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27 June 2016

Benjamin’s TS Phenomenon – comments

Harry Benjamin's book is now 50 years old.
  • Harry Benjamin. The Transsexual Phenomenon. Julian Press, 1966. Warner Books Edition 1977, with a bibliography and appendix by Richard Green.  PDF (with different pagination). 
Part I:  intro and the Scale
Betty (?1938 - ?) female impersonator, salesgirl, model. --- 2nd entry, Appendix D, autobiographies
Part II:  transvestites
Clara Miller (1899 - ?) fur merchant, office worker ---  3rd entry, Appendix D, autobiographies
Part III: trans women
Joe (1920 - ?) cattle breader, art dealer ---  4th entry, Appendix D, autobiographies
Part IV: photos, legal, trans men, conclusions

See also my biography of Harry Benjamin:
Part 1 - beginings
Part 2 - rejuvenation.
Part 3 - transsexualism to 1966.
Part 4 - transsexualism since 1966
Harry Benjamin's other books
The other Harry Benjamin

When I wrote my 4-part biography of Harry Benjamin in October 2012, I had intended to finish with a review of his major book. However it turned out to be a bigger task than I had realized, and I put it aside until now. As this year is the 50th anniversary of the book's publication, this is certainly a good time to reread it.

A close reading reveals that the book is composed of segments that were written at different times. Sometimes this is openly admitted. Such that chapter 1 was published in Sexology in 1961, and part of chapter 7 in Sexology in 1963. Sometimes this is deduced such as at the beginning of chapter 6 where Benjamin writes: “Although this volume does not deal with transvestism specifically, a few remarks as to the therapy of this less serious deviation, in comparison with TSism, may be in order” as if chapters 2 and 3 do not exist. The grumpy bits at the beginning and end of chapter 4 were probably written at a different time from the rest of the book, including the middle parts of the same chapter.

Textual analysis as a tool well developed in literature and Bible studies (e.g. we know the text of TS Eliot’s Waste Land before Ezra Pound edited it, and gave us the version that is best known; The Epistle to the Philippians contains a kenotic hymn at 2:5-11 whose theology is quite at odds with the rest of the document). The tool is only just beginning to be used in transgender studies. The obvious document for such analysis is Neils Hoyer’s autobiography of Lili Elvenes (Elbe), where Sabine Meyer has made a good start.

The Harry Benjamin Archives at the Kinsey Institute, Indiana (a US State where trans persons are not allowed to use the toilets) is quite vast. Does it contain the initial drafts that became The Transsexual Phenomenon? A comparison with the published version would be a useful PhD thesis for somebody to write.


Some parts of the book do not seem to know about Benjamin’s Scale, suggesting that it was developed after the book was partly written. The big problem in the scale is the assignment of Kinsey Scale numbers which led inevitably to erasures, of gay transvestites and gynephilic transsexuals. In a couple of cases Benjamin attempts to get around this by declaring a person to be a Kinsey 3 or 4 while being a husband and father, but a 6 after deciding to transition. As Kinsey and his team based positions on the scale on a person’s sexual history this would be an innovation by Benjamin.  In Kinsey's usage a person who was 3 or 4, and then became exclusively androphilic, would have become a 5, not a 6.   Your previous history becomes part of your current history.


Other problems with the scale are the lack of real difference between Type III and Type IV and the lack of a type for full-time non-ops. This would seem to have grown out of Benjamin’s previous three-part typology 1) those who merely want to ‘dress’ and be accepted as women. 2) those who waver, who want breast development but shy away from surgery. 3) ‘fully developed’ transsexuals. Hence he mainly sees a Type IV more as wavering, rather than choosing to live without surgery (despite the name).

Type I (pseudo-transvestites) is not really thought through. Three subtypes are quickly mentioned:
  1. “Nonaffective dressing” is Type 0 (cis) doing drag for non-existential ends.
  2. Those who cross-dress when young and then desist.
  3. Those who never actually cross-dress, but enjoy transvestic films and literature.
Type II is quite muddied by being labeled ‘fetishistic’ while not understanding fetishism, a practice performed by a few transvestites, a few transsexuals, and mainly cis persons. Type III is ‘true transvestite’, implying that type II is sort of ‘false transvestite’. In what way false? This is not addressed, other than talking about ‘fetishism’. Some trans women who are into fetishism, or go through a period of fetishism, appear otherwise to be true transvestites (Johnny Science, Kim Christy),  and some complete the transsexual journey (Lana Wachowski). In this, as in much else, Benjamin paid too much attention to Virginia Prince who was obsessed that her femmephilics not be regarded as fetishistic.

As I wrote: “Two years after Benjamin’s book, Transvestia columnist Sheila Niles popularized the concept ‘whole girl fetishist (WGF)’ for FPE members who did not pass well enough, particularly if it were for lack of trying. Over the next few years it came to be that those who failed or didn’t bother to fashion themselves as truly feminine were ‘fetishistic’. Susanna Valenti even estimated that the majority of members were WGFs”. I think that here we have the key to what Type II should have been: those who don’t attempt to pass, especially those who get off on being read. Those who want to pass are often uncomfortable around those who don’t care to. This division, into true=wants to pass and false=doesn’t want to pass, can also be applied to female impersonators, as they were then called - as long as we do not insist that they are Kinsey 0-2.  Some female impersonators were women offstage (the pre-op Coccinelle, April Ashley etc) but others were definitely men offstage.

Those who relish attention, on or off stage, are sometimes called drag queens (of whatever sexual orientation) or attention whores. But only a small percentage of them may reasonably be called ‘fetishistic’. So would genderqueer and non-binary be false transvestites in this meaning? Mixing up 1960s questions and ways of thinking with 21st century concepts is an interesting game, but of limited validity.   Nobody in 1966 was  genderqueer or non-binary, and so we need not pursue the question. Today very few people want to declare any one group ‘true’, and another ‘false’. That does not get us anywhere.


The HBS crowd made a big deal of being followers of Benjamin while execrating Virginia Prince. This is intellectually nonviable as Prince and Benjamin were long time associates and Prince is repeatedly mentioned in The Transsexual Phenomenon. She is mentioned 5 times in the first three chapters, and in addition Benjamin also repeats opinions that we know had earlier been expressed by Prince. From chapter 4 onwards, transvestism has been left behind, and perhaps you hope that Prince is also left behind. However she is mentioned another three times.

Prince also deformed the work of Richard Docter and Vern Bullough. I certainly think that Benjamin should have been advised to pay her less attention, and more attention to Louise Lawrence and Patricia Morgan. He should perhaps have also paid more attention to those trans women who could not afford his fees and went to Leo Wollman, Benito Rish or David Wesser instead.


So is a change of sex possible? The Warner Books cover promises: “All the facts about the changing of sex”. Chapter 1 (written 1961) affirms that chromosomes are only one of seven aspects of what is sex. I think that most of us go with this. It is really disconcerting that Benjamin reneges in chapter 3 and declares that “No actual change of sex is ever possible”. And then again in chapter 7 (written 1963): “Furthermore, the operation, even if successful, does not change you into a woman”.

Editor Brooking Tatum did not feel that this inconsistency was something that should be resolved.


Benjamin lists four motives for the conversion operation (p140-2/65-6):
  1. Sexual. “It concerns particularly the younger transsexuals. Their sex drive is not that of a homosexual man but that of a woman who is strongly attracted to normal heterosexual men.”
  2. Gender. “Especially for the older transsexuals, the urgent need to relieve their gender unhappiness can be powerful and impressive”.
  3. Legal. “The constant fear of discovery, arrest, and prosecution when ‘dressing’ or living as women is a nightmare for many. They want to be women legitimately and have a legal change of their sex status.”
  4. Social. “applies only if the transsexual patient happens to have a conspicuous feminine physique, appearance, and manners” [while still presenting as male] 
I will leave (2) until last.
1. This became a standard criticism that androphilic trans women were really gay men in denial.  This, of course, is not so, not only because many 'gay transsexuals' first explored the gay scene, but found that they were something different from gay men.

