At the memorial, Virginia Allen recalled the day that she stumbled upon a cache of patient folders that she found particularly puzzling. “While arranging files one day, I asked, ‘What are these few records off by themselves? They seem so strange—the patients have male and female names.’ H.B. sighed, ‘They’re transsexuals and transvestites, some referred by Kinsey. Not much is known about them.’ ‘Why don’t we do something with them, since we have so much time,’ I asked. He nodded and said, ‘Yes, that may be very good. They are sad people and deserve help but they make everyone, even other doctors, so nervous and uncomfortable. Bring the records in here and we’ll go over them.’ And so it began.”
Benjamin began seeing patients referred by Kinsey and others, including a husband and wife who had been married to each other twice—the second time, in reversed-gender roles. His remaining geriatric patients were not happy about the new crop of patients, and his long-awaited retirement had nearly materialized when Christine Jor-gensen suddenly burst onto the scene, thoroughly upsetting his plans. In December 1952, Benjamin wrote to one of his transsexual patients, an artist named Doris, with whom he had carried on a long and animated correspondence: “The papers here are full of the Jorgensen case, the boy who went to Denmark to be operated on and is now coming back as a girl. I’ll probably see the party when she returns home.”
At the Benjamin memorial, in 1986, Christine Jorgensen described the circumstances under which the two pioneers had met. Returning home from Europe in 1953, she said, she “encountered a mountain of mail and I do mean a mountain—thousands and thousands of letters, many of which were from people who had problems that were similar to mine—in that mountain of mail was a letter from Harry Benjamin, whom I had never heard of before and he asked me—told me that he was guiding people and so forth in the direction of transsexuality. And would I contact him, which indeed I did.”
Describing Benjamin as a “godsend,” Jorgensen recalled that “I could recommend Harry to all these thousands of people who contacted me … because I didn’t know where to recommend people to go, there were no gender identity clinics, there was no place for them to go. So suddenly the deluge fell onto poor Harry’s shoulders.” And a deluge it was. When he met Christine Jorgensen, and began monitoring her hormones and later sending her to see Los Angeles urologist Elmer Belt for the final stage of her surgery, Benjamin had treated fewer than a dozen transsexual patients. By the time he finally closed his practice, twenty-five years later, in 1978, he had seen more than 1,500 patients. It sometimes seems that every transsexual person in America in the sixties and seventies somehow found their way to Benjamin’s office, even before the publication of The Transsexual Phenomenon, in 1966.
In The Transsexual Phenomenon, Benjamin seeks to dissipate some of the scientific and public ignorance shrouding the subject of gender variance. Early in the book he refers to Hirschfeld’s research on transvestism at the Institute for Sexual Science, but he quickly distinguishes transvestism and transsexuality as clinical entities.The transsexual (TS) male or female is deeply unhappy as a member of the sex (or gender) to which he or she was assigned by the anatomical structure of the body, particularly the genitals. To avoid misunderstanding: this has nothing to do with hermaphroditism. The transsexual is physically normal (though occasionally underdeveloped). These persons can somewhat appease their unhappiness by dressing in the clothes of the opposite sex, that is to say, by cross-dressing, and they are, therefore, transvestites too. But while “dressing” would satisfy the true transvestite (who is content with his morphological sex), it is only incidental and not more than a partial or a temporary help to the transsexual. True transsexuals feel that they belong to the other sex, not only to appear as such. For them, their sex organs, the primary (testes) as well as the secondary (penis and others), are disgusting deformities that must be changed by the surgeon’s knife. This attitude appears to be the chief differential diagnostic point between the two syndromes (sets of symptoms)—that is, those of transvestism and transsexualism.
Benjamin created a chart, the Sex Orientation Scale, based on the Kinsey rating scale for homosexuality. In the Kinsey Scale, a completely heterosexual person is ranked zero, and a fully homosexual person six. A person who is equally attracted by either sex would be a three. In the Benjamin scale of transvestism/transsexuality, there are six “types,” which together make up three “groups” of progressively gender-variant individuals. Group one includes the three types of transvestite (“pseudo,” “fetishistic,” and “true”), who cross-dress to varying degrees and for varying reasons. Only the final type, the “true” transvestite, expresses an interest in estrogen therapy or surgery, and this interest tends to be of an experimental nature.
