The Riddle of Gender

by Deborah Rudacille

  The effects of hormones were also very much on the mind of another New Yorker at that time. In 1948—the year that Harry Benjamin met his first transsexual patient—George Jorgensen, Jr., enrolled at the Manhattan Medical and Dental Assistants School, in New York City. Frustrated by his inability to understand the French and German medical treatises on “hermaphrodism” and “pseudo-hermaphrodism” he found in the library at the New York Academy of Medicine, Jorgensen stubbornly sought another route to self-understanding. “Still determined to find some cure or satisfactory compromise for what I considered an emotional and sexual disorder, I enrolled at the Manhattan Medical and Dental Assistants School,” Christine Jorgensen wrote in 1967. At the school, Jorgensen learned to perform chemical analyses of blood and urine, and studied the principles of basal metabolism.

  “However, it was the rare glandular disturbances which intrigued me more. Abnormal growth due to pituitary malfunction, steroids, enzymes, and sex hormones were all new areas of knowledge, but ones which I felt had some bearing on my own problem. Avidly, I discussed glands and glandular disturbances with the doctors who were my instructors,” Jorgensen writes. “These studies occupied my every waking moment, and probably many of my sleeping ones to become an all-consuming drive.”

  Shortly after beginning studies at the school, Jorgensen received another in a series of propositions from gay men, in this case a Danish sailor, at a dance. Disturbed and confused by the desire he inspired in gay men, the student of medical technology turned for comfort to Paul de Kruif’s book, The Male Hormone, which points out that the chemical difference between testosterone and estradiol is merely a matter of four atoms of hydrogen and one atom of carbon. “If Dr. de Kruif’s chemical ratio was correct, it would seem then that the relationship was very close,” Jorgensen writes in her autobiography. “That being so, I reasoned, there must be times when one could be so close to that physical dividing line that it would be difficult to determine on which side of the male-female dividing line one belonged.” Jorgensen decided that she belonged on the female side, and a few days later she walked into a pharmacy “in an unfamiliar part of town” and requested a hundred tablets of high-potency estradiol. At first, the clerk was unwilling to hand over the hundred tablets of ethynyl estradiol without a prescription, but when Jorgensen claimed to be a medical technology student “working on the idea of growth stimulation in animals through the use of hormones,” the clerk relented. “Once out of the store, I headed for the car and unwrapped the package,” Jorgensen writes. “How strange it seemed to me that the whole answer might lie in the particular combination of atoms contained in those tiny, aspirinlike pills.”

  Although estrogen hadn’t received quite the same star treatment as testosterone in the press, research on female hormones had been proceeding in tandem with testosterone research throughout the first decades of the century. In 1923 and 1924, the zoologist Edgar Allen and the biochemist Edward Doisy published papers describing the induction of sexual maturity in young female animals through injections of “the ovarian follicular hormone.” They called the newly purified hormone “Theelin,” a name that was dropped in favor of “oestrin” in 1926. In 1929, various researchers—including Allen and Doisy; Thayer and Veler in the United States; and Adolf Butenandt in Germany—succeeded in isolating oestrin in crystalline form. This pure crystalline oestrin was called “estrone.” One year later, a researcher named Zondek discovered that the urine of pregnant mares was a rich source of the hormone. In 1932, at the International Conference on the Standardization of Sex Hormones, in London, the names “oestrone,” “oestriol,” and “oestradiol” were adopted, and in 1938, chemists working for the German pharmaceutical company Schering developed ethynyl estradiol, the first orally active estrogen. In 1939, diethylstilbestrol, a highly potent synthetic estrogen, was developed and marketed in Germany, and after review by the Food and Drug Administration, in the United States. By 1941, a pill made from conjugated estrogens collected from pregnant mares (Premarin) was being marketed in Canada, and a year later in the United States.

