A Brief Look at the History of Medicalising Sex & Gender — Part Two
The INTENTIONAL GROWTH of the Gender Identity business from the 1960’s to the the 1980’s — Charing Cross Hospital Gender Identity Clinic & Harry Benjamin & creating the WPATH monste
The INTENTIONAL GROWTH of the Gender Identity business from the 1960’s to the the 1980’s — Charing Cross Hospital Gender Identity Clinic & Harry Benjamin & creating the WPATH monster
Harry Benjamin, (born Jan 12, 1885, Berlin, — died August 24, 1986, New York City
German-born American endocrinologist and sexologist known for his pioneering role in “recognising” transsexuality and developing medical interventions for transsexual and transgender individuals.
Benjamin earned a medical degree in 1912 from the University of Tübingen. The scientific study of sexuality, though not a part of his formal medical training, was one of Benjamin’s early interests, and his understanding was strengthened through his friendship with Magnus Hirschfeld, one of the founding fathers of sexology. Benjamin relocated to New York in 1913 and started a private medical practice there. His work concerned the treatments to reverse the aging process and was especially concerned with sex hormones.
Benjamin earned a medical degree in 1912 from the University of Tübingen. Benjamin relocated to New York in 1913 and started a private medical practice there. His friendship with Magnus Hirschfeld, one of the founding fathers of sexology, peaked Benjamin’s interest in the field.
He was a proponent of the so-called Steinach vasoligation, a partial vasectomy procedure devised by his mentor, the Austrian endocrinologist Eugen Steinach, and billed as a means of restoring a patient’s youthful energy and sexual potency.
Benjamin’s politics also brought him into the circle of sexual radicals active at the time, including Margaret Sanger John Money and Alfred Kinsey.
Eugen Steinach — research on the roles of sex hormones and developing hormone drugs.
He experimented on rats by removing their testicles and implanting them elsewhere in their bodies, and he found that the testes interstitial cells produce male sex hormones. He developed the Steinach Rejuvenation Procedure, which he claimed could rejuvenate men by increasing their production of sex hormones.
Steinach — “placebo sexual libido” — By the 1920s, rejuvenation procedures were common. In 1920 greater than one-hundred male scientists, physicians, and professors in Vienna underwent the Steinach Rejuvenation surgery in an attempt to improve sexual health.
Steinach found that the results varied. Many men had invigorated libidos, yet some reported no effects or negative outcomes. Steinach’s results caused researchers and doctors to doubt the procedure and its underlying theories. Some scientists said that positive results could relate to autosuggestion or placebo effects. Others claimed that the science behind the procedure was inaccurate, but still said that the procedure had some medical benefits.
Steinach’s work on female sex hormones and on ovarian extracts led to the development of the first standardised injectable oestrogen. Steinach’s research on reproductive hormones helped researchers explain the roles of sex hormones and develop hormone drugs.
Steinach began discussing ideas and theories with Sigmund Freud, whom he had met while they were both university students.
Steinach — “Conversion of Homosexuality through Exchange of Puberty Glands” — In 1912, Steinach began experimenting with the transplantation of sex organs from the opposite sex in animals. In those experiments, Steinach castrated infant male guinea pigs and implanted ovaries in them. He repeated that process with infant female guinea pigs and implanted testes in them after removing their sex organs. He found that male guinea pigs developed female sex characteristics, like milk-producing nipples, and were pursued by normal male guinea pigs.
In 1918, Steinach began working with a urologist in Austria, on the subject of hormones and homosexuality. Steinach and Lichtenstern published the paper “Conversion of Homosexuality through Exchange of Puberty Glands,” in which they discuss an experiment where Lichtenstern replaced the testes from homosexual men with those from heterosexual men.
The testes transplanted from the heterosexual men were undescended third testes that doctors had removed surgically. After the transplantation, Steinach and Lichtenstern observed the homosexual man’s sexual tendencies. They concluded that, after implantation, heterosexual tendencies replaced homosexual tendencies.
