By adolescence cross-dressing is usually well established 
but is devoid of fetishistic meaning, since feminine dress 
evokes not excitement but a feeling of well-being, serenity, 
and happiness.Extreme revulsion for their genitalia and all signs of 
masculinity often results in persistent importuning for 
surgical " correction," and in some cases self-castration may 
be attempted.2 3 In schizophrenia bizarre self-castration may 
occur with or without delusional ideas about change of sex, 
but in the transsexualist there is no other evidence of the 
schizophrenic process.'1 
By the time he reaches a hospital clinic the transsexualist 
has usually adopted feminine garb in public; facial hair is 
reduced and the testes are small and atrophic owing to self- 
medication with stilboestrol, which the patient often denies.9 
Many authors comment on the exceptional intelligence, 
versatility, and artistic gifts of these patients.'2 13 Though 
usually anxious to assert their feminine normality, many of 
the patients present frank neurotic features.' On most 
psychological tests they show high scores for feminine interest, 
but their conviction that they have an attractive feminine 
physique is sometimes in ludicrous contrast to their hirsute 
muscularity. The sincerity and conviction with which these people 
describe their predicament has inclined many physicians who 
have studied the disorder to regard transsexualism as an 
inborn tendency, but the men patients show no chromosomal 
abnormality and in every possible measure are anatomically 
and physiologically male.1" However, there is an excess of 
abnormal sexual behaviour among patients with Klinefelter's 
syndrome and in association with certain disturbances of brain 
function.About one-third of that amount is used in industry, mostly
in photographic manufacture, and a large proportion of that
in the manufacture of x-ray film.About one-third of that amount is used in industry, mostly
in photographic manufacture, and a large proportion of that
in the manufacture of x-ray film.Sacro-iliitis, with its radiological signs of erosion,
sclerosis, and fusion of the joint surfaces, is sometimes
encountered in the absence of any other abnormality; it is
sometimes associated with ankylosing spondylitis ; and it is
sometimes found in those other conditions whose relation with
one another and with ankylosing spondylitis is incompletely
understood-namely, psoriatic arthritis, Reiter's disease, and
the arthropathy accompanying ulcerative colitis5 6 and
Crohn's disease.One of them
had severe recurrent pain and tenderness localized to the left
sacro-iliac joint and responding promptly to colchicine.