Furthermore there are  men who do want to have sex as a woman, but without being a woman, who seek to acquire a vagina, but otherwise continue living as men. They are rarely discussed. They are not what Benjamin meant here.
3. Fortunately – in most of Europe and North America – it is no longer a crime to dress or live as a woman without surgery. However in many parts of Asia, Africa and South America it still is. And in many of these countries, a conversion operation is not recognised. However even where such legal hassles are present, is the fear of discovery really a greater motivator than the desire to be fully a woman?
4. As it happened there were three outstanding transsexuals in the 1960s who were frequently taken to be women even when dressing as male: Coccinelle, April Ashley, Rachel Harlow. Most of us are not so beautiful. However surely all three became women because they wanted to be women, not that they became women involuntarily to avoid hassles. In the 1990s we had the example of Jaye Davidson who was cast as Dil in The Crying Game because of his beauty. However he is not transsexual, and continued living as a man.
2. “Especially for the older transsexuals, the urgent need to relieve their gender unhappiness can be powerful and impressive”. This sounds like Anne Vitale’s G3 with Gender Deprivation Anxiety Disorder (GEDAD). Should we assume that Vitale’s G1 has been split between 1 and 4?

What is missing is that persons want the conversion operation for existential reasons, in that they want to be women, have always felt that they are women, being a woman is what feels right, being a woman is who they are. There are other ways of saying it. But the overwhelmingly dominant reason for wanting a conversion operation is not mentioned by Benjamin.

One could use this section on the four reasons to argue that Benjamin did not understand at all why trans women asked for and sometimes got the conversion operation.   You could otherwise argue that his support and empathy showed that he did understand, or at least sympathised.   Speaking as a writer I know that sometimes I write something that seems quite dumb on rereading.    A good writer does reread and takes out what jars with the overall theme of the book.   This was not done re the four reasons, but should have been.


Benjamin states clearly that, except for the frequency of hypogonadism, pre-op, pre-hormone trans women are physiologically indistinguishable from cis males - except for their assertion that they are/want to be women.   And likewise for trans men and cis females.    But what about intersex persons who likewise seek a sex/gender change? 

Benjamin worked with John Money and must have been aware of the work that he was involved in with those who at that time were referred to as 'hermaphrodites'.   He would have been aware that most intersex stick with the gender of rearing, but that a few do not.  And some transsexuals discover that they have xxy or mosaic DNA and then announce that they are not therefore transsexual, even though e.g. the vast majority of xxy boys grow up to be xxy men.

It is perhaps a pity that Benjamin did not comment on this.


Female-to-male persons get pretty short shrift. Not only are trans men confined to one chapter, but female transvestites, and implicitly female fetishists, are erased.

There are four autobiographical accounts in Appendix D. Only the first Ava/Harriet is properly discussed in Benjamin’s text, there is also a very quick mention of the fourth, Joe.

24 June 2016

A rereading of Benjamin: Part 4: photos, legal, trans men, conclusion

  • Harry Benjamin. The Transsexual Phenomenon. Julian Press, 1966. Warner Books Edition 1977, with a bibliography and appendix by Richard Green.  PDF (with different pagination).  Page references eg p32/13 mean p32 in the 1977 Warner edition and p13 in the PDF. 
Part I:  intro and the Scale
Betty (?1938 - ?) female impersonator, salesgirl, model. --- 2nd entry, Appendix D, autobiographies
Part II:  transvestites
Clara Miller (1899 - ?) fur merchant, office worker ---  3rd entry, Appendix D, autobiographies
Part III: trans women
Joe (1920 - ?) cattle breader, art dealer ---  4th entry, Appendix D, autobiographies
Part IV: photos, legal, trans men, conclusions


In the center of the Warner edition are 23 pages of photographs: some before and after contrasts, and then close-ups of surgical results. The photographs are not identified in any way, not by a letter, not by a number, not by a pseudonym. Thus it is difficult to refer to any specific photograph. In the PDF of the book, only a few of the photographs are included.

The 6th and 7th pages (not in the PDF) are the before and after of an actor, both in a stereotyped pose more typical of silent films, than of the 1960s. This actor has never been named. How an actor can transition in stealth and keep working is intriguing. The US trans actors of the 1960s were non-op e.g. Candy Darling (however, of course, several of the stars of Le Carrousel in Paris were in films in the 1960s). The first US trans actor known to have surgically transitioned was Ajita Wilson who did so in the mid-1970s. The unnamed actor in the photograph is the true pioneer in her field, and we know nothing of her.

Pages 22-4, the last 3 pages, of the photographs (not in the PDF) are of a tattooed woman who had conversion surgery in 1953 at age 45. Benjamin discusses her on p137/63: “One patient who is now, several years after the operation, a decidedly masculine-looking ‘woman,’ with tattoos all over her body, is getting along well in an active business and is unrecognized as a former male. She is merely considered eccentric by her associates. Under no circumstances, she assured me repeatedly, would she ever go back to living as a man. ‘This way I am at least myself and can relax,’ were her own words. A couple of times she was arrested under the suspicion of ‘impersonating.’ When she was taken to a police station, examined and declared to be a woman, the arresting officers apologized and in one instance, bought her a dinner.

She is named Janet in Wheeler & Cahan Schaefer “Harry Benjamin's first ten cases (1938-1953): a clinical historical note

9. Legal Aspects in Transvestism and Transsexualism

There is actually no law anywhere that expressly forbids a man to dress as a woman; but the New York State Code of Criminal Procedure, Section 887, Subdivision 7, is being used against transvestites, and other states have similar statutes. This law says that a person (designated as a 'vagrant') must not appear with 'a face painted, discolored, or covered or concealed or being otherwise disguised in a manner calculated to prevent his being identified.' This applies to persons 'on a road or public highway, or in a field, lot, wood or enclosure.' This law had been passed more than one hundred years ago for an entirely different purpose. It was directed against farmers who disguised themselves as Indians and sometimes attacked law officers when they tried to enforce an unpopular rent law.” p167/78

Benjamin, advised by attorney Richard Levidow, was right about New York State, but municipalities across the US had passed laws against cross-dressing. See here.

The first case discussed is “A middle-aged man, an airline pilot for many years, of high standing in the community, a recent widower and a father, whom I knew well and for whom I have the highest regard, was arrested last year in the street near his home, wearing a wig, female clothing, and so on.” Readers of this encyclopedia will immediately recognize Felicity Chandelle.

The second case is of a woman, “Back from abroad after the conversion operation, and no longer a male anatomically” who was arrested for impersonation. An examination at the police station told the detectives that they had made a mistake, but unlike what had happened to the woman with tattoos, they changed the charge to ‘soliciting’. Fortunately she drew a sensible judge who dismissed the case.

E, a transvestite who for years had lived as a woman and whom I knew through frequent contacts to be a respected and responsible person, wanted to travel in Europe as a woman although the birth certificate and the given name were that of a man. I wrote the Passport Bureau, State Department, Washington, presenting fully all the facts in support of E's application for a passport to be issued in her female name and identity. Without comment, E's request was granted and she received the desired passport. Someone in the respective department was big enough to override technicalities and, in this instance, common sense won out over possible ‘rules and regulations’." p169/79 This could well be Virginia Prince who somehow managed to get a passport as a woman, and in the late 1960s visited the UK and Australia.

An ancient law threatens surgeons. This is of course the concept of Mayhem, originally a crime against the king in that it rendered a man less able to fight, but by the 20th century it had become a crime of removing a functioning body part. Because of this almost no US doctor was willing to do conversion surgery. Benjamin seems to regard Mayhem as a residual piece of English law in US law codes, but no US surgeon was ever charged, unlike Argentina where Ricardo San Martin was charged in 1961, and Francisco Sefazio in 1969.

After Benjamin’s book was published, Mauricio Archibald was on his way home in April 1967 from a masquerade party when he also was arrested and convicted under Section 887, Subdivision 7. Unlike Felicity, he appealed, but Per Curium the conviction stood as “the wording of subdivision 7 does not require that the State must establish either a lack of means of support or an intention to commit an illegal act”. However Section 887 was repealed that year, but with the caveat that the “newly enacted sections were not to apply or govern the prosecution for any offense committed prior to the effective date of the act".

10. The Female Transsexual

As we said re the title of Chapter 4, the usage, referring to trans men as ‘female transsexuals’ does grate.

Frequency of female transsexualism.
It is probably very unfair to devote only one chapter in this volume to the female transsexual: unfair because her emotional problem is in every way as serious as that of her male counterpart. However, the frequency of female transsexualism is considerably less than that of the male. While the clinical experiences described in the preceding pages are based on 152 cases of male transsexualism, the female transsexuals here reported number only twenty (by the end of 1964). Even so, sometime in the future she may merit a book devoted to her alone.” p178/84

Such a book never did emerge.

