exempted from participating. At 12 he began to use lipstick and powder. He became more and more disgusted at the sight of his genitals. At 25 he consulted an endocrinologist and then began taking estrogens. Two years later he began cross-dressing, at first only now and then, but at 27 he changed over entirely to women's clothes. At the same time he began to long for sex-changing surgery, and finally became convinced that he would not be able to go on without an operation. He had many periods of depression and once attempted to commit suicide. At 37 he got his name changed.
He was erotically attracted to men and had mainly homosexual contacts. His libido was moderate.
Examination at 35 revealed: Hysteroid, asthenic and syntonic personality: IQ 96. Estrogen-induced gynecomastia; atrophied testicles; normal male distribution of hair; normal EEG. Before the estrogen treatment he had a slender masculine build, and normal genitals and prostate.

CASE 29.
Male. One older brother and one sister and three younger brothers and one younger sister. Mother, one brother and one sister mentally retarded. The brother showed behavior disorders and the sister had epilepsy. Some of the father's relatives were said to be retarded. The mother had consulted psychiatrists mainly for help in social conditions.
The patient was born in hospital, weighing 3100 g. At 2 he had severe scarlet fever and his hair fell out afterwards. He was late in learning to talk, and had difficulty at school, repeating the first year. Afterwards he worked in restaurants to begin with, and then as a "female" nurse's assistant.
He said that he had had a happy childhood on the whole. His father was the dominant member of the family. He did not prefer one parent to the other.
At the age of 12 at the latest, he began to feel that he belonged to the opposite sex. He was embarrassed in gymnastics, and was repelled by all the signs he showed of being a male. He began cross-dressing at 12 and at 18 he changed over completely to wearing women's clothes. He always had a weak sexual urge; he had no sexual contacts; he denied masturbating; and he was erotically attracted only to men. He started at an early age to urinate in the sitting position. He had several attacks of depression and thoughts of suicide.
Examination at 21 revealed: Psychoinfantile, asthenic, hysteroid, and syntonic traits; tendency to depression; cerebrolesional syndrome: IQ 72. Slender build; normal penis, testicles and prostate; feminine pubic hair; sparse beard of ordinary distribution; EEG abnormal.
At 23 he got his name changed, and at 24 he had a conversion operation. After this he felt better, got along better with others, and had fewer attacks of depression.

CASE 30.
Male. The patient was born as the second of twins, the other twin being a girl. In addition, he had one older brother and three sisters. His father was hospitalized for an endogenous depression. The parents divorced when the patient was about 10, and the mother afterwards remarried. Before this there had been a great deal of strife in the home; the child welfare bureau had intervened, and placed the patient in foster-homes on several occasions.
The patient was born at home.
Neither of his parents was particularly dominant. He was more attached to his mother.
He went to school both in Sweden and Denmark, where his mother moved when she remarried. After finishing school, he did various kinds of work on land and at sea, and lastly he began working in restaurants as a "woman".
He had felt that he belonged to the other sex as far back as he could remember. He was embarrassed at having to undress for gymnastics. His schoolmates called him by girls' names. At puberty his contrary sex feeling became accentuated and he began to despise his own body, and to want to have it operated on. He urinated in the sitting position. He was erotically attracted to men. He had occasional heterosexual contacts, but they did not satisfy him. Homosexual contacts, however, had given him complete satisfaction. He imagined himself a female when he masturbated.
Examination at 20 revealed: Hysteroid, syntonic traits; good insight; IQ I 11. Ordinary build; normal pubic and axillary hair; beard sparse, needing shaving only every other day; normal penis; testicles soft but normally sized; prostate normal; low total gonadotropins for age and high estrogen titer, but neither value definitely abnormal; normal EEG.
At 20 estrogen treatment was started.