Transgender Surgery III: untruths and unknowns

Part I: 1906 -1965
Part II: 1966 -1975
Part III: untruths and unknowns

Untruths

The old discredited statistics that were refuted in Olyslager and Conway, “On the Calculation of the Prevalence of Transsexualism” ( Online ) are still being repeated. Bizic et al, 2018 (i.e. this year) says yet again: “There are different studies regarding the prevalence of transsexualism in general population accounting for 1 : 7400 to 1 : 2000 in assigned males and 1 : 30040 to 1 : 104000 in assigned females”. This really won’t do!!

Colebunders et al (p251) say ‘Fogh-Andersen initiated the modern era of sex reassignment surgery (SRS) by using penile skin as a full-thickness graft to line the neovagina of Christine Jorgensen”. This is completely at variance with all other accounts that say that Fogh-Andersen performed only an orchiectomy and penectomy on Jorgensen, and that she had vaginoplasty later in the US.

Again and again writers claim that Felix Abraham operated on Lili Elbe and that Lili was a patient of Magnus Hirschfeld. Some examples: the Guardian; GenderSpeaker; Dallas Denny; TransgenderZone. The key document is a paper by Felix Abraham, “Genitalumwandlungen an zwei männlichen Transvestiten“. Zeitschrift für Sexualwissenschaft und Sexualpolitik, 18: 223-226. There is a translation, “Genital Reassignment on Two Male Transvestites” that you can read here. Abraham discusses two patients:

1. “Rudolph (Dora) R., domestic employee, is today a 40-year-old ‘male’. He was born in the Erzgebirge region.”

------ Dörchen Richter sometimes called Dora, was born with the name of Rudolph Richter in the Erzgebirge region in 1891. Therefore she was 40 in 1931.

2. “Arno (Toni) E., painter, a 52 year old patient, had first noticed his inclination at the beginning of the 1920s. Despite his homosexual inclination, he got married and from this marriage a boy was born. In the extremely unhappy marriage he had only occasionally the possibility to wear feminine clothing. As frequently happens, during the first years the urge was weaker - to increase later. His inclination essentially preempted him from performing his profession when he did not have the possibility to wear clothing conforming to him. After the death of his wife, he lived completely as a female. Noticeable during the observation was the contrary behavior in male and female clothing: While he was totally calm and reasonable in the latter, in male clothing he was distraught, nervous and utterly worthless. Additionally, he only owned a single male suit, while having a fairly large female wardrobe.“

---- Toni Ebel born Hugo Otto Arno Ebel in Berlin in 1881 and so was 50 in 1931. She was a painter, she lived through WWII and was compensated by the German Democratic Republic as a victim of Nazism. As a painter, she was recognized at the Akademie der Künste in East Berlin.


Why do people refuse to recognize that Arno (Toni) E. is Toni Ebel? Why do they think that this is a discussion of Lili Elbe? Homosexual? a boy child? wife died? No mention of Denmark or France?

Unknowns

Lesavoy says that Abbe’s report on his work was lost for 40 years until McIndoe found it in 1938. However Bizic et al say that Abraham in 1932 operated “in line with the technique first published by Abbe”. How this was, if the report was not to be re-found for another six years, needs to be explained.

Goffe, in 1903, in effect invented penile-inversion vaginoplasty. Apparently like Gillies 40 years later, he did only one such operation. However he did write up the details and published it in a professional journal, American Journal of Obstetrics and Diseases of Women and Children, where it was as forgotten as Abbe’s report was lost.

Is there a connection between Fogh-Andersen, who reported the use of a full-thickness skin graft harvested from the penile skin to line the neovagina in a 1956 publication, and Burou who started doing penile-inversion vaginoplasties, also in 1956? Denny and Conway give full credit to Burou and say nothing at all about Fogh-Andersen. Bizic et al give full credit to Fogh-Andersen and say nothing at all about Burou. Colebunders et al mention both Fogh-Andersen and Burou on the same page (p251) but say nothing about whether or not Burou copied and improved on Fogh-Andersen.

Bizic et al say that the Gillies-Millard penile-skin-flap technique “remains the gold standard in male to female sex reassignment surgery”. Barbosa, Edgerton and Biber consciously copied Burou’s technique, but I have not found any vaginoplasty surgeon who is said to be following Gillies-Millard. Gillies-Millard did use a penile skin flap, and it could be that Fogh-Andersen consciously improved on their work. However the Gillies-Millard book, The Principles and Art of Plastic Surgery, was not published until 1957, a year after Fogh-Andersen’s publication. Maybe Fogh-Andersen did follow Gillies-Millard, but I have not found any such explanation. Nor have I found any claim that Burou followed Fogh-Andersen. Maybe he did, but nobody says so.

At the First International Symposium on Gender Identity held at the Piccadilly Hotel, London, 25-27 July 1969, arguments arose between the team from Chelsea Women's Hospital who regarded transsexuals as a form of intersex, and the team from Charing Cross Hospital who regarded them as having a psychological disorder. So was there a clinic at Chelsea? Did they guide transsexuals through the process. ???

Peter Stirling, an intersex Australian transitioning to male, went to London and was accepted as a patient at Guys Hospital’s Endocrine Clinic. He was guided through the program by social worker Margaret Branch, who also guided other transsexuals. There is no account of this clinic and its program, other than Stirling’s autobiography.


This is a series about transgender surgery. So why does the world’s most famous anti-surgery activist keep re-appearing: as Stoller’s first trans resource at the UCLA Clinic; as an advisor to Harry Benjamin and quoted several times in Benjamin’s book; as the only trans person – other than Reed Erickson - at the 1969 convention in London?

