Member, Board of Medical Directors, The Oregon Clinic, P.C., 1994
Founding Member, The Oregon Clinic, P.C., 1994
Chairman, Department of Surgery, Providence Medical Center, 1985-88
Physician Research for Physician Review Committee, American Urology Association, 1989
Second Vice Chairman, Providence Medical Foundation, 1986-88
Member, Specialty Task Force Committee, Providence Medical Center
Providence Professional Plaza 5050 NE Hoyt, Suite 514 Portland, OR 97213
(503) 215-2399 Office (503) 238-8373 Answering service (503) 215-2376 Fax Number
Historic contact information
The Oregon Clinic, Urology Division
5050 NE Hoyt St. Suite 514 Portland, OR 97213
Phone: (503) 215-2399 or (503) 238-8373
Answering service Fax: (503) 215-2376
orclinic.com/docs/rbarham.html (through 2004)
Consumer experiences:
My orchiectomy: seven days later
Detailed report one week after surgery by K (2004) /physical/orchiectomy/barham-2003.html
I searched the Internet looking for a doctor who would perform an orchiectomy. I wanted someone of course who is familiar with transsexuals and who was skilled in performing the operation in such a manner that it didn’t interfere with future plans of SRS. One name kept coming up time and again. That of Dr. Barham whose practice is in Portland, Oregon. This is my account of our time together.
I phoned Dr. Barham’s office to inquire about the pricing of an orchiectomy, and his requirements. I was disappointed to find that his office staff stated I needed to supply them with a letter from a therapist stating I’ve been in their care for gender dysphoria, and another from my physician stating I have been on hormone replacement for at least 6 months. And I would need to have an AIDS test ran, also. All these must be submitted, and then verified by the office before an appointment could even be made. This makes it difficult to arrange scheduling plans as I needed to fly in from another state and would need time off from work. Now I haven’t been with a therapist in years for any gender counseling. So to start, I phoned an old therapist and ask “Do you remember me”? She did of course and was happy to write me a letter. But first, I had to inform her of how my life has been going, was I still transitioned, holding a job, and on and on. A good month passed as we worked out the letter details and finally paid her for her time. The physician was an easier task to tackle as he has been over seeing my hormones for years. The AIDS test proved a simple quick preoperative-operative test to have done.
Finally all the paperwork was in and I was able to make my appointment. Another month was required to get everyone’s time rescheduled to coincide and the plane tickets purchased. The doctor likes to have his consultations on Tuesday’s. On Wednesday he performs the procedure, with a follow up exam on Friday. I had plans to fly back home on Saturday and back to work again on Monday. I have to admit to all, there was some soul searching as I considered this step which would leave me totally without. But I found confidence in my decision as I haven’t wanted the testes for years and had been working diligently to block their efforts on my body. With this in mind, I met with the doctor on Wednesday, as I wasn’t able to meet the Tuesday date. Our Tuesday consultation was performed on the phone prior, something the doctor didn’t really want to do. He would much rather meet the individual and explain to them the procedure. I was appreciative that he could accommodate my tight scheduling. Prior to our visit, the doctor had asked that I wash continually a couple of days before our visit with a Betadine solution so as to help cleanse the groin area. I won’t say on Wednesday when I arrived at the office I wasn’t nervous. First thing I had to do upon arrival was confirm some information on prepared paperwork. A simple quick task. Then I was asked for the thousand dollar payment agreed upon for the procedure. Upon paying that, it was a short wait in the office and I was called in prior to my appointment time. My significant other was allowed to accompany me, for which I was very much relieved. I knew about orchiectomies, what they were and all. Still, I was rather pleased when I was called into his office to meet him and discuss the procedure, and was offered a Valium so as to be relaxed. I debated if I really needed to take such a drug, but agreed to it finally. I suggest it for anyone who can accept this drug. Do yourself the favor and take the pill. While the Valium was getting into the system, he explained in very simple terms what we were going to do. He reiterated the obvious, I couldn’t have children, the procedure can’t be reversed, things like that which I suppose are needful. The time in the office seemed to pass very quickly and I was led to the room where we would have the procedure done. I was instructed to remove my bottom garments but to keep my top on. I had thought before hand about wearing a skirt as no tucking is required with those, and I would have room for movement. But on the other hand, slacks and a blouse might be more practical? There was also much conflict within myself about showing up dressed so feminine for a male procedure! I was surprised how much of a conflict that raised. I decided upon the slacks, and a long blouse which covered up the groin area naturally. This turned out to be the best choice and I do suggest the same for others who are having this procedure.
Right after undressing I got on the table, laid back and placed my knees on the covered stirrup as instructed. He began to shave the area where he was going to work. This is something it turned out that I could have done before hand, but no mention was made of it previously. He washed the area throughly, then covered me up declaring this a sterile zone. It was then his assistant came in and I knew, it was time to start.
He began by explaining he was going to inject a local into the spermatic cords so I wouldn’t feel the procedure. And that he would then inject a local into the scrotum where the incision would be made and he would work from. I saw the 1 1/2 inch needle, but not much more as I was laying on my back and unable see what was happening. He gathered up some skin, pinching off a section of the right cord, and then injected. Oh man oh man that hurts! But the pain quickly passes as the local takes effect. He then moved to the left side and did the same thing. Again, oh that hurts a lot! Then he moved to the scrotum and did the injection there. Oh yes again, that hurt quite a bit. From there on however, the pain is very minimal. Mixed with the Valium, I actually had a smile on my face which the doctor was happy to see. And he did make comments about that too, all of which were pleasant. From this point on it’s difficult to say exactly what was being done. He told me when he opened the scrotum up. He stated when the first testis was removed. He informed me also when the second one was gone. And then when he was suturing me back up again. Upon sitting up I saw what looked to be skinned testes in a shot glass. I asked him, “are those them? They look like you skinned them”? He confirmed that yes, those were them and yes, he did remove the membrane surrounding them. He stated that there is less bleeding and complications this way. Well, OK I guess. It was my hope that all material would be removed, but still, the offending testes were out and would not regrow. During the whole procedure my SO was with me. He stated that he had no idea that the spermatic cords were so large. As he indicated to me their size using his index finger as an example. Wow, neither did I!
I was given instructions as to my care when I got back to where I was staying. That included taking pain pills for which I was given a prescription. I was also to take Ibuprofen, along with regular icing to reduce swelling. I was assured I could phone the office if there were any complications, such as bleeding which would lead to swelling of the scrotum sack. As I redressed in my baggy slacks I made my way to where I was staying and applied the ice. I slept in and out during the day in relative comfort. That is until the local injections had worn off.
Later that evening, about 9:00pm, I examined the work for the first time as everything was very sensitive and painful. I was shocked, the sack was larger then I have ever seen before! And it was so painful I could hardly stand up straight. Not that the sack was in pain, rather it was up higher, in the abdomen. I feared that something was dreadfully wrong and images of the sack full of internal bleeding filled my mind. I phoned his office, getting the answering service to whom I stated I thought I was having complications. Shortly the doctor phoned me back and asked some questions. It was determined that I should return to his office so he could evaluate my condition. Thank goodness because I didn’t want to see an ER room with this! We arrived in good time and found him waiting in his office. I placed myself on the table again, and removed my jammy bottoms exposing myself for the second time that day. He looked, touched, and pronounced that all was well. What I was seeing was just swelling, which was expected. Only I had no idea that I would swell from the point of a scrotum with testes, lets say the size of a golf ball. To that of a scrotum with no testes inside and having swelled to a size that totally filled my hand as I cupped it from underneath. The pain I had in the upper abdomen was caused by the local injections into the spermatic cords. So this is normal I pondered? Is he off his nut I wondered silently? He stated that I should only have concerns if the scrotum filled and became hard. Having a smooth polished look to it with black and blue bruising all over. He assured me that he had only one girl ever that went to the ER with a complication like this. I apologized for disturbing his home time for something ‘normal’ and I went back home dearly wanting that ice pack. Feeling somewhat assured that I was OK and throughly embarrassed by my panic.