  In tandem with these advances, scientists learned that women’s urine contained the “male” hormone, testosterone, and the urine of men contained the “female” hormone, estrogen. Though the proportions were different, both sexes produced both male and female hormones. One researcher commented on the baffling discovery by noting that “the present wonder is not that intersexual conditions occur, but that the balance of endocrine factors usually comes down on one side or the other to produce a recognizable male or female—perhaps in these days, I should say, a more or less recognizable male or female.”

  Within two weeks of beginning daily doses of ethynyl estradiol in 1949, Jorgensen noticed physical effects (“sensitivity in my breast area and a noticeable development”) and emotional ones. “The great feeling of listlessness and fatigue, which often seemed to be with me even after a full night’s sleep, had disappeared. I was refreshed and alive and no longer felt the need to take little cat naps during the day.” Encouraged by these results, Jorgensen speculated that “if the female hormones that I was taking without guidance could have such a pronounced effect on me, would it not be possible for an expert to administer them in proper proportions, so that my body’s chemistry would be in complete and correct balance?”

  Jorgensen craftily confessed her secret to a fellow student, Gene-vieve Angelo, whose husband was an M.D. The friend arranged an appointment with her husband, Dr. Joseph Angelo, and after weeks of discussion and research in medical journals, Dr. Angelo agreed to supervise the estrogen administration. “It was his plan to retreat and use strong doses of testosterone, thereby returning me to my original maleness, if the estrogen injections had proven unsatisfactory,” Jorgensen writes. Around the same time, she received a letter from a Connecticut physician whom she had consulted a few years earlier, who pointed out “the course of treatment that you requested” (sex-change surgery) had been carried out in Sweden. Soon after finishing the course at the medical technician’s school, in December 1949, Jorgensen decided to visit family and friends in Denmark, and to proceed from there to Stockholm, “where I hoped to find doctors who would be willing to handle my case.”

  Arriving in Denmark in May 1950, Jorgensen discovered that there was no need to go to Sweden. Instead, in July, she visited the Statens Seruminstitut, in Copenhagen, searching for Dr. Christian Hamburger, a prominent endocrinologist who had published a number of hormone studies. Learning that he was on vacation in the country, the impatient young American sought him out at home and, after pouring out “the whole story of my perplexing life,” asked him point-blank “if he thought I was a homosexual.” Hamburger replied negatively, and when pressed for an explanation, told Jorgensen that “the trouble is very deep-rooted in the cells of your body. Outwardly, you have many of the sex characteristics of a man. You were declared a boy at birth and you have grown up, so very unhappily, in the guise of a man. But inwardly, it is quite possible that you are a woman. Your body chemistry and all of your body cells, including your brain cells, may be female.”

  This theory, which had its roots in Steinach’s guinea pig experiments and subsequent animal experimentation, remained untested in humans—even though, by 1950, rudimentary “sex change” surgeries had already been carried out in more than one European country, on both male-bodied and female-bodied individuals. But European views on these matters were not generally accepted, or well-advertised, in the United States. Meanwhile, in Denmark, Dr. Hamburger was looking for a human guinea pig, and he found one in the young American who had traveled to Europe to seek the knowledge and understanding that he hadn’t been able to find at home. It was a fateful meeting. Jor-gensen recalls Hamburger’s proposal in her autobiography. “There are several questions about the interaction of the hormone which are not quite clear now and I am very much interested in having you help me clear up these complicated matters. They can only be accomplished by observing a person over long periods of time. Since the
y are based on urinalysis, it will be necessary to collect specimens carefully, for several months or even a year, each and every day. You must guarantee you will cooperate fully in this, and be very accurate.” Anxious for help, the young American agreed to become Hamburger’s research subject.

  The first stage of the treatment involved discontinuing the oral doses of estradiol, and beginning a rigorous regimen of fluid collection. Hamburger’s young patient was instructed to save every drop of urine excreted. “Thus began a period in my life when I was never to be without a two-quart bottle, discreetly concealed in a black bag,” Jor-gensen writes. “I began to refer to it jokingly as my yor mor taske, which means ‘midwife’s bag’ in Danish.”

