What is the history of transsexual surgery?

January 12, 2005

Christine Jorgensen

While medical pioneers such as Magnus Hirschfeld and Harry Benjamin made valuable contributions to the field of transsexual care, the most important advance – changing the paternalistic attitudes of the medical profession – was spurred by transgender activists themselves.

The first complete male-to-female operations were performed in Germany in the early 1930s on patients referred by pioneering sexologist Magnus Hirschfeld, an early advocate for gay rights and author of the first-ever book on transgenderism, Die Transvestiten (1910). Lili Elbe, formerly Danish painter Einar Wegener, had a series of operations that included the implantation of ovaries. A patient called Dorchen (born Rudolf Richter) received the first vaginoplasty, performed by Felix Abraham in Berlin. Some female-to-male transsexuals, like Alan Hart in 1918, also sought surgeries – such as ovary removal and mastectomy – to make their bodies better match their identities.

The first sex-reassignment operation to enter the public spotlight in America was that of Christine Jorgensen, who later became a popular nightclub performer. "Now, looking back, I realize it was the beginning of the Sexual Revolution," Jorgensen told an interviewer in 1986. "I just happened to be one of the trigger mechanisms."

Harry Benjamin, a German-born doctor practicing in New York City, traveled frequently to visit Europe's pre-eminent sexologists, including Hirschfeld and Austrian endocrinologist Eugen Steinach, who conducted some of the first experiments on changing the sexual characteristics of animals.

Rejecting the prevailing view that transsexuals were either mentally ill or poorly adjusted homosexuals, Benjamin provided sympathetic care to hundreds of patients at his offices in New York and San Francisco in the 1950s. He became known as the country's foremost expert on transsexualism, and published a groundbreaking book, The Transsexual Phenomenon, in 1966. By the late 1950s, the care of transsexuals had improved markedly thanks to medical advances such as skin flap surgery and hormone therapy, but few U.S. hospitals permitted sex-reassignment surgeries.

In the 1960s, Johns Hopkins Medical Center set up a gender clinic, which began performing sex-reassignment surgeries in 1966. Some 40 or so university-affiliated gender clinics were established in the ensuing decade. In 1969, Stanley Biber – who would become one of the most prominent surgeons in the field – began performing sex-reassignment operations in Trinidad, Colo.

In 1979, a group of experts created the Harry Benjamin International Gender Dysphoria Association (HBIGDA) and put together a standard of care to ensure that only appropriate candidates could obtain surgery. Among the characteristics of a supposed good candidate was adherence to a traditional, heterosexual feminine or masculine role. According to the standards (which are still used today), a candidate must first undergo psychotherapy for at least three months, then he or she can obtain hormones and complete the "Real-Life Experience," which requires living full-time as the desired gender.

While many transsexuals lauded the HBIGDA standards, subsequent social and political shifts led to controversy. Some transgender people felt they should not have to jump through hoops to receive medical treatment, while others opposed the traditional gender role requirement. In response to such criticism, the latest revision of the standards (2001) relaxed these restrictions, and the International Conference on Transgender Law and Employment Policy put forth an alternative standard stating that, "Persons have the right to express their gender identity through changes to their physical appearance, including the use of hormones and reconstructive surgery."

Liz Highleyman is a freelance writer and editor who has written widely on health, sexuality, and politics.

Further Reading
  • Benjamin, Harry. 1977.The Transsexual Phenomenon (Warner).
  • Wolff, Charlotte. 1986.Magnus Hirschfeld: A Portrait of a Pioneer in Sexology (Quartet Books).

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