Sex-Change Surgery In American Hospital

Press, Volume CVI, Issue 31224, 23 November 1966, Page 26

Sex-Change Surgery In American Hospital

(N.Z. Press Assn.—Copyright I NEW YORK, November 20. The Johns Hopkins Hospital has begun performing sex-change surgery, the “New York Times” News Service re-

ported today. Although the controversial surgery has been performed in many European countries in the last 15 years and by a few surgeons in America, Johns Hopkins, Baltimore, is the first American hospital to give it official support. Two operations have already been performed, the first last September, and the second last month. Both subjects were males, one white and one negro, in their 20s.

In the male-to-female operation, which takes three and a naif to four hours, the external genitals are removed and a vaginal passage created. Female hormone treatments before and after surgery gradually reduce secondary sexual characteristics such as body hair, and enhance feminine appearance through breast development and the widening of the hips. About 10 per cent of the 100 applications received by the hospital have been from women, on whom a transformation operation can also be performed. The men and women who seek sex change surgery are called trans-sexuals. They are almost always physically normal, but they have a total aversion to their biological sex that dates from early childhood. • They have the apparently unshakeable conviction that they are either female beings trapped in a male body, or males trapped in a female body. The over-riding desire in the case of men is to be accepted as women. For this reason, psychiatrists believe, they are often sexually inactive before surgery because of their distaste for homosexual relationships. Although trans-sexuals frequently assume the identity of the opposite sex without surgery, they are distinguished from transvestites, who derive pleasure from wearing the clothing of the opposite sex but have no desire for a sex change. While opinion is not unanimous, many leading psychiatrists and psychoanalysts who have examined transsexuals believe that they cannot be helped by psychotherapy. Such persons, moreover, are

regarded as prone to mental breakdown and depression, suicide and, occasionally, selfmutilation.

The Johns Hopkins clinic examines only two patients a month. There already is a long waiting list. Applicants receive a thorough physical and mental examination that costs 100 United States dollars. Only those who show signs of psychosis and appear to have a degree of insight into their condition are accepted.

To reduce the chance of poor adjustment to the new sex after surgery, the committee considers only subjects who are already living entirely as women and receiving female hormones. A number of psychiatrists familiar with the subject regard the majority of transsexuals as emotionally normal except for their gender confusion, which leads to intense feelings of frustration. After surgery and about two weeks of hospital care, the over-all cost of which averages about 1500 United States dollars, the patient is asked to make himself available for further study at the hospital. Also, to retain external female characteris-

tics, he must continue receiving female hormones. Some psychiatrists believe that trans-sexualism is caused by prolonged conditioning early in life, perhaps within the first three years.

The causes seem obvious in cases in which a mother wanted a daughter instead of a son and raised her child accordingly, but the origin of others is obscure.

There appear to be no known cases in which the subject of sex transformation surgery has expressed regrets later. Nor do there seem to be many cases of serious postoperative complications.

Many males who were operated on have obtained new birth certificates giving their sex as female, thus freeing themselves from the possibility of arrest as transvestites. State laws and procedures. however, differ widely.

A large number have also married, in some cases to men who are unaware of their previous life. The operation permits the subjects to have ostensibly normal sexual relations, although they cannot have children. In the case of women who wish to become men, the transformation surgery includes a hysterectomy and breast removal.