If a female transsexual, after having been changed into a male, should receive the same publicity as Christine Jorgensen, it is possible that a greater number of female patients might apply for treatment. How many of them might do so merely as a passing mood, and would then not be acceptable for treatment, is conjectural.” p179/84

There was a press brou-ha-ha when Michael Dillon was outed in 1958, but he disappeared to India rather than stay around and continue the attention.

Why the second sentence? Why suppose that trans men are more likely to apply for treatment “merely as a passing mood”. This phenomenon was not discussed for trans women.

It is interesting to mention in this connection that in our culture about twelve times more women would have liked to have been born as men than vice-versa. They said so when they were questioned in a Gallup-type poll.” p179/84

This was so in the 1960s and earlier. Benjamin’s explanation is: “The more intimate, maternal relationship, however (with its exposure to the mother's female hormones during the nine months of gestation), may offer a possible explanation.” p180/85 Personally I would suggest the strong social restrictions applied to women before second-wave feminism began to gain ground. Far fewer women in the 21st century say that they would have preferred to have been men. Of course today those, that say that they would rather be a man, are likely to be advised that they can indeed change.


The female transsexual has many symptoms in common with the male and much that was said in the previous chapters could apply equally to her. The female transsexual's conviction that she ‘was meant to be a man’ is as strong as the reverse is in our male patients. She resents her female form, especially the bulging breasts, and frequently binds them with adhesive tape until a plastic surgeon can be found who would reduce the breasts to masculine proportions. Transsexual women fall deeply in love with normal or homosexual girls, often those of a soft, feminine type. Besides wanting to be lovers, they want to be husbands and fathers.” p180/85

Before Louis Sullivan in the 1980s, the trans man who wanted to be a gay male, was pretty much invisible. Ray Blanchard kept on maintaining that such trans men did not exist even despite communications from Sullivan.

Benjamin gives a case study but without his usual empathy:

One of my patients so much desired to be a father that she allowed one particular man to have sex relations with her until he could impregnate her, but this man then had to relinquish all claims on her and on the child. She reared the child, a boy, as a father would and wanted him to consider her his father, although the child, when old enough, was informed of the fact that 'father' was really his mother, but his 'natural parent.' The psychological impact on the child's mind of this confusing situation is worth studying. The persistent demand of this patient to be treated, operated upon, and 'made' a man, and her hostile reactions to the refusals by doctors, have brought her several times into mental institutions with the diagnosis of schizophrenic reaction. For patients of this type, Pauly coined the term 'paranoia transsexualis,' an apt label but naturally only a label. Whether the patient 'reacted' with a psychosis to her transsexual problem with its frustrations, or whether the TS problem should be considered part of her psychosis, is still an unsolved question. This patient, in spite of a short course of androgen treatment, is still in and out of hospitals, and the question whether to allow her (him?) custody of the child is undecided at this writing. Further studies of her case may deserve publication at some later date.” p180-1/85

Benjamin concludes this section with: “Menstruation constitutes a psychological trauma to the female TS. Its suppression under androgen therapy affords enormous emotional relief. Interests, attitudes, and fantasies take a masculine direction. Typically masculine occupations such as those of soldier, policeman, truck driver, would be their ideal, but only too often they have to be practical and settle for office work. Just like some of their male counterparts, they frequently show much ability in their work, can be highly successful in business or profession, profiting perhaps by the combination of male and female traits in their constitutional makeup and in their psychological development.” p181/85

Sex Life.

Sexually, female transsexuals can be ardent lovers, wooing their women as men do, but not as lesbians, whom they often dislike intensely. They long for a penis, yet mostly understand realistically that the plastic operation of creating a useful organ would be a complicated, difficult, highly uncertain, and most expensive procedure.” p181-2/85

However only one of Benjamin’s patients had had phalloplasty at that time. “ the operation performed in several stages, but the final result is still questionable. The first surgical attempt, as his doctor explained to me, was ruined because the patient went horseback riding too soon!” p182/86

I have had extensive correspondence with another intelligent female transsexual whom I never met personally. He described 33 plastic operations, but the male organ, although serviceable, still does not seem fully satisfactory. The technique of creating a penis varies greatly with the various surgeons who have attempted it. The textbook by Gillies and Millard goes into considerable detail. The Russians are said to have more extensive experience with this type of operation than anybody else.“ p182/86

Of the twenty patients, five had been married as women before I ever saw them. These marriages were entered into either in the hope that it might reverse the psychological trend, or under pressure from the family, or to escape family supervision. All these marriages failed, ending in annulment or divorce, or, in one instance, in a reversal of roles with the wife becoming the husband and the former husband becoming the wife. Some were never consummated and were highly unpleasant experiences, probably for both partners. There were four pregnancies in three patients with one abortion, one miscarriage, and one ending in normal birth twice. This person, living as a male (whether married as a male is unknown) now has two children to which ‘he’ is the mother.” p182/86

Much that has been said on etiological speculation for the male transsexual applies equally to the female, especially as far as conditioning is concerned. Definite conditioning could be proved in only two cases, and not at all in eleven. The remaining seven were considered doubtful.” p183/86

Again no theory of etiology is convincing.

Physical Data.

“The physical examination of the female transsexual usually reveals a normal girl except that, as in the male, hypogonadism seems to be more frequent than one would expect. Among my twenty patients, it was more or less distinctly evident in nine. There was no sign of hypogonadism in ten, and in one case it is unknown.”

One case was that of a female pseudo-hermaphrodite who underwent corrective surgery late in life and had been happily married as a man for five years when he was widowed.” p184/87

Social Position.
Artist 2
Entertainer 1
Librarian 1
Engineer 2
Selling 1
Ranching, farming 3
Office work 6
Factory work 2
Restaurant 2


A total hysterectomy, including the removal of the ovaries, is often as ardently desired by the female transsexual as the male desires his conversion operation. It is almost as difficult to obtain because surgeons, quite naturally, are reluctant to remove healthy organs. After a more or less extended period of androgen treatment, a physical state resembling pseudohermaphroditism (enlarged clitoris, body hair, etc.) develops, so that some surgeons at times felt justified in operating, especially if the social status (male) of the patient is already well established. In several instances, the patient was not fortunate enough to find a surgeon in the United States and had to go abroad or to Mexico for the operation. Of the twenty female transsexuals here reported, nine had a hysterectomy performed. In eight it was total and in one the ovaries were retained. The average age of the nine patients at the time of the operation was 35.5. Four patients were in their twenties, two in their thirties, two in their forties and one in the fifties, at the time of operation. The corresponding average age in male patients was 33.2.” p187-8/89

Results of therapy.

Psychotherapy with the purpose of having the patient accept herself as a woman is as useless in female transsexualism as it is in male. Psychotherapy can be helpful only as guidance and to relieve tension, provided there is a permissive attitude on the part of the doctor regarding masculinization. If the patient is of age, not acutely psychotic, and reasonably intelligent, the doctor might best say: ‘as to masculinization and your future life, you have to make your own decision’." p189 /89

With one doubtful exception (to be mentioned later), all patients under my observation (and I know the fates of fifteen of the twenty fairly well) were benefited. They still have problems. There still can be spells of depression (mostly reactive) and more or less distinct neurotic or psychoneurotic traits. They were unhappy, disturbed persons before any treatment and they are not boundlessly happy and free of disturbance afterward. Who is? But they are better off; better able to find a satisfactory niche in life, perhaps in a job or profession as a bachelor or as a married man.” p189/89-90

Some examples:

The aforementioned young lady, a student and musician, who seems to have had a doubtful result from her treatment and operations (hysterectomy with the ovaries retained, and mastectomy), was seen about ten years ago. She had been married and divorced, had several years of psychoanalysis, but still wanted to change. After the operation she tried living as a man, then changed her mind and returned to her female role. She even had the shape of her breasts restored by plastic surgery. But she is not unhappy and has no regrets. Her ‘double sex’ may give her a feeling of satisfaction.  Unfortunately I have had no opportunity to see her in recent years, but I know from correspondence and from her physician that she feels her therapeutic attempts ‘basically have worked’." p190/90

One twenty-six-year-old, disturbed, unhappy girl is now, four years later, a busy, handsome, bearded young man, proud husband of a beautiful wife and father of two legally adopted children.” p190/90

One confused, unhappy girl, after two disastrous marriages, an attempted suicide, years of futile psychoanalysis is now, seven years later, a man in his early forties, of some importance in the art world, married to a highly intelligent woman and living in an environment where very few of the numerous friends of this couple have any idea of the husband's past.” p190/90  [This is Joe in Appendix D]

