Once Tina was conceptualized by the treatment team as an example of a "stable" female transsexual, her assessment and treatment were predetermined. In a personal communication Jon Meyer has described a woman like Tina whom the Johns Hopkins gender clinic deemed to be their most stable and reliable patient.

From a strictly DSM III standpoint Tina met all the criteria for a diagnosis of transsexualism. She exhibited a profound sense of gender discomfort and believed that she should have a male body. Indeed, she wished to be rid of her breasts and to have phalloplasty.

The first proposition, focusing on the prior history of homosexuality and the stability of the female transsexual, has been reported consistently throughout the literature. Because this proposition has exerted such an overriding influence on clinicians who evaluate and treat transsexuals it needs to be carefully examined, especially since there has been a recent upsurge in SRS for females. In the example that follows I have chosen to present the case history of a female with a long standing gender identity disturbance who was referred to our clinic for trans sexual evaluation.

Although some mention of female transsexualism was made, there was no attempt to set up specific criteria for diagnosing female transsexuals. It was, however, hinted at in the manual (and evident in the literature), that in many ways male and female transsexualism are qualitatively distinct disorders.

Three types of gender identity disorders were also classified: (1) transsexualism, 302.5x; (2) gender identity disorder of childhood, 302.60; (3) atypical gender identity disorder, 302.85. In deciding to use the designation "transsexual" as opposed to "gender dysphoria syndrome," the authors of DSM III chose the most commonly accepted, widely used term for describing patients with severe gender pathology who met certain criteria (described below).

In response to the phenomenon of large numbers of patients requesting SRS, Fisk (1973) introduced the diagnosis gender dysphoria syndrome, which he felt would more accurately describe the phenomenon being clinically investigated. This diagnosis was elaborated on by Laub and Fisk (1974) and later by Meyer and Hoopes (1974).

As the number of applicants for SRS grew, so it became apparent that patients were requesting SRS for a variety of gender identity and role disorders. The diagnosis of transsexual became synonymous with SRS. What did these requests mean? Why would non transsexuals even request SRS?

While the scientific community debated the usefulness of the term "transsexual," the media and the lay community accepted it unequivocally. And within a short period of time, whether they liked it or not, the scientific community was stuck with the term.

The term "transsexual," which was coined by Cauldwell (1949), was clinically introduced by Benjamin (1966) to differentiate diagnostically two 'distinct disorders: transvestism from transsexualism. The term transsexualism was applied to those patients with a lifelong gender identity disorder who, in addition to cross dressing (which was traditionally associated with fetishism and transvestism), identified completely with the opposite sex, believed that they were trapped in the wrong body, and wanted surgery to correct that disorder.

With the publication of Hirschfeld's Die Transvestiten (1910) the medical field was provided with the first in depth study of cross dressing (now labeled transvestism) in which a woman's enactment of a male life style and her wish to become a male were documented.