[Transsexualism and schizophrenic psychosis. Problems preparing expert opinion on transsexualism]

We report on two schizophrenics with transsexual beliefs to illustrate the problems in nosological classification of these patients and the difficulties in preparing expertises on changing the first name or on the legal changing of sex status according to the German Transsexuals Act (TSG). We should differentiate between rare cases of true comorbidity of schizophrenia and transsexualism, and other patients in whom the transsexual wish presents as a symptom of psychosis. Before approving any legal changes or even sex reassignment surgery, the transsexual wish should have remained unchanged under otherwise successful antipsychotic treatment. Moreover, the patients must be able to translate into reality the desired sexual role in their social environment.