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- Synthetic hormone treatments weren't really available until the late 30s, so rather than endocrinology, urology and plastic surgery governed sex and gender for a while
- And they were interested in correcting abnormality, not in changing people in ways they wanted
- In Europe, esp. Germany, the sexological model provided medical transition starting in the 20s
- Hirschfeld puts intersexuality in dialogue with "transvestism", the desire to live as the other sex.
- In America, they didn't care, they had a whole slippery field with concepts like homosexuality, sexual inversion, hermaphrodism, and transvestism (derogatory)
- It's hard to find "trans life" here because we're looking at it thru postwar transsexuality, but it was there in a different form
- people we'd call trans today were deliberately excluded from any kind of "sex changing" medicine
- 1917: Alan Hart becomes the first trans man on the record to transition with establishment medical support
- A psychiatrist studies his case, he gets a "physical examination", and he's diagnosed with "congenital, incurable homosexuality" and "marked modification of the physical organization from the feminine type."
- He reflected he'd rather die than continue life as a woman. He sought an "operation" which included a hysterectomy and said he "left the hospital as a man."
- Went on to be a distinguished radiologist & tuberculosis researcher
- Historians called him a lesbian, not realizing that then-current labels of "homosexuality" or "sexual inversion" overlapped with transness in many cases
- Hart was an educated adult, though, kids are harder to find in the record.
- "Val" was a trans woman who sought surgery in the 40s (unsuccessfully).
- Endorsements from Harry Benjamin *and* Alfred Kinsey, but doctors quarelled about operating
- While it was up in the air, she told a psych about her childhood
- Extremely early knowledge, refused to wear boy's clothes at 2.
- Parents were on the school board and arranged for her to attend school as a girl
- Local doctor hoped she'd grow out of it at puberty, but she did not, and high school was more hostile. She dropped out and stayed home and did chores.
- She came to read a lot about her condition, incl. Havelock Ellis & Hirschfeld.
- Decides to pursue surgery + hormone therapy. American medical boards refused, so Benjamin and Kinsey tried to find her options in Europe.
- Hart and Val are examples where transness made it into the medical record, but we have to wonder how many trans people lived and died without setting foot in it
- Val's trans childhood "had no substantive relation to medicine, nor did it evidently need one." She didn't seek out sexological texts with tiny readerships until she was 20.
- She just lived how she wanted to, and her community didn't really have a sense of her sexual taxonomy
- Trans & intersex were very much on the same stage at this time
- The surgery that Val heard about and sought was developed thru experimentation on intersex youth to "correct" them
- They were going to the same doctors
- The overlapping categories like intersex and "inversion" led some trans people to argue for their own intersexuality (and thus eligibility for medical intervention)
- in the absence of a reified medical discourse like "transvestism" or "transsexuality", doctors had to scramble to give excuses: an ill-fitting narrative of "psychological homosexuality", for example
- Trans children are present as traces in this archive, but they don't resolve any of these contradictions.
- My goal is to unsettle the belief that "modern medicine played aĀ *causalĀ *role in defining the parameters of trans life."
- "Rather than serving as a 'prehistory' of what came 'before' transsexuality, then, this chapter moves toward framingĀ *multipleĀ *trans childhoods, with multiple definitions of transness (including nonmedical forms of knowledge and identity), each with competing definitions thatĀ *exceedĀ *the binary terms to which transness in general and trans childhood have been confined in the postwar medical model."
- Sexology was not very connected to medicine in the US, moreso social scientists and psychiatrists. Hirschfeld and Havelock Ellis were not read too much, and "transvestism" was a marginal term
- Note that Freud wasn't catching on in the US either
- When "Val" was reading sexological literature, she was in the avant garde ahead of most american doctors
- Harry Benjamin was sort of an exception.
- "Founder" of transsexual medicine at his private practice in manhattan in the 50s-60s. But right now we're talking about before all that.
- Endocrinologist informed by german ideas of "intersexuality".