Bobby, formerly Mary ... When first seen ten years ago at the age of thirty-seven, he was living and working as a man. He had been successful in obtaining a complete hysterectomy as well as a mastectomy and his greatest problem was a legal change of sex status. Red tape offered formidable obstacles. After waiting several years, and with the help of various medical certificates, a new birth certificate was finally issued with strikingly good results on the emotional life and his job prospects. Bobby is now reasonably successful as an architect, gets along with people much better than in years past, and his only regret is that his aged mother never became reconciled to the change, although an older sister had readily done so. Bobby has some flair for writing. He is doing his autobiography now, the first one written by a female transsexual for possible publication as a book.” p191/90”

More cases could be related, almost equally satisfying. There are those for whom an operation is not yet attainable, but androgen treatment is at least a partial substitute. A great and deeply disturbing handicap for some is their inability to secure for themselves the legal change of sex status.” p192/91

Appendix A: Concluding Remarks and Outlook

(December 15, 1965)

Benjamin updates his statistics: “The collection of statistical data in the preceding pages was closed at the end of 1964. Toward the end of 1965, a total Of 307 cases of the transvestite-transsexual phenomenon were observed. Among them were 193 males (S.O.S. IV, V, and VI); 62 of them were operated upon. Besides, there were 27 female transsexuals; 11 of them had either hysterectomies or mastectomies or both performed. The rest of the males were transvestites.” p195/92

He looks to the future: “The etiology of the transsexual state is still largely obscure, but a light seems to blink here and there in publications from the laboratories of brain physiologists.” p195/92 He considers possible future developments in conditioning and imprinting, in genetics, in psychology and in endocrinology.

From the therapeutic end, it cannot be doubted or denied that surgery and hormone treatment can change a miserable and maladjusted person of one sex into a happier and more adequate, although by no means neurosis-free, personality of the opposite sex. The degree of such a change depends upon constitutional factors, as well as upon the environment in which the individual's new life pattern will develop.” p196-7/92

He is most pessimistic about legal changes of identity: “As far as the legal change of sex after a conversion operation is concerned, the respective patient in the United States in 1965 has to be lucky. He has to have been born in a state that proceeds from good will, cuts through red tape, and issues a new birth certificate on application accompanied by medical testimony. If he is not lucky and has been born. in a state like the one mentioned above, he has to have money, swallow his sugar-coated pill of disappointment, entrust his fate to a judge, and hope for the best.” p199/93

Appendix B: Complementarity of Human Sexes by Gobind Behari Lal

The Science Editor Emeritus of the Hearst newspapers combines science and religion, regrets the difference between the sexes, and concludes: “The less we think of the 'opposite sexes,' of the 'war of sexes,' and the more we think of 'human beings – with dual sexes, in varying proportions,' the greater might be the hope of success of a more acceptable civilization than that of today. Not ashamed of their 'female nature,' men of power might become tamed down, so that the nuclear weapons will not go off, as the guns went off in August, 1914, starting the First World War, the epoch of horrors still not past.”

Appendix C: Transsexualism: Mythological, Historical, and Cross-Cultural Aspects by Richard Green

Richard Green repeats the common tales found in Bulliet’s Venus Castina and Gilbert’s
Men in Women’s Guise, plus an early account of gender variance among the North American aboriginals.

Appendix D: Transsexual´s Lives by R. E. L. Masters

R. E. L. Masters was Benjamin’s co-author of Prostitution and Morality, of two years earlier, 1964.

As Masters writes: “As a research worker and author in the field of sexology I have had occasion to come to know a great many sex deviates and other persons whose sexual behavior sets them at odds with society.” One suspects that he had not read the earlier parts of the book.  He also refers to trans women as 'he' even after surgery.

This Appendix consists of four selections from unpublished autobiographies, by Ava, Betty, Clara and Joe, and three clinical profiles, C, H and K presumably written by Masters.

Ava is also Harriet, whom Benjamin had discussed as his example of a Type VI High Intensity. p83-5/38-9

Betty is also K.

Clara is also C.

Joe was discussed by Benjamin p190/90.

H was discussed by Benjamin p106-7/49, was Benjamin's first transsexual patient, and is known as Sally Barry.

Bibliography by Richard Green

This bibliography contains the complete publications of Richard Green up to 1965. It contains many books and articles never mentioned by Benjamin. It does not contain some publications mentioned by Benjamin.

20 June 2016

Joe (1920 - ?) cattle breader, art dealer

Jo was one of four daughters raised in New England. Father, a salesman was frequently away. Jo dressed as a boy except for school, preferred boys toys and activities, and was interested in animals, despite father’s aversion to them.

Jo was sent to a private co-ed school at nine, and a private girls’ school at fourteen, and a girls boarding school at seventeen. The school uniform made it impossible to be taken as a boy, but did provide opportunities for sexual relationships. Jo barely graduated.

Father berated Jo for lack of achievement and so Jo married a male friend to get away from home. Jo permitted intercourse only twice, but became pregnant anyway. However she miscarried in the third month, and they separated. Jo fell in with a fast crowd, and one morning awoke in a man’s bed. Again she was pregnant, they married, and again she miscarried.

Only when she was 26 did Jo meet any lesbians: “however, I never felt that I was in quite the same category”. Jo moved to the US Southwest and started raising pure-bred cattle.

For several years Jo’s companion was Barbara who drank heavily and beat Jo. Jo attempted suicide, and underwent two years of psychiatric treatment, that did nothing at all to deal with her feelings that she should be a man.

Joe had met Helen, a friend of Barbara, and started corresponding with her, but it was some time before they were both free of other involvements. They were very compatible.

In 1956 Joe wrote:
 “In my case, there is the embarrassment of being in public places and not quite knowing what rest-room facilities to make use of.... Yet, on the rare occasions when I wear female attire because of absolute necessity, I feel inwardly that I am masquerading as a woman. I never have this feeling of impersonation when I am dressed as a man. Rather, I feel comfortable and as if living in tune with what has been part and parcel of me all my life and has been so accepted by my family and is now accepted by most of my friends and acquaintances. … I feel I have never dressed as a man just to flaunt my deviation or for any other reason except that to dress and behave as a man is natural for me while to try to live any other way gives me always the feeling of being an impostor.”
Joe met a trans woman, June, who introduced him to Dr Benjamin. He was put on a course of male hormones, his already small breasts were reduced to resemble those of a male, and some years later he had a hysterectomy. He started shaving regularly.

This while living in a small, semi-rural community in Texas. Helen joined him there, and after his birth certificate was re-issued, they married. All members of both families were quite accepting.

Joe and Helen moved to a city, and Joe became an art dealer.
  • Harry Benjamin. The Transsexual Phenomenon. Julian Press, 1966. Warner Books Edition 1977: 190, 272-288. PDF: 90, 128-135.

16 June 2016

A rereading of Benjamin: Part 3: trans women

  • Harry Benjamin. The Transsexual Phenomenon. Julian Press, 1966. Warner Books Edition 1977, with a bibliography and appendix by Richard Green.  PDF (with different pagination).  Page references eg p32/13 mean p32 in the 1977 Warner edition and p13 in the PDF. 
Part I:  intro and the Scale
Betty (?1938 - ?) female impersonator, salesgirl, model. --- 2nd entry, Appendix D, autobiographies
Part II:  transvestites
Clara Miller (1899 - ?) fur merchant, office worker ---  3rd entry, Appendix D, autobiographies
Part III: trans women
Joe (1920 - ?) cattle breader, art dealer ---  4th entry, Appendix D, autobiographies
Part IV: photos, legal, trans men, conclusions

4. The Male Transsexual

The first problem is of course the title. In the 1960s all doctors referred to trans women as ‘male transsexuals’. Ray Blanchard still does. It does grate.

The quotes that one finds from Benjamin that are positive about trans persons are taken from later chapters. What is a surprise is how negative this one chapter is.

From the first four paragraphs:
Readers of the foregoing chapters already should be fairly well acquainted with the (transsexual) man who wants not only to appear as a woman by dressing as one, but who actually wants to be a woman in appearance as well as function and wants medical science to make him such as far as that is possible. In other words, it is the man who suffers from a reversed gender role and false gender orientation. He wants to change sex. As we have seen, these persons, in a strictly scientific sense, fool themselves. No actual change of sex is ever possible. … If a chromosomal study should be made, however, the true (chromosomal) sex would be discovered and this remains true no matter how long the person may have lived as a member of the opposite sex or what operations or hormone treatments may have been applied.” p65-6/30

A trans woman is a “man who suffers from a reversed gender role and false gender orientation ... these persons ... fool themselves. No actual change of sex is ever possible”.