It turns out that yes, I must have been okay after all. When we returned on Friday for my post operative exam, he looked his work over and declared that all looked good. I had lots of bruising on the left side, which is where there was still much swelling to be found. He stated that there had been some bleeding while injecting the local that caused that. But that it would go away and all was well. OK I guess so, were my thoughts still. It looked awful and still swollen quite a bit, more then I ever would have thought so. I was still seeping blood on my pads which he also stated is normal for there wasn’t much at all.
Now that I’m home again, and it’s been 6 days following the procedure. There is still swelling. And I must be careful to not lift, push, or struggle with anything as that causes the left side to bruise anew. I’m still taking pain pills, but comfortable all the same. I can now feel the insides and I find the membranes he left behind are hard, and very large. I assume they will shrink again and I’ll gain the small size I once had before and there won’t be difficulty tucking again. For now tucking is completely out of the question, and I must stand to urinate as sitting to do so is painful. With the swelling I find my penis sits on top of the scrotum and isn’t available for pointing down. Again, I’m sure this is a temporary thing, it had better be! I no longer find blood on my pads, but rather a clear deposit. I’m thinking soon I’ll be able to discontinue the use of pads.
To sum up my experience with Dr Barham’s office. I found his staff very professional. There never was any discomfort due to this kind of procedure versus my gender. He is a very likable man and I was comfortable in his presence exposing myself, something I do have qualms about. He was always readily available as were his office staff. Even when I called him out of his home he was pleasant and stated it was best to be sure then to worry and not be seen. I would be confident recommending his services to anyone who is seeking an orchiectomy. It’s also a comfort to know that the way he performs the incision does not conflict with the Thailand surgeons. An option I keep open for myself when the funds become available. I’ve also been assured I have a letter coming which will enable me to complete my birth certificate changes. From that of Male, to Female. Which my birth state has thus far denied me from having.
I’m back alive and well now with Update
by JG (2004) /physical/orchiectomy/barham-2003.html
‘m back alive and well
by JG
We arrived back home Thursday night [7 August 2003]. We had to rough it for most of the trip. We slept in the car while in San Francisco so we could save the motel money for after the surgery. I am still tired and sore, but that is just on the outside… 🙂
The orchiectomy was considerably more painful than I anticipated. I came up off of the table more than once! This was because there was severe scarring and inflammation from a spermatocele that I had removed back in 1993. This had been causing me a lot of pain ever since then, which increased significantly after starting on hormones in 2001.
The pain is completely gone now, though. And I feel wonderful. It is like for the first time, deep inside, something is finally starting to become right. Plus, it is like starting HRT all over again, too! The colors are brighter again! And no more anti-androgens!!! (“psst, hey buddy, wanna buy a bucket of Spiro???”)
2004 update [15 January 2004]
Yesterday Dr. Barham had to go back in and remove more of the cord that had adhered itself inside the inguinal canal. It was causing a lot of pain ever since the initial procedure in August, and multiple cortizone shots were not making things any better.
The procedure was emotionally more distressing than it was physically painful. When he gave me the local injections, the pain that I experienced made it feel like “they” were suddenly back down there again.
I had a very sudden and very intense “body dysphoria” episode. I started crying incessantly. The flood of memories and sudden distress was almost unbearable. At one point Elane said that I was begging him to stop. The pain was too much of a reminder of what I once had.
When the orchiectomy was performed in August, Elane was there, too. She said I showed no dysphoric reaction. I remember crying then, too, but they were tears of relief and an overwhelming sense of peace when I saw the “evidence” there in a shot glass on the instrument tray. Of course, it did hurt a lot physically then, too. But there was no dysphoria.
Thank goodness my precious Elane was there again to comfort me during the procedure. When w were leaving, Dr. Barham almost tearfully thanked her for being there! She later told me that the terrified look in my eyes emphasized to her the importance of what I needed to do.
I feel that this is something that others who are going to have this procedure may want to know about and be prepared for in case they have to go back for follow-up work. Dr. Barham has only had one “re-do” in the past other than me, and Elane said that he had not seen this reaction before. He is also concerned that, with a total of three incisions to date (1993, 2003 and 2004) that any future work there might complicate the vaginoplasty, so we all hope that this is the last time.
Afterwards, Dr. Barham wrote me a letter stating that he had performed “irreversible genital surgery for Julian, which under the standard of care for gender reassignment, allows Julian to change her gender to that of female. This entitles her to the appropriate gender credentialing”
Wow. WOW!
Memo: be sure to tell people to ask him for the letter! And BTW, I fully intend to challenge that new SSA ruling on the requirement of completion of the process before they change the GM. I worked at HCFA (a branch of SSA) as a contractor in the early 1990s, which may or may not be of help. But I will not stop until not only I get my F, but until I find out who and what was respsonsible for this arbitraty (and ultimately discriminatory) ruling. And I will publicize it. Because I can’t imagine it was anything but a purposeful decision by someone in the know with an axe to grind. If either of you have any suggestions, please let me know.
My orchiectomy with Dr. Barham: a sweet and sour tale!
by R. Crosby (2003) /physical/orchiectomy/barham-2003b.html
by R. Crosby
I received this note in October 2003:
Having traveled to Portland from the Buffalo area I met with Dr. Barham the day before the procedure to discuss what I should expect.
He stated I would feel a slight tugging but otherwise no significant pain. Well, while I have no doubt that Dr. Barham believed this to be true it just didn’t happen that way for me.
I felt absolutely everything other than the incision.
From the initial injections in the groin area to the removal of the testicles I felt excruciating pain that radiated up along the inside of my pelvis into my lower back. As the procedure progressed it became that ‘kicked in the balls’ feeling and this didn’t diminish until shortly following the complete removal of the gonads.
While I was disappointed with this I was still glad to have gone to Dr. Barham because he and his staff were incredibly kind and respectful. I have no doubt that he is a skilled surgeon and he did apologize for what he described as uncommon discomfort.
I still highly recommend Dr. Barham and have no regrets having gone there, just be aware that wherever you go for this procedure where you are only given a local … “you takes your chances” with the level of pain you may encounter, regardless of where you get the surgery done.
Pain During Orchiectomy: A Cautionary Tale by J (2002) http://www.annelawrence. com/castrationpain.html
My Orchiectomy with Dr. Robert Barham in Portland, Oregon by Debra Kohlrust (2001) http://www.annelawrence. com/kohlrustorchiectomy.html
The Big O day: my orchiectomy by Robyn Browning (2001) /physical/orchiectomy/barham-robyn.html
The Big O day: my orchiectomy
by Robyn Browning August 8, 2001 Wednesday
Today I took shower when I woke and scrubbed my genitals with Betadine scrub as Dr. Barham asked me to. Then I got dressed wearing a pair of pants I knew would be easily removed and comfy to wear after my family jewels were removed.
I piddled around at work until about 10:30. I read the book I got from a friend “Urologic Surgery” and found that the section that covered the radical orchiectomy was just one page long.
My fiancée, Georgiana, messaged me about 10:30 and asked how I was doing (emotionally/psychologically). Instead of sending a return message on the computer I called her on the phone and told her that I was doing really badly, and started to huff like I was about to break down and cry and I acted as though I wasn’t sure that I could go through with the procedure.
