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22 May 2018

Transgender Surgery III: untruths and unknowns


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


Untruths


The old discredited statistics that were refuted in Olyslager and Conway, “On the Calculation of the Prevalence of Transsexualism” ( Online ) are still being repeated. Bizic et al, 2018 (i.e. this year) says yet again: “There are different studies regarding the prevalence of transsexualism in general population accounting for 1 : 7400 to 1 : 2000 in assigned males and 1 : 30040 to 1 : 104000 in assigned females”. This really won’t do!!

Colebunders et al (p251) say ‘Fogh-Andersen initiated the modern era of sex reassignment surgery (SRS) by using penile skin as a full-thickness graft to line the neovagina of Christine Jorgensen”. This is completely at variance with all other accounts that say that Fogh-Andersen performed only an orchiectomy and penectomy on Jorgensen, and that she had vaginoplasty later in the US.

Again and again writers claim that Felix Abraham operated on Lili Elbe and that Lili was a patient of Magnus Hirschfeld. Some examples: the Guardian; GenderSpeaker; Dallas Denny; TransgenderZone. The key document is a paper by Felix Abraham, “Genitalumwandlungen an zwei männlichen Transvestiten“. Zeitschrift für Sexualwissenschaft und Sexualpolitik, 18: 223-226. There is a translation, “Genital Reassignment on Two Male Transvestites” that you can read here. Abraham discusses two patients:
  1. “Rudolph (Dora) R., domestic employee, is today a 40-year-old ‘male’. He was born in the Erzgebirge region.”
------ Dörchen Richter sometimes called Dora, was born with the name of Rudolph Richter in the Erzgebirge region in 1891. Therefore she was 40 in 1931.
  1. “Arno (Toni) E., painter, a 52 year old patient, had first noticed his inclination at the beginning of the 1920s. Despite his homosexual inclination, he got married and from this marriage a boy was born. In the extremely unhappy marriage he had only occasionally the possibility to wear feminine clothing. As frequently happens, during the first years the urge was weaker - to increase later. His inclination essentially preempted him from performing his profession when he did not have the possibility to wear clothing conforming to him. After the death of his wife, he lived completely as a female. Noticeable during the observation was the contrary behavior in male and female clothing: While he was totally calm and reasonable in the latter, in male clothing he was distraught, nervous and utterly worthless. Additionally, he only owned a single male suit, while having a fairly large female wardrobe.“
---- Toni Ebel born Hugo Otto Arno Ebel in Berlin in 1881 and so was 50 in 1931. She was a painter, she lived through WWII and was compensated by the German Democratic Republic as a victim of Nazism. As a painter, she was recognized at the Akademie der Künste in East Berlin.


Why do people refuse to recognize that Arno (Toni) E. is Toni Ebel? Why do they think that this is a discussion of Lili Elbe? Homosexual? a boy child? wife died? No mention of Denmark or France?


Unknowns


Lesavoy says that Abbe’s report on his work was lost for 40 years until McIndoe found it in 1938. However Bizic et al say that Abraham in 1932 operated “in line with the technique first published by Abbe”. How this was, if the report was not to be re-found for another six years, needs to be explained.

Goffe, in 1903, in effect invented penile-inversion vaginoplasty. Apparently like Gillies 40 years later, he did only one such operation. However he did write up the details and published it in a professional journal, American Journal of Obstetrics and Diseases of Women and Children, where it was as forgotten as Abbe’s report was lost.

Is there a connection between Fogh-Andersen, who reported the use of a full-thickness skin graft harvested from the penile skin to line the neovagina in a 1956 publication, and Burou who started doing penile-inversion vaginoplasties, also in 1956? Denny and Conway give full credit to Burou and say nothing at all about Fogh-Andersen. Bizic et al give full credit to Fogh-Andersen and say nothing at all about Burou. Colebunders et al mention both Fogh-Andersen and Burou on the same page (p251) but say nothing about whether or not Burou copied and improved on Fogh-Andersen.

Bizic et al say that the Gillies-Millard penile-skin-flap technique “remains the gold standard in male to female sex reassignment surgery”. Barbosa, Edgerton and Biber consciously copied Burou’s technique, but I have not found any vaginoplasty surgeon who is said to be following Gillies-Millard. Gillies-Millard did use a penile skin flap, and it could be that Fogh-Andersen consciously improved on their work. However the Gillies-Millard book, The Principles and Art of Plastic Surgery, was not published until 1957, a year after Fogh-Andersen’s publication. Maybe Fogh-Andersen did follow Gillies-Millard, but I have not found any such explanation. Nor have I found any claim that Burou followed Fogh-Andersen. Maybe he did, but nobody says so.

