How Sex Changed: A History of Transsexuality in the United States (review)

Though there are many themes and subthemes running through this outstanding book—including brief biographies of several transsexuals, and debates within the transsexual community itself—the one that is probably of most interest to readers of this journal is the necessary and often reluctant involvement of physicians and surgeons. There have always been individuals who believed that somehow their anatomical sex did not match their image of what they should be, and who petitioned surgeons to operate to correct what they felt was a mistake of nature. Not only were such requests a challenge to traditional ideas of sex, but the issue was further complicated by a lack of definition of what constituted transsexualism, and what distinguished it from homosexuality and lesbianism as well as transvestism.

Joanne Meyerowitz traces the changes in attitudes among medical professionals, and the establishment of a separate diagnostic category. The beginnings of change took place at the start of the twentieth century in the German-speaking medical community, where it was speculated that sex was more complicated than the genitalia one was born with and that there were infinite gradations. Giving impetus to this new theory were physicians such as Otto Weininger, Wilhelm Fleiss, Magnus Hirschfeld, Sigmund Freud, and particularly Eugen Steinach. Some of the researchers, such as Steinach, experimented with the effects of castration and ovariectomy on animals, and occasionally even on willing human subjects. Magnus Hirschfeld went further and performed sex-change surgery in his clinic in Berlin; his first complete genital transformation was on Dorchen Richter, who underwent a series of operations between 1922 and 1931 to become a woman. A handful of other operations also took place, and it was quickly realized that the availability of hormone injections was a crucial factor in success. The destruction of Hirschfeld's clinic in 1933 by the Nazis did not end such surgical intervention, but the cases were rarely publicized.

The American medical community either dismissed the topic or, if they knew about surgical sex changes, opposed such intervention. The major exception was the physician Harry Benjamin, who had worked briefly with Hirschfeld and Steinach before settling down in the United States after World War I. Benjamin, however, originally was regarded by many of his contemporaries as somewhat on the fringe of medicine, and some even labeled him a quack. Even Alfred Kinsey ignored the subject in his books and only began serious research on the topic in the 1950s.

Though the American tabloids occasionally reported sex changes (and Meyerowitz examines them), it was the case of Christine Jorgensen in December 1951 that created a media explosion. Why other cases were ignored and Jorgensen publicized is something that Meyerowitz attempts to explain, but the answer is still unclear; perhaps, as Jorgensen herself said, if it had not happened to her it would have happened to someone else because the time was ripe. The publicity given to the case by the Hearst Press and the tabloids led to serious discussion at both the public and professional levels, and a number of medical schools established experimental centers to deal with transsexualism.

The medical-school development was taken by independent surgeons who wanted to enter the field as a sanction to proceed further, and it was to these surgeons that most of the transsexuals went for sexual reassignment surgery, partly to avoid the red tape associated with the university programs. Most of these enterprising surgeons were somewhat removed from the main population centers or were located in Third World countries. In the United States, for example, Stanley Biber, who made sex-change surgery the main industry in Trinidad, Colorado, had performed more than 3,800 surgeries by the end of the 1990s. A handful of these operators were not particularly qualified. One of the most notorious was John Ronald...