- He was educated in Germany and tight with Steinach and Kammerer (the eugenics rejuvenation procedure guys)
- Had gone to gay/trans bars in Berlin with Hirschfeld
- For him, sex was fundamentally physical/biological
- He said "Freud was not a Freudian... he would be shocked if he saw what went on today; he was much more of a biologist."
- Had a patient called Otto Spengler, who gave maybe the first medical lecture on transvestism in the US (1906). Other doctors described Spengler's case, but didn't support or pathologize.
- Benjamin set Spengler on hormone therapy
- "the earliest verison of an estrogenic compound, as well asĀ *x-ray treatments to sterilize the testicles"*
- /// wanna be a woman? here, haveĀ *radiation*
- Benjamin described Spengler humorously in a letter as "a man, a woman, *andĀ *somewhat of a lunatic. To be serious: he is a married man, father of several children but is a transvestit [sic], that is, his passion is to go in women's clothes."
- "Despite the humorous tone, Benjamin's characterization of Spengler as at once a man, a woman,Ā *andĀ *"somewhat of a lunatic" points tohow much the first two categories were not mutually exclusive when the third was present.
- Benjamin was participating in eugenics orgs too
- "More precisely, the endeavors overlapped."
- He was talking with Paul Popenoe (Human Bettermend Foundation) about the steinach procedure in the context of "sexual and racial rejuvenation"
- He was in correspondance with Oscar Riddle, eugenics pituitary gland wizard. Wanted to translate his bird experiments into human therapies.
- Riddle took some offense to being called out for plagiarizing Steinach, because he thought that while Steinach changedĀ *secondary sex characteristics*, he was changing the "Actual Sex" (something connected with ovaries/testes)
- Benjamin wasn't actually seeing many trans patients in the interwar period and he wasn't actually making much of an impact.
- But his work here takes on its significance in the late 40s when Kinsey introduces him to a trans girl
- The eventual formation of the category of transsexual will come about partially due to Benjamin's importing euro-sexology. plasticity, eugenics of phenotype, transvestism, etc
- Johns Hopkins child research in this era began with surgery, not HRT
- Hugh Hampton Young, head of the Brady Urological Institute, sets up what will become standard protocol for "producing a binary sex out of the intersex body."
- Step one: figure out what organs they have by touching them a lot (outside and in)
- Step two: cytoscopy; illuminate the bladder, look for vaginal cavity
- step three: *exploratory laporotomy*, AKA "cutting open the abdomen to look inside for a truth to sex."
- H H Young worked with the "gonadocentric paradigm" ; presence of an ovary or testis was the single most important criteria for "true" sex, regardless of how much other evidence stood against it
- Johns Hopkins was ostensibly a charitably hospital, but as it promised care it also demanded access to patients' bodies for study and experimentation (particularly the bodies of black East Baltimore residents).
- This was so much the case that "night doctors" robbing graves, kidnapping, and abusing black patients were staples of local rumor
- "Research at Hopkins was as often coercive and nontherapeutic as it was curative"
- Hopkins saw most intersex kids from the 1910s-30s because local pediatrics had no endocrine or psych wards
- "Hermaphrodism" as a diagnosis spiked exponentially in the 40s and 50s as synthetic hormones changed the game; for now, let's talk about before we had those
- Young was not interested in theorizing hermaphrodism, just in producing binary sex
- but intersex patients were a particular fascination. some patients were strong-armed into letting their bodies be photographed or filmed for research. "Some of these 'strip-teases' are most amusing" -- Young
- As he started seeing more patients, Young had to make exceptions to his gonad criteria for practicality's sake. He would sometimes wait until puberty or try and "follow the body's lead" (by his own criteria).
- Sometimes, this meant changing sex in order to make someone's gay desires into straight ones
- 1915: Robert Stonestreet admitted to Johns Hopkins
- Young: "A case that did not end happily"
- He was brought in because of "hypospadias and undescended testicles", not sexual ambiguity, but sexual ambiguity is what they found.