Timeline of surgery: Part II: 1966 -1975

Part I: 1906 -1965
Part II: 1966 -1975
Part III: untruths and unknowns

1966 Ricardo San Martin, Buenos Aires

San Martin was convicted of assault. The patient's consent was considered invalid because of 'his' low mental and emotional age and 'the fact that his neurotic craving for surgery made his consent involuntary’.

1966 April 9 – British Medical Journal

“The sincerity and conviction with which these people describe their predicament has inclined many physicians who have studied the disorder to regard transsexualism as an inborn tendency, but the men patients show no chromosomal abnormality and in every possible measure are anatomically and physiologically male.” Online.

1966 Harry Benjamin, New York

• Harry Benjamin. The Transsexual Phenomenon. The Julian Press, Inc, 1966. 

Then and for many decades later, the definitive book on the subject.  A four-part close-reading.

1966-1979 Psychohormonal Research Unit, Johns Hopkins Hospital, Baltimore

Following on from the genital reconstructive surgery done by Hugh Hampton Young in the 1930s-1940s, Lawson Wilkins set up a new pediatric endocrinology clinic where it was recognized that doctors could not tell a person’s sex just by looking at external genitalia, and in some cases recommended to the child and parents that the child’s sex be reversed. The Psychohormonal Research Unit was set up in 1951, and persons who wanted a change of sex kept coming. Milton Edgerton and John Money were major advocates of a new approach. Money became head of the PRU in 1962. He arranged subsidies from Reed Erickson, and met frequently with Harry Benjamin and Richard Green. They decided to set up a Gender Identity Clinic. At first this was in stealth. The first patient was Phyllis Wilson, who became a dancer in New York. The New York Daily News picked up the gossip. Thus outed, the clinic gave an exclusive to the New York Times. Plastic surgeon John Hoopes became chairman of the clinic. This was 1966, the same time that Benjamin published The Transsexual Phenomenon. Within a year, over 700 desperate transsexuals wrote and implored the doctors at the Johns Hopkins Clinic to help them; however very few were recommended for surgery. Initially the clinic did vaginoplasty using skin taken from the patient’s thigh. However they examined trans women who had returned from Casablanca. Dr Edgerton adopted and adapted Dr Burou’s method.  However much of the actual surgery was done by gynaecologist Howard Jones. When Edgerton was contacted by Dr Stanly Biber in 1968, the adaption of Burous’s method was recommended. In 1967 an orchiectomy and construction of a rudimentary vulva was done on 22-month-old Bruce Reimer (later to be David) under the aegis of John Money. In 1975 Catholic psychiatrist Dr Paul McHugh became head of the Psychiatry department at Johns Hopkins. He later wrote that he intended

Mr & Mrs Simmons

from the start to put an end to sex change surgeries. He pushed for a negative review of the operations and got one in 1979 from psychiatrist Jon Meyers and co-author Donna Reter. By this time Green, Erickson, Jones, Edgerton had already left. In fourteen years only thirty people had been operated on. The David Reimer case became a scandal in the 1990s when the adult Reimer was found to have rejected his female assignment. He died by suicide in 2004, and Money stubbornly refused to admit that he had been in error. Other notable patients include: Dawn Langley Simmons, Kiira Triea.

1966 - 1979 – Minnesota Medical School, Minneapolis

The mayhem law had been dropped in Minnesota when the criminal code was recodified in 1963. A trans woman was admitted to the psychiatric section of the University Hospital, and the staff were persuaded that she should have the surgery that she so desired. After two years of discussion and planning, the School established a Gender Committee under psychiatrist Donald Hastings. Two members went to New York to examine patients of Harry Benjamin and Leo Wollman who had had surgery abroad. Their surgeon, John Blum, went to Johns Hopkins to observe transgender surgery. The first Minnesota operation was done secretly but the press found out anyway. The program opened officially in December 1966. English doctor, Colin Markland, became the chief surgeon on the program. The first two-dozen operations where financed by the state as a research program. Sociologist Thomas Kando interviewed 17 of the first patients, and depicted them as ‘the uncle toms of the sexual revolution’ in his 1973 book Sex Change; The Achievement of Gender Identity Among Feminized Transsexuals which was extensively quoted by Janice Raymond. Up to closure at the end of the 1970s, 41 trans women were operated on, and later 8 trans men also. This from the 300+ applications that the Clinic received each year. In 1974 Markland used bowel segments. This was the first intestinal vaginoplasty done on a trans woman. This procedure was quickly adopted by Dr Laub at Stanford. John Brown also offered it later in his career, but with less satisfactory results. Urologist Daniel C. Merrill later took three cases including Cuban dancer Shalimar and semi-fictionalized their stories. One of the last patients was Margaret O’Hartigan 1979.

1967-? Northwestern University Medical School, Chicago

Orion Stuteville, born in a covered wagon in Oklahoma, was on the US Olympic wrestling team in 1924. He was hired at Northwestern University as a wrestling coach and assistant football coach. He earned a master’s degree in orthodontics, and then an MD at the medical school. After 17 years in the dental school faculty, he became chairman of maxillofacial and oral surgery in 1950. He then directed a plastic surgery residency program, first at Cook County Hospital . He had already performed several transgender surgeries when he set up a gender clinic at the Northwestern Univeristy Medical School in 1967. While the surgeons at Johns Hopkins settled on a posteriorly pedicled penile skin flap, Stuteville used an anteriorly pedicled penile skin flap. Stuteville semi-retired in 1970, and in 1975 became a country doctor in Arkansas.

1967-? Gender Identity Research and Treatment Clinic, University of Washington, Seattle

Barbara

Headed by John Hampton, previously of Johns Hopkins. Notable patients include: 1969 Barbara Dayton.

