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AMERICAN JOURNAL OF PSYCHOTHERAPY

genetic or endocrine origin. Hirschfeld spoke of metatropism as an organic state.

On the other hand, there is the strictly psychoanalytic explana- tion which traces all such deviations to psychological conditioning, infantile traumata, childhood fixations, or an arrested emotional de- velopment.

I believe that in the face of clinical facts, logic and objective ob- servations, either approach as an exclusive key to the phenomenon is untenable.

An organic explanation of intersexual phenomena would have to be looked for either in the genetic mechanism or in the endocrine constitution or in a combination of both. Organically, sex is always a mixture of male and female components. The ratio varies with the individual, determining the constitutional makeup, physical and mental. Between the "full-female" and the "full-male," con- stituting the two extremes on either side (and they are naturally not 100% either), there is every possible intermediate status.

The chromosomal sex (or "genetic sex") normally producing the homogametic female (bearing XX chromosomes), or the hetero- gametic male (bearing XY chromosomes) is subject to disturbances most strikingly evidenced by hermaphroditic and pseudo-herma- phroditic deformities. Investigations into the chromosomal sex (11) have shown that it is probably contained in the nuclear struc- ture of all body cells. It has been detected and demonstrated in the epidermal nuclei of the skin. It does not always correspond to the respective gonad, that is to say, the endocrine sex. Future re- search along these lines may thus determine the dominant sex in an individual and may do much to clarify our still incomplete knowledge of the nature of sex. To speak of a male when there are (or were) testicles and of a female when there are (or were) ovaries may be the most practical way to differentiate the sexes, but it is scientifically incorrect and unsatisfactory to the geneticist.

Similarily the term "transsexualism" answers a practical pur- pose and is appropriate in our present state of knowledge. If fu- ture research should show that male sex organs are compatible with (genetic) female sex or female sex organs with (genetic) male sex the term would be wrong because the male "transsexualist" is ac- tually female and merely requires a transformation of genitals.

The endocrine aspect of the problem is intimately related to the genetic. If we find in a transvestite underdeveloped gonads and