Transsexualism : A Journey Across Lines of Gender
Margaret Lamacz, a sex researcher at Johns Hopkins University in Baltimore, remembers her confusion when she began working with transsexuals at the Medical Academy in Krakow, Poland. For every male desiring to be a Christine Jorgenson, she found five females who wanted to become men.
“We were always puzzled,” Lamacz said. “That did not agree with the literature,” which held that transsexualism was primarily a male phenomenon.
Now, in a distant echo of what Lamacz encountered nearly a decade ago in Poland, clinics and therapists from California to Virginia are finding that increasing numbers of women are stepping forward to join hundreds of Americans who change their sex each year.
25% Are Biological Women
Biological women, thought to account for only 6% of the nation’s transsexual population in the early 1950s, now make up around 25% of the 10,000 to 25,000 trans-gender people in the United States, according to a survey of those in the field. Even more striking, some leading gender clinics today have as many female as male clients “in transition.”
“Until the last couple of years, we didn’t think there were as many genetic females” interested in sex reassignment, said Dr. Stanley Biber, whose clinic in Trinidad, Colo., has been nicknamed the sex change capital of the world. “From our communications, that type is increasing tremendously.”
The shift is partly a result of recent medical advances, which are enabling surgically created males not only to pass as men on the street and on the job but in the locker room and in the bedroom. Improved surgical techniques are allowing these new males to cast aside below-the-waist padding and lead more normal lives as men.
Advanced Methods
Adam, 34, a Minneapolis waiter whose surgery was completed in January, said he can now “go around without clothes” in a locker room filled with other men without being stared at. “It feels really good. Things are so far advanced now. I know people who just had the operation a few years back. They wish they had waited.”
The growth in numbers of female-to-males is also being attributed to increasing media attention on transsexuals, especially on television shows in which Geraldo Rivera, Oprah Winfrey and Phil Donahue bring sexual minorities into middle-class living rooms.
Men who became women, in the style of World War II ex-G.I. Christine Jorgenson and male-eye-surgeon-turned-woman-tennis-player Renee Richards, have been common fare on such programs. But genetic females who felt uncomfortable with their gender “never knew anybody like themselves,” said Paul Walker, a San Francisco psychologist.
Now that’s changing. Walker recently appeared on one show with twin sisters who became twin brothers.
Female-to-males have not been as flamboyant as Richards, who conducted a public battle to play women’s tennis in the 1970s, or Sister Mary Elizabeth, a San Juan Capistrano transsexual who took vows of chastity earlier this year to inaugurate her own order of nuns only to be repudiated by the Episcopal Church. But inside, their feelings are remarkably the same.
“They all give a similar story,” said Leslee Schraeder, head of the mental health clinical program with the Hollywood Mental Health Service. “They wish they were the opposite sex way before puberty.”
Often their earliest memories are of feeling that they were issued the wrong kind of body and of fighting with their parents over clothing. As a girl, Luke, 34, a Camarillo female-to-male recovering from breast-removal surgery, would wear walking shorts under a skirt.
“I don’t really understand the female mind,” he said without a trace of irony.
More Expensive, Difficult
The increasing number of people such as Luke who are stepping forward for surgery is especially arresting, since changing genders for women is much more expensive and difficult than sex reassignment for a man. A biological woman who opts for the latest in plastic surgery may spend more than $50,000, endure weeks of painful recuperation in the hospital and cope with unattractive scarring and the need for periodic repairs of their newly masculinized bodies.
Insurance can cover much of the cost of the surgery.
Transsexualism is a condition in which one’s private gender identity differs from one’s sex. A person with a male body can be convinced that, deep down, he really is a female. His preference in a sexual partner may be either male or female, though the majority of post-operative transsexuals prefer males, believing themselves to be heterosexual women.
Some medical policy-makers in effect deny the existence of transsexualism, believing transsexuals are trying to escape their gender responsibilities or are afraid of admitting homosexuality. But sympathetic therapists and physicians regard transsexuals as the victims of a sort of birth defect.
