Own Study

Age of conscious onset

As each patient was interviewed and examined on several occasions and all of them gave me the impression of giving a frank account of their case, and as the information they gave tallied in other respects with that from outside sources in all except I case (case 37), 1 felt I could rely on what they said about the age they began to feel as -if they belonged to the opposite sex.
For further check on this point, I asked as many as possible of the parents when they first noticed the patients acting as if they belonged to the opposite sex. This I could do for 14 of the male patients and 5 of the female. In the rest of the cases, either the patients did not want me to contact their relatives, or the relatives were dead, or the patients did not know where they lived. In 17 out of the 19 cases the relatives agreed on the point of time with the patients. In I case (case 38) the parents had not noted anything unusual while the patient was a child. In I case (case 2), in which the patient said that he first noticed his anomaly when he was 10 years old, the parents had not noted anything in particular at that time. Despite the risk that the patients might in fluence their parents' opinions on how they were as children, I concluded that the information from the parents pointed to the patients' truthfulness on this point, The breakdown was as follows:

These figures tally fairly well with those from the literature. Thus the "cross-gender behavior" began before the age of 15 in about 90 per cent of the male case; I collected from the literature, and in about the same percentage of the women. Benjamin (1964a, 1966a) reported much the same figures.
In only 3 of the present cases (cases 6, 11, 15), all men, is it sure that the contrary sex feeling did not begin until after the age of 15.
In case 6, the transsexualism did not begin until the patient was 21, in connection with the development of gynecomastia and the observation of abnormal hormone titers in the urine. As a child the patient had been ambivalent about his gender role, though he leaned slightly towards the feminine role.
Case I I began at about the age of 16 in connection with a change in personality. It is impossible to rule out a psychotic reaction in this case. The transsexualism persisted and grew more intense, however, though the mental condition otherwise remained stable afterwards and no signs of psychosis developed.
Case 15, already reported (Walinder, 1965), began at the age of 23, a few years after a head injury. Up to then, the patient had developed normally psychosexually.
Whether the concomitant disorders in these three cases had anything to do with the transsexualism will not be discussed here. All I should like to point out here is that in all three cases in which the cross-gender behavior set in late compared with the other cases, it was preceded by another disorder