In 1911 Freud published his account of the Schreber case, in which one of the patient's initial symptoms in his personality decompensation was a delusion that he was changing sexes and becoming a woman.

As the women entered adolescence, their gender dysphoria intensified. While some of them occasionally crossdressed and fantasized about being men, others impersonated men and lived and worked as men. These behaviors continued throughout adulthood, some of the women explained their behavior as a conscious deception meant to attract women as sex objects (since they felt that as females they would be rejected by heterosexual women), or to obtain better jobs.

The remaining seven cases were reported under the heading "congenital sexual inversion in women." These were not simply cases of female homosexuality, but all involved impersonation of the male role, wearing of male clothes, dreaming and imagining oneself in the male role, and early childhood experiences in which the woman revealed a preference for stereotypically male toys, games and roles (behavior we would label tomboyism).

Physicians began recording case histories of female transsexualism in the early part of the nineteenth century. It was not, until the publication of Krafft Ebing's Psychopathia Sexualis (1894) that these disturbances were recognized as being worthy of medical investigation.

A review of the major literature in English, French, and German highlighted the international aspects of the disorder.

What clearly emerged were several lines of investigation which characterized the different branches of the basic sciences and the social sciences which have attempted to study female transsexualism.

In essence, the female transsexual was viewed as having a more alloplastic defense system than the male's autoplastic defense system. In conclusion, Sorensen and Hertoft felt that "the transsexual female seeks to subdue [an] insecure gender identity by obtaining ego satisfaction in adoption of strong outer attitudes and actions. She takes on a caricatured masculine attitude is genitally fixated and preoccupied with sexual display."

Strassberg (1979), using the Tennessee Self Concept Scale, reported that on this measure seventeen female "candidates for sex change surgery (average age 23.71 years) varied appreciably in self concept and adjustment, and as a group are indistinguishable from psychiatric controls." They found that "between one fourth and one third of the [female] applicants for sex change surgery are seriously psychologically disturbed."

Fleming (1980) compared the scores of seventy two transsexuals (fifty five male and seventeen female) on the Bern Sex Role Inventory (BSRI). The females were noted to have scored primarily as masculine sex typed (n = 6) or androgynous (n = 6). The females' scores, when compared with Bern's male and female norms, showed some interesting results.

Fleming and Nathans (1979) reported on a case study of a 23 year old female transsexual with whom art therapy was used in order to understand the central issues behind her transsexual wishes. The patient had a lifelong gender identity problem and always considered herself to be a male (but more to the point, "a reincarnation of a Greek god"). In all other areas of thinking her reality testing and orientation were intact.

Green (1978) published a preliminary report on the sexual identity and orientation of thirty seven children (age range 3-20 years) raised by homosexual and transsexual parents. Nine of the children were raised by female to male transsexuals. Green noted that four of these children did not know that their "father" or "stepfather" was transsexual.