- Young "discovered" that Robert was female and advised his father to allow him to make his child "normal"
- Cutting him open, They found "an infantile uterus with tubes and ovaries of normal appearance." This was surprising to Young given Robert's many masculine attributes (voice, facial hair, "general bodily habitus", "mental processes")
- This showed a challenging edge case to the gonadocentric model; were they really going to disregardĀ *all of this other data* because of the gonads?
- This points to the eventual adoption of endocrinology as a more workable theory
- Robert's father declines treatment and leaves. Young says he wanted Robert to stay a boy to keep working on the farm, but maybe this was an embellishment and they simply believed their child.
- Nude photos were taken of Robert's body before he left. He looks miserable and tries to cover himself. These photos were published in a medical journal.
- 21 years later, Stonestreet comes back to Young to say that his childhood hermaphrodism diagnosis is now grounds for a priest refusing his marriage, and he demanded a medical testimony of his maleness.
- Young refused to budge on his opinion that Stonestreet was female.
- Three days later, Robert committed suicide. Young took the opportunity of his autopsy to test a theory of his and publish the results.
- /// holy fucking shit.
- Patients and families frequently opposed Young's methods.
- His insistence on expensive surgeries was prohibitive
- He would see intersex kids again and again when his surgeries fell short of his "aesthetic and functional ideals", leading to "painful complications like incontinence and the development of fistulae"
- "The labor of forcibly resocializing the child and parents was often tortured."
- Social Work Department at Hopkins + charities secular and religious would collaborate in enforcing a kid's 'real sex' via home visits and arranging announcements
- Black families in particular seemed to accept intersex kids very frequently and oppose medical intervention. J.H. dismisses them as unscientific / uneducated / irrational
- In the 20s and 30s, Young performed a number of adrenal gland surgeries (often just removing one) thinking it could halt masculinization in young children. It didn't really work. The kids died sometimes.
- A toddler with ambiguous genitalia was brought in, and Young sent them away for a few years because he thought the kid was too small to operate on. Years later, he goes right for the vaginoplasty, then removed one of the kid's (enlarged, as predicted) adrenal glands.
- Recovery was rough. Frequent sickness and infected wounds.
- Young didn't remove Stonestreet's adrenal glands, we should notice; the difference is that this kid was young, and he believed a developmental window was still open for them
- His ability to act within this developmental window was very difficult and rarely efficacious. As the 40s began, he was able to start experimenting with HRT to transform bodies, but this was very new and unpredictable stuff.
- "By now, all of Young's attempts at sex reassignment had been resisted by this child's actual growth." He recommends the kid to see Lawson Wilkins, head of pediatric endo at the Harriet Lane Home.
- Young depended on an idea of plasticity, which both offered potential for change and threatened to undo binary sex.
- The undoing of the gonadocentric paradigm put into serious question the whole idea of sexual dimorphism
- "To resolve this instability, the plasticity of sex was coded in this clinical research as an abstracted form of whiteness, a latent capacity to be reformed and transformed into something new."
- White intersex kids had the chance to Become Normal; black ones were considered subjects for experimentation and little else
- Transfer of animal experiments to human medicine was racial; head of Harriet Lane Home once assumed that the condition found in a black intersex child "[had] been duplicated in mammals"
- One of the defining features of the modern medicalization of sex is this "differential between the abstract whiteness of plasticity and the visual regimes of race and antiblackness that inflected the clinical treatment of actual children"
- At the Harriet Lane Home, they didn't talk about "inverts", "homosexuals", or "perverts", which might make us think that there weren't any people we'd today call trans.
- We'd be wrong though, since inter- and trans-sexuality were not separated at this point. 20th century trans people often appealed to an intersex condition to legitimize their transitions
- Johns Hopkins contributed to this by studiously keeping transition medicine away from people who didn't have anatomical abnormalities. These people were "just homosexuals."
- Though this, too, was fraught. Young writes in a textbook about how his intersex patients sometimes showed homosexual "symptoms" as well.
