Transsexualism is a poorly understood, uncommon, and controversial entity of recent interest to the lay public and medical profession. Important features of the condition are discussed, surgical procedures for genital conversion in male transsexuals are compared, and our experience at the University of Virginia where 53 patients have been treated surgically is presented. All patients have made satisfactory postoperative psychosocial adjustment despite a surgical complication rate approaching 50 per cent. It is concluded that alternative (better) surgical procedures for male transsexuals should be explored.