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Friedemann Pfäfflin,
Ulm University, Germany

Walter O. Bockting,
University of Minnesota, USA

Eli Coleman,
University of Minnesota, USA

Richard Ekins,
University of Ulster at Coleraine, UK

Dave King,
University of Liverpool, UK

Managing Editor:
Noelle N Gray,
University of Minnesota, USA

Editorial Assistant:
Erin Pellett,
University of Minnesota, USA

Editorial Board


book Historic Papers


© Copyright

Published by
Symposion Publishing

ISSN 1434-4599

Volume 5, Number 2, April - June 2001

Special Issue on David O. Cauldwell (1897-1959): Classic Reprints Series
(Reprints Series edited by Richard Ekins and Dave King)


(Originally published in Sexology, vol. 16, 1949, pp. 274-280. Copyright, 1949, by Sexology Magazine.)

One of the most unusual sexual deviations is PSYCHOPATHIA TRANSEXUALIS – a pathologic-morbid desire to be a full member of the opposite sex. This desire is so powerful that the individual insists on – often impossible – elaborate surgery that would turn him into a complete woman, or her into a biologically perfect male. Our distinguished author gives us a most interesting case review under his personal observation. The condition, incidentally, is not at all rare. Thousands of cases exist.

By Dr. D. O. Cauldwell

Citation: Cauldwell D.O. (2001) Psychopathia Transexualis. IJT 5,2, http://www.symposion.com/ijt/cauldwell/cauldwell_02.htm

Among both sexes are individuals who wish to be members of the sex to which they do not properly belong. Their condition usually arises from a poor hereditary background and a highly unfavourable childhood environment. Proportionately there are more individuals in this category among the well-to-do than among the poor. Poverty and its attendant necessities serve, to an extent, as deterrents.

When an individual fails to mature according to his (or her) proper biological and sexological status, such an individual is psychologically (mentally) deficient. The psychological condition is in reality the disease.

When an individual who is unfavorably affected psychologically determines to live and appear as a member of the sex to which he or she does not belong, such an individual is what may be called a psychopathic transexual. This means, simply, that one is mentally unhealthy and because of this the person desires to live as a member of the opposite sex.

That which pertains to the psychopathic transexual may be called psychopathia transexualis. There are varying degrees of psychopathic transexuality. This article deals with one specific case.

Case History – Subject’s Background

The subject of this study was born a normal female into a well known and fairly well-to-do family. On the maternal side there was a physician whose son became a lawyer and succeeded in his aspirations to hold political office. The paternal grandfather was prominent in politics and civic affairs. The father was a spoiled son, petted and spoiled by his mother and sisters. He was frequently put in jail for drunkenness and his family were in the habit of sending his wife (the subject’s mother) to retrieve him from the clutches of a courtesan in a brothel.

There were two brothers older than the subject. One, the eldest by 13 years, evidently had survived environment and was on his way up in the world when the subject was born. The other, about 10 years old when the subject was born, was feebleminded, never learned to talk, and while in his 20’s was committed to a state institution.

The subject, as a small girl, was impressed with the adulation with which the men of the family were showered. She herself was not, however, neglected. Frequently she was dressed as a boy. One of her fondest memories is a picture of herself in boy’s attire and smoking a pipe. The picture was made when she was five years old. She was told often what a cute child she was and emphasis was placed on her cuteness as a "boy."

At no time did the subject desire to be a female. Through taught differently, she grew up thinking of herself as a boy. Early she began playing the role of a male on every occasion possible. When she was 18 she discarded feminine attire entirely. She determined that she would live as a male and that nothing could stop her.

Through having written numerous booklets on sexological and related subjects, I have built a large list of correspondents. I first knew of the subject of this study through a letter. After that there was a considerable correspondence. Eventually the subject wrote that she intended to visit relatives near my home and asked if she might see me. I extended an invitation – my wife acquiescing – to visit my home. In doing so I made it clear that my time was devoted entirely to writing and research in science, and that I was not now engaged in active medical practice.

I shall call the subject Earl. This is not her name but this name, like her own, is frequently borne by members of both sexes.

During Earl’s brief stay with us we agreed that we had never had a more inoffensive guest in our home. She wore levis and regular men’s shirts while at home but changed to feminine attire without prompting when we went for drives or away from home. She appeared to be more puzzled than determined to live as a male. She admitted one homosexual "crush." The relationship was one of heart rather than one of sexual indulgence, although she claimed to have had sexual satisfaction through various intimate bodily caresses, regular lip-kissing, and similar caresses. She assured me that no caresses of any kind had been bestowed lower than the breasts. Her friend had professed sexual satisfaction. The relationship was broken up, evidently by the other girl’s family and circumstances pertaining to her own family.

