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10 November 2020

Colin Markland (1929 - 2012) sex-change surgeon

Colin Markland, whose father owned a butcher’s shop in Bolton, Lancashire, won local and state scholarships to Bolton Grammar School and Cambridge University (Caius College) and trained medically at Westminster Hospital.

At age 24 he started a general practice in a small Canadian town near Windsor, Ontario with office hours twice daily, house calls, surgery, obstetrics, local hospital staff, even serving as the township medical officer. After six years he started a urology residency at Massachusetts General Hospital in Boston, followed by a year as a Post-Doctoral Fellow at the Renal Research Unit, Leeds University in the early days of organ transplantation. After being Assistant Professor at the University of Iowa he became an Associate Professor of Urology, University of Minnesota Medical School in 1964 where he worked in neurovesical dysfunction, along with the challenges of resident training. He ran a Graduate Trainee Program in Urology, with research interests involving radical cancer surgery, pediatric urology, neurologic vesical dysfunction and renal function after ischemia.

The Gender program opened at the University of Minnesota Medical School, shortly after the similar program at Johns Hopkins in Baltimore. The first Minnesota operation was done secretly but the press found out anyway. The program opened officially in December 1966. Dr Donald Creevy, the head of the urology department was in his late 60s and disinterested in such a new development. He delegated to Markland who was pleased to be given such a challenge, and became the chief surgeon on the program, sometimes assisted by Daniel Merrill who later wrote a book about the operations. Markland was under the incorrect impression that Christine Jorgensen’s operations in Copenhagen had included vaginoplasty, although it was noted that the Danish physicians had not described how to do one. But Markland, having to innovate, had given much thought to the procedure drawing on his experience doing perineal prostatectomy where the surgeon must develop a space between the urethra and prostate above and the anus and rectum below to expose the prostate gland – this is the space where the neo-vagina is formed. He intended to use the inverted penile skin to line the neo-vagina, but found it insufficient. He supplemented it with a skin graft from the right buttock. The details of Dr Burou’s penile inversion method did not become available until some years later.

The first two-dozen operations where financed by the state as a research program. 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. The most famous patient was the Mexican dancer, Shalimar.

In 1969 Creevy retired. Markland hoped to gain his position as head of the Urology Department, but Elwin Fraley, who had been junior to Markland at Massachusetts General, was appointed instead. As Fraley puts it: “Colin decided to be helpful rather than an adversary, as too often happens in these situations”.

In 1971 the Erickson Educational Foundation announced that the National American Urological Association had presented an award to Markland for a film referred to simply as “the University of Minnesota Transsexual Research Project Movie,” which he had screened at the annual meeting of the American College of Surgeons. The film followed Minnesota’s gender identity clinic five-year treatment program, giving what the newsletter called “an interim report on how well the total project is faring” and reviewing “surgical procedures and results” of its twenty-five “male [-to-female] transsexuals.

Markland gave a paper based on his work at the September 1971, Second International Symposium on Gender Identity, Elsinore, Denmark.

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.

Markland had lost interest in doing transsexual surgery by 1975, and passed the task to Merrill and others in the department who used his techniques.

Fraley, the Urology Department head and a political conservative, did not like the concept of sex-change surgery and questioned it repeatedly. Finally he closed it in 1979, shortly before the similar program at Johns Hopkins was also closed.

Markland spent a year as Fulbright scholar professor in Burma, followed by three years at Louisiana State University as chairman of a new training programme. After a midlife crisis he was professor at the Medical University of South Carolina in Charleston, where he stayed until retirement. Afterwards he acquired a 47 foot Wellington cutter, sailed two years from Newfoundland to South America, and several Atlantic crossings. He regarded the US Coast Guard Captains license the toughest exam ever.

Colin Markland died of a heart attack at age 83.

  • Colin Markland. “Testicular Tumors”. Current Problems in Surgery, 5, 9, 1968. 
  • Colin Markland & Daniel Merrill. “Accidental Penile Gangrene”. The Journal of Urology, 108, 1972.
  • “Symposium Highlights” and “Genetic Females, Too”. EEF Newsletter, 4,4, Winter 1971. Online.
  • “Minnesota Film Honored,” EEF Newsletter2, Summer 1972: 3. Online.
  • Colin Markland. “Complications in male transsexual surgery”. In Donald Laub & Patric Gandy (eds) Proceedings of the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome, Palo Alto, Stanford University Press, 1973.
  • Colin Markland & Donald Hastings. “Vaginal Reconstruction using Cecal and Sigmoid Bowel Segements in Transsexual Patients”. The Journal of Urology, 111, 1974.
  • Colin Markland & Donald Hastings. “Vaginal Reconstruction using Bowel Segments in Male-to-Female Transsexual Patients”. Archives of Sexual Behavior, 7, 4, 1978.
  • Colin Markland & Donald Hastings. “Post-Surgical Adjustment of Twenty-Five Transsexuals (Male-toFemale) in the University of Minnesota Study”. Archives of Sexual Behavior, 7, 4, 1978.
  • David M Brown, Colin Markland & Louis P Dehner. “Leydeig Cell Hypoplasia: A Cause of Male Pseudohermaphroditism”. Journal of Clinical Endocrinology and Metabolism, 46, 1, 1978.
  • Colin Markland. “ ‘Red Alert!’ Accidental Penile Necrosis”. JAMA, 244, 11, 1980.
  • Margaret Dierdre O’Hartigan. Chrysalis, 2, 3, Spring 1996. Online. 
  • “Obituaries: Alan Colin Markland”. BMJ, 2012;345:e7448. 
  • “Obituaries: Alan Colin Markland”. ObitTree, September 2012. Online.
  • Daniel C Merrill. Trapped: The true stories of Shalimar, Linda and Jackie – transsexuals who believed they were female born in a male’s body. Xlibris, 2012: ix, 23, 26-7, 30-2, 35-6, 49, 51, 54-5, 82. Excerpt
  • Elwin E Fraley. Teaching Surgeons’ Hands to Heal: A Urological Surgical Chairman’s Chronicle: The History of the Department of Urological Surgery, University of Minnesota 1969-1993. Author House, 2014: 9, 53, 77, 140.


Merrill in his book writes: “It also is clear that he [Markland] has no recollection of my contribution to the project other than as an assistant in some of the procedures he performed. Specifically, Dr. Markland believes that it was his idea to use the sigmoid colon to form a neovagina for our male transsexual patients. I expect that, when all is said and done, it is not at all that important whose idea it was to form a neovagina out of a segment of large intestine. It is important, I think, to document that this innovative approach to the problems inherent in the formation of a neovagina were first employed by surgeons of the division of urology at the University of Minnesota.” p49

And “I contacted him recently to fill in some of the blank spots in the narrative I was writing for this book. Dr. Markland indicates that he lost interest in the project because the transsexual patients were very demanding and because he received no compensation for the complicated and laborious surgical procedures he performed on them.” p49

Merrill claims that Shalimar was the first trans patient in the Minnesota program after it formally opened - however he also says that he fictionalized his account.

++Both Elmer Belt and Markland were prostate surgeons.   If Belt published an account of how he did transgender surgery, I have not found it.  I suspect that Marland's method was a re-invention of how Belt did it. 

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