Steinach — “the pituitary gland & corpus luteum with Heinrich Kun — After a period during which Steinach studied the pituitary gland with Heinrich Kun, Steinach returned to studying female hormones in 1931. Steinach experimented with the corpus luteum, a hormone secreting structure produced in the ovary after discharge of the ovum in female mammals. The corpus luteum is involved in producing hormones during the menstrual cycle, the luteal hormones, and disappears in a few days unless fertilization occurs. He found there were two luteal hormones, one that was female-specific, which affected the uterus, and the second present in both sexes and affected masculine characteristics
The corpus luteum forms from the empty follicle left behind after ovulation. It is the last active stage of an ovarian follicle’s lifecycle. Without it, early pregnancy cannot be maintained. The corpus luteum doesn’t get enough credit for the important role it plays in the menstrual cycle and pregnancy. The corpus luteum is actually a temporary gland structure. It secretes the hormones estrogen and progesterone to prepare the body for the possibility of conception. These hormones help build up the lining of the uterus (to form a nice bed for the egg to implant into) and help maintain that lining. If conception does not take place, the corpus luteum begins to break down. This leads to a drop in progesterone and estrogen, which triggers menstruation.
Harry Benjamin & Kinsey — Links — Kinsey will be covered in more detail in a future video
In 1948 Kinsey recommended a patient to Benjamin. Born male, the patient expressed an acute desire to become a woman. At the time, the recommended treatment for individuals such as Benjamin’s patient was psychoanalytic therapy aimed at making the mind fit the body.
Benjamin, however, was unconvinced of the effectiveness of that approach. Seeing gender identity on a continuum, he believed that some people could be born male but feel female and that the more-sensible treatment would be alter the body to better fit the patient’s perceived gender. He counseled the patient to travel to Europe, where surgeons performed one of the earliest gender-reassignment operations.
Benjamin ultimately gained a reputation among people seeking to change their sex as a medical expert sympathetic to their plight. In the 1950s Benjamin helped found the Society for the Scientific Study of Sexuality. In 1966 he published The Transsexual Phenomenon, which drew on his work with clients who had a variety of “sexual disorders.” He argued that transsexuals were a group distinct from transvestites (heterosexual men who derived sexual pleasure from dressing in women’s clothing but who did not wish to become women) and homosexuals. While he acknowledged that overlap between groups was certainly possible, he argued against collapsing them into one category of “sexual pathology,” as each condition required a different treatment approach.
In The Transsexual Phenomenon, Benjamin also challenged the dominant psychological treatment of transsexuality. He argued that psychoanalysis did not lessen the desire to change sex; it simply forced patients to go underground with their desires and lead miserable lives. Benjamin instead advocated that transsexuals be given hormones for the sex they wished to become in an attempt to fit the body with the mind. Benjamin also advocated surgery for patients deemed by medical experts to fit the diagnostic criteria for transsexuals. Benjamin’s views positioned him as a maverick in the medical community.
However, his treatment approach to transsexuality eventually gained precedence over psychoanalysis. In the 1970s Benjamin formed what later became the Harry Benjamin International Gender Dysphoria Association (HBIGDA), an association of therapists and psychologists. HBIGDA devised a set of “standards of care,” largely derived from Benjamin’s case studies, that sanctioned the criteria and diagnostic procedure for transsexuality. (In 2007 HBIGDA became the World Professional Association for Transgender Health.(WPATH) Although those care standards came under fire in the early 21st century by transgender activists who saw them as creating regulatory systems of gender, they continued to be seen as legitimate guidelines for the treatment of gender dysphoria — also known as gender identity disorder — the formal psychological diagnosis for transsexual and transgender individuals.
Paul A. Walker, PhD 1979–1981, HBIGDA’s founding president ran a private practice in San Francisco, serving as psychologist for transgender patients for many years. He began a sex offender treatment program at the University of Texas Medical Branch in Galveston, TX, and ran the Gender Clinic there. After receiving a doctorate in social psychology from the University of Rochester in 1976, he performed research at Johns Hopkins in collaboration with John Money. Dr Walker passed away in 1991.
Donald R. Laub, MD 1981–1983 (discussed in Part One) is a plastic surgeon and the second president of WPATH (née The Harry Benjamin International Gender Dysphoria Association). Don was Associate Professor (now Adjunct Clinical Professor) of Surgery, Stanford University School of Medicine. In the course of research, teaching, and patient care for gender dysphoria, he studied whether the condition labeled 302.85 DSM-5 was a bonafide condition appropriate for study at a major university. Specifically, it was the issue of whether a treatment for this condition was helpful. In the course of this patient care, research and teaching, he managed about 2,000 patients, himself evaluating and treating, along with other members of the Gender Dysphoria Program Committee. Many were accepted into the program which was run both by Stanford University and the Palo Alto Gender Dysphoria Program, of which he was the President. The committee consisted of faculty members, behavioural scientists, social workers and plastic surgeons. This committee drew heavily from multidisciplinary expertise in urology, gynecology, endocrinology, general surgery, and consultations on most patients.