“If you think getting married and having kids will suppress the problem--you can not suppress it,” said Leah Schaeffer, a New York psychotherapist. “You came into the world with it, and you’ll die with it.”
There have been studies of laboratory animals confirming that pre-birth conditions can have an effect on the gender identification of an adult.
Dr. John Money, a noted author and professor emeritus at Johns Hopkins, said one recent study showed that the male offspring of overly stressed pregnant rats are homosexual or are unable to mate properly, even if heterosexual. While that is intriguing, he pointed out that human beings are not such “hormonal robots.” Gender roles are still being shaped after birth, until age 5 or so.
“The big question about transsexuals is, are they in some way more vulnerable?” to subtle gender influences than other human beings, Money said.
What doctors call gender dysphoria--meaning anxiety or discomfort with one’s sex--is hardly new. People in other cultures and other centuries have lived as members of the opposite sex.
Tammany Hall Member
A notable example was Murray H. Hall, who played poker, smoked cigars and was an influential member of the infamous Tammany Hall political machine in New York City. When “he” died of breast cancer in 1901, the secret was discovered.
“Suspect he was a woman?” asked Sen. Bernard F. Martin, a contemporary of Hall. “Never. He dressed like a man and talked like a very sensible one.”
Hall’s tale is told in a 1985 handbook entitled “Information for the Female to Male,” written by and for women who are trying to live as men. The book lists stores that sell small-sized men’s shoes by mail order and offers tips on men’s room etiquette--”just use the stall”--for preoperative female-to-males.
The modern era in transsexualism, most observers agree, dawned with the headline in a New York paper on Dec. 1, 1952: “Bronx G.I. Becomes a Woman--Dear Mom and Dad, Son Wrote, I Have Now Become Your Daughter.”
The newspaper introduced to the world Christine Jorgenson, who was recovering in a Denmark hospital.
In those days, Schaeffer said, it was felt that 15 of every 16 transsexuals were biological males. Over time, the disparity between male and female transsexuals has slowly narrowed. How much and how fast is difficult to judge since there is no centralized reporting system, according to Harry Benjamin of the International Gender Dysphoria Assn. based in Palo Alto.
Annually now, between 350 and 1,000 sex change surgeries are performed in the United States, according to best estimates. A growing number, Walker and the Gender Dysphoria Assn. say 40% or more, are of the female-to-male variety.
The nation’s leading gender clinics confirmed the trend. The University of Minnesota’s Program in Human Sexuality, the Center for Gender Reassignment in Norfolk, Va., the University of Virginia and the Palo Alto Center for Plastic Surgery say at least 50% of those coming to them today are female. Even Biber’s clinic in Colorado, known primarily for its male-to-female procedure, reports a sudden increase in the number of women asking to be added to the patient list.
Hot Line for Transsexuals
“I’m probably seeing 15% to 20% more female-to-males than three or four years ago,” Sister Mary Elizabeth said. She operates a popular hot line for transsexuals in San Juan Capistrano that often is the first place a prospective transsexual turns for help in finding a gender clinic or a sympathetic physician.
Why the burst in interest? The word has gotten around that surprising things are being done in the operating room. “Since the advent of better surgery, more folks are coming forward,” said Marsha Botzer, president of the Ingersoll Gender Center in Seattle.
Mastectomies, hysterectomies and steroid hormone treatment have been available for years to help female-to-males to pass in public as men. But unlike surgery for male-to-females, which has become so skillful that doctors say some patients can fool gynecologists, genital surgery for female-to-males has been more problematic.
Michael, 43, a printer from Seattle, waited nearly 20 years to have his surgery because it was “very barbaric” in the past. His phalloplasty--construction of a phallus--was performed three years ago, and he is delighted.
“For me, without question, it was an absolute salvation,” he said.