1967- 2001 Michel Seghers, St Joseph’s Hospital, Brussels

In October 1967 Peggy Wijnen died of a blood clot shortly after transgender surgery. Her surgeon, Andre Fardeau, was charged with inflicting fatal blows and wounds with premeditation and willingly but without intent to kill, but died during the trial. This attracted Segher’s attention, and shortly afterwards a French psychiatrist introduced him to a patient who lived and passed as female and had attempted suicide several times in despair. Seghers studied the literature, and realized that he was the only hope for the patient. The operation at St Joseph’s Hospital was successful, and afterwards Seghers communicated the facts to the Belgian Society for Plastic Surgery. He performed over 1,600 operations on trans women, and some top surgery for trans men before he retired in 2001. Notable patients include: Maud Marin, 1974, Yeda Brown, 1975, Veronica Jean Brown, 1985, Michelle Duff, 1987, Michelle Hunt, 1988, Dallas Denny, 1991, Lechane Bezuidenhout, 1992, Christine White, 1993, Rusty Mae Moore, Chelsea Goodwin, 1995, Karine Espineira, 1998, Catrina Day, 1999.

1968 Otto de Vaal, Amsterdam

The first transgender operation in the Netherlands was done by Otto de Vaal in 1968. Very quickly 200 other patients registered with him. He ensured that the operations were covered by the Dutch national health system, and arranged for a politician to introduce a bill so that their name and gender could be changed in the civil registry. In 1971 de Vaal published Man of vrouw?: Dilemma van de transseksuele mens.

1968-2003 Stanley Biber, Mount San Rafael, Trinidad, Colorado

Dr Biber

Biber did his first sex change surgery in 1968 for Ann, a social-worker friend who had been completing her real-life test without his realizing. Biber consulted with Harry Benjamin, who had started Ann on estrogens, and then sent to the Johns Hopkins Hospital for diagrams describing Dr. Burou's technique.  By the late-1970s when the Johns Hopkins Gender Clinic and others closed, Dr Biber had become the major alternate source of transgender surgery in the US. He went on to do thousands of the operation, resulting in Trinidad, Colorado becoming known as the “Sex-Change Capital of the World”, and also trained other surgeons in transgender surgery. He became a celebrity and appeared on television. Notable patients include:  1976 Yasmene Jabar,  1978 Diane Delia, 1979 Nancy Ledins,  Joseph Cluse, 1980 Kay Brown, 1981 Susan Faye Cannon, 1983 Walt Heyer, Rosalyne Blumenstein, 1984 Susan Kimberly, Brenda Lana Smith, 1986 Kate Bornstein,  Leslie Nelson , 1989 Les Nichols, 1991 Valerie Taylor, 1992 Claudine Griggs,  Cynthia Conroy, 1994 Melanie Anne Phillips,  Terri O'Connell, 1995 Gloria Hemingway.

1968 onwards – Gender Identity Clinic, Stanford School of Medicine, California

Donald Laub became assistant Professor of Surgery and Chief of the Division of Plastic and Reconstructive Surgery at Stanford University, 1968-1980, where he and Norman Fisk opened the Gender Clinic. In February 1973 the Stanford School of Medicine sponsored the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome, and both Georges Burou and John Brown made presentations. Dr Laub made one of the first academic investigations into the efficacy of transgender surgery. He pioneered rectosigmoid vaginoplasty for trans women from the mid-1970s. He is credited with inventing metoidioplasty and the ‘post-modern’ phalloplasty. Since 1980, the clinic has existed as a non-profit foundation in Palo Alto, Calif., and is not affiliated with the university. More recently the program has been run by gender counselor Judy Van Maasdam. Over 600 have had surgery. Notable patients include: 1968 Charlotte McLeod, 1974 Sandy Stone, 1997 Ben Barres, 2007 Alice Miller.

1968-1980 Benito Rish, Yonkers Professional Hospital, New York

Part-owner of the hospital, and president of its board, Rish did surgery on patients referred by Harry Benjamin and Leo Wollman. Notable patients included Erica Kay 1968; Liz Eden  1973; Mario Martino in 1977, and probably Perry Desmond. From 1972 Dr Rish was sued for malpractice. Yonkers Professional Hospital was closed down after a surprise inspection by the state in 1980.

1968 onwards Viktor Kalnberz, Riga

Kalnberz had already performed four sex correction operations on intersex patients, when in the winter of 1968 he was approached by a 29-year-old trans man, an engineer who had already attempted suicide three times, whom we know only by his female name of Inna. Kalnberz treated him over the next four years. In September 1970 the operation was approved, and it was done in stages. In 1974 Kalnberz was issued a US patent for his penile implant using polyethylene plastic rods – in all he held 23 patents in different countries. He did a further five sex-change operations. He was a member of the USSR Supreme Soviet 1975 – 1990.

1969 onwards, Clarke Institute of Psychiatry (later CAMH), Toronto

Maxine Petersen

In 1969, Betty Steiner, a psychiatrist but without any experience of transsexuals, was appointed the first head of the new Gender Identity Clinic. Her first patient approved for surgery was Dianna Boileau, who was operated on at the Toronto General Hospital using Edgerton’s variation on penile inversion. In January 1973, Steiner reported that 6 patients had been operated on. The Czech Kurt Freund, penile plethysmographer, and USian Ray Blanchard, psychologist, joined the team, and proposed the theory of Autogynephila, which was laid out in the Clarke-published anthology Gender Dysphoria, 1985. In 1984 in the Toronto Star Steiner attributed the social success of the 102 clients who had had surgical sex change through the Clinic in its first 15 years to the fact that only 1 in 10 'men' who request it are approved. By then surgeons in Toronto were reluctant to do transgender surgery, and the Clarke started sending patients to Montréal and the UK for surgery. Steiner retired in 1986 and was replaced by Robert Dickey. Psychologist  Maxine Petersen transitioned to female in 1991, making the Clarke the only Gender Clinic to have a staff member transition. Steiner and her husband died from carbon monoxide poisoning in 1994. Freund retired in 1995 and committed suicide in 1996. Blanchard became head of the Clinic. In 1998 the Clarke was merged with other institutions and became the Centre for Addiction and Mental Health (CAMH).