She replied to hearing this with “Oh, baby…” in a tone of sympathy. I abruptly interrupted and said “Nah, just kidding.” I followed explaining that as the last couple hours counted down that I was really fine with the procedure and ready to get it over with. We talked and finalized our plans for lunch. I had expected to be nervous, but as the time approached I felt ready and sure.
Karen from downstairs came up for a rest break and gave me a hug wishing me good luck on the orchi. That was really sweet of her I thought and I wished her luck on her upcoming IUD procedure.
Georgiana and I met at 12:00 for lunch. I carried down a bunch of stuff from the office I thought I could work on while I would be recovering. We went to Big Town Hero and grabbed lunch. We walked over the two blocks from my office to the water front and sat down to eat under the large shade trees. While we ate I took my Valium that I had been saving for two months. I was going to smoke some pot too for extra relaxation but we forgot the lighter. I had read accounts of this procedure being very discomforting and painful. I was not looking forward to that part.
We then drove over to Dr. Barham’s office. It was only twenty mintues from my office. I told the receptionist my name and that I had an appointment. She knew instantly what I was there for. I also said that on the phone when I made the apointment to remind the nurse ‘something about a pill before hand’. I knew it was another Valium.. hey the more the merrier, I thought.
G and I sat down and a couple minutes later a blonde nurse came into the waiting room with a pinkish pill and a glass of water. I swallowed it down too. Yum… Valium. By this point I don’t think passing tornado would have phased me. I was feeling really mellow.
It wasn’t even ten minutes and the nurse poked her head out the door and called for “Robyn”. Hmmm, that must be me.. the old guy to the left with the urine bag doesn’t look like a “Robyn”. I asked if Georgiana could accompany me and she said it was Ok.
So George and I walked down the hall to the room where it would be done holding hands all the way. We sat in the two chairs that were in the tiny room. We were left alone for a few minutes. There was a window, a table and drawers in front of the window, a medical table with stirrups and white towels wrapped around the knee part of the leg stirrups, two chairs in which we sat. To the left was “the table”, a surgical pack wrapped in blue fabric fresh from the autoclave sat on small stand at the foot and to the side of the table.
I got up after a minute feeling a bit fidgety and peaked into the drawers… seeing if there were any cool medical toys to play with. G verbally shunned me for being curious. About the time that I shut the drawers and sat down Dr. Barham came in followed by a nurse. He greeted Georgiana, sat down on the stool at the end of the table and asked if ‘I was ready to do this’. I replied to him that I would not be sitting here if I was not ready and smiled broadly to him. Honestly, I almost felt like his question was a joke. I had stewed on this decision for weeks. Yes, by the gods, I was wholly ready to do this. He asked me to get undressed. I asked if he meant everything or just the pants and underwear…he said that was it.. I could leave the top on (thank goodness), just they lower bits.
After doing this G moved her chair to the head of the table and I had climbed up on it. Dr. Barham asked me to place my butt on the metal plate on the table at the foot of it with white lines of goo on it then to place my legs in the stirrups. Now that boys and girls was a new, frightening and yet interesting experience for someone who has never placed their legs on medical table stirrups. I tried to ease back. My butt slid on the metal plate that was covered with it’s white conductive jelly goo.
I was scrubed thoroughly with more Betadine. They didn’t need to shave as I had done a great job of shaving that area that morning. Doc reach out and took my scrotum in his hand and started to feel out the cord of my right teste and found a point high up… above the top edge of the scrotum and but still able to feel the cord. There he made a couple injections deep into tissues and into the cord and injected Lidocaine. The injection, to my surprise, didn’t hurt. There was a tiny prick but that was it. It hurt I tiny bit, but not even enough to say “ouch”. I never really noticed my testes getting numbed. He repeated the procedure on the left side. Next he told me he was going to inject the scrotum where the incision would be. I had heard in previous accounts that this hurt the most. For me, however, it was no more or less discomforting than the cord injections. I had expected much worse. I had Georgiana’s hand as he began the incision to remove my “manhood”. After the initial scrotal incision he used the cautery tool to cut and cauterize through the tissues that held the teste inside the end of the course, a thin, yet strong fibrous tissue and muscle on the distal end of the teste.
I heard accounts from other people who had orchies saying the room stank of burning flesh, however, I could really only smell a faint odor from the cautery and I would not have called it burnt flesh or any such thing. Organic yes, but not vile.
As I realized that I couldn’t really feel a damn thing, I just had to sit up and watch what he was doing. I was surprised to see the cord and all was as thick as it was. From what I could feel all my life through my own scrotum the cord didn’t seem so large and thick. As I had read the book ,Urologic Surgery, the night before I asked Doc a few questions about what he was doing like “Are you doing to suture the primary teste artery to the ligament so you don’t end up with advanced arterial retraction that could lead to hematoma post op?” He said that he would. Turns out he was using 2-0 SAS instead of the 3-0 SAS suture I had anticipated. Personal choice I suppose, I would have gone with 3-0 I think.. but then I wasn’t looking at the cord at the time so tissue friability would matter.
The doc finally had to ask me to lay down as I kept myself propped up on my elbows trying to see what he was doing. Years studying and working in medicine will do that too you. I have such a deep scientific curiosity. I was propped up so much and so fascinated that I hardly held G’s hand during the procedure.
The same removal and cautery process was used on the left side. This time as he was about to ligate and cut the cord I could actually feel the cord being pulled on deep with in my lower abdomen. The tugging could be felt someplace deep in the center and toward the back. It was not painful, but not a wholly comfortable experience either. Nothing to be scared of that is for sure.
Before I knew it the last teste was removed.
This experience ended up being more like a science field trip than the deeply emotional process and surgical amputation I had expected. I was more curious than anxious, scared or in pain.
Dr. Barham made subcu SAS sutures which was really nice. It means it will not be necessary to return to have the suture removed. Also they tend to hold better, cause less scaring and are less likely to get infected. They take a little more time to do than regular mattress sutures and tiny bit more patience and skill but are the best in the long run. I was pleased to see him use that suture.
Dr. Barham had placed both testes into a small glass container that looked very much like a shot glass on would take tequila shots with. When he had finished the procedure I asked him if he could put “those” in 10% formalin for me to take home. I thought that was a long shot request… but he was like “Sure” and the nurse got a specimen jar for me and he placed them in there. Pics
Dr. Barham wiped up the mess on me that had been made and placed some cotton on my incision line. I stood up, took a paper towel from the Dr. and wiped the conductive goo from my buttocks and put my panties and pants back on. I was surprisingly pain free immediately after the procedure. I could no more tell if I had testes or not.
When we left to pay the receptionist she asked if I could would like a brown bag for “them”. I told her I would very much like a brown bag. The idea of walking around with my testes in a clear jar visible to the public is simply really bad form. We left and walked down the hall remarking that I was in fact, in reality, was this very moment, holding my own testicles in my right hand. I was really tripping on that concept.
We drove from the Dr.’s office my work to print off some invoices. I was surprisingly mobile still but starting to feel pain. Then we drove to the pharmacy to get my meds. But his time.. some 40 minutes later I was really quite needing my pain medication. I went in with Georgiana thinking that they may want to verify who I am before giving out the script and I didn’t want any delay caused simply because I sat in the car and didn’t come in.
The woman was quite prompt as I think she could read the expression of pain on my face. I took a pill as soon as I could.
We drove home and I immediately hit the sack to lay down. I stayed that way until late the next day. I got up to pee a couple times and found that pushing when I had to go number two only caused greater pain than before. So potty had to come slowly and naturally.
48 hours post op:
Up, mobile and feeling little pain, only mild discomfort. Minor swelling.
72 hours post op:
Decided to be active and ran around town shopping.. got sore.
