Sex Change Surgery - The Beginning

"The Johns Hopkins Hospital has quietly begun performing sex change surgery.
The Baltimore hospital, one of the most eminent teaching and research institutions in the country, has also established a "gender identity clinic," staffed by a special committee of psychiatrists, surgeons and other specialists, to screen applicants for the operation.

Although the controversial surgery has been performed in many European countries in the last fifteen years and by a few surgeons in this country, Johns Hopkins is the first American hospital to give it official support.

Two operations approved by the committee of specialists have already been performed, the first last September and the second last month ... They are said to be recovering satisfactorily.

In the male-to-female operation, which takes three-and-a-half to four hours, the external genitals are removed and a vaginal passage created.

Female hormone treatments before and after surgery gradually reduce secondary male sexual characteristics such as body hair and enhance feminine appearance through breast development and the widening of hips.

About ten percent of the 100 applications received by the hospital have been from women, on whom a transformation operation can also be performed.

The men and women who seek sex change surgery are called transsexuals. They are almost always physically normal, but they have a total aversion to their biological sex that dates from early childhood. They have the apparently unshakable conviction that they are either female beings trapped in a male body or males trapped in a female body.

The overriding desire in the case of men is to be accepted as women. For this reason, psychiatrists believe, they are often sexually inactive before surgery because of their distaste for homosexual relationships.

Although transsexuals frequently assume the identity of the opposite sex without surgery, they are distinguished from transvestites, who derive pleasure from wearing the clothing of the opposite sex but have no desire for a sex change.

While opinion is not unanimous, many leading psychiatrists and psychoanalysts who have examined transsexuals, believe that they cannot be helped by psychotherapy. Such persons, moreover, are regarded as prone to mental breakdown and depression, suicide and, occasionally, self mutilation.

Dr. John E. Hoopes, a plastic surgeon who is chairman of the Johns Hopkins committee, said last week:

"After exhaustively reviewing the available literature and discussing the problem with people knowledgeable in this area, I arrived at the unavoidable conclusion that these people need and deserve help."

Transsexualism is thought to be relatively rare and far more frequent in men than in women. Dr. Hoopes said transsexuals in this country probably numbered in the thousands.

About 2,000 persons have undergone sex change surgery. Of these, perhaps 500 are from the United States. The best known is probably Christine Jorgensen, formerly George Jorgensen, who was operated on in Copenhagen, Denmark, in 1952 and has since become a nightclub performer and actress.

Virtually all the operations have been performed in Europe, Morocco, Japan, and Mexico. A few surgeons have performed the operation in this country, probably not more than a dozen times in all, but many hospital boards have refused to permit it.

Experts in the field believe that the Johns Hopkins decision that the surgery does not violate legal restrictions on mutilation or ethical and moral codes will lead to its being performed at other hospitals in the United States.

The Johns Hopkins committee was formed a year ago. After preliminary studies, it began accepting applications for surgery in July. Most of its patients have been referred to it by the Harry Benjamin Foundation here.

The foundation is headed by Dr. Harry Benjamin, an endocrinologist, who has been studying and treating transsexuals, often without charge, for the last 15 years.

Dr. Benjamin has led the fight to have these persons regarded as a distinct medical phenomenon and coined the term transsexual to describe them. Earlier this year he published a book, The Transsexual Phenomenon.

His work is supported by the Erickson Foundation of Baton Rouge, Louisiana, which also pays the cost of transsexual research at Johns Hopkins. The foundation, headed by Reed Erickson, also supports research in air pollution and human resources. Mr. Erickson is a consulting engineer of independent wealth.

The Johns Hopkins clinic examines only two patients a month. There already is a long waiting list. Applicants receive a thorough physical and mental examination from the committee, which costs $100. Only those who show no signs of psychosis and appear to have a degree of insight into their condition are accepted. . . . A number of psychiatrists familiar with the subject regard the majority of transsexuals as emotionally normal except for their gender confusion, which leads to intense feelings of frustration.

"It flies in the face of everything I believed when I began," said a Los Angeles psychiatrist-psychoanalyst, who has done considerable research in the field. "They are shockingly normal except for that one area."

After surgery and about two weeks of hospital care, the overall cost of which averages about $1,500, the patient is asked to be available for further study at the hospital. Also, for a former male, for example, to retain external female characteristics, he must continue receiving female hormones.

"This program, including the surgery, is investigational," Dr. Hoopes said. "The most important result of our efforts will be to determine precisely what constitutes a transsexual and what makes him remain that way.

"Medicine needs a sound means of alleviating the problems of gender identification and of fostering public understanding of these extremely unfortunate individuals. It is too early in the program to be either optimistic or pessimistic."

The origins of transsexualism are not yet certain. No organic basis for the condition has been found, but research is continuing into the possibility that it may be at least partly due to heredity or abnormal glandular functions before birth.

Psychiatrists believe that transsexualism is caused by prolonged conditioning early in life, perhaps within the first three years. Some cases, in which a mother wanted a daughter instead of a son and raised her child accordingly, seem obvious, but the origin of others is obscure.

By means of the family histories that it takes from transsexuals, the Johns Hopkins committee, as well as the Benjamin Foundation, hopes to shed new light on the problem. Similar investigations, although without surgery, are also being carried on at the University of California at Los Angeles Medical Center."

This amazing news was rapidly propagated by other newpapers all around the country.

This article appeared on the front page of The New York Times on November 21, 1966: