Preface

The desire to dress in the clothes of the opposite sex is a phenomenon that has existed in every age and in every culture. The first description of it in the medical literature seems to have been given by the German, J. Friedreich in 1830, and some years later Esquirol gave a brief account of two other cases. In 1910 Hirschfeld coined the name transvestism for the phenomenon, and since then this has been the name most commonly used. As Hirschfeld pointed out, however, the name is only concerned with how the condition is manifested outwardly, not with its inner psychologic core. Many transvestites not only want to dress in the clothes of the opposite sex, they feel as if they belonged to the opposite sex, that they have been given the wrong body, especially the wrong external sex characteristics, and they want to be operated on so that their body looks as much as possible like that of the opposite sex. Cauldwell (1949) suggested the term "psychopathia transsexualis" for persons who feel this way. After this, Benjamin (1954) coined the word transsexualism, a term which has been used more and more in recent years.

Only recently have transvestism and transsexualism been given systematic study. But only a few authors have been able to collect series of any size (BUrger-Prinz & Weigel, 1940; Overzier, 1955; Randell, 1959; Taylor & McLachlan, 1962, 1963a, b, 1964; Benjamin, 1964a; 1964b; 1966a; Money & Pollitt, 1964; Roth & Ball, 1964; Ball, 1966; BfirgerPrinz, Albrecht & Giese, 1966). Different authors use different criteria for transvestism and transsexualism, and it is hard to draw any general conclusions from most of the cases reported hitherto.

Transvestism and transsexualism give rise to many problems: social, medical, ethical and legal. Yet not much experience has been collected, for instance, on the epiderniologic characteristics of these phenomena, on what causes them, how they progress, and how to treat them. Most of the writing on the subject consists of speculation and the decisions that physicians make in cases of transsexualism, some of vital importance, have been based on shaky theoretical reasoning. Lately, Benjamin (1954, 1964a, 1966a), Roth & Ball (1964) and Green, Stoller & MacAndrew (1966) have pointed out the need of systematic examinations of transvestites and transsexuals, people who probably have much greater psychologic and social problems than do those with anatomic intersex states.

The aim of the present study was to give a multidimensional picture of transsexualism. I chose to study transsexualism as it seems to be easier to delimit than transvestism, cross-dressing being a component of several abnormal conditions.

For valuable advice and the many hours they devoted to helping me in this study I wish to thank Professor Hans Forssman, Associate Professor Hans Olof Akesson and other colleagues at St. Jdrgen's Hospital, and also other members of the staff there, especially Miss Inga Thuwe and Mr. Ernest HArd. I am also indebted to Professors Bengt LindegArd and Rolf Luft, Associate Professor Ingemar Peters6n and Dr. Oskar Steinwall, and many other colleagues who have assisted me in one way or another. Lastly, I am grateful for valuable help in matters of psychology to Messrs. Sven Marke, Bertil Bj6rkman, Eric Osterberg and Ake Ahlberg, and for help with the literature to Mr. Folke Str6m, the head of the Medical Library in G6teborg, and other members of his staff.

For financial support I am acknowledged to the Medical Faculties of the G6teborg and Uppsala Universities, the Gbteborg Medical Society and the Ferrosan Drug Co. Fund.
January, 1967.

Jan Wålinder