Group two includes only one “type,” the “nonsurgical transsexual,” a person who “wavers between TV and TS,” cross-dressing “as often as possible with insufficient relief of his gender discomfort.” This non-surgical transsexual will be likely to request hormones for “comfort and emotional balance,” Benjamin writes, but while he finds the idea of sex-reassignment surgery attractive, he will not pursue it with the intensity of the latter two types (group three), “true transsexuals” of moderate or high intensity. These individuals tend to feel “trapped in the wrong body,” according to Benjamin, and will hope for and work for sex reassignment surgery. The major difference between these final two types is that the “true transsexual, high intensity” doesn’t just dislike his genitals; he despises them and may attempt to mutilate his sex organs or commit suicide if unable to achieve his goals.
Like Hirschfeld, Benjamin focuses mainly on male-bodied persons in his book, even though he knew and treated female-bodied persons as well. He does include a final chapter on “the female transsexual,” but as with Hirschfeld, his interest in these persons appears somewhat secondary. He notes that in his practice, the proportion of male-to-female transsexuals to female-to-male transsexuals is eight to one— though he defers to the three-to-one estimate of Christine Jorgensen’s physician, Christian Hamburger, based on the letters from around the world that Hamburger received after the Jorgensen case was publicized. Hamburger received 465 letters from individuals desiring sex-change surgery in the months following the Jorgensen media blitz, with three times as many men as women requesting help. Benjamin notes the paradoxical fact that though Gallup polls report that “in our culture about twelve times more women would have liked to have been born as men than vice-versa,” many fewer female-bodied persons requested sex-reassignment surgery.
Like male-bodied transsexuals, female-bodied transsexuals “resent” their sexual morphology—“especially the bulging breasts,” says Benjamin, noting that his female patients “frequently bind them with adhesive tape until a plastic surgeon can be found who would reduce the breasts to a masculine proportion.” Most of his female-to-male patients also requested a total hysterectomy, including removal of the ovaries, and treatment with androgens. The latter request was relatively easy to fulfill, though the former was more difficult, because of the unwillingness of most surgeons to remove healthy organs. Of the twenty female-to-male patients Benjamin reports on in his book, only nine underwent hysterectomy (at an average age of thirty-five). Five of those patients also underwent mastectomy. Another five patients underwent only mastectomy without hysterectomy. Sixteen of the patients were taking testosterone, which eventually produces “a physical state resembling pseudohermaphroditism (enlarged clitoris, body hair, etc.),” Benjamin reports.
In The Transsexual Phenomenon, Benjamin’s compassion for his patients comes through clearly, although the distancing language of science and traces of paternalism can work to disguise this. As a result of his age and personal history, Benjamin was able to offer not only a clinical perspective on the subject, but also historical parallels to the resistance that he and other clinicians had encountered in their attempts to help transsexual patients. Near the end of the book he recalls his youth in Berlin and the fate of another pioneer. “F
ifty years ago, when I was a medical student in Germany, plastic surgery began to shape noses and perform face-lifting operations for cosmetic purposes. I remember a surgeon in Berlin who specialized in nose operations. His name was Joseph and he was referred to as the ‘Nasen Joseph’ [Nose Joseph]. He was bitterly criticized for what he did. Surgeons such as he were refused membership in medical societies and were branded as quacks by some of their particularly orthodox colleagues. And then, sex was not even involved.”
Though he doesn’t say so explicitly, Benjamin must have been aware that criticisms of “Nasen Joseph” stemmed from discomfort with the manner in which rhinoplasty was perceived as facilitating another kind of “passing”—from Jewish to German. As a “foreign” physician, Benjamin understood exclusion. Although he was invited by friends to deliver presentations at the New York University School of Medicine in 1963, at the Albert Einstein College of Medicine in 1964, and at Stanford University in 1967, his academic affiliations were limited, and throughout most of his career his practice remained “isolated and unconnected,” said Christine Wheeler. His insights and achievements seem all the more remarkable in light of these facts.