Remember that this is our premier advocate. It is also the same doctor who wrote Chapter 1, wherein he explained that chromosomes alone do not constitute sex. It is also in contradiction with the subtitle on the cover of the Warner paperback: “All the facts about changing of sex through hormones and surgery.” If Benjamin actually thinks that “No actual change of sex is ever possible” Then what is this book?

In the dedication, Benjamin thanked Brooking Tatum for editing the book. Perhaps Tatum should have pointed out these contradictions.

The transsexual in life and love. “There is hardly a person so constantly unhappy (before sex change) as the transsexual. Only for short periods of his (or her) life, such as those rare moments of hope when a conversion operation seems attainable or when, successfully assuming the identity of a woman in name, dress, and social acceptance, is he able to forget his misery. It is not always the frustrated, passionate sexuality, but more so the heart-breaking anguish of the transsexual's gender disharmony that makes him forever a candidate for self-mutilation, suicide, or its attempt. The false relief obtained from alcohol and drugs is not an infrequent complication.” p66/30

There is actually much in this chapter that would be of use to anyone writing a rant against transsexuals. It is noteworthy that Janice Raymond did not actually use this material.

Benjamin then discusses a small number of his patients who resorted to self-mutilation, and then a patient, Juana, who committed suicide at age 30 in 1963.

Psychological state and sex life in transsexuals. Benjamin discusses the rationalizations of transsexuals who still have sex with their wives. He then discusses those who have a boyfriend/husband. “The ‘husband’ in such a union offers an interesting psychological study. Are there actual or latent homosexual inclinations in him so that he can be attracted to a transsexual man? Naturally, the attraction is to the ‘woman’ in this man, but could completely normal, heterosexual men be able to forget the presence of male sex organs, or, if an operation has been performed, even their former existence?” p70/32 More recent studies have established quite well that the husbands (no quotes) of trans women are in fact mainly heterosexual. They may appreciate some extra aspect of their wife, but they are not interested in men. However this was not understood in 1966.

He then discusses those transsexuals, before and after the ‘conversion operation’ who make a living as a prostitute – the topic of his 1964 book – although only briefly, and with no mention of those like Patricia Morgan who did so successfully.

And then, this paragraph, which many would read as a gratuitous calumny against his clientele:

It has happened in a few cases that all of a sudden, money became available to go abroad (and come back a broad, as somebody quipped) without any evident source. Being aware of the overwhelming, desperate urge of the transsexual to be made ‘female,’ doubts have sometimes crept into my mind whether funds were not acquired illegally, other than by prostitution. A parallel to the crimes committed by equally desperate drug addicts readily comes to one's mind.” p71/32

If one is to make comments like this about a group of people, it is a reasonable rejoinder that one should either put up or shut up. How about some examples where this has actually happened. A short paragraph like this without details is gossip at best and should not be in a serious book. This is not to deny that a small percentage of trans women are criminals – about the same percentage as the general population.

And then a quote from Dr Ira Pauly: “"Because of his isolation, the transsexual has not developed interpersonal skills, and frequently presents the picture of a schizoid or inadequate personality.” p71-2/33

Bemjamin then finishes the section by reassuring us: “Improvement of the mental condition occurred under estrogen treatment as well as after the corrective surgery, but by no means in all cases. Much is yet to be observed and studied along these lines. As a general rule, however, transsexuals are nonpsychotic.” p72/33 Just as well that he says that, for I was beginning to worry about transsexuals.

The physical state of male transsexuals. “The physical examination of transsexual patients usually reveals nothing remarkable. …. Among my patients I discovered no so-called Klinefelter syndrome ..., although such combination of transsexualism and Klinefelter syndrome has been observed and reported in the medical literature. Otherwise the transsexual male and female are genetically normal.” p72/33

This is still so. Every now and then a biological marker of transsexualism is claimed – H-Y antigen, BSTc size, etc – but in the longer run, replication tests fail, and the claim is dropped.

Benjmain’s hope of a future (post 1966) development was with hypogonadism: “Such more or less distinct underdevelopment, known as hypogonadism, but rarely to the point of eunuchoidism, was found in 61 cases out of a total of 152 male transsexuals, approximately 40 per cent. These findings may eventually prove to have significance as far as the underlying causes of transsexualism are concerned.” p73/33

The transsexual’s plight. This section is mainly about the lack of access to transgender surgery in the US. I took this to refer to the period between 1962 when Elmer Belt ceased operating, and 1966 when operations started at John Hopkins Hospital in Baltimore. In this period, and also before, most US transsexuals who did obtain surgery had to go to Europe or Africa to get it. In particular, many went to Dr Burou in Casablanca.

The greatest plight of any true male transsexual is the problem of where to turn to have the conversion operation performed. Even if they find a surgeon who is willing and competent to do the operation (and there are undoubtedly many urological surgeons in this category in the United States), the problem is by no means solved. A hospital is needed for this operation and hospitals have their boards. These boards are partly composed of laymen; among them may be priests, ministers, and rabbis. Without the board's permission, the operation could not be performed in that particular hospital.” p74/34

Six pages are then devoted to a reprint from Sex & Censorship Magazine, 1, 2, apparently 1958, but Benjamin does not say. So this is actually referring to the late 1950s. The article, “The Unfree’ is by William J O’Connell, apparently the previous male name of a trans woman: “The happiness I chose to pursue - had to pursue, more precisely - was simply and shockingly, an operation to change my ostensible sex; for I am a person, physically male, whose mind and heart are feminine. … My decision was made in the clear perception that my life was quite intolerable in its falseness. After some hard, realistic thinking, I went to a sexologist, a man wise in the ways of glands and their secretions. He received me with kindness and understanding, and sent me to a psychiatrist who confirmed his judgment that I was of sound mind and quite competent to decide where my happiness lay. Then he carefully began the process of feminization by the administration of estrogen and other female hormones.” A surgeon was found in the US. “The surgeon, skilled and courteous, was not to be rushed; it was necessary that he be certain in his own conscience that what he was doing was best for me. I could not doubt that this great gentleman, like the sexologist, truly intended, in the words of Hippocrates, to govern his treatment by the needs of the sufferer. To make assurance doubly sure, he sent me to another psychiatrist who, in turn, convened a panel of his brethren. After many hours of discussion and questioning and study, these three psychiatrists unanimously recommended the operation, adding that they were powerless to alter my feminine psyche and that the surgeon would be doing me a great service by operating. Even then the surgeon was not wholly convinced and there were further discussions with him before he at length consented.” O’Connell was admitted to the hospital, but days go by. “Finally a member of the all-important Tissue Committee appeared: the Committee, because of protest from the ‘religious elements’ of the hospital, were to review my case. But my visitor, although he was perhaps to present my side of the matter to his colleagues, seemed much more interested in talking than in listening; I think his mind was made up, and I think that neither justice nor ‘the needs of the sufferer’ found any room there. The Tissue Committee refused to permit the operation. They did not ask me to present my case; indeed, it was quite obvious (as I was told by one of the doctors) that they did not consider me at all but only considered placating the ‘religious elements’." p74-80/34-6

However: “For all that, they did not hesitate to charge me two hundred of the dollars I had so laboriously saved for the operation - two hundred dollars for discomfort and profound disrespect. No other hospital, now, would accept me after this one had turned me out; in any case, my short vacation was gone for another year.”  According to this Inflation Calculator, $200 in 1964 would be $1,540 in 2016.

Benjamin adds a note that “this patient, after another year or so, did find a skillful surgeon abroad. The operation was successful as I was able to convince myself. This is a more contented person now.” p81/37  However he never gives us a female name by which to refer to her.

Three different types of transsexuals.

Type IV Nonsurgical. Benjamin’s associate Virginia Prince would declare herself in 1968 to be living full-time as female, in effect a non-surgical transsexual, but apparently never accepted this label. However this was after Benjamin’s book came out and thus is not mentioned. The androphilic non-surgical trans women whom I mentioned in Part I of this rereading such as Holly Woodlawn were not yet famous in 1966. However Benjamin’s associate Louise Lawrence who educated Benjamin about much of the trans scene is an obvious person to mention here. That is what I assumed Type IV Nonsurgical to be.