At the First International Symposium on Gender Identity held at the Piccadilly Hotel, London, 25-27 July 1969, 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. So was there a clinic at Chelsea? Did they guide transsexuals through the process. ???

Peter Stirling, an intersex Australian transitioning to male, went to London and was accepted as a patient at Guys Hospital’s Endocrine Clinic. He was guided through the program by social worker Margaret Branch, who also guided other transsexuals. There is no account of this clinic and its program, other than Stirling’s autobiography.


This is a series about transgender surgery. So why does the world’s most famous anti-surgery activist keep re-appearing: as Stoller’s first trans resource at the UCLA Clinic; as an advisor to Harry Benjamin and quoted several times in Benjamin’s book; as the only trans person – other than Reed Erickson - at the 1969 convention in London?

Billings & Urban

A history of transgender surgery that I did not consult for my transgender surgery timeline was,
  • Dwight B. Billings and Thomas Urban. “The Socio-Medical Construction of Transsexualism: An Interpretation and Critique”. Social Problems, 29, 3, Feb., 1982: 266-282.
This was reprinted in In Richard Ekins & Dave King (eds), Blending Genders: Social Aspects of Cross-Dressing and Sex-Changing, Routledge 1996: 99-117, and various other places. It is much cited.

Here is the abstract:
“This article examines transexualism and its treatment by sex-reassignment surgery. Physicians have drawn upon their previous experience with hermaphrodites and the psychological benefits of elective surgery to legitimate sex-change surgery for what they view as a distinct patient population, transexuals. We demonstrate that transexualism is a socially constructed reality which only exists in and through medical practice. Furthermore, we contend that sex-change surgery reflects and extends late-capitalist logics of reification and commodification, while simultaneously reaffirming traditional male and female gender roles.”
The paper closes with:
“But rather than support contemporary movements aimed at reorganising gender and parenting roles and repudiating the either/or logic of gender development, sex-change proponents support sex-reassignment surgery. By substituting medical terminology for political discourse, the medical profession has indirectly tamed and transformed a potential wildcat strike at the gender factory”.
This was published only three years after Raymond’s The Transsexual Empire, and agrees with it that transsexuals would not exist without pushy profit-oriented doctors.  !!

Billings & Urban are not incorrect in what they write, although they twist the interpretation as indicated. They are extremely US-centric and have no interest at all in the work done by GilliesFogh-AndersenBurouRandelSteiner or Ratnam. What facts they do have that are not in my timeline are those relating to the opposition by psychiatrists. That is another tale. I am first concentrating on the surgeons who made transgender surgery what it is.

However there are two items in their footnotes which are not mentioned anywhere else.

1) “Thomas Urban was a participant observer for three years (1978–80) in a sex-change clinic”.

But they do not say which one or otherwise elaborate. Did he leave, as did Grant Williams from the Charing Cross Clinic, because he disagreed with the program? This is an unknown.

2) Footnote 8 reads:

“Other university hospitals, such as the University of Minnesota’s, began surgical treatment at roughly the same time but avoided public disclosure. In addition, a few operations were secretly performed in the 1950s at the University of California at San Francisco. We have learned that Cook County Hospital in Chicago was performing sex-change operations as early as 1947, predating Jorgensen’s famous European surgery by five years.”

We know that Elmer Belt (not mentioned at all in Billings & Urban) was doing such operations at the University of California at Los Angeles in the 1950s. Do they have the wrong city, or is this something lost to history?  Louise Lawrence worked with Alfred Kinsey and Harry Benjamin in San Francisco in the 1950s.   If these surgeries happened there is strange that neither Lawrence nor Benjamin knew about them.  The Langley Porter Clinic, while admitting that psychotherapy did not work, generally would not recommend surgery, although it is said that they did arrange surgery in a couple of cases.  Dr Frank Hinman, urologist, author of  “Advisability of Surgical Reversal of Sex in Female Pseudohermaphroditism”, 1951, was brought in in 1953 to save Caren Ecker after an auto-orchiectomy, which was felt to require a penectomy.


I cannot find any account of transgender surgery at Cook County Hospital in 1947. Orion Stuteville who did transgender surgery at Cook County and Northwestern University Medical School twenty years later was already a surgeon there, but in the dental school. Was it he who did the transgender surgery, or someone else?   Harry Benjamin had requested Max Thorek, a renowned surgeon in Chicago to do an operation, but, after consulting his lawyer, he declined. Again what Billings and Urban are referring to seems to be lost to history.

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