25-7 July 1969, The First International Symposium on Gender Identity, London

This was held at the Piccadilly Hotel.. It was sponsored and organized by the Erikson Foundation and the Albany Trust. This symposium brought together various London hospitals that had trans patients, with similar specialist from other countries. Papers were given by John Randall (Charing Cross), surgeon Fred Oremland (Los Angeles), Margaret Branch from Guys Hospital (who had guided Peter Stirling through transition), Richard Green (UCLA), John Money (Johns Hopkins)and Zelda Suplee (EEF). Also in attendence were Poul Fogh-Andersen, Harry Benjamin, Reed Erickson and Virginia Prince. Arguments arose between the team from Chelsea Women's Hospital who regarded transsexuals as a form of intersex, and the team from Charing Cross Hospital who regarded them as having a psychological disorder. The Symposium did bring together the doctors working in the field. PDF of Program.

1969 Richard Green & John Money. 

• Richard Green & John Money.Transsexualism and Sex Reassignment.. The Johns Hopkins Press., 1969.

The first anthology of papers by the major doctors and psychologists doing transgender surgery in the late 1960s. Includes papers by Richard Green, John Money, Ira Pauly, Robert Stoller, Waedell Pomeroy, Jan Walinder, Donald Hastings, Christian Hamburger, Harry Benjamin, Howard Jones, Leo Wollman, John Randell.

1969 Francisco Sefazio, Buenos Aires

Sefazio was charged with aggravated assault but was acquitted on the technicality that all of the patients were actually ‘pseudohermaprodites’ and that he had clarified rather than changed their sex.

1969 onwards Shan Ratnam, Lim & Anandakumar, Singapore

Ratnam was pestered by Shonna who was desirous to have sex change surgery. He became intrigued by the possibility, read the literature and finally practised the operation on two cadavers in the mortuary. He had Shonna evaluated by a team of psychiatrists who confirmed that she was indeed transsexual. Legal clearance was sought from the ministry of health and granted. Surgery was performed 30 July 1971 at the Kandang Kerbau Hospital 竹脚妇幼医院. This was the first such operation in east Asia. A Gender Identity Clinic was set up headed by Prof Ratnam, who ran it until his retirement in 1995, when it was passed to his nephew, Dr. Anandakumar. In 30 years more than 300 sex change operations were performed.

1969 onwards Derk Crichton, Cape Town and then Durban

Crichton, based his technique on that of Shan Ratnam. By 1993 Crichton had done 58 transgender surgeries. Notable patients include : 1975 Lauren Foster.

1970-1980 David Wesser, Yonkers Professional Hospital, New York

Wesser’s first transsexual patients were those who had had surgery elsewhere, and corrections were needed. By 1980 Wesser had done 200 sex-change operations, mainly using Burou’s technique. Yonkers Professional Hospital was closed down after a surprise inspection by the state that year, and the next year he was charged with negligence by a panel that was hand-picked to be partial against him.

1970 -1995 Milton Edgerton, University of Virginia, Charlottesville

Edgerton from Johns Hopkins, became first Chairman and Professor of Department of Plastic Surgery at the University of Virginia. Transgender surgery was discontinued after Edgerton’s retirement.

1971 onwards Roberto Farina, São Paulo Medical School

Farina performed the first transsexual operation in Brazil on Waldirene Nogueira. In 1975 she applied for rectification of her entry in the São Paulo Civil Registry. Her application was denied, and the incident drew attention to her physical condition. In 1976 João Nery was referred by Dr Cesar Nahoum and clandestinely Dr Farina performed a mastectomy and hysterectomy. Attention to Waldirene Nogueira led to Dr Farina being charged, convicted and sentenced to two years imprisonment for serious bodily injury. This interrupted Farina’s intention to perform phalloplasty on João Nery. On appeal in 1978, the judge ruled that the surgery was the only way to assuage the patient’s suffering, the board of the Hospital das Clínicas de São Paulo was in favour of the surgery, and no deception was practiced by Dr Farina. A year later, the 5th Câmara do Tribunal de Alçada Criminal de São Paulo confirmed the appeal and ruled that such surgery was not forbidden by Brazilian Law or by the Code of Medical Ethics.

12-14 September 1971, Second International Symposium on Gender Identity, Denmark

This was held in Elsinore, . Papers were given by Ira Pauly (Portland), Kurt Freund (Clarke Institute), Leo Wollman (New York), Colin Markland and Donald Hastings (Minnesota GIC), V. Hentz and Donald Laub (Stanford GIC), Poul Fogh-Andersen (Copenhagen), Zelda Suplee (EEF) Margaret Branch (Guys Hospital), G Sturup (Copenhagen), Jan Walinder (Goteborg), Marie Mehl (EEF, Miami), Norman Fisk (Stanford), Otto deVaal (Amsterdam), Richard Green (UCLA).

1972-1985 Roberto Granato, New York

From Argentina, Granato did further training in New York. He did about 800 vaginoplasties using the Burou technique. He also did phalloplasties. Notable patients include: Diane Kearny, Renee Richards, Eleanor Schuler, Jeanne Hoff.

2-4 February 1973 Proceedings of the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome, Stanford GIC

Both Georges Burou and John Brown gave well-received papers.

1973-1977 Baptist Medical Center, Oklahoma City

Drs David William Foerster and Charles Reynolds founded the Gender Identity Foundation at the Baptist Medical Center. They had done over 50 vaginoplasties, mainly Burou-style penile-inversions, by 1977, and there were another 50 trans women waiting. The Baptist General Convention of Oklahoma finally realized what was happening. One pastor on the hospital Board of Directors called the operations “a Christian Practice”. However in October 1977, the Board of Directors of the Baptist General Convention of Oklahoma voted 54-2 to ban such operations at the Baptist Medical Center. The Gender Identity Foundation transferred to the Oklahoma Memorial Hospital, but the program was ended here too in 1981.