96 hours post op:
Less active. Had to take a pain pill and get off my feet.
120 hours post op:
Quiet day, wore too tight of pants all day, was at work. Mild soreness. Walking fine. Occasional momentary instances of pain that come quickly and leave just as fast.
142 hours post op:
Noticed a throbbing bulge appear in my right teste blank spot. Feels like the artery end inside the sutured cord has blood some and the closed cord has swollen a little. Reducing activity, wearing lose clothing, no aspirin, only Ibuprofen. Seems ok by night.. Swollen but stable, mild throb once periodically.
11 days post op:
Majority of swelling is gone. Only minor soreness when pressure is applied directly to the area of the cord. No further swelling. Very active and can wear almost all my clothes. The firmness of the remaining swelling prevents good tucking of the penis back:
14 days post op:
No sensations of pain. Only soreness when pressing on the area of removal. Incision is mostly healed. Tiny bit of suture where it was tied is visible and should fall away in about another week. Occasional itching due to the suture and the body breaking it down. Feeling great overall. Glad to be off the anti-androgen pill.
Emotional state:
All in all feeling wonderful that I had it done. They are gone. I fell them gone. I can feel the absence of T in my body. No more Spiro than the gods. Wonderful procedure. I should have been less active for one week.. my fault for the later swelling. Highly recommend procedure for suitable candidates. I expected to have a decrease in sex drive but have experienced none. In fact feeling more sexual now. Having had the procedure has taken a lot off my mind and feel freed to think about other things. I can still be become erect when stimulated and that discovery surprised me. It’s interesting to see that sexual function and sex drive are not both uniformly controlled by the amount of testosterone in the body. In just one week I have seen a slight increase in breast fullness and overall size. I’m 110% pleased about having the orchiectomy.
Cost $750.00 Total. Procedure time under 1 hour. Recovery really, one week for 60% reliable ability, mobile but not with great exertion, i.e…. no running, lifting, etc.
Robyn Browning
Addendum: August 16, 2001
I am still not able to tuck things out of the way due to the swelling that remains in the sac at the in end of the cord. All my pants and slacks fit snuggly in the groin and not being able to tuck is really limiting my options. I have only minor pain now… and it is brief. The middle and lower back part of the scrotum hangs down in a funny fasion. More accurately it hangs in an empty fassion. A word of advice is to STAY INACTIVE for at least a week after the procedure. I a small hematoma internally due to the fact that I was feeling better after a few days and got up and was doing all kinds of stuff. DON’T. I’m lucky my sac didn’t fill up like a purple orange. I feel great though. Sex drive is still intact.. adjusting to high dose spiro long term really helped me I think. I can even get erect manual and orgasm. That was a big surprise that I could still do that. Though there is zero fluid coming out. I expect over time even manual stimulation will fail.
Addendum: October 21, 2001
That tucking issue has long be put behind me. As the internal swelling has gone and the scrotum has contracted I can now *cough* put things away much easier. Jeans fit better and there doesn’t seem to be much to hide. I’m so please to have had it done. Interestingly, my sex drive has dramatically increased after stopping anti-androgen therapy and having the orchiectomy.
Arlen Dwight Denny (born May 1, 1947) is an American craniofacial surgeon who trained a number of surgeons who serve our community.
Denny studied with Paul Tessier and focused on pediatric surgeries. He is one of the surgeons who trained Jordan Deschamps-Braly.
Denny retired from his medical practice.
Archival contact info:
Address: 8915 W Connell Ct, Milwaukee, WI 53226
Phone: (414) 266-6430
Murray Harris Kimmel (May 28, 1930 – October 28, 2013) was an American urologist who served our community.
Background
He attended Central High School in Philadelphia. He earned his medical degree at Temple University School of Medicine and completed his residency in urology at Thomas Jefferson University Hospital in 1959. He was certified by the American Board of Urology and practiced at Parkway Medical Associates in Philadelphia, Pennsylvania. He retired around 2009 due to illness and died in 2013.
Kimmel offered hormone prescriptions, orchiectomy, and other gender-related health care. He was known for providing services to clients who had been turned down by others.
Former contact information
2301 Pennsylvania Avenue (Parkway at 23rd Street) Philadelphia, PA 19130
Office 215-563-0847
Fax 215-563-4881
Consumer reports
Castration in Philadelphia with Dr. Murray Kimmel by Jennifer Bentley (2002) http://www.annelawrence. com/kimmelaccount.html
My Orchiectomy Experience in Philadelphia, Pennsylvania by Brianne (2002) http://www.geocities.com/brianne669/page1
Orchiectomy In Philadelphia with Dr. Murray Kimmel by Samantha (2006) http://www.electrolysisfinder.com/~samantha/Kimmel-orchi.html
Choomchoke Janwimaluang was a Thai plastic surgeon who served our community. He practiced on Koh Samui island at The Samui Clinic and Bandon International Hospital.
According to an online report from a former patient, Dr. Choomchoke died in September 2015.
Archival contact information:
Address: Box 109, Nathon Post Office, Koh Samui, Surat Thani, Thailand 84140
Rosemary2001 (February 6, 2016). The world has lost an artist. Realself https://www.realself.com/review/bandon-international-hospital-koh-samui-thailand-66-years-stop-mirror-gorgeous
Greechart Pornsinsirirak is a Thai plastic surgeon who has served our community. He practiced out of Yanhee Hospital in Bangkok. In 2019 Yanhee Hospital confirmed Dr. Greechart is no longer operating from their hospital.
Archival contact information:
Address: Yan Hee General Hospital, 454 Charunsanitwong Road (Soi 90) Bang-O Bangpad Bangkok, 10700 Thailand
• LINK: Sexchange at Pattaya is a new section of their commercial site. http://www.pattaya-inter-hospital.co.th/service_sexchg.html
Ellie Zara Ley (born ~1973) is a Mexican-American surgeon. She performs gender surgeries with the Gender Confirmation Center in California.
Background
Ley was born in San Luis, Sonora. She received treatment as a child in the US for a medical condition. She earned bachelor’s degrees in Spanish literature and biochemistry from University of Arizona in 1995. She earned her medical degree from the medical school of Universidad Autónoma de Guadalajara in 2000, then returned to the United States to work at New York Medical College and at University of Arizona. Following her fellowship in pediatric craniofacial plastic surgery at Primary Children’s Medical Center in Utah, she trained at UCLA in hand and microsurgery. She then returned to the University of Utah for a fellowship in plastic and reconstructive surgery.
She founded the LEY Institute of Plastic & Hand Surgery before joining Toby R. Meltzer at The Meltzer Clinic in Arizona. In 2022 she joined the Gender Confirmation Center with Scott Mosser. She is licensed to practice in Arizona, California, Oregon, and Utah.
Gender identity and expression take on different meanings within different systems of thought. Because medical technologies are available to assist in the somatic expression of these identities, several medicalized disease models of the phenomena have developed. This article examines three disease models as typically applied to those who seek feminization:
The GID model is currently considered legitimate within psychological literature and is a required diagnosis to receive access to trans health services in many places. The author reviews several problems with mental illness models, including “childhood gender nonconformity” and “transvestic fetishism,” two other “mental disorders” currently considered legitimate diagnoses. The article makes several analogies, asking readers to consider whether “racial nonconformity” or “religious identity disorder” seem legitimate as well.
Pathology (“birth defect” model)
This third metaphor of impairment describes a physical disorder rather than a mental one. The “order” implied by positioning these traits and behaviors as diseases reinforces heteronormative hierarchies. These models use scientific-sounding terminology to reinforce the social belief that the “purpose” or “function” of sex and sexuality is procreation. This leads to an examination of historic problems with anatomical thresholds for determining sex. The author then draws parallels with other bioethical debates about technologies that disrupt the “natural” order of procreative sexuality. Interest in feminization is stigmatized in many cultures, and the article concludes with some suggestions for ways to consider it independently from models of sin or disease.
