PSYCHIATRIC understanding of the transsexual requesting sexual transformation is typically frustrated by the unreliability of the patient as a historian. Contrived biographies, rationalization, memory disturbances, and frank distortion1-4 are enlisted to support the patient's insistence on a lifelong mistake in sexual identity, which the male transsexual supports with details of early feminine interests. Even the most experienced investigators5 appear to accept his historical data at face value although they describe these patients as being "emotionally immature, unreliable, enormously self-centered and irresponsible, with occasional paranoid trends." Additional efforts at reconstruction of psychological data are frustrated by the determined reluctance of these patients to enter into psychotherapy and the paucity of reported success of such ventures according to Pauly's2 extensive review.
We recently had the opportunity to review the extensive records accumulated by a child guidance clinic and two psychiatric hospitals