However Benjamin’s actual description is: “’Dresses’ as often as possible with insufficient relief of his gender discomfort. May live as a man or a woman; sometimes alternating.” Let us look again at Benjamin’s description of Type III True Transvestite: “’Dresses’ constantly or as often as possible. May live and be accepted as woman. May ‘dress’ underneath male clothes, if no other chance.” This difference is subtle rather than definite. Surely Type IIIs are sometimes taken to be Type IVs, and vice versa. And the difference of Type IV from Type V and Type VI is not simply surgical, despite the name.

The only example that Benjamin gives is
 “Peter A. (who, however, much prefers to be called Irene). He is a rather well-known musician from Oregon, married for twenty-five years, with a grown-up daughter who knows nothing of her father's hobby. The wife knows and makes the best of it, but does not want to see him ‘dressed,’ except perhaps on occasion of a masquerade ball.” p81/37 Benjamin estimates Irene to be a Kinsey 2 or 3. She has not gone full-time nor committed to surgery “But as things are, he would harm too many people, could not continue in his profession, or preserve his present standard of living.” Apparently, Irene never did transition, or we would be celebrating her as one of the very first trans musicians, earlier than Wendy Carlos or Canary Conn.

Given that Peter/Irene matches Benjamin’s Type IV, where do the full time non-op trans women go?  Benjamin later (see below p115/53) does tell us that he knows a dozen who are living, illegally,as women, although unable to obtain the operation.

Like gay and female transvestites and gynephilic Type VI s they have been erased from Benjamin’s schema.

Type V Moderate Intensity. Ricky V, late fifties, had lived and worked as a woman in a business office for seven years. Ricky had previous married and had two children, by then grown up. Ricky was anxious to have TS surgery but was unable to afford it. Benjamin estimates her to have been a Kinsey 3, but she currently had no sex life. [Remember that Benjamin’s scale decrees that Type V are Kinsey 4-6.]

Type VI High Intensity. Harriet [called Ava in the biographical appendix to the book] was 28 in 1964. Raised in foster homes, he married at 19. “With the help of fantasies, he succeeded in fathering three children”. He twice attempted suicide. Benjamin put Harriet on estrogen, and she stayed in her male job until she had enough money for the operation. Attempts to have the operation in the US failed, and in 1965 she had the operation in Europe. Later she found an older man and became his wife. Benjamin regards Harriet as a Kinsey 4, when a father, and later a 6. [Remember that Benjamin’s scale decrees that Type VI are Kinsey 6 – and some would say that a true Kinsey 6 would never actually be able to father children, no matter what fantasies he invoked.] p83-5/38-9

In the biographical appendix is the story of Betty, a Kinsey 6 from childhood, a female impersonator who was in the US Navy, and had corrective surgery at age 24. I don’t know why she is not mentioned here.

Further handicaps of transsexuals. Benjamin discusses unsympathetic doctors. “But, alas, the failure of psychotherapy to achieve any change in the patient's attitude is fully acknowledged by those who have had any pertinent experience. With a rather unprofessional antagonism, some physicians are known to have hurt these patients psychologically.” And then: “Cross-dressing is a help, but not always and not enough. The law forbids them to ‘dress’ and hold a job as a woman. Yet this would be the most effective form of therapy (together with estrogen) until an operation can be had, provided the demand for it persists.” p86/39   The antagonism to his patients expressed at the beginning of the chapter seems to have been forgotten.

Benjamin tells how he started providing his patients with a letter that could be produced if the patient were arrested – as Hirschfeld had arranged in Berlin in the 1920s. It was rarely required. However one policeman tore it up and threw it in the patient’s face. In other cases it had the hoped-for result. However in one case the patient was convicted for ‘impersonating’ by a District Attorney who then complained to the County Medical Society, who passed it to the Division of Professional Conduct, and Benjamin was politely but firmly asked not to write any such certificates again. p87-8/40 Benjamin does not say what year this happened, but it was probably shorty afterwards that the Johns Hopkins Gender Clinic started issuing identity cards with the Johns Hopkins phone number.

Then Benjamin returns, as at the beginning of the chapter, to negative aspects of transsexuals: “Another handicap for many transsexuals is their character and their behavior. From a so-called ‘character neurosis’ to outspoken hostile, paranoic demands for help from the doctor, all kinds of objectionable traits may exist. Unreliability, deceitfulness, ingratitude, together with an annoying but understandable impatience, have probably ruined their chances for help in more than a few instances. Many transsexuals are utterly self-centered, concerned with their own problems only and unable to consider those of anyone else. A surgeon wrote once to me: ‘Our experience is growing in regard to the fact that most of them (transsexual patients) are willing to do anything on earth before operation, but nothing at all afterwards’." p89/40

But balances this with: “On the other hand, there are also those patients who are touchingly appreciative, grateful, and eager to cooperate. They compensate the doctor for many of his disappointments. Alas, they seem to be in the minority.” p89/40

He gives the tragic case history of Joan. “She was twenty-six when I met her and that was just after she had her conversion operation as well as plastic breast surgery. She was then a strikingly attractive redhead, vivacious, possibly somewhat reckless, making her living as a call girl and cocktail waitress. I lost sight of her for several years. When I saw her again, I was hardly able to recognize her. Her attractiveness was all but gone. She had lost much weight, had aged considerably, and looked sick. She had become a ‘goof ball’ addict and was still in the 'racket.’ One day, she was found dead in her furnished room. There was a vague rumor of suicide but no evidence. The medical examiner's office listed her death as ‘narcotic.’ In all probability, she died from an overdose accidentally administered when she experimented for the first time with an injection.” p90/41

The great majority of transsexuals, let it not be forgotten, are merely utterly unhappy individuals. Some of them have become misfits through their gender disorientation that neither society, nor the law, nor the medical profession at present understands and acknowledges as an undeserved misfortune.” p90/41

5. The Etiology of Transsexualism

Benjamin considers various explanations: genetic, endocrine, imprinting and childhood conditioning, but finds none of them convincing. He concludes:

"Our genetic and endocrine equipment constitutes either an unresponsive, sterile, or a more or less responsive, that is to say, fertile soil on which the wrong conditioning and a psychic trauma can grow and develop into such a basic conflict that subsequently a deviation like transsexualism can result." p108/50

6. Nonsurgical Management of Transsexualism

The chapter opens with “The management of transsexualism is, in the majority of cases, radically different from that of transvestism. Although this volume does not deal with transvestism specifically, a few remarks as to the therapy of this less serious deviation, in comparison with TSism, may be in order.” p110/51

How can he say that after spending two full chapters on transvestism? Possibly this was written before it was decided to include the transvestism chapters. It would seem that Brooking Tatum in his role as editor has failed again.

Therapy in transvestism. “The true transvestite as a rule does not want any treatment. … There are instances, however, when transvestism may be a great handicap for the patient and he would then be ready to undergo treatment with the hope of being cured of his strange and embarrassing compulsion.“ p110/51 On the next page Benjamin describes [remember that this is 1966] a “new and rather outlandish form of therapy”, that is behavior or aversion therapy whereby a subject is given emetics or electric shocks.

(Anticipation of 21st century trans politics)
The next section. which is easily missed as it is the conclusion to Therapy in Transvestism is quite interesting in that it anticipates how trans politics will evolve in the next half-century. While Benjamin’s scale presents TV-TS as a continuum, this section contains the roots of opinions expressed by Kay Brown or Charlotte Goiar, that there is difference between the ‘addicted’ transvestite who needs bigger fixes, and a true transsexual who is indifferent to the clothes.

The transvestitic urge (fetishistic or transsexual) contains an element of addiction. Larger "doses" may be required for certain individuals as time goes on. Therein may lie a ‘progressive’ nature of TVism in some instances. If untreated and uncontrolled, ‘dressing’ may be desired more and more frequently and even the idea of physical changes through hormone treatment or through an operation may be gaining ground, particularly in unfavorable - that is to say, constantly stimulating - surroundings. Here psychotherapy and proper guidance at the right time may help, provided a transsexual tendency is not too deep-seated. Such seemingly progressive aggravation of transvestism was rarely noticed under treatment, although it did apparently occur in a few cases. However, later on, these patients proved to be initially unrecognized transsexuals. The opposite was more frequently observed: under estrogen medication, the desire to ‘dress’ became often less demanding and less sexual and the inability to indulge grew somewhat less frustrating. The explanation probably is that the libido was reduced in its intensity through estrogen and since the transvestitic urge is part of the libido, it was likewise lowered. But I am anticipating a later discussion. The foregoing ... (if repetition may be permitted) apply chiefly to that form of transvestism that is its own purpose, which is to say that it is not the chief symptom of transsexualism. As soon as physical changes are desired, it ceases to be true transvestism, and inclines toward transsexualism (Type IV). The full and complete transsexual (S.O.S. V and VI) finds only temporary and partial relief through ‘dressing.’ I have even met transsexuals who would not ‘dress’ at all.” What good is it?" they said; "it does not make me a woman. I am not interested in her clothes; I am only interested in being a woman." That is the true transsexual sentiment.” p113-4/52-3

Psychological guidance in transsexualism. This section is Benjamin’s classic call for tolerance.

