From Sexual Hygiene and Pathology, 1965 by John F. Oliven, MD:
From the section, “Primary Transvestism,” which is part of chapter 20, Sexual Deviations:
Transsexualism. Where the compulsive urge reaches beyond female vestments, and becomes an urge for gender (“sex”) change, transvestism becomes “transsexualism.” The term is misleading; actually, “transgenderism” is what is meant, because sexuality is not a major factor in primary transvestism. Psychologically, the transsexual often differs from the simple cross-dresser; he is conscious at all times of a strong desire to be a woman, and the urge can be truly consuming. He is repelled by his own masculinity and may loathe everything that reminds him of it – his genitalia, his voice, his clothes, his work or his name. Many believe that they are women who by some incredible error were given the bodies of men; they are firmly convinced that they are the “victims of a cruel fate,” a “joke of nature.” Such patient will resits strenuously any organic or psychiatric attempt to restore his masculine identity, but he will try anything that holds out the faintest hope of producing an appearance in conformity with his “real self.” He may canvas physicians, hospitals or clinics about “conversion” operations; surgeons known to have performed “sex-changing” surgery have found their mail swelled with requests for help from many parts of the world, many, of course, by cross-dressing passive homosexuals, but a fair percentage by desperately pleading primary transvestites who may also employ pseudoscientific reasoning, or even threats of suicide. These transvestites have turned to veterinarians and to abortionists with their requests for castration and a few, to “force the surgeon’s hand,” have crudely amputated all or part of their scrotum. However, others have mutilated themselves in an extreme near-psychotic panic state.