The syndrome of male transsexualism is characterized by a life-long preference for the feminine role, predicated on the conviction of belonging to the female sex. This conviction is held and persists despite the painfully obvious fact of normal male anatomy and genitalia, before and after puberty, and in the absence of delusional ideation or psychosis in the majority of transsexuals studied. He is disgusted with the development of his primary and secondary sexual characteristics, to the point where the male transsexual frequently contemplates and occasionally performs self-mutilation of his genitalia. He prefers normal, heterosexual men as sexual partners, and rejects homosexual men or the idea that his sexual activity is homosexual. Feeling he belongs to the female gender, he considers it appropriate to have a love relationship with a man, and he feels “unnatural” in a relationship with a woman, considering this “homosexual.” There is some evidence that sex or overt sexual activity, whether it be considered homosexual or heterosexual, plays a minor or secondary role. The transsexual may decide to pass and become accepted as a female, either before or after sex reassignment surgery, depending upon individual circumstances.