Twenty-seven adolescent gender identity patients (10 girls and 17 boys) who presented with transsexual wishes for sex reassignment surgery were the subjects of investigation. The average age of the patients was 16.80 years for the girls (range 13-18) and 16.53 for the boys (range 12-19). A psychiatric, psychological, and social profile of the patients is provided, and follow-up of the patients over a period of 5 years is reported. Four major stressors correlated with the presenting request for sex reassignment surgery: (a) a recent loss or change in a relationship which reactivated separation anxiety, (b) physical maturation of the body which threatened the self system, (c) stigmatized homosexuality, and (d) a flight from masturbatory activity.