Physical methods (such as insulin shock) cannot cure transvestism as such but can relieve the patient fromsome accompanying psychoneurotic symptoms, such as depressions feelings of guilt, anxiety etc.

63.

Glandular treatment, which amounts to "chemical cas- tration" has been applied to transvestites with the aim of inhibiting testicular function. Hamburger also advo- cates glandular treatment, though he uses it rather as a preparatory measure for the subsequent surgical procedure.

Surgical treatment is most controversial as it in- volves ethical and legal problems as well as medical ones. The main reservation is the obvious irreversibility of a conversion operation, should the "demasculinized" patient later change his mind. No surgeon could later provide him with arteficial testicles and an artificial penis.... Such a situation is not only theoretically possible, it has already occurred. Patient B of Battig, four years after his castration and "legalization as a woman, came back as a man into the psychiatric polyclinic ...He lost his illusions...he cared now only to be changed again into a man...He was utterly lonely, very depressed... blaming the authorities, but no less the doctors". This poor creature presented a most pathetic picture of a "cured" transsexualist, and is a grave warning to all enthusiasts of conversion operations...

Yet in spite of all this, and in spite of the fact that, "sex, being genetically determined, cannot be changed" (Benjamin), there are still some authors who favor a "surgical treatment". Curiously enough, Benja- min himself recommends such procedures "in suitable cases" although it "is to be considered only as a last resort". Dukor also feels that (in certain) transvest- ites there is a true suffering, and that, after all other kinds of treatment proved unsuccessful, an operation should be "legally granted and justified from the point of view of medical ethics.".........In the opinion of the present writer surgical "treatment" is contrary to medical ethics and is without any rationale.