Benjamin “understood that you couldn’t separate the body from the mind,” Christine Wheeler says, and he looked forward to the day when an organic understanding of transsexualism was possible. “He always held out hope that the biological key would be found,” she says, “but he also believed that we didn’t have the tools to understand it” at the time he was working. Benjamin was “a product of his age,” Wheeler says, and some of his views have been revised by later researchers and clinicians. His attitude about surgery is one of them. According to Benjamin, “you weren’t a true transsexual if you didn’t desire surgery,” Wheeler says, whereas Wheeler, who has been in practice for thirty-three years, has many clients who “move in and out of transition … according to what feels safe at the time.” She also sees about a dozen people who have lived in their birth sex their entire lives but who decided “in their sixties and seventies that they couldn’t go to their graves” without talking with someone about their lifelong gender dysphoria. “They’ve never cross-dressed, they’ve never taken hormones,” she says. Are they transsexuals? Not in Benjamin’s view, but a new generation of clinicians and activists might argue differently.
Wheeler, along with her colleague Leah Schaefer, is the guardian of Benjamin’s archives, the voluminous patient records, correspondence, and other products of a lifetime of writing and research on two continents. This archive will provide a rich trove of data for future historians and other scholars. Someday, a biography of Harry Benjamin—far more than the brief sketch of his work in this chapter—will illuminate the significance of his research not only for transgendered people seeking a solution to their personal difficulties, but toward a broader and more comprehensive scientific understanding of sex and gender in the twentieth century.
“Treating the gender dysphoric person was ultimately the sum total of all of Benjamin’s previous interests and knowledge. One might say his work in the field was an accident for which he was totally prepared,” Schaefer and Wheeler wrote in 1995. “The course and events of Benjamin’s professional life were destined to crown a career that would unlock the door to an area of study that would have the most profound implications for our understanding of human nature and would change the lives of countless people forevermore.” Transsexual people themselves often express a less adulatory, though still generally positive, view of Benjamin and his accomplishments. Susan Stryker calls him “a genial old paternalist, a really nice guy who cared about his clients and saw himself as doing what he could to help. Really going above and beyond the call of duty in trying to arrange surgery for people, really compassionate.” Still, Benjamin could also be “very sexist and elitist and condescending to people,” Stryker says. “He called [transwomen] his ‘girls’ and he would only work with, take under his wing, the ones he thought were really attractive.”
Nonetheless, like his predecessor, Hirschfeld, “Benjamin did a lot of good progressive political work,” Stryker says. His office was in San Francisco’s Union Square, and many of his patients lived and worked in the Tenderloin, the city’s notorious red-light district. She adds (though I have not been able to confirm this) that Benjamin also served as “clap doctor for some of the best whorehouses in town” and that he performed abortions for the city’s elite Pacific Heights crowd. “If you look at some of these early sexologists, the people who are involved in doing transsexual/transgender work also tend to be involved in abortion rights and in prostitution rights,” Stryker says. Benjamin and sexologist colleagues such as Kinsey were sexual pragmatists, Stryker says, whose attitudes can best be summarized as “people fuck, and they fuck in lots of ways—get over it. Some people dress in different ways—get over it.”
Like Hirschfeld, Benjamin refrained from judging his patients/ clients. He was aware that many dabbled in prostitution, for example, admitting in The Transsexual Phenomenon that “the unfortunate fact that a number of patients went into prostitutional activities right after their operations has turned some doctors against its acceptance as a legitimate therapy.” He quotes a urologist who told him, “I don’t want a respectable doctor’s clinic to be turned into a whorehouse.” Such a physician, Benjamin says, “may enjoy the feeling of being on the side of the angels but he scarcely has ethics or logic for support. Should a physician refuse to heal the injured right hand of a pickpocket because he may return to his profession and perhaps forge checks besides?” he asks. “Should a urologist—for argument’s sake—decline to treat sexual impotence because a cure may induce the patient to start an illicit love affair, or, if married, lead him to adultery?”