Author’s note: This personal viewpoint is not intended to be representative of any side or group participating in these discussions.
Download a printer-friendly version: A defining moment in our history (PDF)
Introduction Interest in feminization, historically revered or feared, has benefited from advances in science that expand possibilities for its physical expression. These advances led to scientific models of gender variance, which were positioned as objective alternatives to the judgmental “sin” models promoted by some religions. Unfortunately, some allegedly scientific models being used merely replace metaphors of sin with metaphors of disease and impairment, rather than using objective scientific language. The time has come to examine these judgmental models: the assumptions behind their definitions, how they masquerade as science, their roots in eugenics, their impact on our access to health services, and their political implications.
The most insidious disease model appears at first glance to be progressive, even liberal, but on closer examination, it views gender variant behavior in children and adults as a psychosexual pathology (a fancy way of saying it’s a sex-fueled mental illness). Though the idea has been around since the 19th century, new language for this “disorder” was proposed by Ray Blanchard (1989) and restated by Anne Lawrence (1997) and J. Michael Bailey (2003). Though the Bailey-Blanchard-Lawrence (BBL) model claims to be non-judgmental in a moral sense, it is undeniably judgmental in suggesting gender variance is a disease.
These old school sexologists still use terminology based on century-old ideas about gender-variant behavior as a sex-fueled disease. Their definitions tangle up several distinct threads about sex and sexuality in our community. Inflammatory language about transwomen like “man who would be queen,” 1 “man without a penis,” 2 or “men trapped in men’s bodies” 3has led to responses in kind about BBL and their apologists, but thankfully, such polemics are now limited to shrill but secluded fringes of discussions about untangling the mess they’ve made.
Definitions and thresholds
Scientific language evolves with understanding, and scientific discussions require that words be used with scientific precision. In short, definitions matter. A definition simultaneously includes and excludes. It affects how people view our community, especially those who expose problems with existing definitions. BBL and their apologists mock the evolution of definitions and ideas as “politically correct,” 4, 5, 6, 7 a term used by guardians of convention that signals a lack of intellect and contempt for scientific progress. For instance, Lawrence’s opening salvo brags of being one of the “troublesome people who are inclined to doubt the conventional wisdom” about transgender eroticism, then just ten sentences later defends Blanchard’s use of the inaccurate and offensive term “homosexual transsexual” because it is “conventional usage in the psychiatric literature.” 8 [emphasis mine]
Specialized definitions for many words in this debate evolved within separate institutional realms. Though used differently, a term as defined in one field influences another field, especially as we see attempts to merge biology, psychology, law, and medicine into biopolitics. 9 Within the current medico-juridical system, clinical thresholds affect legal thresholds and vice versa.
Imprecise and idiosyncratic definitions plague this debate. The BBL model declares transsexual women are men with one of two sexual desires: “homosexual” (males aroused by males) and “autogynephilic” (males aroused by the thought or image of themselves as women). Both categories efface our identities as women, but “autogynephilia” is more problematic in many ways. One major problem is the tendency for some who embrace the term to look at the etymology and think it denotes an innocent and happy form of feminist self-esteem: “I love myself as a woman!” they’ll say. I do too, but that’s not what this word denotes. When I say, “‘Autogynephilia’ is defined by its creator as a type of paraphilia,” some say, “Well, that’s not how I use it.” That’s like saying someone is a pedophile because she loves children, or that someone is a zoophile because he loves his pets. Those terms are clinical and legal descriptors. Yes, “pedophile” literally means “love of children” in Greek, and “autogynephile” means “love of self as woman,” but both terms are inexorably linked to their clinical origins as psychosexual pathologies.
Calling oneself or others “autogynephilic” is participating in one’s own pathologization, and it legitimizes this fake disease when people claim they don’t have it. BBL are engaging in scientific McCarthyism, where they claim a hallmark of “autogynephilia” is that those afflicted will deny it. Any refutation becomes proof they are right, a no-win situation like asking “when did you stop beating your wife?”
When we say “autogynephilia” is a made-up disease, some mistakenly think we are claiming erotic interest in feminization is made-up, too. Obviously, this exists. Many women in our community have been very open and honest about their erotic interest, 10 yet still take issue with labeling it a disease. 11
Sex and sexuality
My response to “sexology” is similar to how a person of color might respond to “raceology.” I question anyone who seeks to draw bright lines between nuanced possibilities of sex and sexuality, especially when they claim their attempt is science instead of something arbitrary and subjective. Trying to map a scientific schema onto complex traits and behaviors is like turning an impressionist painting into a paint-by-numbers. Those who fear miscegenation of the sexes or sexualities are just like those racists who use “science” to reinforce socially constructed categories of ethnicity. As Anne Fausto-Sterling notes, “Labeling someone a man or a woman is a social decision. We may use scientific knowledge to help us make the decision, but only our beliefs about gender—not science—can define our sex. Furthermore, our beliefs about gender affect what kinds of knowledge scientists produce about sex in the first place.” 12
What kinds of knowledge about sex are BBL producing? They claim variously that homosexuality appears to be an evolutionary mistake 13 and a “developmental error” 14, and gender variance is a “defect in a man’s sexual learning,” 15 and a “sexual problem.” 16 It makes sense that a doctor would choose a disease metaphor and psychologists would use a mental disorder model to describe their observations and impressions. If we have a disorder, then what is the “order” to which they adhere? They imply the “purpose” and “function” of sex and sex organs is procreation. Why, it’s so obviously true that the belief shouldn’t even be examined, right? According to people who believe this overly simplified idea, males have evolved (or were designed) to be attracted to females, and vice versa. In their worldviews, anything that deviates from that is, well, deviant.
Well, to borrow a phrase, a few troublesome people are inclined to doubt this conventional wisdom. 17 Many of us question Lawrence’s claim that sexual desire is “that which moves us most.” 18 We point to our experiences and feel our identities are what drive us; Wyndzen shows psychology supports our recognition of how powerful a force “identity” can be. 19 We even question some passages of Darwin and the Bible (at the same time, no less!). BBL get very upset when highly respected evolutionary biologists like Roughgarden 20 or Gould 21 question their most deeply-held beliefs about sexual selection and human behavior.
Eugenics, genetics, degenerates, gender
The words “eugenics,” “genetics,” “degenerates,” and “gender” all derive from the same Greek root meaning “to produce or bring forth life.” Some sciences and some religions seek to explain our genesis and control our reproduction of subsequent generations. New reproductive technologies are ushering in a host of bioethical issues and raising the specter of a new wave of eugenics, where the genocide (another related word) will happen before or shortly after conception, after genetic material is screened for “undesirable” traits. Should people with Down Syndrome or dwarfism be eliminated from the gene pool? How about intersexed people? If Bailey’s colleagues find the “gay gene,” 22 should we wipe out sexual minorities, too? What about gender minorities? Will we see a “transgenocide”? Who decides what’s a disease or a degeneracy?
