In 1965, the Hopkins Hospital became the first academic institution in the United States to perform sex reassignment surgeries. Now also known by names like genital reconstruction surgery and sex realignment surgery, the procedures were perceived as radical and attracted attention from The New York Times and tabloids alike. But they were conducted for experimental, not political, reasons. Regardless, as the first place in the country where doctors and researchers could go to learn about sex reassignment surgery, Hopkins became the model for other institutions. But in 1979, Hopkins stopped performing the surgeries and never resumed.
In the 1960s, the idea to attempt the procedures came primarily from psychologist John Money and surgeon Claude Migeon, who were already treating intersex children, who, often due to chromosome variations, possess genitalia that is neither typically male nor typically female. Money and Migeon were searching for a way to assign a gender to these children, and concluded that it would be easiest if they could do reconstructive surgery on the patients to make them appear female from the outside. At the time, the children usually didn’t undergo genetic testing, and the doctors wanted to see if they could be brought up female.
“[Money] raised the legitimate question: ‘Can gender identity be created essentially socially?’ ... Nurture trumping nature,” said Chester Schmidt, who performed psychiatric exams on the surgery candidates in the 60s and 70s.
This theory ended up backfiring on Money, most famously in the case of David Reimer, who was raised as a girl under the supervision of Money after a botched circumcision and later committed suicide after years of depression.
However, at the time, this research led Money to develop an interest in how gender identities were formed. He thought that performing surgery to match one’s sex to one’s gender identity could produce better results than just providing these patients with therapy.
“Money, in understanding that gender was — at least partially — socially constructed, was open to the fact that [transgender] women’s minds had been molded to become female, and if the mind could be manipulated, then so could the rest of the body,” Dana Beyer, Executive Director of Gender Rights Maryland, who came to Hopkins to consider the surgery in the 70s, wrote in an email to The News-Letter.
Surgeon Milton Edgerton, who was the head of the University’s plastic surgery unit, also took an interest in sex reassignment surgery after he encountered patients requesting genital surgery. In 2007, he told Baltimore Style: “I was puzzled by the problem and yet touched by the sincerity of the request.”
Edgerton’s curiosity and his plastic surgery experience, along with Money’s interest in psychology and Migeon’s knowledge of plastic surgery, allowed the three to form a surgery unit that incorporated other Hopkins surgeons at different times. With the University’s approval, they started performing sex reassignment surgeries and created the Gender Identity Clinic to investigate whether the surgeries were beneficial.
“This program, including the surgery, is investigational," plastic surgeon John Hoopes, who was the head of the Gender Identity Clinic, told The New York Times in 1966. “The most important result of our efforts will be to determine precisely what constitutes a transsexual and what makes him remain that way.”
To determine if a person was an acceptable candidate for surgery, patients underwent a psychiatric evaluation, took gender hormones and lived and dressed as their preferred gender. The surgery and hospital care cost around $1500 at the time, according to The New York Times.
Beyer found the screening process to be invasive when she came to Hopkins to consider the surgery. She first heard that Hopkins was performing sex reassignment surgeries when she was 14 and read about them in Time and Newsweek.
“That was the time that I finally was able to put a name on who I was and realized that something could be done,” she said. “That was a very important milestone in my consciousness, in understanding who I was.”
When Beyer arrived at Hopkins, the entrance forms she had to fill out were focused on sexuality instead of sexual identity. She says she felt as if they only wanted to consider hyper-feminine candidates for the surgery, so she decided not to stay. She had her surgery decades later in 2003 in Trinidad, Colo.
“It was so highly sexualized, which was not at all my experience, certainly not the reason I was going to Hopkins to consider transition, that I just got up and left, I didn’t want anything to do with it,” she said. “No one said this explicitly, but they certainly implied it, that the whole purpose of this was to get a vagina so you could be penetrated by a penis.”
Beyer thinks that it was very important that the transgender community had access to this program at the time. However, she thinks that the experimental nature of the program was detrimental to its longevity.
“It had negative consequences because when it was done it was clearly experimental,” she said. “Our opponents were able to use the experimental nature of the surgery in the 60s and the 70s against us.”
By the mid-70s, fewer patients were being operated on, and many changes were made to the surgery and psychiatry departments, according to Schmidt, who was also a founder of the Sexual Behaviors Consultation Unit (SBCU) at the time. The new department members were not as supportive of the surgeries.
In 1979, SBCU Chair Jon Meyer conducted a study comparing 29 patients who had the surgery and 21 who didn’t, and concluded that those who had the surgery were not more adjusted to society than those who did not have the surgery. Meyer told The New York Times in 1979: “My personal feeling is that surgery is not proper treatment for a psychiatric disorder, and it’s clear to me that these patients have severe psychological problems that don’t go away following surgery.”
