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Whatever the forces are that drive some individuals to procure the outward physical appearance of the sex that they were not born to, the normal man and woman tend to be shocked on discovering the extent that others will go to in the search for sex metamorphosis. A sense of shock may be a natural reaction to what is described in this paper, but it should surely be tempered through pity-the two men whose cases are reported here experienced tragedy of a sort unprecedented even among such tragedy-prone people. Theirs was the realization of a possibility that they had lacked the knowledge to anticipate; many must feel sympathy for them, and perhaps something of anger at what was done to them by men and women prostituting medical skills.Neither of these patients was ever in a London hospital. None of the operations that either underwent was carried out by British surgeons, and the only operation performed in the British Isles was the mammoplasty in Case 1.Both patients had seemingly been physically healthy young men before embarking on the long course of the metamorphosis that entailed castration and other feminizing operations, including mammoplasty and in one case the construction of a pro-vagina. Both patients received considerable amoung of oestrogens by implantation, by mouth and by inunction into the breasts. One of them, whose doctor took him to be a woman, was prescribed contraceptive pills, which he took regularly according to the recommended schedule. The other was a heroin addict. The one who had a pro-vagina experimented occasionally in prostitution and was proud to have had a conviction, as a woman, for soliciting. Both were financially of independent means. There was nothing to suggest that the two had ever met. Both were experienced in homosexual practices before seeking metamorphosis and had also had some reputedly normal heterosexual liaisons.Both patients died of rapidly progressive metastasizing mammary carcinoma. The tumour appeared in one case five yers after completion of the metamorphosis. The interval was probably of much the same length in the other case. It seems wholly reasonable to conclude that the development of the cancer was a side-effect of the feminizing procedures.The two cases have been referred to briefly elsewhere (Symmers, 1966

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