Transsexual males appear at psychiatric clinics for an operation to change them into women. They express a persistent wish to be a member of the opposite sex; which is epitomized by the desire for sex reassignment surgery. Their external anatomy is usually normal and male, although many have already received some form of hormonal treatment and electrolysis for hair removal to be more convincingly feminine. Transsexuals argue that they are really females trapped in male bodies; that nature made a mistake. They often stick to their conviction rather firmly. They simply want a psychiatrist to approve an operation to have their penises and testicles removed and to create artificial vaginas. At times they may be very convincing females, such as Mr. A. His psychiatrist described their first encounter as follows:
I was tired that Monday morning. I had been on call and had responded to an emergency at 4:00 a.m. I was developing a cold and thought I would be better off going to bed than meeting a client. I stepped off the elevator at my floor feeling miserable and as I entered the reception area to my office, there was one patient sitting waiting for me. I momentarily forgot that I was seeing a transsexual and that "she" was as male as I was. "She" was dressed in a fashion some other clinicians have referred to as "midnight whore". "She" had a clinging black dress with a plunging neckline and a slit up the side. "Her" shape was convincingly female, with full round breasts and hairless legs. She had long red hair and an alluring smile. This was the woman of my wildest erotic fantasies and I couldn't help myself--I was turned on--for a moment. I found myself treating her like a woman, opening doors and lighting "her" cigarette. I was really taken in, and then "he" spoke. The illusion was shattered.