Two years running I posted this quote on IDAHOT. RadicalBitch/Cathryn Platine criticized me for doing so.

Too many individuals are that way; what they do not like must be forbidden and punished. Then they are satisfied. I have even met transvestites who dislike (or pretend to dislike) transsexualism so much that they are against estrogen treatment and operation (for reasons of self protection?). There are also transsexuals who dislike transvestites as well as homosexuals. Intolerance can be found in strange quarters.” p114-5/53.

Benjamin quotes journalist Walter Alvarez (who did put trans persons in contact with Benjamin, and wrote the introduction to Benjamin & Masters Prostitution and Morality, 1964) in the New York Herald-Tribune, July 1, 1957 as writing in sympathy, although times have so changed that many now would see his words as both patronizing and casually racist: “We must all learn to have sympathy for these persons who were so badly gypped by Nature. But for the grace of God, we too might be caught in the same cruel trap. “ p115/53

Benjamin continues: “Living completely as a woman (though illegally) can actually be a life-saving measure for those transsexuals who find an operation unattainable. I know at least a dozen who are in this situation right now. They work as women in offices, factories, beauty salons, as nurses, domestics, and some, alas, as prostitutes, all quite unknown to their employers, associates, or clients. They would best have psychological as well as medical help in addition to living in their female gender identity; but very few actually have such help. Merely the opportunity to talk to somebody about their problems has its therapeutic value. To find some understanding from a doctor instead of coldness, rejection, or ridicule goes a long way toward easing their burden.” p115/53

See my comments above on who is or is not a Type IV Nonsurgical Transsexual.

Psychotherapy in transsexualism.

Psychotherapy with the aim of curing transsexualism, so that the patient will accept himself as a man, it must be repeated here, is a useless undertaking with present available methods. The mind of the transsexual cannot be changed in its false gender orientation. All attempts to this effect have failed. … Since it is evident, therefore, that the mind of the transsexual cannot be adjusted to the body, it is logical and justifiable to attempt the opposite, to adjust the body to the mind. If such a thought is rejected, we would be faced with a therapeutic nihilism to which I could never subscribe in view of the experiences I have had with patients who have undoubtedly been salvaged or at least distinctly helped by their conversion. This help has been given by two therapeutic measures aside from psychological guidance and living as a woman: first, estrogen medication and second, surgery. Most of the time, both.” p116/53

There are still psychotherapists who do not accept this. However 50 years later they have still not divised a better psychotherapy that actually does 'cure’ trans persons. The quote that I have just given still stands as the classic rational for transition.

Estrogen therapy. Benjamin discusses in detail the how and why of estrogen therapy. I assume that most readers of this encyclopedia are well acquainted with this topic, and there is no need for a summary.

7. Conversion Operation

Benjamin discusses in detail the conversion operation. I assume that most readers of this encyclopedia are well acquainted with this topic, and there is no need for a summary.

Bemjamin includes the text of an article he wrote for Sexology Magazine, December 1963, wherein he advises: “Furthermore, the operation, even if successful, does not change you into a woman. Your inborn (genetic) sex will remain male. You must be aware of this fact, although it may have no practical meaning for your later life as a woman. If the surgeon castrates you as part of the operation, you would be, technically and from the glandular point of view, neither male nor female. You would be a ‘neuter.’ Only your psychological sex is female. (Otherwise you would not have wanted the operation in the first place.) If the surgeon merely places your testicles in the abdomen to make them invisible, you would have to be considered a male, from a glandular viewpoint as well as legally. Yet, it is true, you could look like a woman in the genital region and function as one after the operation. Even a climax (orgasm) during sex relations has been reported by most such patients. But remember, a time may come when sex is no longer important. Would you still want to be a woman then?” p134/ 62 Again he defies the subtitle of the book!

He lists four motives for the conversion operation (p140-2/65-6):
  1. Sexual. “It concerns particularly the younger transsexuals. Their sex drive is not that of a homosexual man but that of a woman who is strongly attracted to normal heterosexual men.”
  2. Gender. “Especially for the older transsexuals, the urgent need to relieve their gender unhappiness can be powerful and impressive”.
  3. Legal. “The constant fear of discovery, arrest, and prosecution when "dressing" or living as women is a nightmare for many. They want to be women legitimately and have a legal change of their sex status.”
  4. Social. “applies only if the transsexual patient happens to have a conspicuous feminine physique, appearance, and manners” [while still presenting as male]

8.   51 Male Transsexuals and the Results of Their Operations

Benjamin summarizes:

"By the end of 1964, a total of 249 male transvestites were observed in my offices, either in New York or in San Francisco. Of these, 152 were diagnosed as transsexuals. This figure, however, may actually be higher as some transvestites do not reveal their true intentions during the first few interviews. In some others, an apparent transvestism may gradually seem to progress into transsexualism with or (more likely) without any treatment and patients originally diagnosed as transvestites (of the II or III type in the S.O.S.) are actually transsexuals (V or VI on the S.O.S.). A few of them are among the 51 cases operated upon.

These patients were, in the earlier years, mostly operated upon in Denmark, Holland, or Sweden, and a few in Mexico. Then, Dr. Elmer Belt in California performed a series of such operations. In approximately half of them I could observe the results. Dr. Belt discontinued this type of surgery a few years ago, largely for personal reasons. During the last three or four years, most conversion operations among patients I know were done in Casablanca, Morocco, by a French surgeon, Dr. Georges Burou. Reports have reached me of operations being done occasionally, rather secretly, in the United States, rather freely in Japan, occasionally in Mexico,and a few in Italy. “ p146/68

The technique employed by the different surgeons undoubtedly varied from time to time and according to the patient, particularly concerning the formation of the vagina. In the majority of the 51 cases of operation in this country, the vaginal canal was lined with skin taken from the thigh, while in all those operated upon in Casablanca the inverted skin of the penis was utilized. In two patients that I know of, a short piece of gut (ileal loop) was removed and used to form the vagina. This technique naturally constitutes a more extensive operation as it involves the opening of the abdominal cavity. In four of my 51 patients, the technique is unknown.” p147/68

So up to this time, it was mainly those operated on in Casablanca by Dr Burou who had the penile inversion method.   Dr Edgerton at Johns Hopkins then adopted and adapted this method.  When he was contacted by Dr Stanly Biber in 1968, this was the method that was recommended.

The fees reported to me by patients ranged in the majority from $2,000 to $4,000, usually including a three- to four-week stay in the hospital. It was disheartening to some patients to be prepared to pay the reported fee of $2,000 or even $3,000 to a particular surgeon, only to find out when they tried to make a definite appointment that the price had gone up $5oo to $1,ooo in only a few months' time. The surgeon, however, is said to have operated anyhow, allowing the patient credit for the balance of the fee.” p148/69 According to this Inflation Calculator, $2000 in 1964 would be $15,400 in 2016.

Here is the age distribution:
23 in their 20's
14 in their 30's
11 in their 40's
3 in their 50's

and occupations:
Office work 10
Salesperson 3
Musician 1
Store proprietor 3
Hairdresser 6
Housewife 5
Stockbroker 1
Show business (acting) 10
Domestic 1
Office manager 1
Prostitute 3
Teaching 2
Practical nurse or companion 2
Photography 1
Retired 1
Unknown 1

So show business/acting and office work are the most common. Show business would include female impersonation. The later trans stereotype of computer work was of course very rare in 1964. But where are the military? Study after study has shown that trans women are over-represented there, usually as an attempt to deny their destiny. The reprint of Benjamin’s 1953 paper "Transsexualism and transvestism as psychosomatic and somatopsychic syndromes" had been in particular demand by army doctors.