1973-1999 John Brown, California and then Tijuana

After a well-received presentation at the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome at the Stanford School of Medicine in February 1973, Brown was being recommended by Vern Bullough and Zelda Suplee. This was quickly regretted as it came out that Brown operated on kitchen tables and in hotel rooms, used unqualified assistants and took valium before operating. However he networked with transsexual peer groups and charged far less than other surgeons. He initially used the glans penis to form a clitoris, and lined the vagina with scrotal skin. After about 200 operations, his California Medical License was revoked in 1977. He later resumed practice in Tijuana. Some patients were extremely pleased with the results; other suffered many years of pain; some died. Angela Douglas was an early patient.

1974-2004 Herbert Bower & Trudy Kennedy, Monash Medical Centre, Melbourne

Bower and Kennedy proposed a gender Dysphoria clinic to the Queen Victoria Hospital, assembled a team of a psychiatrist, an endocrinologist, a speech therapist, a gynaecologist and a plastic surgeon. The first transgender surgery was done the next year, and later the clinic moved to Monash Medical Centre. They had operated on 600 patients by 2004 when a patient, who changed her mind about becoming male, sued for malpractice.

1975 onwards - Vrije Universiteit, Amsterdam

Louis Gooren founded a gender clinic at Vrije Universiteit in 1975. Surgery was done by Philip Lamaker. They have treated over 2,200 transsexuals. Gooren was one of the first sex-change doctors to accept patients as young as five years old, although not for surgery at that age. Notable patients include: 1976 Rachel Pollack, 1983 Veronique Renard.
____________________________

The following were consulted:

• Malcolm A Lesavoy. “Vaginoplasty – Construction of Neovagina”. Abdominal Key. Online.
• Joanne Meyerowitz. How Sex Changed: A History of Transsexuality in the United States. Harvard University Press, 2002.
• Lynn Conway. Vaginoplasty: Male to Female Sex Reassignment Surgery: Historical notes, descriptions, photos, references and links, 2006. http://ai.eecs.umich.edu/people/conway/TS/SRS.html.
• “The Development of Modern Sex Reassignment Surgery (SRS)”. January 2008. Online.
• Dallas Denny. “Gender Reassignment Surgeries in the XXth Century”. May 10, 2015. Online.
• Britt Colebunders, Wim Verhaeghe, Katrien Bonte, Salvatore D’Arpa & Stan Monstrey. “Male-to-Female Gender Reassignment Surgery”. In Randi Ettner, Stan Monstrey & Eli Coleman. Principles of Transgender medicine and Surgery. Routledge, 2016: 250-278.
• Britt Colebunders, Salvatore D’Arpa, Steven Weijers, Nicolaas Lumen, Piet Hoebeke & Stan Monstrey. Female-to-Male Gender Reassignment Surgery”. In Randi Ettner, Stan Monstrey & Eli Coleman. Principles of Transgender medicine and Surgery. Routledge, 2016: 279-317.
• Marta Bizic, Vladimir Kojovic, Dragana Duisin, Dusan Stanojevic, Svetlana Vujovic, Aleksandar Milosevic,Gradimir Korac and Miroslav L. Djordjevic. “An Overview of Neovaginal Reconstruction Options in Male to Female Transsexuals”. The Scientific World Journal 2014 (2014): 638919. PMC. Web. 30 Apr. 2018.. www.researchgate.net/publication/263514761_An_Overview_of_Neovaginal_Reconstruction_Options_in_Male_to_Female_Transsexuals. (Click though may not work: copy and paste) or https://www.hindawi.com/journals/tswj/2014/638919.
• David Andrew Griffiths. “Diagnosing sex: Intersex surgery and ‘sex change’ in Britain 1930-1955”. Sexualities, 21,3, 2018: 476-495. Online.

Timeline of transgender surgery to 1975: Part I 1906 -1965

Part I: 1906 -1965
Part II: 1966 -1975
Part III: untruths and unknowns

Both vaginoplasty and phalloplasty were first developed for cis persons: either because the organ was missing at birth (agenesis) or had been lost/damaged in battle, in crime or in an accident. Secondly the operations were applied to intersex persons to normalize their bodies. This was sometimes, against the wishes of adults, but sometimes perceived as correction surgery and welcomed. However it was also done to children when they were unable to consent, and many later, as adults, inevitably resented what had been done. This article is primarily about the development of surgery for transsexuals, that is, those who wanted such surgery. The development of surgery on cis and intersex persons is recounted in that it came first.

Entries in blue pertain to operations on cis and intersex persons.

There are ancient traditions of transgender surgery by transgender communities, without the assistance of doctors, without anaesthetics, without antibiotics. However that is another story.

Part I: 1906 to 1965

1832 Jean Zuléma Amussat, Paris

The first known vaginal reconstruction. Amussat used ‘progressive perineal dilation’ (a condom packed with iodoform gauze). This was mainly a making of an opening in the cellular tissue between the bladder and the rectum, and attempting to maintain it by the wearing of some form of tampon or plug. No skin grafting.

1872 Heppner

Heppner improved on what Amussat did : a vaginal reconstruction using the labia, and split thickness skin grafting.

1890-1914 Franciszek Neugebauer, Warsaw

Like most doctors of his generation Neugebauer was very concerned to establish a person's 'true sex' for otherwise “disastrous consequences may follow an erroneous declaration of sex, and that not merely for the individuals immediately concerned, their families and connections, but for others besides". The 'true sex' of course was established by finding hidden testicles or ovaries, not by asking the person which sex they felt that they were. His major work is Hermaphroditismus beim Menschen, 1908, which summarizes 2000 cases of hermaphroditism across history and around the world. He had observed forty or so of the cases first hand. 

