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A challenging case of transsexualism


P. Ginige ,

University of Peradeniya, LK
About P.
Department of Psychiatry, Faculty of Medicine
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H. K. K. I. De Alwis

Teaching Hospital Peradeniya, LK
About H. K. K. I.
Psychiatry Unit
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A transsexual is an individual who seeks or has undergone a transition to the preferred sex. A 39-yearold man presented expressing the strong desire to change his sex to that of a female. He said he started feeling and behaving like a female and had homosexual relationships with boys at the age of 10-12 years. He had later started a relationship with a woman, and had an open marriage with her. But he reported having no sexual desire towards his wife or his casual male partners, and reported feeling guilty after sexual interactions with both parties. He had stopped sexual activities altogether over the one and half years preceding presentation, reportedly due to lack of desire, and had started taking ethinyl estradiol to become a woman. During this time he had also separated from his wife, because the latter had commenced a committed relationship with a different man. Six months subsequently, he approached healthcare services, seeking help for a sex change. On examination he presented as a pleasant young male, with mild feminine gestures. His wife claimed she was unaware that he was unhappy in his male sex. When the patient was referred for a second opinion, he became verbally abusive. Although this patient fulfilled the criteria for transsexualism, there were also other psycho-social features, such as depression, grief, and personality traits, which extended beyond the stereotypical sexual orientation that determines gender identity. The case exemplifies the complexities and challenges in diagnosing and managing gender dysphoria.
How to Cite: Ginige, P. and De Alwis, H.K.K.I., 2021. A challenging case of transsexualism. Sri Lanka Journal of Psychiatry, 12(2), pp.44–46. DOI:
Published on 31 Dec 2021.
Peer Reviewed


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