Post-operative follow-ups, at an average of 5-6 years, rated the conversion as follows:
Good 17
Satisfactory 27
Doubtful 5
Unsatisfactory 1
Unknown 1

Considered unsatisfactory was the case of a "woman" now sixty-four years old, of Latin extraction, operated upon in Europe in 1955 without my consent. She was the only one who expressed regret over the decision to be sex changed. The operation, incidentally, did not include the formation of a vagina. This patient, in his former male role, was reasonably prosperous, having always held a well-paying position in the business world. As a woman, he was never able to make a satisfactory living and was always in financial difficulties, although fully acceptable as a women in appearance and manner. She had insisted on conducting her own mail-order business in which she had no experience. Her command of the Spanish language was hoped to be a great asset. Alas, it did not prove to be so. Her general health had also failed, perhaps owing to psychosomatic influences (lack of a sex life?) and a return to the male status is now being considered and most likely advisable. In this case, the sex motive had probably played an equal part with the gender and legal motives when the operation was decided upon at the age of fifty-six. Emotional frustration, however, compounded by economic failure and the aging process, probably led to the present unsatisfactory state which, as may be hoped, can be improved under a new life pattern. Here, the outcome of his venture into the female world was considered unsatisfactory by the patient himself. Such self assessment, I feel, is necessary to justify an unfavorable diagnosis. I found no other similar example among the 51 patients.“ p151-2/71

Three of the 51 had already died by 1964.
  • One was successfully married as a woman for six years, a house wife and clubwoman, a charming, intelligent lady who succumbed to a fatal heart attack at the age of 50.” p152/71
  • Joan, mentioned above, who died a narcotic death.
  • The third died in her 51st year. Her "sex change" dated back to 1954 when she was operated upon in Holland but without the formation of a vagina. This was first attempted later in the same year in the United States, but unsuccessfully. The vagina was reconstructed in the United States in 1958 but a vaginorectal fistula developed. It was repaired successfully the following year. In the meantime, the patient had lived in reasonable comfort as a woman, held a clerical position with a large business concern for ten years, and was fully accepted as a woman. She enjoyed several "sex affairs" after the final operation on her vagina. The patient died late in 1964 of a complication of illnesses requiring repeated operations. Several large liver cysts were removed. (There was a history of hepatitis in the late forties.) Part of a benign pancreatic tumor was excised. Later a "dormant" carcinoma of the pancreas was discovered. She was also operated upon for stomach ulcers, developed diabetes and hypertension, but the immediate cause of death was a pulmonary embolism.” p151-2/71
An example of success.

Jonathan, usually called Johnny, was twenty-four years old when I saw him first. He was a miserable, unhappy young man of rather short stature, slightly overweight and moderately underdeveloped sexually, a transsexual of the VI type in the S.O.S. He worked in a restaurant as a checker. One of the headwaiters was homosexual and gave our patient a bad time with his unwanted propositions. While Johnny was attracted to men, he disliked homosexuals. ‘They want another man,’ he said, ‘but I feel I am a girl.’ Finally Johnny had saved enough money, his family was understanding, and a psychiatrist to whom I had sent him definitely recommended surgery. One year later, he went to Europe (in 1955) and, in those earlier years, had only a castration and penectomy done. An American surgeon, two years later, fashioned a well-functioning vagina. Then Johnny (now Joanna), met a man a few years older than he (now she) when she was working as a receptionist in a dentist's office. He was and still is a reasonably successful salesman. He fell in love with Joanna and married her. He knows only that Joanna as a child had to undergo an operation which prevented her from ever menstruating or having children. They have had a distinctly happy marriage now for seven years. Joanna no longer works but keeps house and they lead the lives of normal, middleclass people. To compare the Johnny I knew with Joanna of today is like comparing a dreary day of rain and mist with a beautiful spring morning or a funeral march with a victory song. The old life in the original (male) sex is all but forgotten and is actually unpleasant to be recalled.” p153/72

The male transsexual's life after conversion.

The sex life is less essential or altogether immaterial if the gender motive was the driving force for the operation. Of these 51 patients, twelve married as women. Also, twelve were married previously as men. Five have experienced married life from both sex angles (as a male, unsuccessful, some not even consummated); five were divorced [3] as females and three remarried one or more times. Of the 39 unmarried, twenty-three reported sex relations. Of these, nine are part or full-time prostitutes, at least at this time of writing. The unfortunate fact that a number of patients went into prostitutional activities right after their operations has turned some doctors against its acceptance as a legitimate therapy.” p159/74

The medical literature on the conversion operation.

This section includes two pages by Leo Wollman which we have already quoted. And also quotes from Ira Pauly and Per Anchersen, that support what Benjamin has been saying in this chapter. Anchersen was a Norwegian doctor well known for his work with transsexuals in the 1960s, but now almost completely forgotten. He has no entry in Wikipedia at all, not even in NO.Wikipedia.

Conclusions: “My observations have forced upon me the conclusion that most patients operated upon, no matter how disturbed they still may be, are better off afterward than they were before: some subjectively, some objectively, some both ways. I have become convi nced from what I have seen that a miserable, unhappy male transsexual can, with the help of surgery and endocrinology, attain a happier future as a woman. In this way, the individual as well as society can be served. The rejection of the operation and/or treatment as a matter of principle is therefore not justified.” p164-5/77

13 June 2016

Clara Miller (1899 - ?) fur merchant, office worker

Ralph was born in London, the 11th of 13 children to Jewish parents, The father was a fur merchant of varying success, and also a Yiddish language novelist and playwright, although without any success.

At age five, Ralph contracted diphtheria, and for nine weeks was on the verge of death. From then on an older sister encouraged him to wear girls’ clothes and took him for walks so dressed. Even dressed as a boy he was regarded as effeminate, and would be beaten up by the boys at school.

The father refused a bar mitzvah for Ralph because of his effeminacy. At 15 he was taken from school and went to work for a friend of the father. One night, working late, he was raped by two co-workers, a boy and a girl. He told his father, who called the police and both assailants were sentenced to five years in prison. The girl died there.

Ralph, as Clara, went out at night, and found a sweetheart who kissed and held hands. However Clara finally had to tell the truth and the relationship ended. At 16 Clara asked the family doctor that her male organs be removed. The doctor called in the parents, and the father gave Ralph a good beating.

At 17 he was sent to New York to help a brother run the business. The brother let Ralph be Clara and even took her to parties. In 1918 Ralph enlisted in the US Army to make a man of himself. However he could not take it and deserted.

In 1921 he returned to London, as his father was dying. With his mother he took over the business, but the stress made him ill-tempered and he flew into rages. Despite this the business prospered. Clara met another who also aspired to become a woman. In 1923 Ralph met May, a young woman, 17. Under pressure from his mother, Ralph and May became engaged and then married. He could perform sexually, only underneath and when wearing something feminine. They managed to have a son and a daughter in the first three years, and then discontinued sexual activity.

They returned to New York, where Ralph became an office worker. He wore female clothing at home, and sometimes went out so dressed, against May’s objections, and later the children’s strong objections.

Ralph served in the US Army in the Second World War in North Africa, and admitted his earlier desertion. Early in 1945 he found work at the Veterans Administration as a clerk. He was also elected president of his local Veterans of Foreign Wars branch.

At the end of 1944, his daughter Barby and her husband set up a small business, and moved in with Ralph and May to save expenses. Barby nagged him constantly that he was not to be seen in female clothing. This got worse after the birth of a grandchild.

In spring 1947, after a late-night scene with Barby, Ralph dressed quickly and went out. He encountered a rookie policemen keen to make an arrest, and was charged with male prostitution. He was lucky to get a considerate judge, who required only a psychiatric report, after which he was released.

The fights with Barby got worse, and Ralph made a suicide attempt. Shortly afterwards, Barby, her husband and child moved to California. Ralph was able to be Clara more often.

She she became a patient of Harry Benjamin, and had surgery in 1957. Three years later she started living with a man, fifteen years younger, who was separated but could not obtain a divorce because he was Catholic.

Clara reports that they have excellent sex, and that the man has no idea about her earlier life. For a while she had associated with two other trans women, but broke away in case they gave away her secret. She reported being happier and better adjusted than before, and has no regrets about transition.
  • Harry Benjamin. The Transsexual Phenomenon. Julian Press, 1966. Warner Books Edition 1977: 256-272, 289-298. PDF: 118-128, 136-8.

In "The Transsexual Operation" by Tom Buckley, Esquire. April 1967,  we find:

Is this Clara?  Apparently this uncredited photograph is by Diane Arbus,