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19 May 2018

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

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

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

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

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

Part I: 1906 to 1965

1832 Jean Zuléma Amussat, Paris

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

1872 Heppner

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

1890-1914 Franciszek Neugebauer, Warsaw

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

1892 WF Sneguireff, Paris  

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

1898 R. Abbe, New York

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

1900 Beck, New York

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

1902 A. Geijl, Amsterdam

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

1903 J. Riddle Goffe, PolyClinic Hospital, New York

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

1904 James F Baldwin, Grant Hospital, Columbus

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

1906 Georg Merzbach, Berlin

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

1912-1921 Richard Mühsam, Berlin

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

1918 J Allen Gilbert, Portland, Oregon

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

1926 Il’ia Golianitski, Moscow

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

1922-1933 Institut für Sexualwissenschaft, Berlin

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

1927 G.A. Wagner

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

1930-1931 Kurt Warnekros, Staatliche Frauenklinik, Dresden

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

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

Young pioneered genital reconstruction surgery, but not on transsexuals.

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

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

1936 Nikolaj Bogoraz, Moscow

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

1938 JB Banister and Archibald H McIndoe, London

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

From this point on, external hormones are available, but still not used for all transsexual transitions.

1939-1965 Ludwig Levy-Lenz, Cairo

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

1941-1942 Charles Wolf, La Chaux-de-Fonds, Switzerland

Arlette-Irène Leber had a series of operations including vaginoplasty following Sneguireff's method using part of the intestine. In 1944 a Cantonal Court approved her change of civic status to female.

194? Josef Mengele, Auschwitz

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

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

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

1950-1 Nippon Medical School Hospital, Japan

Akiko Nagai had an orchiectomy, a penectomy and breast augmentation.

1950-1962 Elmer Belt, and Willard Goodwin UCLA, Los Angeles

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

1951 onwards - various hospitals, Copenhagen

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

1956-1987 Georges Burou, Clinique du Parc, Casablanca

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

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

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

1959 ST Woudstra Arnheim Municipal Hospital, Netherlands

Plastic surgeon S.T. Woudstra did a phalloplasty for a trans man. This was published in the Dutch Journal of Medicine resulting in letters of protest and questions in Parliament. Woudstra never did a second such surgery.

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

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

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

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

1962 onwards Gender Identity Research Clinic, UCLA

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

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

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

1964  Taro Kono, Tokyo

Gynecologist Taro Kono performed sex change operations on three trans women at a Tokyo clinic — and was arrested the following year and charged with violations of the Eugenics and Motherhood Protection Act of 1948, as  well as an  unrelated  violation of the Controlled  Substances  Act.  In 1969 he was found guilty of all charges , sentenced to two years and fined Ɏ400,000. The case attached a stigma to transsexualism and made it taboo for medical professionals for many years to provide adequate care or even information. This lasted until the late 1990s.

? - ? Jaime Caloca Acosta, Tijuana

? - ? Francesco Sorrentino, Naples

1965 Ira Pauly, University of Oregon Medical School

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

Continued in Part II.

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