  After Hamburger had established baseline levels of male and female hormones in Jorgensen’s body by running tests on the urine, he began injections of high-potency estrogen. “The first few injections brought my energy back up a startling rate,” Jorgensen reports. The injections were then replaced by the administration of much higher oral doses of estrogen. “By these methods of hormone administration, the male complement of my system was being suppressed into a slumbering state. I was undergoing what medical experts called a ‘chemical castration.’”

  It was during this period that Jorgensen had her first plastic surgery—one that had nothing to do with sex but that corrected a condition that she had found a source of annoyance all of her life. She had her “prominent” ears, a source of lifelong teasing, pinned back.

  Miraculously, the complex I’d had for years disappeared almost overnight. I regarded it as a small victory, as it was the first conquest of one of the things I disliked about myself.” At the same time, the high doses of estrogen were “imparting added weight in the hips and some bust development,” without any adverse effect on the pituitary—one of the doctor’s concerns. Most important of all to Jorgensen, “when the male chemistry was inert, I became alive and vigorous and felt fully capable of meeting my responsibilities and problems with competence.”

  After five months, the doses of estrogen were halted so that the experimenters could assess their subject’s reaction to the withdrawal. “The hormone tablets were discontinued for several weeks and I was upset physically and mentally as the male hormones, no longer suppressed, took over again. Almost at once the old fatigue and disturbing emotions returned,” Jorgensen reports. Around this time, Hamburger sent his patient to see Dr. George Sturup, a psychiatrist. Sturup’s job was to find some psychological explanation for his patient’s desire to become a woman, some “childhood trauma or emotional aberrations that would give me the cause.” He never found one, and later told Jorgensen, “I felt you could not be cured, psychologically. After many visits, it was finally clear to me.” Jorgensen’s physicians then applied to the Ministry of Justice for permission to surgically castrate their patient. Sturup applied to the Medico-Legal Council of the Ministry, submitting his findings together with those of Hamburger and the other physicians who had consulted on the case. Jorgensen too was asked to submit a letter, stating why the surgery was being requested. She closed the letter with a poignant plea, not only for herself but also for the unknown others who shared the mysterious condition, which her doctors were alternately calling “genuine transvestism” and “psychic hermaphroditism.” “To return to my old way of life would destroy all my hopes and ambitions as well as my body. This operation would not only be helping me, but perhaps open a whole new field of investigation for similar cases. If you could really realize how desperately we, of my kind, need help.”

  The last hurdle to surgery was cleared when Helga Pederson, the attorney general of Denmark, brushed aside the reservations expressed by the Ministry of Justice about performing a castration on someone who was not even a citizen of Denmark. The operation was performed on September 24, 1951. Soon after the surgery, Jorgensen wrote to the Angelos, “As you can see by the enclosed photo, taken just before the operation, I have changed a great deal…. Half the time, people in shops call me ‘Miss’ or ‘Mrs.’ and it doesn’t embarrass me because I’m not afraid of people anymore.” As the months flew by and autumn turned to winter and then to spring, Jorgensen continued her daily visits to the Seruminstitut and her consultations with Dr. Hamburger. In May, she visited the American Embassy in Copenhagen for another momentous step—changing her sex on her passport. Presenting letters from her doctors and the Ministry of Justice, Jorgensen was greeted cordially by Mrs. Eugenie Anderson, the American ambassador to Denmark, who inquired what name Jorgensen wished to submit to Washington for the new passport. “I admit the question didn’t take me by surprise, for I’d given it much thought in the previous year and to me the choice was a logical one. Dr. Hamburger was the man to whom I owed so much, above all others. I transposed his first name, Christian, into the feminine Christine, a name which I’d always thought attractive. Thus, my new name of Christine Jorgensen.”

  When the new passport arrived, Jorgensen “felt free at last to take my place in the outside world,” and for the first time appeared in public in feminine attire. In June, she wrote “the most important letter of my life,” to her parents, which a visiting aunt promised to hand-deliver. In the letter, Christine first tells her parents that she is “happier and healthier than ever before in my life,” before offering a brief lesson in endocrinology. In a famous phrase, reprinted months later in hundreds of newspapers, she says, “Nature has made a mistake, which I have corrected, and I am now your daughter.” The shocked but supportive Jorgensens responded with a telegram: “Letter and pictures received. We love you more than ever. Love, Mom and Dad.”

