Doctor’s first interview was arranged as a home visit with Randi’s mother present. Randi was a boyish looking female, dressed in asexual clothing, with her short hair styled in a masculine fashion. She had been self administering male hormones for several months and revealed some male hair pattern growth, a slightly lowered voice, and, reportedly, an increase in her sexual drive. She looked like a mannish female.

While her affect was generally bland she had a Madonna like smile. She spoke to me in a monotonic voice, calmly and rationally describing her wishes for sexual transformation. There was no irritation, no strain in her voice. She was putting on a great performance and knew it. Had this been an ordinary clinical interview, it was clear that the mother and daughter were locked in a hostile dependent symbiotic relationship in which the roles were reversed. The mother dissolved under Randi's threats, looking at me in a pleading, helpless way, begging for advice and direction. Randi was smug; she dominated mother and coerced and controlled her behavior. I was struck by Randi's omnipotence, her inability to separate from mother (and vice versa), and wondered how her need for control related to her transsexual wishes. It was easy to understand how she had already been diagnosed as a true transsexual at a local gender clinic.

Randi proudly displayed her transsexual imprimatur a letter guaranteeing her transsexual status and acknowledging that she was a candidate for surgery. Whatever my "second opinion" might be, she had already been provided a certificate of approval; from my reading of it I concurred with her brother's appraisal that she had probably gone to a clinic that was more interested in certifying transsexuals than in treating them. In spite of her trump card, Randi had to be ambivalent about surgery since she allowed me to continue to meet with her to explore her gender conflicts. Indeed, my offices, being a thousand miles from her home, certainly offered an obstacle to obtaining a second opinion. None the less, Randi continued to see me, accepted a referral for treatment near her home, and now, several years later, still threatens to have SRS but has never followed through on her threats. It seemed that as long as her mother remained in treatment Randi backed off from her threats of surgery. When mother was strong willed and refused to participate in Randi's decision regarding surgery, Randi no longer had the need to act out her transsexual wishes for SRS.

Randi's case history has been culled from several sources over a long period of time. These sources included extensive interviews with the patient, her mother (who also provided me with a written document on the early childhood history of her daughter), the mother's boyfriend, the brother, and daughter in law. Additional information was obtained from physicians who treated Randi, the family attorney, and the staff of the hospital where Randi was psychiatrically hospitalized for a transsexual evaluation. Moreover, extensive psychological testing on the patient and her mother was obtained. (see THE ROLE OF THE FAMILY IN THE DYNAMICS OF FEMALE TRANSSEXUALISM PART IV)