Earl’s paternal family had contributed to her upkeep and schooling. There was an aged grandmother and there were two aunts – one a maiden, the other a widow. During her first visit Earl expressed the desire to undergo surgery which would, she hoped, bring about sex transmutation, thus making her a full male.

In cases of doubtful sex – usually cases of pseudo-hermaphroditism – surgical sex transmutation has often occurred. Actually, surgical measures have succeeded in establishing a nearer approach to the normal sexual integration of the individuals involved. I explained all of this to Earl and at her request gave her what we call the biological type of examination, which showed that her menses were regular and normal. Her external genitals were of perfect feminine formation, the clitoris normal, although the glans was unusually small. Hair distribution and voice normal.

It should be noted that the average sized clitoris with an unusually small glans is the opposite of male pseudo-hermaphroditism.

When Earl left us I believed that she would make an uneventful adjustment. But there were matters of family background with which I was not familiar at that time.

When we learned that Earl had entered a college for women it was felt that she had accomplished a satisfactory adjustment. We heard from her rarely. Once she wrote asking if I could help her to avoid taking physical education. I urged her to take the subject. In one letter there was a statement that a number of members of the faculty were homosexuals and that about 60 per cent of the student body appeared to be homosexuals. There was no hint of individual homosexuality on Earl’s part. There were complaints about the house-mother who had been a matron or supervisor at a girl’s reformatory and who, apparently, insisted on using reform school disciplinary tactics on these young college women.

Suddenly there was a frantic telegram. "If you are going to be at home and I can come, wire me collect. Important."

That was a puzzling message. I was inclined to think that she had become pregnant and thought that we could teach her how to become a good mother. Hence, I wired a welcome. Days passed and there was no word. Then suddenly, there was a collect telegram asking that we meet her at a certain time. We met her. She was a pitiful sight. She was dressed in a helter-skelter get-up of male attire and was thoroughly unkempt. She was broke. She had been sleeping on park benches and had been in police custody.

Earl Determines to Be a Male

Earl was desperate to become a male. I listened as she calmly explained that she wanted me to find a surgeon who would remove her breasts, her ovaries, and close the vagina and then create for her an artificial penis. She would then take male hormones and that she thought would, with masculine attire and occupation, solve her problem. I was amazed at such utter simplicity.

I explained that what she desired was impossible. A surgeon can castrate a woman, of course, and can readily remove her breasts. An artificial penis for cosmetic effect only, has been created by successive grafts of bone, skin, etc. But it is of no material use on a female and has no more sexual feeling than a fingernail. 1 BUT – it would be criminal for any surgeon to mutilate a pair of healthy breasts and it would be just as criminal for a surgeon to castrate a woman with no disease of the ovaries or related glands and without any condition wherein castration might be beneficial.

Earl was dissatisfied with my explanation. Why was it criminal if she wanted it done? How unreasonable! Earl also wanted to know if I didn’t believe what I advocated in my writings: that the individual has a right to live his or her life as he or she chooses provided that in doing so no innocent party is involved. A surgeon evidently did not appear as an innocent individual in her mind.

Because Earl was of legal age, and the further fact that I felt her confidence should be fully kept, I had not communicated with any members of her family. Indeed, there had been no occasion for me to do so.

Just as I was beginning to learn that in my broad and tolerant consideration of people and of the sexual nature of the human being, I had overlooked the psychopathic traits in Earl, her brother and aunt called. We found them to be well integrated people and of the highest moral and social fiber. Earl’s mother, not having heard from her for many days, had phoned that she might possibly be with us. (She had known of Earl’s previous visit.)

By now we were beginning to learn something of the real Earl. We knew that her ambitions were to live parasitically. She would not work. She believed her grandmother and aunts were fabulously wealthy (which they were not) and that, without earning money herself, she could worm it out of them just as she had long wormed it out of them through deception. She refused to go away with her aunt or her brother. The aunt left her $10 for incidentals. A little later I realized that that Earl’s relatives had been relieved that she had refused to go with them.

A Summary of Facts

Earl’s relatives began learning of her activities during recent months through various sources. Earl had been asked to withdraw from college on account of suspected homosexual activities. She admitted such activities. A woman who thinks of herself as a physical and psychological male is capable of only pseudo-homosexual activities with either sex. (With males she still would be a sexological female and with females she would be an imagined or fantasied psychological male.)