Benjamin concludes that the responsibility of the physician is to heal, not to judge the morals or behavior of his patients. “A doctor could hardly be held responsible, and should not hold himself responsible, for what a patient will do with his regained health. That is none of his business. Such an attitude could lead to endless absurdities as the above examples show.” This attitude was quite rare among physicians encountering transsexual and transgendered patients throughout the latter decades of the twentieth century, and remains rare today. Nearly every transgendered person I spoke with had experienced some painful interaction with a health care provider, most often a doctor, whose distaste for gender-variant people was hardly disguised. In Trans Liberation: Beyond Pink or Blue, the author and activist Leslie Feinberg describes a series of such encounters, one of which culminated in a physician shoving his hands down her pants and shouting, “You’re a freak!” Whatever Harry Benjamin’s flaws, he was at least cognizant of the fact that his Hippocratic oath applied to all his patients, not just the normatively gendered ones.
Benjamin died in August 1986, at the age of 101. His friend Christine Jorgensen, for whom he felt immense respect and gratitude, outlived him by only three years, dying of bladder cancer at the age of sixty-two. In the introduction to The Transsexual Phenomenon, Benjamin pays tribute to Jorgensen in words that echo the praise of his own friends and colleagues at his memorial service.Without her courage and determination, undoubtedly springing from a force deep inside her, transsexualism might still be largely unknown—certainly unknown by this term—and might still be considered to be something barely on the fringe of medical science. To the detriment if not to the desperation of the respective patients, the medical profession would most likely still be ignorant of the subject and still be ignoring its manifestations. Even at present, any attempts to treat these patients with some permissiveness in the direction of their wishes—that is to say, “change of sex”—is often met with raised medical eyebrows, and sometimes even with arrogant rejection and/or condemnation. And so, without Christine Jorgensen and the unsought publicity of her “conversion,” this book could hardly have been conceived.
In a 1953 letter to Benjamin, written soon after they met, Jorgensen explained why she had overcome her initial resista
nce and was beginning to speak to the media and accept offers to perform in nightclubs— in other words, to embrace her notoriety, rather than running from it. “As you know, I’ve been avoiding publicity, but this seems the wrong approach. Now I shall seek it so that ‘Christine’ will become such an average thing in the public mind that when the next ‘Christine’ comes along the sensationalism will be decreased. You know what I’m trying to do is not as great as the big medical discoverers in the past, but it will be a contribution. With God’s help and those who believe as you do, I know this will be a step into the future understanding of the human race. I wonder where there are more who join us in this struggle.”
CONVERSATION WITH ALESHIA BREVARD
Aleshia Brevard is an actress and writer. A graceful woman in her sixties, in 2001, Brevard published a memoir, The Woman I Was Not Born to Be, in which she describes her childhood in Tennessee, her pre-transition years in San Francisco, performing as Lee Shaw at the famous drag club Finocchio’s, and her post-transition life and career as an actress and a Playboy bunny in Hollywood. Brevard, who transitioned in 1962, is a member of the first generation of Americans who underwent sex-reassignment surgery, a group whose belief that one’s identity as a transsexual is left behind in the surgical suite has been increasingly challenged by a later generation.
Q: Do you have any childhood memories of the big media splash surrounding Christine Jorgensen’s return to the United States after her surgery in Denmark? Was she an inspiration to you? Did you ever meet her?
I never met Ms. Jorgensen, nor can I even say that she was a true inspiration for me when contemplating my own surgery. The media frenzy that accompanied Christine’s arrival at New York International Airport [sic], February 13, 1953, actually had a decidedly negative effect on me as a high school freshman. The hoopla surrounding the Jorgensen gender transformation focused an unflattering spotlight on me as an overly feminine teenager. “Buddy must have caught what Christine has,” was my classmates’ taunting chant for several weeks at Trousdale County High. I wasn’t thrilled to have my carefully constructed male cover blown by Christine Jorgensen’s high-powered publicity splash. I felt exposed. I felt very threatened. I was not yet aware that I was Christine’s transgendered sister. I’d always believed I was meant to be a girl, but the jokes, horror, and general commotion that surrounded Christine Jorgensen’s transition kept me from believing I might be a girl like America’s first transsexual.
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