An American hijra: a report of a case of genital self-mutilation to become India's "third sex".

We report a case of male genital self-mutilation related to the subject's desire to become a "hijra," the "third sex" described in East Indian mythology. The patient is the first American hijra of which we are aware. He emasculated himself, performed a penectomy, and created a perineal urethrostomy. This report adds another potential cause for genital mutilation of which the urologist should be aware, along with accidents, gender dysphoria, psychotic self-injurious behavior, and assault.