Social, economic, and educational factors are emphasized in describing an untreated group of 60 persons, each of whom felt that inwardly he was really a member of the opposite sex. The syndrome was generally well established by age 19, sexual propensity was mostly homosexual, unrealistic expectations of a complete sex change operation were held, there was a high incidence of male prostitution, and social maladjustment was shown in the high percentage of antisocial and criminal behavior. None of the women remained married, but surprisingly 1/2 of the marriages by men survived, despite cross-dressing and attempts to have sex-change operations.