After Meyer’s study was published, Paul McHugh, the Psychiatrist-in-Chief at Hopkins Hospital who never supported the University offering the surgeries according to Schmidt, shut the program down.
Meyer’s study came after a study conducted by Money, which concluded that all but one out of 24 patients were sure that they had made the right decision, 12 had improved their occupational status and 10 had married for the first time. Beyer believes that officials at Hopkins just wanted an excuse to end the program, so they cited Meyer’s study.
“The people at Hopkins who are naturally very conservative anyway … decided that they were embarrassed by this program and wanted to shut it down,” she said.
A 1979 New York Times article also states that not everyone was convinced by Meyer’s study and that other doctors claimed that it was “seriously flawed in its methods and statistics and draws unwarranted conclusions.”
However, McHugh says that it shouldn’t be surprising that Hopkins discontinued the surgeries, and that he still supports this decision today. He points to Meyer’s study as well as a 2011 Swedish study that states that the risk of suicide was higher for people who had the surgery versus the general population.
McHugh says that more research has to be conducted before a surgery with such a high risk should be performed, especially because he does not think the surgery is necessary.
“It’s remarkable when a biological male or female requests the ablation of their sexual reproductive organs when they are normal,” he said. “These are perfectly normal tissue. This is not pathology.”
Beyer, however, cites a study from 1992 that shows that 98.5 percent of patients who underwent male-to-female surgery and 99 percent of patients who underwent female-to-male surgery had no regrets.
“It was clear to me at the time that [McHugh] was conflating sexual orientation and the actual physical act with gender identity,” Beyer said.
However, she thinks that shutting down the surgeries at Hopkins actually helped more people gain access to them, because now the surgeries are privatized.
“Paul McHugh did the trans community a very big favor … Privatization [helps] far more people than the alternative of keeping it locked down in an academic institution which forced trans women to jump through many hoops.”
Twenty major medical institutions offered sex reassignment surgery at the time that Hopkins shut its program down, according to a 1979 AP article.
Though the surgeries at Hopkins ended in 1979, the University continued to study sexual and gender behavior. Today, the SBCU provides consultations for members of the transgender community interested in sex reassignment surgery, provides patients with hormones and refers patients to specialists for surgery.
The Hopkins Student Health and Wellness Center is also working toward providing transgender students necessary services as a plan benefit under the University’s insurance plan once the student health insurance plan switches carriers on Aug. 15.
“We are hopefully working towards getting hormones and other surgical options covered by the student health insurance,” Demere Woolway, director of LGBTQ Life at Hopkins, said. “We’ve done a number of trainings for the folks over in the Health Center both on the counseling side and on the medical side. So we’ve done some great work with them and I think they are in a good place to be welcoming and supportive of folks.”
Schmidt does ongoing work to provide the Hopkins population with transgender services, and says he would like for Hopkins to start performing sex reassignment surgeries again. But Chris Kraft, the current co-director of the SBCU, says that this is not feasible today, as no academic institution provides these surgeries since not enough people request them.
“It is unfortunate that no medical schools in the country have faculty who are trained or able to provide surgeries,” he wrote in an email to The News-Letter. “All the best surgeons work free-standing, away from medical schools. If we had surgeons who could provide the same quality services as the other surgeons in the country, then it would make sense to provide these services. Sadly, few physicians are willing to make gender surgery a priority in their careers because gender patients who go on to surgery are a very small population.”
Beyer, however, does not think that the transgender community needs Hopkins to reinstate its program, and that there are currently enough options available.
“We’re way, way past that,” she said. “It’s no longer the kind of procedure that needs an academic institution to perform research and development.”
Though she finds the way that Hopkins treated its sex reassignment patients in the 60s and 70s questionable, she thinks that the SBCU has been a great resource for the transgender community.
“Today those folks are wonderful people,” Beyer said. “They’re very helpful. They’re the go-to place up in Baltimore. They’ve done a lot of good for a lot of people. They’ve contributed politically as well to passage of gender identity legislation in Maryland and elsewhere.”
The Maryland Coalition for Trans Equality’s Donna Cartwright said that the transgender community does not have enough resources available to them. She said offering surgery at a nearby academic institution could provide more support to the community.
“Generally, the medical community needs to be better educated on trans health care and there should be greater availability [of sex reassignment surgery],” she said. “I think it would be good if there was an institution in the area that did provide health care, including surgery.”