54.

this fact is clear: a case of simple transvestism can be helped by psychotherapy, combined with an understand- ing and permissive attitude on the part of his environment.

2.

Transsexualism, on the other hand, shows a progress- ive, malignant course, and any permissive gesture or con- cession always brings some new, more far-reaching, and more morbid demands.

3.

The few intermediate cases seem to belong to two

clinically different sub-groups. In the first group a hitherto typical case of transvestism becomes acutely disturbed (usually under the impact of some sensational literature), turns, as it were, malignant and degener- ates into a full blown picture of transsexualism with its gloomy prognosis. To the second group belong the cases of transsexualism turning "benign" after the ini- ial mutiliation and showing a spontaneous arrest, just on the verge of a full conversion operation.

4. Time, as such, does not appear to have any therapeu- tic, or limiting, effedt either on transvestism or trans- sexualism. The same applies' to the factor of age. "The problem is alive in men almost aged 60" (Hamburger), and our patient was 54 when he wrote in his autobiography, "All through the years the feeling of really being a woman has persisted....."

Frequency of Occurrence of Transvestism

There are no statistical data on the incidence of transvestism. Hence the views on the occurrence of this phenomenon are not only diverse but highly speculative. Thus one group of authors believes that the number of transvestites is negligible. "Genuine transvestism is certainly an exceedingly rare afflication....We are in personal contact with five Danish transvestites in a pop- ulation of nearly 4 million" (Hamburger). (((Only those interested in surgery would have had reason to contact Hamburger so that he was in fact commenting about trans sexuals and not about TV's as they would not have gone