Increasingly Ruth: toward understanding sex reassignment.

Both the clinician and the patient present accounts of a 44-year-old male's search for a comfortable gender identity. The juxtaposition of these two perspectives illustrates many of the dilemmas inherent in the therapy of gender dysphoria. Ruth underwent sex reassignment surgery in 1976--one year after the assumption of a full-time female gender role. Six months after surgery, she made a serious suicide attempt. At age 50, she has now consolidated her feminine gender identity and has become a thoughtful, unusually honest, articulate person. The physician's "objective" and the patient's retrospective perspectives provide evidence of the psychodynamic nature of transsexualism and the limitations of evaluation criteria for sex reassignment surgery.