(All quotations from Anderson 2015, unless otherwise specified).
Ira’s father was a successful bookmaker who raised his three sons and a
daughter in Beverly Hills, Los Angeles. Ira was the youngest, and the first in
the family to go to university. He graduated from the University of California,
Los Angeles in 1953. He was a noted rugby and US football player. In the latter,
he was on the UCLA winning team of 1953, and Pauly was the B’nai B’rith
Angeles Jewish Collegiate Athlete of the Year.
“I applied to medical school. And even though my, I had a pretty good GPA,
probably 3.4, 3.5. But the guys that were getting in had 3.8 and 4.0s. But you
know, because by then I had become known as a football player, I was the first
one to get accepted at UCLA, I was told. So that didn’t hurt. They were looking
for people who were so-called well-rounded.“ (p2)
He graduated from the UCLA
in 1958. After doing a surgical internship at UCLA, he was
accepted for a psychiatric residency at Cornell Medical
in New York. He married in 1960, and he and his wife had four sons.
In 1961 he was doing a rotation in the consultation service when he was
called to urology to counsel a trans man who was in for a hysterectomy. He
attempted research in the hospital library but found material on transsexualism
only in French and German. He had patients who were willing to do longhand
translations for him.
He then discovered a paper by Cauldwell
“And then there was a brief article by someone named Harry
Benjamin. And in those days, it was in a somewhat obscure journal. I don’t
quite remember which journal it was. But it had his address. And it was an
address that was about five blocks away from the hospital that I was working at.
So I looked up his name in the phone book and told him that I was a psychiatry
resident, and I had a little experience with a transgender, transsexual patient.
And was there any way I could come over and talk to him, because I had read—he
was an endocrinologist. And a lot of these folks, the first step in the physical
transition is taking the contrary hormone.” (p6)
For much of that year, he attended Benjamin's Wednesday afternoon clinic.
“So every Wednesday afternoon, through the generosity and mentorship of
Harry Benjamin, I was able to see probably more transsexual patients than any
psychiatrist in North America. … As I got to know the patients, they uniformly
described being happier into the gender role that they felt they were in from
the very beginning. And that the only thing that needed to be done as far as
treatment was concerned was to get the body on board with the gender of their
Pauly set out to aggregate 100 cases from the literature and from among
He had been in the Reserve
Officers’ Training Corps
(ROTC) at UCLA and would normally have done military service at the end of his education, but he had developed glaucoma, and the army
no longer wanted him. In 1962 he obtained a position at the University
of Oregon Medical School.
He completed "Male Psychosexual Inversion: Transsexualism. A Review of 100
Cases" in 1963, but it was not published until 1965. He concluded that that
gender surgery had positive results and that trans patients should be supported
by medical professionals in their quest to live as the gender of their identity.
He then received a thousand requests from doctors around the world for offprints
of his article. It also resulted in a job interview at Johns
s, but Oregon doubled his salary to keep him.
++His presentation at the American Psychiatric Association in 1964 led to a sensationalized article in the National Insider that while quoting him that the desire to change is found in childhood, it then blames alcoholic fathers who punished their children, and that "It apparently gave them a reason to escape from responsibility and from being a man".
However, Harry Benjamin, in his 1966 The Transsexual Phenomenon
quotes Pauly as saying:
“Because of his isolation, the transsexual has not developed interpersonal
skills, and frequently presents the picture of a schizoid or inadequate
Speaking to the American Psychiatric Association in May 1964, Pauly said:
“The transsexual attempts to deny and reverse his biological sex and pass
into and maintain the opposite gender role identification. Claims of organic or
genetic etiology have not been substantiated. … Although psychosis is not
frequent in the schizophrenic sense, in its most extreme form, transsexualism
can be interpreted as an unusual paranoid state, characterized by a
well-circumscribed delusional system in which the individual attempts to deny
the physical reality of his body. The term Paranoia Transsexualis has been
suggested as an appropriate descriptive term for this syndrome. Psychosexual
inversion is seen as a spectrum of disorders, from mild effeminacy to
homosexuality, transvestism, and finally transsexualism, each representing a
more extreme form, and often including the previous manifestation.” (quoted in
He proposed the term ‘pseudotranssexual’ for those who sought transition to
He was one of the first doctors to point out that transsexuals tell the
doctor what he wants to hear. He called them “unreliable historians”. (Benjamin,
Pauly also saw private patients.
