Paula

Paula

Paula had scheduled an appointment with the office secretary a couple of months previously.  She had made no mention of why she wanted to see a psychiatrist. She said a friend had recommended me.

When she entered the office I was immediately struck by her appearance.  She was tall, slender, well proportioned.  Her skin was lightly tanned.  Her eyes were engaging.  She was smartly dressed in subtle colors. When she began to speak, her voice was husky and mellow. 

I soon became aware of the fact that I found her to be sexually attractive.  This was an unusual experience for me in my practice.  I quickly reassured myself with the thought “She’s young and beautiful, dresses well, relates warmly and appropriately, who wouldn’t be attracted to her?”

After obtaining some basic information I asked her what had brought her to see me.

She said she had been requested to obtain a psychiatric evaluation before undergoing an elective surgical procedure that was to be performed by a surgeon in Colorado. She then explained that her name was Paul and not Paula and that she was seeking surgery that would change her sex from male to female.

She went on to describe how ever since she had been a small child she had felt like a girl and later a woman trapped inside a male body.  She had managed to relate to her peers in ways that did not lead to being singled out as effeminate or gay.  She had participated in sports and had performed up to the junior varsity level in high school.  She had not dated.

She had confided her feelings to her parents at an early age and they had remained supportive and accepting of who she was. Although they were not in a position to help her financially they did approve of her quest for a sex change.  She had been engaged to a man for over 3 years who also approved of the procedure and they planned to get married as soon as she recovered.

Paula was now 35 years old and had been living in San Francisco where she, for the past 10 years, had lived as a woman.  She had attended regular group therapy sessions for people considering sex changes.  She had taken hormones that were prescribed to her to decrease her masculine features. She had undergone a painful procedure to remove her facial hair. 

Nothing in this interview suggested that Paula was unstable or that her judgment was in any way impaired as she was making this life changing decision.  I informed her of my conclusion and indicated I would later that day send a report to her surgeon in Colorado in which I would strongly recommend that she receive the surgery she had requested.

Dictating the report was both easy and difficult.  It was easy in the sense that I was confident that Paul would live a more fulfilling life having his physical attributes replaced by those of a Paula.  The difficult part was keeping track of the pronouns he, she, him, her.  In spite of the fact that Paula was still a Paul physically, the person with whom I had just interacted was certainly a woman.  So, just like in the narrative above, I just stuck with the she and her. 

I never saw or heard from Paula again.

2006