As evidenced by BBL’s metaphors of disorder and disease, people can only express ideas in the language they have available. Their models of sex and sexuality originated with doctors and criminologists in the late 19th century eugenics movement, and BBL’s ideas haven’t evolved much from the influential works that shape their thinking. After Darwin’s Origin of the Species (1859) came Francis Galton’s Hereditary Genius (1869). Following ideas in that book, Galton coined the term “eugenics” in 1883, which melded with the emerging fields of criminology and sexology. Though the term “eugenics” is now rightfully associated with Nazism, a few modern adherents hope to usher in an “Age of Galton.” Bailey and Blanchard are charter members of a conservative-run eugenics discussion group devoted to this pursuit. 23
Three physicians who were Galton contemporaries are central to the BBL worldview: Richard Freiherr von Krafft-Ebing, who wrote Psychopathia Sexualis (1886); Havelock Ellis, who wrote The Criminal (1889) and Sexual Inversion (1897); and Magnus Hirschfeld (coiner of both “transvestite” and “transsexual”), who in 1897 founded Germany’s Scientific Humanitarian Committee, whose motto was “justice through science.” Like BBL, these doctors genuinely believed that social ostracism of sexual minorities would be eliminated through science, but we all know what happened next in Germany. These doctors’ “scientific” models were imbued with eugenic paternalism (they believed homosexuals had a pathology and were unfit for procreation), and they claimed those who engaged in non-procreative sex were biologically different. By mid-century, Hirschfeld’s institute had been destroyed, and persecuted minorities had been rounded up and murdered based on “scientific” models that claimed groups like Jews, gays, and other persecuted minorities were “degenerate,” biologically distinct, and a threat to “social hygiene.”
Lest we think this is an isolated phenomenon that only happened in Nazi Germany, in America, disability and race took center stage in the eugenics movement, 24 which focused on sterilization and birth control for the “unfit.” 25 In Canada during the same period, the focus was immigrants, and the method of control was psychiatry. A physician named Charles Kirk Clarke oversaw the two largest Canadian asylums before accepting Canada’s top mental-health post. Clarke advocated eugenic policies to limit the immigration and marriage of the “defective.” He also used psychiatric diagnoses to incarcerate new citizens. Foreign-born patients were 50% of his institutionalized population, including political activists, homosexuals, and other “defectives.” 26
Clarke’s sociobiological leanings are still alive and well at the institution named after him, The Clarke Institute in Toronto, where Ray Blanchard works. 27 There, Kurt Freund and Blanchard used Freund’s controversial plethysmograph to delineate deviance. 28 Though the quack device is just a lie detector for the penis (open to manipulation and interpretation by both subject and observer), they used it extensively to separate homosexual from “non-homosexual,” and later to do sex experiments on “male gender dysphorics, paedophiles , and fetishists,” which they lumped together, yet divided into homosexual and “non-homosexual.” 29
In historic diagnoses for sex problems, homosexuality and masturbation were “diseases” that could strike either sex, but other problems were gendered degeneracy: women who had “too much” interest in straight sex had the now-discredited disease “nymphomania,” while men who had “too little” interest in it were inverts or perverts, a still legitimate disease category called “paraphilia.”
Dysphoria, disease, disorder, disability, defect
According to my medical records, I am mentally ill. The psychiatry industry’s Diagnostic and Statistical Manual of Mental Disorders (DSM) alleges that I am afflicted with “gender identity disorder” (GID). Before that, I had “childhood gender nonconformity,” from their special “kids’ menu” of mental disorders. Others with an interest in feminization get diagnosed with the “disorder” of “transvestic fetishism.” 30 For many years, some in our community have relied on mental illness models as a form of validation. I ascribe to the view that “psychiatric diagnoses are stigmatizing labels, phrased to resemble medical diagnoses and applied to persons whose behavior annoys or offends others. ‘Mental illness’ is not something a person has, but is something [a person] does or is.” 31
I suppose I had a “dis-ease,” an uneasiness, a dysphoria about the sorts of social and sexual expression I was allowed in the gender roles assigned to me at birth. I did not conform until it became clear in 7th grade that the other option was ever-increasing ostracism and violence, but since when is non-conformity a disease? Imagine a mental illness diagnosis for “racial nonconformity” or “religious identity disorder.”
Disease models affect the kinds of knowledge produced by those who use them. Bem called sex researchers’ preoccupation with the causes of homosexuality “scientifically misconceived and politically suspect” because embedded in their preoccupation with causality is the idea that something went wrong that needs to be diagnosed and fixed. 32 The situation is no different when we look at how sex researchers study transgender persons. BBL are what Ordover calls “biological apologists” who look to the body for absolute truths. A major medicalization of homosexuality occurred in the 1990s, in response to AIDS (a disease which led to renewed interest in a “gay gene” and later a “gay germ” disease model of homosexuality). 33 While Bailey was drawing federal funds to isolate homosexuality the way others looked for HIV, nobody was looking for the “straight gene” or “straight germ.” Like a good eugenicist who believes biology is destiny and genetics dictate human behavior, Bailey started linking gender roles to genetic discussions: “childhood gender nonconformity does not appear to be an indicator of genetic loading for homosexuality.” 34 Is gender genetic?
Despite these problems, many in our community embrace a disease metaphor. Lawrence intones about “symptoms” of transsexualism, its “clinical course,” the benefits of “palliative treatment.” 35 Lawrence then magnanimously claims that “everyone has a right to self-define,” yet asserts that those who disagree with Lawrence’s diagnosis aren’t being very honest with themselves or others. A “palliative treatment” helps symptoms while leaving the disease uncured, and the uncured disease can be a personal and political identity. In her important series of scientific criticisms of Blanchard, Wyndzen cites studies on self-verification where people “assimilated their illnesses into their identities.” 36 Almost everyone who is attracted to the concept of “autogynephilia” identifies through metaphors of impairment. Many participants in the main “‘autogynephilia’ support” newsgroup are on public assistance, which seems related to their fears about removal of gender variance from the DSM. They fear subsidized medical services will be denied if there is no mental illness classification. But what do they think will happen if there is differential diagnosis that claims their subgroup does all this to indulge an autoerotic interest? Should insurance companies give out high heels as “palliative treatment” for shoe fetishists?
As Lawrence notes, “There are many human behaviors that look like the same thing, but really aren’t.” 37 Previous medical attempts to catalogue behavior like Lawrence’s were not only pathologizing, but insulting: People like Lawrence were “transvestitic applicants for sex reassignment” 38 who are “aging” 39 and “distressed,” 40 suffering from “pseudotranssexualism” 41 a “non-transsexual” variant of “gender identity disorder” (GIDAANT), 42 and “iatrogenic artifact.” 43 Many notable “borderline” cases are doctors: Renee Richards, Anne Lawrence, Gregory/Gloria Hemingway. They may epitomize these published observations. They all self-treated, vacillated, and “detransitioned” to varying degrees, and all three challenge existing diagnostic categories. 44 If interest in feminization is an iatrogenic artifact (a disease made up by doctors), wouldn’t doctors be the best evidence of that? Further, why would Dr. Marci Bowers transition without incident in the same hospital group that forced Anne Lawrence to resign? Do they really have the same “disease”? I have never heard Dr. Bowers have to assert she’s a “real” transsexual, as Dr. Lawrence has.
