- 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
Comments
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):
-
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.”
-
Gender. “Especially for the older transsexuals, the urgent need to relieve
their gender unhappiness can be powerful and impressive”.
-
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.”
-
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
p148/69
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
p148-9/69
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
