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21 May 2018

Timeline of surgery: Part II: 1966 -1975

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

1966 Ricardo San Martin, Buenos Aires

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

1966 April 9 – British Medical Journal

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

1966 Harry Benjamin, New York

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

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

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

Mr & Mrs Simmons
Following on from the genital reconstructive surgery done by Hugh Hampton Young in the 1930s-1940s, Lawson Wilkins set up a new pediatric endocrinology clinic where it was recognized that doctors could not tell a person’s sex just by looking at external genitalia, and in some cases recommended to the child and parents that the child’s sex be reversed. The Psychohormonal Research Unit was set up in 1951, and persons who wanted a change of sex kept coming. Milton Edgerton and John Money were major advocates of a new approach. Money became head of the PRU in 1962. He arranged subsidies from Reed Erickson, and met frequently with Harry Benjamin and Richard Green. They decided to set up a Gender Identity Clinic. At first this was in stealth. The first patient was Phyllis Wilson, who became a dancer in New York. The New York Daily News picked up the gossip. Thus outed, the clinic gave an exclusive to the New York Times. Plastic surgeon John Hoopes became chairman of the clinic. This was 1966, the same time that Benjamin published The Transsexual Phenomenon. Within a year, over 700 desperate transsexuals wrote and implored the doctors at the Johns Hopkins Clinic to help them; however very few were recommended for surgery. Initially the clinic did vaginoplasty using skin taken from the patient’s thigh. However they examined trans women who had returned from Casablanca. Dr Edgerton adopted and adapted Dr Burou’s method.  However much of the actual surgery was done by gynaecologist Howard Jones. When Edgerton was contacted by Dr Stanly Biber in 1968, the adaption of Burous’s method was recommended. In 1967 an orchiectomy and construction of a rudimentary vulva was done on 22-month-old Bruce Reimer (later to be David) under the aegis of John Money. In 1975 Catholic psychiatrist Dr Paul McHugh became head of the Psychiatry department at Johns Hopkins. He later wrote that he intended from the start to put an end to sex change surgeries. He pushed for a negative review of the operations and got one in 1979 from psychiatrist Jon Meyers and co-author Donna Reter. By this time Green, Erickson, Jones, Edgerton had already left. In fourteen years only thirty people had been operated on. The David Reimer case became a scandal in the 1990s when the adult Reimer was found to have rejected his female assignment. He died by suicide in 2004, and Money stubbornly refused to admit that he had been in error. Other notable patients include: Dawn Langley SimmonsKiira Triea.

1966 - 1979 – Minnesota Medical School, Minneapolis

The mayhem law had been dropped in Minnesota when the criminal code was recodified in 1963. A trans woman was admitted to the psychiatric section of the University Hospital, and the staff were persuaded that she should have the surgery that she so desired. After two years of discussion and planning, the School established a Gender Committee under psychiatrist Donald Hastings. Two members went to New York to examine patients of Harry Benjamin and Leo Wollman who had had surgery abroad. Their surgeon, John Blum, went to Johns Hopkins to observe transgender surgery. The first Minnesota operation was done secretly but the press found out anyway. The program opened officially in December 1966. English doctor, Colin Markland, became the chief surgeon on the program. The first two-dozen operations where financed by the state as a research program. Sociologist Thomas Kando interviewed 17 of the first patients, and depicted them as ‘the uncle toms of the sexual revolution’ in his 1973 book Sex Change; The Achievement of Gender Identity Among Feminized Transsexuals which was extensively quoted by Janice Raymond. Up to closure at the end of the 1970s, 41 trans women were operated on, and later 8 trans men also. This from the 300+ applications that the Clinic received each year. In 1974 Markland used bowel segments. This was the first intestinal vaginoplasty done on a trans woman (apart from Charles Wolf in 1942). This procedure was quickly adopted by Dr Laub at Stanford. John Brown also offered it later in his career, but with less satisfactory results. Urologist Daniel C. Merrill later took three cases including Cuban dancer Shalimar and semi-fictionalized their stories. One of the last patients was Margaret O’Hartigan 1979.

1967-? Northwestern University Medical School, Chicago

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

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

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

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

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

1968 Otto de Vaal, Amsterdam

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

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

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

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

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

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

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

1968 onwards Viktor Kalnberz, Riga

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

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

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

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

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

1969 Richard Green & John Money. 

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

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

1969 Francisco Sefazio, Buenos Aires

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

1969 onwards Shan Ratnam, Lim & Anandakumar, Singapore

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

1969 onwards Derk Crichton, Cape Town and then Durban

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

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

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

1970 -1995 Milton Edgerton, University of Virginia, Charlottesville

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

1971 onwards Roberto Farina, São Paulo Medical School

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

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

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

1972-1985 Roberto Granato, New York

From Argentina, Granato did further training in New York. He did about 800 vaginoplasties using the Burou technique. He also did phalloplasties. Notable patients include: Diane KearnyRenee RichardsEleanor SchulerJeanne Hoff.

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

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

1973-1977 Baptist Medical Center, Oklahoma City

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

1973-1999 John Brown, California and then Tijuana

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

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

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

1975 onwards - Vrije Universiteit, Amsterdam

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

The following were consulted:

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

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