Benjamin suggested that the etiology of female transsexualism involved early childhood conditioning, and constitutional predispositional factors. He seemed to believe that one day researchers would uncover an innate biological factor underlying transsexualism. He noted that in all cases the sense of being male first appeared during the oedipal period (age 5) and that many of the patients were first born (whose mothers may have wanted a son), Physiological data were unremarkable. However, Benjamin always recommended a thorough medical screening of each patient, including a physical exam, and chromosomal genetic and hormonal tests. However, none of his medical investigations demonstrated a physiological explanation for the women's transsexualism.

The twenty female transsexuals seemed to represent all social classes and a wide variety of occupational types. Benjamin was clearly anti-psychoanalytic and viewed psychotherapy that aimed at total rehabilitation of the patient's gender as useless. He was, however.. quite enthusiastic about the use of surgery and hormones, claiming that fifteen of the women who had androgen therapy "greatly benefitted." However, one woman who had undergone surgery was reported to have converted back to the female role.

Benjamin reported that seven of the eight patients who had genital surgery had a satisfactory outcome. Some had even married and were leading relatively stable lives. The only case history presented in any depth (a patient referred to as Joe) appeared in the Appendix. The patient, a post surgical transsexual, had a history of early childhood gender identity confusion, suicidal acting out, and a two year psychiatric treatment which failed to correct her gender problems. Joe's early childhood was not reported. She did, however, reveal a chronic longing for a penis. She also reported being encouraged (even at an early age) by mother, the maternal grandmother, and occasionally father, to cross dress in male attire. The patient was described as married (in her male role) and leading a happy life.

In 1967 Gittleson and Dawson Butterworth investigated the relation between female schizophrenia and subjective ideas of sex change. Their findings suggested that female schizophrenics, as opposed to nonschizophrenic controls, had a greater incidence of genital hallucinosis and delusions, in addition they had a higher frequency of ideas of being in the process of, or of becoming, or of having become a neuter or a man. They did not compare their findings with a control group of transsexuals.

Simon (1967) reported on a case of a 37 year old female who was married, had two children, and presented with a wish for sex change. He labeled her condition "transsexualism." The patient, an immature childlike individual, was reportedly quite volatile and profoundly suicidal. She also had a chronic history of pelvic pain and had been hospitalized for a total of four years on an inpatient psychiatric service, "usually for symptoms of acute anxiety, depersonalization, and threatened suicide." During latency she developed a strong attachment to her father and became inseparable from him. At this time (age 8) she was also molested by a middle age man. The patient eventually left home, married, and had two children (a girl and then a boy). As an adult she often took alcohol as self medication. After one of her hospitalizations she was placed in intensive psychotherapy. The therapy goals, which aimed at converting her to heterosexuality, failed. The patient then began dressing full time as a man. Eventually, she had her ovaries removed (which did not abrogate her pelvic pain), After surgery the patient began living with a woman in a marital type relationship. (see THE TRANSSEXUAL PHENOMENON PART III)