In the course of surgery, he invented and popularized three operations: rectosigmoidvaginoplasty (the “Rolls Royce Vagina”), metoidioplasty (using female tissues with hormones to form male structures), post-modern phalloplasty (fasciocutaneus fat and skin, from the abdomen tubularized to form the shaft of the penis). It was made sensitive using a microsurgical nerve transfer from the erotic nerve in the lower abdomen. The placement of a removable silicone urinary assist device (UAD) and also an implanted erectile device, completed the final two functions of urination and sexual intercourse. He did this work without a grant from anyone. In teaching, the experience was helpful to plastic surgery residents and visiting faculty because a very large number of basic plastic surgery techniques were taught.
He organized two international gender conferences at Stanford University and two others in Bordeaux, France, and New York City, New York. He was a member of the organizational committee to found The Harry Benjamin International Gender Dysphoria (HBIGDA). He was one of the authors of the Standards of Care (SOC) developed by HBIGDA for the management of gender dysphoria. He presented over 50 times at the HBIGDA biennial symposia. HBIGDA, now WPATH, contributed different opinions. These opinions provided the basis for a never-to-be-forgotten set of principles for everyone involved. “In retrospective review, we found that the patients were not harmed.”
Milton T. Edgerton, MD 1983–1985 has played a pivotal role in the history of plastic surgery at Johns Hopkins. After earning his medical degree at Johns Hopkins and serving as captain in the U.S. Army Medical Corps, Dr. Edgerton returned to Johns Hopkins in 1951, completed a residency in surgery and, following his term as the first official resident in the division of plastic surgery, he became board certified in both surgery and plastic surgery that same year. While serving under Dr. Alfred Blalock, Dr. Edgerton established the Division of Plastic Surgery and also created the Johns Hopkins Plastic Surgery Training Program, which he directed until 1971. Dr. Edgerton served as the first full-time chief of plastic surgery and plastic surgeon-in-chief, in addition to holding the position of professor of plastic surgery. After 16 years at Hopkins, he became chairman of the Division of Plastic Surgery and then chair of the Department of Plastic and Maxillofacial Surgery at the University of Virginia Medical Center where he remained for the duration of his career.
“Edgerton was ahead of his time in sponsoring Transgender Surgery and created a unique multidisciplinary clinic, perhaps the first university to offer these services in the U.S.” He would continue this work at the University of Virginia after 1970. Within the first two years of its Hopkins existence, 8 other centres asked Edgerton for consultative assistance in initiating their programs. The Hopkins clinic was closed for a period after his departure, then re-opened in 2017, attributing Edgerton’s visionary founding of these services to being a ‘surgeon ahead of his time’
Gender Identity
In 1975 psychiatrist Robert Stoller of the University of California, Los Angeles, wrote something bizarre in his textbook on sex and gender. He asserted that people who were assumed to be boys when they were born but whose gender identity or expression did not match that assumption “oftenhave pretty faces, with fine hair, lovely complexions, graceful movements, and — especially — big, piercing, liquid eyes.”Based on this observation, he suggesteda theoretical model in which transgender girls become transgender because they are especially cute. Society treats them more like girls, he reasoned, and because of this experience, they start to identify as female.
“Gender is a term that has psychological or cultural rather than biological connotations. If the proper terms for sex are “male” and “female,” the corresponding terms for gender are “masculine” and “feminine”; these latter may be quite independent of (biological) sex. Gender is the amount of masculinity or femininity found in a person, and, obviously, while there are mixtures of both in many humans, the normal male has a preponderance of masculinity and the normal female a preponderance of femininity. Gender identity starts with the knowledge and awareness, whether conscious or unconscious, that one belongs to one sex and not the other, though as one develops, gender identity becomes much more complicated, so that, for example, one may sense himself as not only a male but a masculine man or an effeminate man or even a man who fantasies being a woman. Gender role is the overt behavior one displays in society, the role which he plays, especially with other people, to establish his position with them insofar as his and their evaluation of his gender is concerned. While gender, gender identity, and gender role are almost synonymous in the usual person, in certain abnormal cases they are at variance. One problem that arises to complicate our work is that gender behavior, which is for the greatest part learned from birth on, plays an essential part in sexual behavior, which is markedly biological, and at times it is very difficult to separate aspects of gender and sex from a particular piece of behaviour.
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