The relationship between the adequacy of surgical result and postoperative psychopathology was examined in 14 male-to-female transsexuals selected for the absence of preoperative psychopathology. Data indicated that the best predictors of postoperative psychopathology as rated on Hunt and Hampson's (1980) Standardized Rating Format were breast scarring, erectile urethral meatus, current social supports, family reaction, urinary incontinence, and need for extra surgery. Together, these accounted for 98% of the variance in postoperative psychopathology. These data suggest that factors which make it difficult for postoperative transsexuals to "pass" or which continue to remind them of their gender-reassigned status are associated with adjustment difficulties. Surgical results may be a major determinant of postoperative psychopathology.