- "Individuals, apparently not otherwise abnormal, occasionally assume the attire, mannerisms, and habit of the opposite sex... Some of these cases also become homosexual. The etiology is often obscure and may possibly be due to glandular and endocrine abnormalities as complex as those encountered in hermaphrodism"
- Interestingly, this description is pretty similar to Hirschfeld's definition of "transvestism"; sexual inversion PLUS mysterious physiological origin
- Young adopts "vaguely freudian" sexual-inversion model for such cases
- Jewish boy brought in for "masturbation" and sent home soon after. note: "perversion, homosexual type."
- Soon after, Young gets a letter from the hospital superintendent that referred him, apologizing for not giving him the full story
- "It is quite probably that the boy did not tell you the whole truth"
- He was expelled from a religious school a month after being sent there, stated reasons were unclear. Superintendent went to investigate
- He had "assaulted" a boy, and was forced to leave town at the request of the boy's mother
- This "assault": telling said mother he was gay?
- "This frightful practice had been going on before he left Virginia... these facts lead me to believe that he is a pathological type, possibly inheriting some glandular deficiency."
- Young's reply: If he keeps being gay, I guess we could try replacing his gay balls with some dying straight guy's balls. We tried it recently with a hanged criminal's balls and it worked great.
- For the record, it didn't actually work very well in that case
- It was normal to consider prisons a free source of bodies to experiment on
- He didn't wind up doing this to the jewish kid, but this case shows that Young was beginning to consider surgical intervention for "sexual inverts" on the basis of a hypothesized glandular etiology. Intersex medicine was preparing to branch into the gay/trans sphere
- "Organotherapy" (gonad replacement) wasn't in fashion for long since synthetic hormones came around just after.
- Young sometimes gave men testosterone to try to make them less gay. it didn't work. he passed them off to a psychiatrist. that didn't work either, but it wound up being the treatment with more staying power
- "The psychiatric approach was weakest in the face of trans patients who, fluent in the idioms of intersex and endocrine plasticity, sought out Young hoping to undergo sex reassignment, rather than be 'cured'". Example: "Bernard"
- Bernard: textile worker, late twenties, AFAB but lived as male, only attracted to women, jealous of brothers.
- Young's notes: "she [sic] believes she urinates through the phallus... she has felt definite mass or testicle in right groin. Patient's voice chanced at an early age. She shaves once a week and definitely wants to be a man."
- Bernard self-reported an intersex condition, suspecting his penis was "bound down" and wanted corrective surgery. Young seemed somewhat on board with this narrative.
- Young's Endo colleague, Samuel Vest, was very skeptical. Vest dismissed all supposed intersex symptoms and said that this was a woman who was deluding herself or lying. "This case is entirely mental."
- Bernard's letter to Young: I've been referred to you as an expert. I've always liked boy's clothes, books, and games. I only feel at ease in men's garb. "As I understand it, a person may have secondary sexual organs which control his mental and emotional life; while the primary organs are of the opposite sex. What I want to know is canthese secondary organs really be developed in such a way that a person who has been known as a female becomes a male? I know that sex books say that no one is really 100% of either sex. If this can be done, I would like to know about what the cost would be and the time required. I have read that most of these operations are yet in the experimental stage, but I am perfectly willing to become a part of the experiment."
- /// wow. that's powerful.
- Bernard uses natural bisexuality theory + intersex surgeries to sort of independently invent and suggest sex reassignment.
- When he says he had a natural voice drop, that he felt a testis, etc, maybe he really believed this, maybe it was a strategem. Either way, he succeeded in getting Young's attention.
- Young referred Bernard to Rennie, the psychiatrist. Rennie is overwhelmed.
- In the absence of transsexuality or transvestism as concepts to rely on, he hacks together his own theory of Bernard's experience; freud, endocrine plasticity, BUT he's definitely a gay woman!
- "The resulting document is a fascinting look into the confounded state American medicine had created for itself. Given the stubborn resistance of psychiatrists and physicians to accepting a patient's embodied self-knowledge as meaningful, Rennie could only attempt to aggressively theorize his way through Bernard's life."