“But these folks were, among other things, very grateful because they had
great difficulty getting a physician to empathize with their situation, let
alone treat them. And prescribe hormones and refer them to the surgeon for
surgery. So the word got around. So I probably treated everybody in the Portland
area on a one-to-one basis.” (p12)
Oregon had no surgeon performing transgender surgery, so at first patients
were referred to San Francisco, and then to Dr Biber
in Trinidad, Colorado. Pauly did his own endocrinology prescriptions. In that
period he also attempted to treat gay persons wishing to become heterosexual.
“And there was the occasional transgender person that wanted to go back to
accept himself in the gender role that was consistent with what his body said.
And some of us tried to help out in that regard. But I personally tried to do
that with a couple of patients. And the only thing I really accomplished was to
kind of push them into a psychosis. So that, by trial and error, I learned that
I certainly didn’t have the ability to help them with that problem.” (p19)
In 1969 he contributed two papers to Green & Money’s Transsexualism
, one on trans women, one on trans men; each includes
four case studies, and an overview.
Paul McHugh, who would close down the gender identity clinic at Johns Hopkins
after 1975, was dean of the University of Oregon Medical School until 1975.
In 1975 Pauly’s student Thomas Lindgren, wanting something more objective
than a patient’s self-history, developed a body-image scale where patient’s
rated how they felt about different parts of their body. Not surprisingly pre-op
transsexuals rated their genitals worse than their arms or legs. However it was
also used for anorexia and other conditions, including those wanting homeogender
In 1978 Pauly became chair of the University of Nevada Medical School. He was
a founding member of the Harry
Benjamin International Gender Dysphoria Association
, (now WPATH) in 1979,
and served as president of the Harry Benjamin International Gender Dysphoria
Association from 1985 to 1987.
In the late 1980s, Louis
was lobbying the American Psychiatric Association and the Harry
Benjamin International Gender Dysphoria Association and the gender identity
clinics to recognize the existence of gay trans men. Pauly was one of the few
psychiatrists to respond, and made a three-hour video interview with him.
Pauly retired in 1995, did sabbatical work in New Zealand, and returned to
work in the state hospital in Reno, Nevada and became medical director for the
Northern Nevada Adult Mental Health Service.
In 2004, Pauly was inducted into the Southern California Jewish Sports Hall
He retired again in 2010.
- Ira B Pauly. "Female Psychosexual Inversion: Transsexualism. Read before the American Psychiatric Ass., St. Louis, May 1963.
- Arnold Wells. “Exclusive! MD Reveals The Fourth Sex! Not Male, Not Female, And Not Homosexual”. The National Insider, 5, 3, July 19, 1964. Online.
- Ira B Pauly. "Male Psychosexual Inversion: Transsexualism. A Review of 100
Cases". Archives of General Psychology, 13, 1965:172-181.
Ira B Pauly. “The current status of the change of sex operation”.
Journal of Nervous and Mental
Disease, Nov;147, 5, 1968:460-71.
Ira B Pauly. “Female Transsexualism”. Archives of Sexual Behavior,3,
Harry Benjamin. The Transsexual Phenomenon. Julian Press, 1966. Warner
Books Edition 1977, with a bibliography and appendix by Richard Green. PDF
(with different pagination): 71-2/33, 162-3/76, 164/76, 179/84, 181/84.
Ira B Pauly. “Adult Manifestations of Male Transsexualism” and “Adult
Manifestations of Female Transsexualism”. In Richard Green & John Money
(ed). Transsexualism and Sex-Reassignment. Baltimore: The Johns Hopkins
Press, 1969: 37-87.
Joanne Meyerowitz. How Sex Changed: A History of Transsexuality in the
United States. Cambridge, Ma, London: Harvard University Press, 2002: 123,
124, 125, 174.
- Amy Bloom. Normal:
Transsexual CEO's, Cross-Dressing Cops, Hermaphrodites with Attitude, and
More. Vintage, 2014: 18-22.
Maija Anderson. Interview with Ira B. Pauly, MD. Oregon Health &
Science University, Oral History program, Februray 18, 2015. Online
For some reason Harry Benjamin calls Pauly “Ira S Pauly”.
The EN.Wikipedia article is almost the same as the TSRoadmap article.
At the end of Maija Anderson’s interview, Pauly is asked what he thinks about
, the famous trans doctor from Portland, Oregon, who transitioned in
1917. Despite having lived in Portland for 16 years where Hart is remembered, he
replies: “No. I wish I had seen that. Where was it published again”, and then
“And as far as I knew, the first published female to male, as we referred to it,
was the patient I described in the New York Hospital”. Obviously he does not
spend much time reading trans history.