  In November 1952, Christine once again entered Rigshospital, in Copenhagen, for the second stage of her transformation, which she defined as “removal of the immature sex organs,” or penis. Ten days after the surgery, as she lay recuperating in her bed, she was handed a telegram by a young woman who identified herself as a reporter for Information, a Danish newspaper. “Filled with a kind of unknown dread, I reached out to take it from her hand, and read the message: BRONX GI BECOMES A WOMAN. DEAR MOM AND DAD SON WROTE, I HAVE NOW BECOME YOUR DAUGHTER.” A family friend, someone to whom her parents had confided their secret, had sold the story to the newspapers.

  “To me that message was a symbol of a brutal and cruel betrayal,” Jorgensen writes years later. “A lifetime of agonizing unhappiness, two years of medical treatment and two surgical operations had been telescoped into a couple of succinct lines on a telegraph form, and I knew without being told that it would go far beyond that hospital room.” By the time the twenty-four-year-old photographer returned to the United States, in February 1953, after two life-transforming years abroad, she was arguably the most famous person in the world. More news stories were filed on Christine Jorgensen in 1953 than on any other single individual or event. A private decision, arrived at after much soul-searching and struggle, had become a public scandal.

  One of the people who read about Jorgensen’s surgery in the New York newspapers was Harry Benjamin, but unlike most Americans, Benjamin was not surprised. Beginning in the thirties, he had begun spending his summers in San Francisco, living at the Sir Francis Drake Hotel and seeing patients in the office building across the street. In 1945, he met the American sex researcher Alfred Kinsey, and like many other friends and colleagues, had his sex history taken by the Kinsey researchers. In 1948, while conducting interviews at the hotel, Kinsey met a young man who “wanted, as he said, to become a girl, and his mother supported him in this. Kinsey had never seen a case like this, and it was new even for me,” Benjamin recalls in an interview years later. “It went well beyond the by then recognized transvestism. The concept of transsexualism did not yet exist. It only gradually took shape in my thinking, not least because of this first case.”

  Like Jorgensen, this patient (referred to as “Barry” in Benjamin’s case studies) had from his earliest childhood felt that he was in fact a girl, and after reading about “operative procedures which feminized men” had “p
ressed his parents to find a surgeon who performed such operations.” Unlike Jorgensen, however, Barry became emotionally disturbed when he was unable to fulfill this desire and had been institutionalized by the courts when his frustration erupted into violence.

  Barry was taken by his parents to see Alfred Kinsey in 1948, when the famous sex researcher was taking case histories at the Sir Francis Drake Hotel. Kinsey, whose previous research had not prepared him for Barry, sent the boy to Benjamin, then seeing patients in the same hotel.

  “Benjamin’s first inclination was to send the boy to a psychiatrist, but he soon discovered that this was not a good idea,” says Christine Wheeler. When asked whether or not castration and peotomy were indicated for the “very effeminate” boy, “the psychiatrists disagreed among themselves,” Benjamin says. “Some were for it, others were against it.” He started the boy on a course of hormones, which “had a calming effect,” but was unable to find a urologist in the United States willing to perform surgery. He advised the boy (and his mother) to travel to Germany for the operation.

  When the Jorgensen story broke, in 1953, Harry Benjamin was sixty-seven years old and looking forward to retirement. He had enjoyed a long and a productive career, and as his geriatric patients died, he stopped acquiring new ones. He recruited Virginia Allen, a doctor’s wife whom he had met at a meeting a few years earlier, to help him slowly phase out his practice. “He invited me for drinks at the Sulgrave Hotel and told me he felt he had only a few years left and wanted to spend them quietly in a retirement practice,” Allen recalled at the memorial that was held following Benjamin’s death, in 1986. However, things didn’t work out quite the way that Benjamin had planned.