- Rennie goes over Bernard's childhood in a way that is very legibly trans; always wanted to be a boy, wanted to be a doctor like his father, suspected he had male organs "concealed somewhere", thought he was the only one who felt this way until recently
- Bernard had read a 1916 study about opposite-sex cow fetuses where a specific "endocrine situation" led to the masculinization of the female, then hypothesized that this was his own story
- Rennie doesn't buy it, but Bernard is adamant that all he wants is surgery, not a psychotherapeutic cure. Denied this, Bernard goes home.
- Rennie goes on, grasping at different authorities for an explanation. He cites a psychoanalytic developmental schedule where childen begin purely hedonistic, proceed to homosexuality, then graduate to straight.
- This model was ill-fitting for Bernard, but it points out something important: homosexuality was thought of as *not yet pathological* in children. Trans children, then, would not have been assigned this diagnosis.
- "The deployment of homosexuality in this case and the practiced ignorance of the staff of Hopkins over the concept of transvestism were powerful forms of gatekeeping. I read this case as evidence of how American medical science produced for itself an advantageous state of ignorance."
- Bernard, a moderately educated blue-collar Alabama trans man, produced a sophisticated theory of trans life and transition that Rennie refused to fathom
- Around the same period, "Karen" enters the record. A mid-thirties trans woman.
- Young says she's a gay man "seeking advice and possible correction of his [sexuality]", and makes SURE to note that she had "no physical deformity sexually, but has noticed female fat distribution and small hands."
- She requests surgery to a feminine body, not psychiatry to dissuade her of it.
- Psych: "Whether or not alterations of circulating sex hormones are present in homosexual individuals is, so far as I am aware, still an unknown point. We could do determination of male and female sex hormones, if Dr. Young feels this is indicated. It would be a far cry, but, perhaps, worth trying to see how testosterone might influence this patient."
- Young wasn't down for hormone therapy and rejected surgery request. Karen leaves baltimore.
- People like Bernard and Karen were labelled homosexuals, but appealed to physiological theories and plastic sex to argue for transition, so clearly they didn't 100% fit the concept of the time
- Children's privileged superplasticity meant that at this time, they couldn't really be seen as "trans"; adults transitioning was weird, but for kids it was "natural"
- In the 1950s, John Money comes to Hopkins, and with him the term "transvestism". However, only eight patients were ever diagnosed as such
- By 1965, when Money co-founds the Gender Clinic, Christine Jorgensen had become famous and Harry Benjamin had started publishing on transsexualism, and so "transsexual" supplanted "transvestite"
- Mid-thirties trans man came to Hopkins hoping for top surgery and was dismissed; he told doctors that he had been living as a man happily since childhood and only approached trans medicine in his 30s
- Another case of a trans woman who left home young and lived as a woman full-time, then a doctor framed her as intersex, legitimating her transition
- these and Val are all cases where trans people were drawn to intersex as the category that permitted transition
- I think that it remains viable to say that there was such a thing as trans life before transsexuality. We probably give too much causal force to the 1950s.Ā
- "Cold war military, scientific, political, and capitalist milieu of state and medical biopolitics resulted in a new diffusion of techniques for making sexuality and the sexed body productive, and to that extent transsexuality was an artifact of that midcentury moment." BUTĀ
- Young was doing SRS before that
- Jorgenson was not the first trans celebrity
- Benjamin had been working with trans patients since the 20s
- Plus: we don't want to be "technodeterministic". Hausman argued in "Changing Sex" that medical discourse literally produced trans subjectivity. Let's get away from that
- My answer: trans childhood has "no ontological reliance on medicine at all"; therefore, the absence of a grand medical narrative prior to transsexuality is irrelevant to the question of "whether trans people existed"
- Medicine did not change children; *children changed medicine*
- This epistemological crisis in medicine re: sex led Money and co. to start talking about "gender" instead, which they hoped would save the sex binary and "control plasticity"