Dear Ann Landers,
his is no phony from Yale. I live in Hartford and I don't drive a car. My problem is real and I need an answer. How do parents introduce a 27-year- old son who has had a sex-change op-eration? Do we say, "This is our son Bob," or, "This is our daughter Ro-berta?" We are trying to be broadminded about the whole thing and it hasn't been easy. Please give us some assist- ence. STRUGGLING DESPER-ATELY TO BRIDGE THE GAP

DEAR FRIEND,
Since Bob has gone to considerable lengths to be "Roberta," he surely must be dressing in feminine attire. To introduce him as "Bob" would be ludicrous. It seems to me that you are being extremely co-operative and he (or she) should help you out of the tight spots by intro-ducing himself-or herself. Transsexualism is a rare condition characterized by the conviction on the part of a person that he (or she) is of the opposite sex. Thus a transsexual man might say, "I am a mistake of Nature. I am a woman locked in a man's body." The transsexual woman would say the same thing in reverse. Both statements would carry the fervent desire to be let out of the "wrong" body by a surgeon-an operation that would change the body, insofar as it is feasible, to resemble that of the desired sex. This is called "sex-reassignment surgery." For the transsexual man this would mean surgical removal of the penis, testicles and scrotum and the formation of an artificial vagina. It would also mean taking female sex hormones for life. For the transsexual female, sur-gery would remove breasts, ovaries, tubes and uterus and would mean the construction, by plastic surgery, of an artificial penis. It would also mean tak-ing male sex hormones for life (which might, for example, produce a beard). Transsexualism is often described as a reversal of gender identity. This means the person's concept of his sexual self does not match what he sees when he looks in a full-length mirror. In 1953 the United States and the civilized world were startled to read of an American soldier who was "changed into a woman" by an operation in Denmark. When he returned to the United States he went on the stage under the name of Christine Jorgensen. While a few such operations have been done without fanfare during the several decades before 1953, the Christine Jorgensen case created worldwide publicity and intense curiosity as to how such a thing could happen. It was the beginning of an era that would see, twenty years later, sex-reassignment surgery being done in a dozen major American medical centers. The causes of this strange condition are not known. Guesses range all the way from speculation having to do with how the child was raised by parents (particularly by the mother) to guesses at the other end of the yardstick that have to do with physical or constitutional factors of genetics, body chemistry and the like. However, it must be kept in mind that as of 1977 no one can give a scientific explanation about the causes of transsexualism. They are simply not known. Nor is it known how often this rare condition occurs in the population. Unlike Public Health surveys of cancer, for example, which quite accurately predict how many cases of various cancers (breast, bladder, colon, etc.) will occur in each 100,000 members of the population, no similar information ex-ists for transsexualism (or for homosexuality and transvestism either). There is no way to send out a questionnaire asking the public to describe them-selves sexually, nor could one have much confidence in the accuracy of the results of such a questionnaire if it were attempted. A typical history of a twenty-year-old transsexual person would read some-thing like this: His (or her) earliest childhood memories give clues of gender confusion. As a little boy, he could not be interested in "boy" sports such as baseball, playing with toy guns and fire trucks or riding on the tractor with his father if they lived on a farm. Rather, this little fellow would prefer to play with dolls, hang around with girls his own age, and play house with them. In his mind, he would be the mother, and try to help his mother in the kitchen. As he grew older, he would, if he could, play Udress-up" in the clothes of a sister which would make him feel "natural and comfortable." He would impress everyone as an extremely feminine boy and be regarded as a "sissy." Later on, others would regard him as "queer" or a "homo." At no time in his life would dressing as a woman cause him to get "charged up" sexually and become so excited that he would have to masturbate to relieve the tension. Such feelings are characteristic of the transvestite, who experi-ences intense sexual urges on cross-dressing. The transsexual dismisses the matter of cross-dressing simply by saying that it makes him feel more com-fortable. The homosexual, on the other hand, has no problem with gender identity. If you ask a male homosexual, for example, if he is a man or a woman, and if he takes you seriously, he will answer, "Of course, I am a man. Why do you ask?" If you go further and ask him if he would like to have surgery to remove his penis and testicles, the homosexual male would look at you in as-tonishment and indicate that you are asking a crazy question that does not deserve a serious answer. "Why would anyone want his genitals cut off when they give so much pleasure?" is the obvious intent of such a response. This stands in stark contrast to the attitude of the transsexual, who regards his genitals as hated symbols of his despised anatomy. (The transsexual female regards her breasts as similarly hated symbols.) The transsexual female would give corresponding replies but in the oppo-site direction. As a little girl she would have been interested in boys' activi-ties: baseball, toy guns, fire engines and the like. She would have had nothing to do with dolls and little-girl play, but if she had "played house" she would have been, in her fantasy, the father. As she reached her teens, fantasy would see her imagining herself to be a man with a penis and having sexual rela-tions with a "straight" female and fathering her children. Please note that many normal young girls are tomboys who outgrow their preference for boys' activities and parents should not become alarmed unless this preference persists beyond the midteens. As to treatment, the ideal therapy (if it existed) would be to change the mind to match the body. All sorts of treatments have been tried in an attempt to accomplish this-psychoanalysis, persuasion, behavior modification in-cluding aversion techniques, hormones, electric shock and tranquilizers. None has been successful. Perhaps one day future research will show the way to make the mind fit the body, but as of 1977 no such solution is in sight. At present only one treat-ment method exists, and that is to change the body surgically, insofar as this is feasible, to match the mind. It is on this basis that sex-reassignment sur-gery is done, and the long-term results are quite good in carefully selected cases. There is no other treatment known for the transsexual condition as of this date. credit: Donald W. Hastings, M.D., Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota.