Flight into femininity. The male menopause?

This paper reports on an unusually interesting group of patients who were seen in the Gender Identity Clinic, Clarke Institute of Psychiatry, during the first two years that it was clinically active. (September 1975 to August 31, 1977). The sample consists of 21 male patients, between the ages of 40 and 65, who diagnostically have been transvestites most of their lives. They present with the request for surgical sex reassignment. This request for surgery comes at a period of “middle-age crisis” in their lives. A comparison is made between these older male patients and 27 younger male patients seen in the Clinic who also requested surgery. The findings show that the older group tend to be younger at their age of initial cross-dressing, are more socially introverted than the younger transsexuals, and show greater scholastic ability. The most important finding is the predominantly strong heterosexual orientation in these older men when compared with younger gender disordered males. In certain respects these “older” men are rather typical of normal, heterosexual males. The authors speculate on the findings and suggest that this older male group who request surgical sex reassignment in their middle years, use the desire to “become a woman” as a defence mechanism against an underlying depression. Essentially they are going through the climacteric or “the male menopause”, and should be treated by individual and/or marital therapy (providing the spouse is still living with her husband) together with antidepressant medication, if necessary.