1892 WF Sneguireff, Paris

Sneguireff was the first surgeon to use a segment of the rectum to build a vagina.

1898 R. Abbe, New York

Abbe dissected a canal and lined it with split-thickness skin grafts. These non-genital skin grafts were placed over a rubber stent packed with gauze. After 10 days, the stent was removed, and the skin grafts were completely vascularized. The patient was asked to wear a vaginal conformer postoperatively, and intercourse was possible. However, Abbe’s report of the operation was lost for almost 40 years.

1900 Beck, New York

Beck made a vagina using an internal downward incision next to the bladder to the space between the bladder and rectum which was met by an upward cut from the peritoneum in the usual way, which was then lined with skin flaps from the thigh and stuffed with gauze.

1902 A. Geijl, Amsterdam

Geijl operated on a 20-year-old ‘male hermaphrodite’ who had been raised as a girl, and was about to marry as a woman. He removed the penis and created a vagina. Against the practice of the time he did not define sex as determined by gonads; rather he was led by the patient’s sense of self.

1903 J. Riddle Goffe, PolyClinic Hospital, New York

‘A pseudohermaphrodite, in which the female characteristics predominated. Operation for removal of the penis and the utilization of the skin covering it for formation of a vaginal canal’. This seems to be the first report of a penile-inversion vaginoplasty – 50 years before those done by Fogh-Anderson and Burou.

1904 James F Baldwin, Grant Hospital, Columbus

Baldwin used the ileal segment from the small intestine to create a vagina, but he also suggested that the sigmoid colon might be used for the same purpose. However difficulties were reported with bowel transposition such as necrosis, infection, and abscess formation.

Karl Baer

1906 Georg Merzbach, Berlin

Karl Baer, raised as female but living as male, went to hospital after being hit by a tram. His body incongruity was discovered, his body was corrected as far as possible to male, and he was released with a medical certificate confirming his male identity, and an endorsement by Magnus Hirschfeld.

1912-1921 Richard Mühsam, Berlin

Mühsam did a series of partial operations, orchiectomy, mastectomy, hysterectomy, on trans men and trans women, one at the request of Magnus Hirschfeld. Most of them were tentative.

1918 J Allen Gilbert, Portland, Oregon

At the request of his patient, Alan Hart, Gilbert did a hysterectomy. This is an early cooperation of a doctor to supply as much of a sex change operation as then technically feasible. Dr Gilbert published an account of his patient, referred to as 'H' in Journal of Nervous and Mental Disease in 1920.

1926 Il’ia Golianitski, Moscow

Professor Il’ia Golianitskii, well-known for his work on plastic surgery and tissue transplantations, successfully performed sex-change operations on both men and women.  Entitled “Underdeveloped people” and illustrated by a photograph of one of the patients, the reportage described five successful sex-change operations: “four on women and one on a man." However this did not continue.

Toni Ebel 

1922-1933 Institut für Sexualwissenschaft, Berlin

Under the aegis of Magnus Hirschfeld, a few surgical operations for trans women were performed, using a similar technique to that of Abbe and non-genital skin grafts, The operations were mainly done by Drs Erwin Gohrbandt, Felix Abraham and Ludwig L. Lenz. Dörchen Richter was operated on in 1922 and 1931; Carla von Crist in 1929-1930; Toni Ebel 1930-1931. Abraham published a paper giving the details of the operations on Richter and Ebel in Zeitschrift für Sexualwissenschaft und Sexualpolitik in 1931 Translation.

1927 G.A. Wagner

Very similar to what Baldwin had done, except that Wagner used the sigmoid colon to create a vagina.

1930-1931 Kurt Warnekros, Staatliche Frauenklinik, Dresden

On a visit to Paris, Warnekros, who had operated on Carla von Crist for Magnus Hirschfeld, was consulted by a 48-year-old married man, who was concerned that he was being taken over by a female personality. Warnekros arranged for the patient to have an orchiectomy in Berlin and then admitted her to the Staatliche Frauenklinik. He performed genital surgery on her and transformed her into Lili Elevenes (Elbe). An extra operation, possibly an ovary or uterus transplant, was performed. Lili died a few months later.

1930-1945 Hugh Hampton Young, Johns Hopkins Hospital, Baltimore

Young pioneered genital reconstruction surgery, but not on transsexuals.

1930s-1940s Lennox Broster, Charing Cross Hospital, London

Broster did pioneer research and provided hormonal therapy and surgery for intersex patients, especially those with adreno-genital syndrome (now known as Congenital adrenal hyperplasia). His work on intersex patients was reported in The News of the World, in 1943, which attracted patients who would now be regarded as transsexual. However there is no evidence that he operated on any such person, and Clifford Allen, the psychiatrist who worked with him, specifically rejected surgical treatment for ‘transvestites’ (the term then in use). His most notable patient was 1935 Mark Weston, who did change gender but was not regarded as a ‘transvestite’.

1936 Nikolaj Bogoraz, Moscow

Bogoraz did the first phalloplasty. He reconstructed a total penis using a rib cartilage within a reconstructed tubed abdominal flap.

1938 JB Banister and Archibald H McIndoe, London

Abbe’s 1898 report was re-discovered, and his surgery replicated by Bannister and McIndoe (cousin to Harold Gilles), albeit modified by using a rigid plastic mould. This approach came to referred to as the McIndoe technique. McIndoe reported 63 repairs.


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From this point on, external hormones are available, but still not used for all transsexual transitions.
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1939-1965 Ludwig Levy-Lenz, Cairo

Previously a surgeon at the Institut für Sexualwissenschaft, Levy-Lenz settled in Cairo after being driven out of Germany by the Nazis. He did transgender and other surgery and was very successful, and had a villa near the Giza pyramids. After WWII he also practiced in Baden-Baden.