I do not defer to people just because they are clinicians. My work fighting quacks and consumer fraud has put me in touch with countless “experts” who have no business in science or medicine. Some “expert” will probably diagnose my questioning “experts” as “authority nonconformity” or some other made-up disease to undermine my credibility. After all, my questioning the legitimacy of “autogynephilia” is evidence I’m afflicted with it. To refute that kind of argument, we need to contextualize the term. “Paraphilia” and “autogynephilia”
The term “paraphilia” first appeared in 1923, in a book prepared for doctors and criminologists by physician Wilhelm Stekel. 45 Over eighty years later, BBL collaborator Simon LeVay still calls paraphilias “illnesses that need treatment.” 46 “Paraphilia” is the psychiatric term for problematic sexual desire or behavior. The current name for this alleged mental disorder first appeared in the DSM in 1980. 47 It describes “paraphilia” as “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving (1) nonhuman objects (2) the suffering or humiliation of oneself or one’s partner, or (3) children or other non-consenting persons…. The behavior, sexual urges or fantasies cause clinically significant distress in social, occupational, or other important areas of functioning” 48
Some people who identify with the diagnosis of “autogynephilia” chime in at this point and say, “Well, then I don’t have a paraphilia, because I don’t think I have a problem.” The most recent version of DSM was revised just for them—it says this illness can be diagnosed even if the person does not experience any subjective distress or impaired functioning. 49 LeVay notes: “This is quite a significant shift; it emphasizes that psychiatrists may go beyond responding to clients’ complaints and may use their expertise for other purposes, such as protecting society from sex crimes.” 50
“Autogynephilia” is not a behavioral model, it describes a sex-fueled mental illness that lumps gender variance in with sex crimes. BBL believe that paraphilias cluster, meaning that they believe that “autogynephiles” are more likely to be aroused by children, corpses, excrement and other illegal and socially unacceptable things. This diagnosis was widely ignored after Blanchard first suggested it in the Journal of Nervous and Mental Disease in 1989. 51 By the end of his series of papers, Blanchard was shoehorning other behaviors into his model with crackpot variants like “partial autogynephilia.” 52 However, Blanchard and his colleagues had enough influence in this rarely-studied subspecialty to get “autogynephilia” mentioned in the DSM. 53 The work would have remained an obscure intradisciplinary skirmish until Lawrence found Blanchard’s articles in 1997, during a time of great need. A year earlier, Lawrence’s erotic interest in ritualized genital modification led to indulging that interest. 54 Lawrence had taken “physician, heal thyself” to heart previously, and after yet another failed “cure” in the form of vaginoplasty, Lawrence’s fascination did not wane. In 1997, a lack of social acceptance at work (described in one account as “bizarre behavior”) 55 and an incident where Lawrence examined an unconscious patient for signs of ritualized genital modification ended a respected career. 56 Discovering Blanchard was clearly revelatory for Lawrence, who now had a diagnosis to explain what happened. Suddenly, this forgotten diagnosis had a vocal and influential champion. I dismantle the pseudoscience behind “autogynephilia” in a longer essay elsewhere. 57
A scientific or reasonable discussion of “autogynephilia” is like a scientific discussion of horoscopes: there’s no science to discuss, only pseudoscience. Yes, both concepts exist, but that does not mean either are legitimate science. Some people have a need to create an identity based on a worldview where people are predictable based on vague, unproven categories that arbitrarily assign traits to everyone, imposing order onto an unpredictable and incomprehensibly complex world.
“Transsexual” defined
BBL have proposed several definitions for “transsexual” that include people not previously considered within that definition. Their definitions view gender variance through the lens of disordered sexual desire. Bailey defines “transsexual” as anyone who has “the desire to become a member of the opposite sex.” 58 They do not have to act on this desire—“only serious thoughts” are enough to qualify. 59 This model reflects Bailey’s definitions of sexual orientation: someone is a homosexual whether they act on their desire or not. Lawrence believes transsexuality is “fundamentally about changing one’s anatomy, or sex; and that sometimes it may have little to do with gender identity, or with gender role.” 60 Some do this “not primarily because they have a gender problem, but because they have a sex problem, and indeed a sexual problem… the expression of a paraphilia” 61Blanchard says he’s reluctant to label children as “transsexual,” 62 which is reminiscent of the “pre-homosexual” language used by his homophobic counterparts in “gay cure” groups like NARTH. 63 Blanchard’s colleague Ken Zucker is a vocal advocate of reparative therapy for gender-variant children, and he considers transsexuality “a bad outcome.”64 In fact, Bailey has noted that unchecked, this disease could spread: a world tolerant of gender-variant children “might well come with the cost of more transsexual adults.” 65
Echoing Lawrence’s strict anatomical construction of “transsexual,” a quaint aphorism claims, “If you aren’t a transsexual before surgery, you are after.” Really? What about David Reimer or others surgically altered as children who do not identify as transsexual? 66 Conflicting definitions occur within any demographic grouping. Extremist separatists from both sides of any constructed binary often create unlikely alliances: for instance, “people of color” and “African-American” are terms debated by both ethnic separatists and conservatives. 67 In our community, pluralist concepts like “queer” or “transgender” are debated in circles where distinctions between gay men and transwomen, or between crossdressing and transsexualism, are very important.
Lawrence insists the few who embrace this diagnosis “do not declare ourselves sick.” 68 Not morally sick, anyway, but physically sick. Lawrence’s self-descriptions have remarkable parallels with descriptions of binge-and-purge cycles among crossdressers who hate their behavior, or those “afflicted” with “unwanted homosexuality”: “The loneliness and disconnection from others that typically accompany autogynephilia [sic] are a large part of what makes this condition feel like genuine paraphilia (i.e., a “disorder”) to many of us who experience it (and I’m including myself here) and not merely a “benign variant” form of human sexuality.” 69 Swap “autogynephilia” with the word “homosexuality,” and Lawrence’s comment would feel right at home in a NARTH publication. Lawrence’s “problem” is not self-love, but self-hate.
For those of us who view “gender” and “sex” as socially constructed, transsexualism can’t be separated from its social component. Phenotype can trump genotype; gender expression can trump anatomy. Those who need to use anatomy as evidence of their identity have failed in gaining acceptance within a social or institutional framework. Everyone has a right to self-identify, but if others don’t accept that proclaimed identity, we must either accept their lack of acceptance, or work to change their minds. People can legislate rights, but not acceptance. That has to be earned.
Audre Lorde said “Your silence will not protect you.” 70 I say your anatomy will not protect you, either. Legal and medical models based on anatomical benchmarks for “male” and “female” will inevitably conflict and fail. Sexists who wish to efface the identities of women like me can always find a physiological or behavioral reason to say I am “‘really’ a man,” and some of the worst offenders are “helping professionals” and people in our community. They echo the racists who came up with “scientific” schemes to determine who was “‘really’ black,” or heterosexists like BBL who create ways to determine who is “‘really’ gay.”
Gatekeeping versus services on demand
Much of my early activism was informed by sex-positive, pro-choice feminism. We passed out condoms and “Just Say Yes” sex-ed books at Chicago Public Schools, and we defended clinics from Operation Rescue. One of our major initiatives was family planning services (including abortion) that were “safe, free and on demand.” I have always seen parallels between family planning and transition-related medical services, both of which were once only available through back alley clinics and black market sources. Women in our community died from this, and still die from illegal and unregulated products and procedures because of our legal status. I believe controlling our bodies is a fundamental human right. If someone wishes to undergo a vasectomy, vaginal rejuvenation, abortion, facial tattoo, piercings, tongue splittings, facial feminization, breast implants, mastectomy etc., I believe these procedures should be available to anyone who is willing to sign a release. I find it quite telling that our surgical procedures and abortion both face similar challenges, since both involve altering one’s capacity to reproduce.
Psychiatric gatekeeping only works for those who are unwilling or unable to find easier and faster ways. Before the internet, most young people got what they needed through extralegal networks (many poor people still do), and anyone who had the means would skip gatekeeping altogether and jet off to an exotic locale, as it had been done for many years before the gender clinics began imposing controls. At the apex of the gender clinic system, only those willing to endure a process akin to criminals at a parole hearing took that route—people who would say whatever the gatekeeper wanted to hear in order to get what they desired. 71 Ironically, many who tried to get around gatekeeping during their own involvement now insist it remain in place. 72 Lawrence, who is fond of quoting Audre Lorde, 73 must have missed “The master’s tools will never dismantle the master’s house.” 74 Gatekeeping also appeals to those who don’t get much validation except from gatekeepers. The acceptance letter becomes about the only acceptance they get. Not only is getting a vagina a status symbol and evidence of identity for this tiny group, but “beating the system” is a status symbol, too (which might also explain the correlation between online “‘autogynephilia’ support” and welfare support).
