Transcending Genders #2

Originally appeared in Transgender Tapestry #105, Spring 2004.

How is it that Cher could alter her nose, breasts, thighs and buttocks to little public comment while dentist Richard Raskind
underwent a little plastic surgery, hidden from all but the most intimate social intercourse, and caused a furor? What is unusual
about the bell curve of economic success as it describes transgenders?

Harry Benjamin Was a Hero

by Judy Osborne

For people old enough to remember the sixties, news of Kennedy?s assassination arrived with such emotional force that almost everyone recalls exactly what he or she was doing at that moment. Transgender people who were alive and aware a decade earlier have another such memory filed away.
?Ex-GI Becomes Blond Beauty? the New York Daily News headline screamed on a day in October of 1952. Radio stations and newspapers repeated ever more sensationalistic versions of the story. By nightfall, people everywhere had heard the news. Transgender people mired in lifelong isolation discovered suddenly that there was someone else; that others like us existed somewhere. So emotional was the news that each of us remembers exactly what we were doing at the moment we heard.
The story, and Christine Jorgensen?s long-lived celebrity after she came back from Denmark, brought out a torrent of applicants seeking hormone therapy and sex reassignment surgery.
Christian Hamburger, the scientist
and endocrinologist who managed Jorgensen?s care in Denmark, soon found himself overwhelmed by applicants for similar services. Into the breech stepped
a U.S. endocrinologist and sexologist named Harry Benjamin. He began performing triage soon thereafter for a horde of men desperate to become women and a smaller but significant number of women equally desperate to become men.

Benjamin sought out psychologists, surgeons, and endocrinologists willing to work with transsexuals (he coined the term) and referred candidates to them. For more than a decade he carried on this work, culminating in 1966 with the publication of The Transsexual Phenomenon, a classic work in which Benjamin organized his unique set of observations as a guide to others.

By the late 60?s, a number of medical and mental health resources were serving the needs of transsexuals, the most prominent in the United States being the Johns Hopkins Gender Identity Clinic which had opened in 1965. Considerable controversy remained attached to the physical treatment of transsexuals. A lack of long-term follow-up studies rendered the treatment modality vulnerable.

J.K. Meyer and D.J. Reter of Johns Hopkins in 1979 published a longitudinal study of satisfaction and regrets which concluded that sex reassignment surgery offered no significant benefits. Though the study was widely criticized for flawed methodology, media coverage of its results and criticism from other sources caused the Johns Hopkins Gender Identity Clinic to close late in 1979. (A long string of subsequent studies have indicated long-term dissatisfaction in
the one to two percent range.)

The controversy highlighted a need
for a set of standards to guide professionals evaluating and treating transsexuals. And so, named to honor the pioneer
who devoted the final years of his practice to serving the gender conflicted (a designation some of us like better than ?dysphoric?), the Harry Benjamin International Gender Dysphoria Association (HBIGDA) was born.
The HBIGDA was designed by pro-fessionals for professionals. Although significant numbers of transgender psychologists, surgeons, and endocrinologists existed even then, few if any felt comfortable about revealing themselves to their peers. The first version of The Standards of Care (SOC), issued by the Association in 1979, contained little or no input from the consumers they affected.
The SOC assigned a ?gatekeeper? role to mental-health professionals, requiring patients seeking opposite gender hormones or sex reassignment surgery to get specific kinds of approval from specific kinds of therapists. Since transsexuals tend to be relentless, impatient and intractable in pursuing their lifelong quest for a change in gender, mental-health professionals came to be viewed primarily as roadblocks keeping transsexuals from attaining their urgently-felt goals.

To make matters worse, the original SOC were rigid. Individual differences in the integrity of people?s approaches to their transsexualism were ignored by the original standards, as were variations in knowledge and evaluative experience among mental-health counselors. The one-size-fits-all approach frustrated transsexuals who were ready to move
on, encouraged manipulation instead
of genuine therapy, engendered distrust, reduced the credibility of therapists who served our community, resulted in erroneous research, and interrupted the lives of people on their way toward healing.
The HBIGDA meets every two years. The cumulative changes to the SOC since 1979 have been breathtaking. Requirements for hormones and surgery are far less rigid. Transgender professionals and well-studied laypeople not only are sought out as members and presenters; at least a few are current and past members of the HBIGDA board.

Nevertheless, controversy over the SOC continues to rage among transgenders. Some resentment surely is left over from earlier times, but other issues continue to demand resolution before peace can reign. Issue No. 4 will trace the evolution of the SOC since 1979 and look at unresolved issues, our anger at gatekeepers, and alternatives to the SOC.

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