University of Virginia Library

Transsexual Crisis Resolved In Surgery

By LAURI GOODMAN

In a cloud of perfume and
jangling of bracelets, Karen
(not her real name) entered the
room. Her long brown hair fell
across her face and she swept it
back with a graceful motion
while she flirted with the
doctor. Karen was more
self-conscious about her
femininity than many women,
but with good reason, for up
until a short time ago, Karen
had been a man.

***

The transsexual is a complex
individual, a prisoner within his
own body. He has the mind
and emotions of one sex within
the physical and sexual body
of the other. This cruel Joke
of Nature and the unnatural
twists it can cause in a person's
life are not easily understood.

Stories of transsexualism
have existed since the
beginning of written history,
but it has only been within the
last 20 years that a treatment
has been developed. Surgical
operations now alter the
physical sex of patients to
correspond to their desired
gender.

Only about one dozen
medical centers in the United
States and Canada offer any
in-depth help for transsexuals,
and only six or seven of these
hospitals perform surgery. The
University of Virginia Hospital
is one of the few performing
operations to fulfill the
transsexuals' dream of a
complete life.

Dr. Milton Edgerton,
Chairman of Plastic Surgery at
UVA Hospital, is a pioneer in
this developing field. Dr.
Edgerton got his medical
training at Johns Hopkins
University and returned there
to teach and start their plastic
surgery department. Twenty
years later he came to the
University and founded a Gender
Identity Clinic similar to
the one in operation at
Hopkins.

The Gender Identity Clinic
is a new concept in treating the
problems of transsexualism,
involving many different fields
of medicine including
gynecology, urology,
psychiatry and surgery.
Surgery is the final step, taken
only after extensive treatment
and testing to determine that a
prospective patient is truly a
transsexual in need of a surgical
change.

Psychiatric Techniques

Dr. Edgerton explained, "A
number of attempts have been
made with psychiatric
techniques. Unfortunately the
attempts have been uniformly
unsuccessful, and it is only
because of that, that doctors
have even considered anything
as specific as surgery."

Before the surgery is
performed, psychiatrists
attempt to separate transsexuals
from homosexuals, transvestites
and those who are mentally ill.
"Homosexuals don't wish
operations... if one of them
were operated on, it would be
a tragic mistake," stressed Dr.
Edgerton. Similarly, a
transvestite doesn't wish an
operation. But the transsexual is
very serious about the surgical
change."

Another pre-operative
requirement is that the patients
live as a member of the sex
they hope to become; dressing,
dating and working, as a
member of that sex. "We're
not really changing the sex,"
Dr. Edgerton said. "The patient
doesn't come in the hospital, as
a lot of magazines might lead
you to believe, with one sex
and leave with another. Before
these operations are even
considered, they have lived for
years in the sex of their
conviction."

For years, doctors have
tried to determine what causes
an individual to become a
transsexual. Throughout the
case histories of transsexuals
there runs a persistent echo of

abnormality in the male
patients' relationships with
their mothers, and in their
childhood behaviors.

Like many transsexuals,
Karen was very feminine as a
little boy and preferred dolls
and drawing to baseball and
firetrucks. Her parents had
wanted a girl and treated Karen
(then a male) as though she
were a female. By the time she
was a teenager she was
occasionally wearing lipstick
and dressing as a woman in
public. She was certain that she
wanted to live her life as a
woman.

Environmental Cause

Despite this seemingly clear
evidence for an unclear
environmental cause, many
doctors insist that
transsexualism defies
explanation. "Mothers who
want a girl tended to raise the
child with some unconscious
slant in that direction," Dr.
Edgerton said.

"But the evidence is not
very strong that the
environment has been the
cause," he continued. "Many
of us working in this field
suspect that there is a genetic
factor. The reason for this is
that it begins at such a young
age and it seems so far to be
totally irreversible – very
unlike most conditions that are
environmental in nature."

The actual surgery itself,
primarily the construction of
genitalia, is an intricate
process. It is easier to construct
female genitals then male
genitals, according to Dr.
Edgerton who has personally
operated on 26 patients. This
may account for the greater
number of male transsexuals
reported in America.

To supplement a sex
change, most transsexuals also
receive hormones and other
operations to alter their
outward appearance. Karen
had her nose and chin
re-shaped, her breasts enlarged
and electrolysis performed on
her face and body for a more
feminine appearance.

Most sexual transformations
have been successful.
"We've not had a single patient
who has regretted the surgery,"
remarked Dr. Edgerton. "They
seem to be the happiest
patients that I see after
surgery." For the first time in
their lives, many of them are
able to be fulfilled sexually as a
true member of their preferred
sex. "Both male and female
transsexuals after surgery
rather consistently report
successful sexual intercourse
and reach orgasm," Dr.
Edgerton said.

Although for many
transsexuals a lifelong need has
been cured by surgery, their
problems do not vanish as
easily as their scars. Dr.
Edgerton was unsure of
whether the problems were
greater or less after surgery,
but in any case, legal and moral
tangles abound.

"Before surgery, the police
are unlikely to be sympathetic
if they (transsexuals) happen to
be arrested while they are
living in the gender of their
need," said Dr. Edgerton. After
surgery relatives and friends
are often unable to accept the
patients' new identity, forcing
many transsexuals to seek
another part of the country
after their operations with new
names, new bodies and new
legal birth certificates to start
life over again.

Moralists

There has always been
criticism of surgical sex
changes. Many moralists will
declare that only God can
decide a person's physical
gender ("It's not nice to fool
Mother Nature"). But as a
physician, Dr. Edgerton
endorses sex charge operations
on the grounds of the mental
anxiety he has seen in his
patients and the tortured lives
they have revealed to him. He
has listened to the stories of
suicide attempts and viewed
the remains of desperate
self-mutilations.

"There will always be a
tendency for people who don't
know anything about the
patients to be disapproving,"
he said. "The alternatives are
so bad, however, for the
patients."

Many of these patients, if
they're not helped, have
become suicidal. There's very
high incidence of suicide at an
early age if doctors reject
them," Dr. Edgerton said. "If
the patient is stable and
mature, and shows the ability
to meet the problems, when
the alternative is so absolutely
wretched, when there's
no other treatment offered; it's
not an easy choice but it's a
much better choice than
anything else."

***

Karen is one of the lucky
ones. She was able to connect
her body and her mind to end
her former suffering and
confusion. There are endless
possibilities stretching before
her: a new job, marriage;
maybe she'll adopt a child. Just
a normal life, as defined by
society, but the end of a long
search for fulfillment.