1941-1942 unknown surgeon, La Chaux-de-Fonds, Switzerland

Arlette-Irène Leber had a series of operations including vaginoplasty. In 1944 a Cantonal Court approved her change of civic status to female.

194? Josef Mengele, Auschwitz

“I met another boy whom the scientists of Auschwitz, after several operations, had successfully turned into a woman. He was then thirteen years old. After the war, a complicated operation was performed on him in a West German clinic. The doctors restored the man's physical masculinity, but they couldn't give him back his emotional equilibrium.”

1942-1957 Harold Gillies, Ralph Millard & Patrick Clarkson, Harley Street, London

Harold Gillies

Gillies had developed pioneering phalloplasty for war-damaged soldiers in WWI and WWII. He and Millard performed a series of operations from 1942-6 on  Michael Dillon, who himself later qualified as a doctor. This was the first ever operation anywhere to change a woman into man. They used an abdominal tube flap and added a rib cartilage graft for rigidity. Gillies and Millard also performed the first UK male-to-female operation on Betty Cowell in 1951 using a penile skin flap.  These operations resulted in Gillies having to appear before the General Medical Council, and he did no more such. Their technique was discussed in their 1957 book: The Principles and Art of Plastic Surgery. Georgina Turtle had had an appointment with Gillies, but been dismissed. She later had surgery with Clarkson, a colleague of Gillies, using his techniques, in January 1957. Both Gillies and Clarkson were from New Zealand (as was Archibald McIndoe, Gillies’ cousin).

1950-1962 Elmer Belt, UCLA, Los Angeles

Belt was the first surgeon in the US to do sex change operations, many on patients referred by Harry Benjamin. To avoid charges of mayhem which inhibited other doctors, he preserved the testicles, pushing them into the abdomen. He ceased the operations at the end of 1954 when a committee of doctors at UCLA decided against the practice, however he restarted quietly a few years later. He discontinued finally in 1962 under family pressure, and because of complaints about the way that he treated some patients, after he heard about the growing practice of Georges Burou. Notable patients include: 1956 Barbara Wilcox, 1959 Agnes, 1961 Patricia Morgan, 1962 Aleshia Brevard,

1951 onwards - various hospitals, Copenhagen

Among the first trans patients in Denmark were the US women, Christine Jorgensen and then Charlotte McLeod. There was so much publicity after Jorgensen’s operations that a law was passed to restrict the operation to Danish nationals. Jorgensen’s surgeons were Poul Fogh-Andersen and Eling Dahl-Iversen. The early operations were orchiectomy and penectomy only, but by 1956 Fogh-Andersen was the first to report the use of a full-thickness skin graft harvested from the penile skin to line the neovagina. In the same year the first surgery on a trans man was performed.

1956-1987 Georges Burou, Clinique du Parc, Casablanca

Burou is taken to have invented penile-inversion vaginoplasty. He was apparently unaware of the Gillies-Millard skin flap technique which is a similar approach. He advanced beyond what Fogh-Andersen did in Copenhagen. Penile Inversion was a major advance on previous vaginoplasty for trans women which had usually been done by taking skin from the thigh. He performed surgery for several of the performers at Le Carrousel. Burou had performed over 3000 penile-inversion operations by 1973. Notable patients include: 1958 Jacqueline Dufresnoy (Coccinelle), 1960 Marie-Pierre Pruvot (Bambi),  April Ashley, Capucine, 1961 Gloria Greaves, 1962 Betty , 1963  Amanda Lear, 1970  Della Aleksander, Michael Brinkle, Lyn Raskin, Deborah Hartin, Hélène Hauterive, 1971 Colette Berends, 1972 Jan Morris, Carrol Riddell, Nana , 1973 Jean Lessenich, Karūseru Maki , 1975 Vanessa Van Durme, 1980 Marcella Di Folco.

1950s- 1978 Mr Edwards, Royal Victoria Infirmary, Newcastle

Charles Armstrong, endocrinologist, specialized in intersex patients and that included transsexuals. He testified for the patient in both the Ewan Forbes and the Corbett v. Corbett cases. Surgery on intersex and trans persons ceased in late 1978 when the surgeon, Mr Edwards, retired and was not replaced. This was to the chagrin of Mark Rees who had just been accepted as a patient.

Early 1960s onwards - Jose Jesus Barbosa, Hospital del Prado, Tijuana

An early adaptor of Burou’s penile inversion. Barbosa had performed over 300 vaginoplasties by 1973. Notable patients include: Lynn Conway, 1968, Phoebe Smith, 1970, Canary Conn, 1972.

1960s onwards – Peter Philip, Charing Cross Hospital, London

Carrying on from the pioneering work on intersex patients done by Lennox Broster, Charing Cross Hospital started accepting ‘transvestite’ patients after John Randell was appointed Physician for Psychological Medicine in 1950. Through the 1960s he was seeing 50 such cases a year. However he was not in favour of surgery until his patients who had had surgery abroad returned with positive evaluations. In the mid-1960s Peter Philip, who was already a consultant urologist at Charing Cros, surgeon was appointed as surgeon to work with trans patients. Even then less than 10% of Randell’s patients managed to achieve surgery and only a third of these trans women had vaginoplasty. However most gender surgery performed in the UK was done at Charing Cross. In the mid-1980s Philip stepped down and was replaced as surgeon by James Dalrymple (who also did private transgender surgery). Notable patients include: Mark Rees 1969, Adèle Anderson 1973, Caroline Cossey (Tula) 1974, Rachael Padman 1977, Rachael Webb 1978, Julia Grant 1980, Stephanie Anne Lloyd 1983, Christine Goodwin 1985, Luiza Moreira (Roberta Close) 1989.

