Historical Influences

information the basics some history of transsexualism

Throughout history there have been numerous reports of males and females who have sought to live life in the 'opposite-sex'.

As far back as the 1700s, there have been documented lives of these female-bodied men working in the military or in religious orders (Alter, 2000-2007; Devor, 1997). After five marriages and a career as a jazz pianist and singer, Billy Tipton was revealed after death in 1989 to be phenotypically (physiologically) female by the coroner. There are also many cases of 'male' people who dressed and behaved as women. One such case is that of French nobleman, Chevalier D'Eon in the court of King Louis XV(Kates, 2001).

These older reports support the view that the condition existed even though medical sex affirmation procedures were unavailable at the time. These older reports support the view that the condition existed even though medical sex affirmation procedures were unavailable at the time.

In 1886, a German doctor called Richard von Krafft-Ebing, began a study among the homosexual population into a condition (which he considered to be a mental illness) in which a person believed him or herself to be of the opposite sex. Von Krafft-Ebing called this 'illness' gynandry.

By 1910 Dr Magnus Hirschfeld, a German physician, coined the term transvestism, and first used transsexualism in a 1923 paper titled, Die intersexuelle Konstitution. He reclassified transsexualism to be a condition affecting people who believed they actually were members of the sex opposite to that represented by their phenotypes. He also defined it separately to transvestism (from Latin trans-, "across, over" and vestere, "to dress or to wear"), referring to individuals who dressed in the clothes of the opposite sex but did not perceive themselves to actually be the opposite sex. Hirschfeld, himself a transvestite, was convinced that only a biological cause could explain the phenomenon of transsexualism.

Hirschfeld was willing to offer surgical solutions to some of his patients who identified themselves as the opposite sex. He performed incomplete reassignment surgeries for female-to-male patients in Berlin in 1912, reporting them in the medical literature in 1918. These were incomplete attempts, which were simply the removal of the reproductive organs of the patient. In 1918, a medical student, Alan Hart, underwent this procedure based solely on his male gender-identity, carried out by Dr. Joshua Gilbert, an Oregon physician. Dr Gilbert published details about the case in the Journal of Nervous and Mental Disorders in 1920, keeping Alan's identity a secret.

In Berlin, around the same time, Dr Felix Abraham and Dr Gohrbandt, began to practice some basic sexual reassignment procedures. Dr Hirschfeld delivered the first scientific lecture on transsexualism to the Association for the Advancement of Psychotherapy in 1930.

In 1930, an early attempt at ovary transplantation for Lily Elbe (a male-to-female patient) in Germany resulted in her death the following year from surgical complications. This promising early work in Germany was soon halted with the Nazi rise to power in 1933. This unfortunate turn of events only forced the specialty further a field, as surgeons took their skills overseas.

The early years of WWII assisted female-to-male transsexuals with the wartime genital reconstructive techniques of flap surgery. In 1944-45, a British surgeon, Harold Gillies, performed some initial operations on Michael Dillon. Dillon described his case in Self: A Study of Ethics and Endocrinology in 1946.

However, it was Reid Erickson, an American transsexual man, who changed the face of medical inquiry into transsexualism. Erickson inherited a fortune from his father, and began treatment as a male under the supervision of Dr. Harry Benjamin. Between 1964 and 1977, Erickson formed an organisation, the Erickson Educational Foundation (EEF), to promote the study of transsexualism.

The Johns Hopkins University benefited from the generosity of the EEF with Drs John Money, Howard Jones and Milton Edgerton starting America's first Gender Identity Clinic in 1965. There were other clinics starting in the US around this time at universities such as UCLA in 1962, Stanford in 1968 and Minnesota in 1966.

Erickson funded the early research efforts of Dr Benjamin and of the Johns Hopkins Gender Identity Clinic in Baltimore USA. By 1966, Benjamin published his observations on treating and following up on a number of transsexual patients in the book, The Transsexual Phenomenon. Benjamin is credited with first describing the symptoms and suggesting they were due to a condition. He described the condition using the terms 'gender dysphoria' referring to the two major characteristics of the condition: a focus on a person's outward social expression of sex (gender) and the severe discomfort (dysphoria). To honour him for this contribution, the worldwide organisation of professionals who care for transsexuals was named: The Harry Benjamin International Gender Dysphoria Association.¹

Gradually, changes in law in various countries began to see surgery being made available for transsexual men and women. In 1967, Britain began performing sex-reassignment surgery; Germany followed in 1969 and France in 1971. The American Medical Association (AMA) added transsexualism as a separate heading in the Index Medicus in 1968 and it was three years later in 1972 when the Association mentioned surgery as the most successful treatment for transsexualism (American Medical Association, 1972). A year later, psychiatrist Dr Norman Fisk coined the term 'Gender Dysphoria Syndrome'.

With news of the impending closure of the EEF in 1977, plans evolved to create the Harry Benjamin International Gender Dysphoria Association (HBIGDA). Around this same time, criticism and political pressure from feminist, gay and lesbian socio-political movements resulted in many universities reducing or discontinuing their own gender treatment programs (Raymond, 1979; Meyerowitz, 2004).The closure of the Johns Hopkins Gender Identity Clinic occurred in 1979 as the result of a study by Dr Paul McHugh and Dr Jon Meyer (This Meyer & Reter (1979) paper, which has been criticised as flawed, claimed sex affirmation surgery offers no advantages for transsexuals. The decision to close the John Hopkins program in Baltimore was based on this paper.)

Despite these negative outcomes, HBIGDA undertook the task of setting standards in the field for treatment of gender dysphoric conditions, under the guidance of Paul Walker. The HBIGDA adopted a group of guidelines called the Standards of Care to provide professional members with consistent guidelines when prescribing treatment.

various theories of causality of transsexualism

Historical Influences

Further reading