TRANSSEXUALISM AND TRANSVESTISM

other signs of a congenital hypogonadism or if there are unde- scended testicles or hypospadia, we may be justified to suspect the sexual deviation to be due to a primary genetic disturbance also. But on the other hand all physical abnormalities can secondarily have far-reaching psychological repercussions.

The all-important role of environment and of psychological con- ditioning need not be stressed before this audience. There are any number of situations in early childhood that can be held responsible for the development of a sexual deviation. From the "smothering mother" to the dominant female in the family and the cross-dress- ing of the little boy to please a parent, each case of transvestism can have a different inception. Emotional development arrested during an early phase may play the most frequent role.

In some case histories the transvestitic tendency appears to have developed spontaneously at an early age. It may be well, therefore, to recall the fact as Dukor (7) expressed it: "The possibility of a purely psychological cause for a sexual deviation does not prove its correctness. There may be other factors besides. In a recent published monograph Bürger-Prinz, H. Albrecht and H. Giese (8) express the belief that there is no single principal cause for trans- vestism. Alden of San Francisco includes the realm of all mental and emotional reactions into the individual's constitutional equip- ment.

The effeminate male may look and behave as he does on a purely psychosomatic or psychological basis (imitating his mother, for in- stance) but he may also be the product of a somato-psychic mech- anism originating in his chromosomes. It is often impossible to distinguish between the two.

Havelock Ellis has this to say in regard to etiology: "Early environmental influences assist but can scarcely originate Eonism. The normal child soon reacts powerfully against them. We must in the end seek a deeper organic foundation for Eonism.'

THREE TYPES OF TRANSVESTITES

Let me briefly sketch my impression of the three principal types of transvestites as I have seen them in my practice and as the eti- ology suggested itself to me.

1. The principally psychogenic transvestite. He is anatomically a normal male but may lack masculinity. The feminine component in his make-up is sufficient to allow an early psychological condi-