1962 onwards Gender Identity Research Clinic, UCLA

Technically, this clinic which followed the operations done by Elmer Belt at UCLA and was founded by Robert Stoller and Richard Green, was the first Gender Identity Clinic in the US. Unlike the later clinics it was not oriented to providing support and surgery to trans persons, although a small number were so processed. One of the first research sources recruited by Stoller was
Virginia Prince whom he met twice a month for the next 29 years. Stollers published two collections of papers titled Sex and Gender. He argued against the concept of a ‘female transsexual’ implying that trans men did not exist. In the 1970s the Clinic was involved in the Feminine Boy Project led by Green, George Rekers and Ivar Lovass.

1963-? Jan Wålinder, St Jorgens Hospital, University of Goteborg

The major Swedish doctor treating transsexuals in this period, with significant publications. Amazingly he has disappeared from history. Even the Swedish Wikipedia does not have an entry for him.

? - ? Jaime Caloca Acosta, Tijuana

? - ? Francesco Sorrentino, Naples

1965 Ira Pauly, University of Oregon Medical School

Pauly compiled and published the first aggregate study of post-op trans women: "Male Psychosexual Inversion: Transsexualism. A Review of 100 Cases". He concluded that that gender surgery had positive results and that trans patients should be supported by medical professionals in their quest to live as the gender of their identity. He received a thousand requests from doctors around the world for offprints of his article.

Continued in Part II.

penile-inversion vaginoplasty in 1903

The official history of penile-inversion vaginoplasty is that Harold Gillies & Ralph Millard pioneered the use of of penile skin-flap in 1951, but that their method was not penile-inversion vaginoplasty as we later knew it.   Poul Fogh-Andersen in Copenhagen, who had operated on Christine Jorgensen, continued to innovate, and in 1956 he reported that he had successfully used a full-thickness skin graft harvested from the penile skin to line the neovagina. This was taken further by Georges Burou in Casablanca, also in 1956, who set the standard for future surgeons.   His method was quickly adopted by Jose Jesus Barbosa in Tijuana and Milton Edgerton at Johns Hopkins in Baltimore.   It was Edgerton who passed on details of Burou's method to Stanley Biber in Trinidad, Colorado.

This was the 1950s.

Let us turn back the clock to 1903.

________________

E.C. had been raised as a girl in New York, and identified as a woman. At age 20 she was referred by her family physician to the gynaecology professor, J. Riddle Goffe, in that she wanted to get rid of a growth between her legs. She also had a partial vagina and facial hair. Goffe examined her, and also asked her whether she wanted to be a man or a woman. She decidedly wanted the latter.

In March 1903, he operated on her at the Polyclinic Hospital (later called the Stuyvesant Polyclinic) in the presence of his class and some invited guests. He used the skin of the penis/enlarged clitoris to form the inside of the vagina. Three months later she returned and was very happy about the success of the operation.

Goffe describes the case: “The case of pseudo-hermaphroditism which I have to present is of special interest on account of the operative procedure which I instituted and performed, and which effectually eradicated all semblance of duality of sex and placed the young patient safely in the ranks of womankind, where she desired to be”. The editorial caption under the surgical photographs reads: “operation for removal of the penis and the utilization of the skin covering it for the formation of a vaginal canal”. E.C. also undertook treatment three times a week for removal of facial hair by electric depilation.  Goffe wrote up the case in the American Journal of Obstetrics and Diseases of Women and Children.

Goffe's describes the operation: "The skin adjacent to the vulva was so harsh and bristled so with hair that it was not available for filling in the lateral gaps in the mucous membrane of the vagina. The only apparent resource was to allow them to fill up by granulation, when suddenly the thought occurred to me, Why not use the skin covering the clitoris? This was soft and delicate and free from hair. It
was therefore decided upon." (p760 in Goffe, quoted p76 in Mak, 2005.  Mak comments: "As far as I know, this was the first case in which the skin of a clitoris/penis was used to construct a vagina.")

Apparently the editor of the journal altered the title of Goffe's paper to say “for removal of the penis”, despite Goffe referring to the organ as a clitoris throughout. Goffe’s comment “where she desired to be” caused controversy among surgeons and gynaecologists in that the consensus at the time was that only gonads truly define sex – a position that Goffe himself had set forth in his introduction, but to which he did not in fact adhere.

A few other doctors in the very early 20th century did as Goffe did, and considered the patients wishes in deciding what surgery to do (see Mak 2011) rather than insisting on gonadal determinism, but there does not seem to be any record of any other surgeon using the skin of the penis/clitoris until 50 years later.

• J. Roddle Goffe. “A pseudohermaphrodite, in which the female characteristics predominated: Operation for removal of the penis and the utilization of the skin covering it for formation of a vaginal canal”. American Journal of Obstetrics and Diseases of Women and Children, 48:6, 1903: 755-763.
• Geertje Mak. ‘ "So We Must Go Behind Even What the Microscope can Reveal". The Hermaphrodite’s “Self” in Medical Discourse at the Start of the Twentieth Century.’ GLQ A Journal of lesbian and Gay Studies, 1,1, January 2005: 66-7, 71-8, 80-4
• Christina Matta. “Ambiguous Bodies and Deviant Sexualities: hermaphrodites, homosexuality, and surgery in the United Sattes, 1850-1904”. Biology and Medicine, 48,1, winter 2005: 75, 80-1.
• Geertje Mak. Doubting Sex: Inscriptions, Bodies and Selves in Nineteenth-Century Hermaphrodite Case Histories. Manchester University Press, 2011: 176-82, 258-9n32.
• Elizabeth Reis,. Bodies in Doubt: An American History of Intersex.: Johns Hopkins University Press, 2012: 78-80. .