To the Editor:
—The use of surgery to minimize the difference between a patient's appearance and the appearance for which he has a neurotic craving is a novel suggestion. In their paper "Transvestism: Hormonal, Psychiatric, and Surgical Treatment" (J. A. M. A.152:391 [May 30] 1953), Hamburger, Stürup, and Dahl-Iversen propose that plastic surgery be employed to resolve such a discrepancy even in cases in which there is no objective anomaly or deformity that requires correction. If such a procedure is seriously proposed, it requires serious discussion. In discussing the etiology of transvestism, the authors suggest that it is a form of biological intersexuality. In their view, then, the surgical intervention they suggest consists actually of correction of an anomaly. It has not proved possible, to date, to associate the appearance of traits, mannerisms, or behavior patterns characteristic of one sex in persons of the other sex with any