He relieves his bladder through the surgically created organ. And he also can perform sex, including climax. His wife-to-be “was not put off by it. Her feelings are, it is not noticeably different” from sex with other men.
The phallus is created by cutting and shaping a flap of skin either from the forearm, abdomen or thigh. The most recent advances have come in delicate microsurgical techniques involving the transfer of a nerve supply for the phallus.
“There is total sensation there. It’s part of me,” said Steve, a 6-foot, 181-pound forklift driver from Rhode Island. “It’s like it’s always been there.”
Dr. David Gilbert in Norfolk has begun moving the clitoris to the end of the phallus for better sensation. “The fact that you can touch the phallus and come away with an erotic feeling . . . signifies the brain’s adaptability,” Gilbert said in an interview.
Lengthy Recuperation
There may be a lengthy and uncomfortable recuperation period after the surgery, but the biggest adjustments for the patients may come still later.
Lou, a 36-year-old San Francisco secretary, learned some lessons about manhood when he returned to work. “All of a sudden, everything I said was brilliant. I got a promotion and a title and a secretary” of his own, he said.
While no research has been done on this subject, anecdotally “there is no question female-to-male patients feel better accepted” by society after surgery. “They feel smarter; they’re treated better,” said Dr. Sharon Satterfield, former director of the Program on Human Sexuality at the University of Minnesota.
For male-to-females, the reverse may be true. Clinicians at the University of Minnesota joke that male-to-females “automatically lose 20 IQ points” during surgery, said Dr. Michael Metz.
But the university’s own study of 39 male-to-females conducted in 1979 concluded that they were doing better as a group after surgery. None was on welfare, and the average annual income was $22,000, placing them in the upper 15% of female wage earners that year, according to the U.S. Census Bureau.
A patient at the Ingersoll Center in Seattle learned another lesson about maleness on a darkened street. He rushed to his counselor in alarm because a woman he was approaching suddenly darted to the other side of the street.
“By then, he was full-bearded and muscular,” said Botzer, so the reason could not have been the stranger’s disgust at an unconvincing gender change.
They finally decided that the woman probably was behaving on a more instinctual level, reacting with fear to a muscular man striding purposefully down an urban street.
“It was an affirmation of manhood,” Botzer said, even if an unwelcome one. Her client came away with a “bit of muted sadness in realizing that was part of the role.”
Some professionals in the field have been surprised and discomfited to discover that some female-to-males are gay. As a girl, Lou was attracted to boys, “but I didn’t like them to treat me like a girl,” he said. “I’d never heard of anything so bizarre.”
Rejected for Surgery 3 Times
Neither had the Palo Alto gender clinic, which rejected him three times for surgery before he found a private physician willing to do it. Lou perhaps should not be such a shock, since several physicians and therapists said it is well known in the field that up to 40% of male-to-females become lesbians, continuing their already established preference for women as sexual partners.
Why this is so no one is quite certain.
Tragically, Lou, a member of a gay club in San Francisco, has contracted AIDS and is now taking the experimental AZT drug.
He would not trade his life, however, strange and ironic as it is. “Ma says now that she sees how much happier I am. She realizes (the surgery) was the right thing. I was very much a recluse before. I feel so happy” now.
Although the medical advances already have improved the lives of many transsexuals, the promise for the future is even greater. “We are not finished with our work,” said Gilbert in Norfolk. Still eluding his medical team is finding a device to help female-to-male patients have sex without the use of prosthetic rods.
Because of these problems, some females who are coming forward for mastectomies and other types of gender surgery are still hesitating to go ahead with the genital surgery until the next generation of surgical technique arrives.
Johns Hopkins’ Money said his “science fiction” solution for trans-gender problems envisions a time in the next century when the new growth factors that have recently caught the attention of the medical world can be used in revolutionary new ways. One could be to medically treat a grown female in such a way that her genitalia would regress and her body would re-make itself as a male.
He emphasized this is in the realm of the fantastic now.