There had been but one homosexual affair according to Earl’s statements. According to other authentic information, there had been a number of them. In some instances Earl had been, no doubt, the seducer and in others there had been mutuality and hence, no seduction.

She believed that she had a perfect right to go out just as any young male and court a female and, just as young males sometimes seduce young females, she thought that it was within her right to do the same thing.

Against her family Earl had death wishes. They did not, she contended, know how to use or to enjoy money. She – Earl, did.

She resented being referred to as "her and she." She had been immensely happy when, in a restaurant (in male attire of terrible taste) she had been referred to, or addressed as "Sir."

If doctors would not do exactly as Earl wanted them to do, or if they could not, then she would continue as she had done and bind her breasts as tightly downwards as possible, dress as a male and live as much the role of a male as possible. She already was pleased that she could use men’s rest rooms. Frequently she had been referred to as "Sonny." She shaved in an effort to grow a beard. She kept on her guard in her effort to affect a masculine voice. (It never sounded in the least masculine.) She delighted in ultra-loud (and severely tawdry) socks and ties. The men’s shoes she wore were far too large for her and made walking difficult. Her hair was conventional masculine trim. She was narcissistic and reveled in just seeing and feeling herself (as much when alone as otherwise) in the role of a male. She admired herself probably as much as the original Narcissus.

The expression of death-wishes annoyed my wife. We had to do something with our guest. Fortunately we were able to turn her over to her brother and within two or three days he passed her on to grandmother and aunts. They gave her all of the encouragement possible and bought her a complete feminine wardrobe. She would not don or touch a garment.

Unable to cope with a personality such as Earl’s her family gave her a ticket to a city where she assured them she would get a job. They gave her enough cash for an intelligent person to get along on until more can be earned. They did not, any more than did I, expect that Earl would get a job or work. They felt as I feel that she would soon run afoul of the law and that the State would find it necessary to make some legal disposition of the case.

That there are better integrated transexuals we are well aware. There are case histories of outstanding social, civic and other leaders who were transexuals. In Arkansas a comparatively few years ago a Dr. Brown lived and practiced until in the 60's and was regarded as a male and a highly competent physician. She lived with a sister. In her final illness physicians who treated her discovered her true sex.

In my files I have numerous case histories of males who have lost their genitals through accident and who have become well-integrated transexuals living useful lives and helping, rather than hindering, society. I have other case histories of females who, usually because of an endocrine disturbance or an adrenal tumor, or ovarian disease, have felt that their masculine characteristics were a hindrance to them in careers as females. They have succeeded as well-integrated individuals, living as transexuals. These transexuals are, however, transexuals by affectation only. Evidently they are all, in their sexual activities, purely autosexual.

Dr. Hirschfeld’s Pronouncement

In "Sexual History of the World War." by Dr. Magnus Hirschfeld, a case is reported of a young woman who sought to enlist in the German Army of the first world war. She made several unsuccessful attempts. Eventually she was examined by Dr. Hirschfeld who pronounced her "a psychological male." She was thereupon accepted and became an excellent fighter, serving as a male soldier.

The psychopathic characteristic is manifested not, as may be thought, in actual homosexuality or transvestism, nor yet in the adoption of a male role and career, but in such practices as seduction, parasitism, violation of the social codes in numerous ways, frequently kleptomania and actual thievery, pathological lying, and other criminal and unsocial tendencies. (The adoption of a female role and career applies in the case of actual males.)

Although heredity had a part in producing individuals who may have psychopathic tendencies, such pitiful cases as that described herein are products, largely, of unfavorable childhood environment and overindulgent parents and other near relatives.

Some of the individuals involved, as was the subject of this study, are amenable to rehabilitation through a few organizations now in existence. A large enough number of suitable organizations might succeed in rehabilitating the majority of individuals of both sexes falling into the category of psychopathia transexualis.

Progress is being made. Within a quarter of a century social education may serve as a preventive in all but a few cases and social organizations may be able to rehabilitate the few who fall by the wayside.


1. An artifical penis that is biologically effective can be built. SEXOLOGY has reported a number of such cases. These cases, however, were all males ones. During the war a number of soldiers were mutilated by gun shot, mines, etc., which deprived them, in some cases, completely of their penis. By plastic surgery an artificial organ was then built up on the remaining stump. Such organs, strangely enough, permit the subject to have gratifying marital union and offspring. – Editor [of Sexology].