Surgery: A Body to Match the Mind

When ex-G.I. George Jorgensen went to Denmark and returned, after a series of operations, as “Christine,” the U.S. public and medical profession alike were appalled at what seemed to be “mutilative surgery.” Attitudes have changed so much since 1952 that last year a Baltimore court ordered Johns Hopkins surgeons to perform an identical operation on a 17-year-old boy. And last week the university announced that it has opened a center for the diagnosis and treatment of transsexuals. Hopkins surgeons have already operated on five men and five women.

Emotional Crossover. The longtime champion of these unhappy people is Berlin-born Dr. Harry Benjamin, 81, who swings his practice between Manhattan and San Francisco. It was he who coined the word transsexual, and his new book, The Transsexual Phenomenon (Julian Press; $8.50), is already the standard reference on the problem. It is of prime importance, says Dr. Benjamin, to define what a transsexual is not. He is not a hermaphrodite, to whom a cruel quirk of nature has given some of the organs of both sexes. He is not a pseudohermaphrodite, with the organs of his own sex so unusually formed that they are mistaken for those of the other. He is not a homosexual in the accepted sense. He usually has a normal male physique, but feels emotionally like a woman. The converse criteria apply to the masculine-oriented woman. Both types of transsexuals are likely to be transvestites, preferring the clothing of the “opposite” sex.

There is no explanation in heredity or hormones. A possible cause in some cases is that a boy was born when his mother wanted a girl, and she treated him as a girl. By adulthood, says Dr. Benjamin, the crossover of emotion and thought may be so deeply ingrained that “true transsexuals feel that they belong to the other sex, they want to be and function as members of the opposite sex, not only to appear as such.” Psychiatric treatment, including long-continued analysis, has proved virtually worthless to patients who do not want to be changed emotionally, leading Dr. Benjamin to conclude: “Since the mind of the transsexual cannot be adjusted to the body, it is logical and justifiable to attempt the opposite, to adjust the body to the mind.”

Radical Procedures. Adjusting the body means, for the male transsexual, castration and the creation of an artificial vagina. For the female, it means enclosing the urethra in a pseudo penis (which is not capable of intromission) and reducing the breasts. These procedures are so radical that most U.S. surgeons have been reluctant to try them. Among Dr. Benjamin’s 152 transsexual patients, only 51 have had surgery, and nearly all have had that surgery outside the U.S.

Last week’s announcement from Johns Hopkins marked the first time that a prestigious medical center has risked its reputation to give organized help to transsexuals, who are estimated to number 2,000 or more in the U.S. They are probably about evenly divided between men and women, according to Hopkins Psychiatrist Norman J. Knorr, but more men than women ask for, and get, sex-changing surgery.

Dr. Benjamin and the Hopkins group, of which Surgeon John E. Hoopes is chairman, emphasize that they are not interested in simply transforming a male so that he can more nearly simulate a female sex partner. They are concerned with the entire health and personality of the crossover deviate, whom they maintain on hormone treatments for the rest of his, or her, life. Dr. Benjamin evaluates the results in his 51 patients as: good, 17; satisfactory, 27; doubtful, 5; unsatisfactory, 1; and unknown, 1. As evidence of good results, he cites twelve formerly male patients who have married successfully as women; some have achieved motherhood by adoption.

Dr. Benjamin admits that many patients remain disturbed after the operation, but he insists that they are better off than before. He contends that if a miserable male transsexual can be happier as a woman, society benefits as well as the individual. Hopkins Surgeon Milton T. Edgerton Jr. says: “We’re not sure yet that we are on solid footing. We’re still looking for the best ways to bring these patients full relief.”