I should note that I had a great therapist who helped me immensely. I probably would have gone even without being required. Therapy and support should be encouraged, but voluntary, and without the stigma of disease, in the way that someone questioning their spiritual beliefs might find therapy helpful without needing their spiritual journey labeled as a “religious identity disorder.” With gatekeeping, we end up with people like BBL controlling access to services in exchange for money or sex. “Sexology” is an unregulated activity in most states, meaning anyone could set up shop as a sexologist or sex therapist. Bailey, Lawrence, and others have all used their “sexologist” credentials to gain easier access to sex partners. Some dismiss this as OK because they sign our little permission slips so we can get medical services. Call me old-fashioned, but I don’t feel it’s ethical or scientific for gatekeepers and sex researchers to have sex with clients and research subjects. I also don’t want my tax dollars federally subsidizing the sex life of a self-hating [trans]-chaser like Bailey, so he can meet women like me and later claim we “have the brains of men but the genitals of women” 75 or are prone to criminal activity and sexual promiscuity.
Here’s my question: why not cut out these middlemen and simply request and receive services? If people go to their physician and say they are depressed or anxious, the doctor believes their self-report and suggests options. Why can’t it be that simple for us?
Replacing GID as the principal diagnostic means for obtaining medical service is considered a top health priority in our community. Citing a progressive San Francisco program, the National Coalition for LGBT Health states: “There is a great need for more such programs that avoid GID as a requirement for access… this [requirement] results in many transgender people avoiding the psychiatric diagnosis process altogether, and not accessing medically regulated Trans Health Services.” 76 The interest itself isn’t the problem, it’s the anxiety and depression caused by depriving its expression. 77 If in some cases hormones and surgery help relieve anxiety and depression, they should be available as an effective, time-tested option.
Roughgarden notes: “Their bogus categories and made-up diseases are intended to subordinate, not to describe.” 78 Until we get away from this childlike dependence and deference to so-called “experts” simply because they take our money or don’t kick us out of their offices, our accommodation in healthcare and law will not be fully realized.
Beyond BBL
People like BBL rarely admit they are wrong, because they are very concerned about their academic legacy (which mirrors their beliefs about offspring). They will spend the rest of their lives fighting tooth and nail to defend their words and actions, but in the end BBL will be regarded as an interesting curiosity from the waning years when our community was considered disordered and diseased because of our interest in feminization, in whatever form that interest might take. Luckily, we don’t have to convince them they are wrong; we just have to convince everyone else.
We need to embrace judgment-free models to describe these phenomena. I hereby suggest the phrase that leads off this article: interest in feminization (IF) and the subset erotic interest in feminization (EIF) as umbrella terms without the stigma of disease. It encompasses not only our community, but anyone regardless of motivation, affectional orientation, or gender assigned at birth. Change “F” to “M” in the acronym for the F to M folks. I can think of a laundry list of problems with this proposed terminology, but this article is part of an ongoing evolution of ideas. I’ll leave the definitive statements to those who fancy themselves “experts” who claim they know “the truth.” My thoughts here won’t be the end of old ways of thinking, but with luck, it will spark some new ones, where we describe ourselves and our identities without the stigma of sin and disease.
From the day in April 2003 when Professor Lynn Conway began an investigation into Bailey’s book, 79 it was clear that this was a defining moment for our community. We mobilized all around the world as never before. 80 We made sure this book did not become another Transsexual Empire. 81 BBL underestimated everything about us, from our numbers, 82 to our intelligence, 83 to our ever-strengthening network, to the direct contact we have with our youngest and most vulnerable, to our influential positions in every career and profession, to our ability to effect positive change. 84 This isn’t just evolution, it’s revolution. We’re replacing sin and disease with pride and strength, and this is only the beginning.
Los Angeles September 2004
Acknowledgments
The author would like to thank Drs. Madeline Wyndzen and Nancy Ordover for key insights and research that informed this article.
References and notes
Please note: Anne Lawrence is notorious for removing website materials as soon as comments in them become difficult to defend. While every effort has been made to keep up-to-date links, some materials may no longer be available online.
4. Lawrence AA (2000). Sexuality and transsexuality: A new introduction to autogynephilia [sic] http://www.annelawrence.com/autogynephilia.html
5. Pinnel R (2003). Gay, straight, or lying? Science has the answer. Joseph Henry Press sales materials for The Man Who Would Be Queen. http://www.jhpress.org/press_release/10530.pdf [archive]
6. Petersen M (2003). Resignation letter to HBIGDA, 4 November 2003. http://www.tsroadmap.com/info/maxine-petersen.html
16 Lawrence AA (1999). Lessons from autogynephiles [sic]: eroticism, motivation, and the Standards of Care. http://www.annelawrence.com/1999hbigda1.html
23 Bierich H, Moser B (2003). Queer science: An ‘elite’ cadre of scientists and journalists tries to turn back the clock on sex, gender and race. SPLC Intelligence Report, Winter 2003. http://www.splcenter.org/intel/intelreport/article.jsp?sid=96 Sailer founded the group on 3 March 1999; Bailey and Blanchard both joined on 4 March. Like early eugenicists, this group advocates what they believe is a “benign” form of eugenics called positive eugenics, where “good” traits are encouraged, but this inevitably leads to negative eugenics, where “bad” traits are eliminated. For a Who’s Who of the modern eugenics movement, see the full list at: http://www.tsroadmap.com/info/human-biodiversity.html
25 Buck v. Bell, 274 U.S., 200, 207 [1927]: Associate Justice Holmes: “It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes.” http://www.dnalc.org/resources/buckvbell.html (click “Court’s decision” and see page 3 for full text)
45 Stekel W (1923). Der Fetischismus dargestellt für Ärzte und Kriminalogen. Störungen des Trieb- und Affektlebens (die parapathischen Erkrankungen) 7. [Volume 7: The fetishes, prepared for doctors and criminologists. Disorders of the Instincts and the Emotions (the parapathic illnesses)] Berlin/Wien: Urban & Schwarzenberg, 1923. First English translation by S. Parker as Sexual Aberrations. 1930 Liveright Publishing, New York. http://www.amazon.com/exec/obidos/tg/detail/-/0871400499/qid=1094416834/sr=1-1/ref=sr_1_1/002-8778638-7938457?v=glance&s=books
62 Federoff JP, Blanchard R (2000). The case for and against publicly funded transsexual surgery. Psychiatry Rounds, April 2000. http://www.tsroadmap.com/info/psychiatry_rounds.pdf
63 Byrd AD (2004). Book review: The Man Who Would Be Queen. via NARTH (National Association for Research and Therapy of Homosexuality) e.g. “Bailey’s focus on femininity among pre-homosexual boys and homosexual men…” http://www.narth.com/docs/queen.html
64 Bailey JM (2003). The Man Who Would Be Queen, p. 31. http://books.nap.edu/books/0309084180/html/31.html
65 Ibid. p. 33. http://books.nap.edu/books/0309084180/html/33.html
66 Colapinto J (2001). As Nature Made Him: The Boy Who Was Raised as a Girl. Perennial. As I discuss in my essay “Wannabes?”, transsexual women seek medical options to confirm their identities as women; others seek them to confirm their identities as transsexuals. Differential diagnosis appeals to some people who wish to be distinguished from or included with a group of people. Some people who seek bodily feminization base their evidence of inclusion on these procedures and use the disparaging term “just a crossdresser,” as if that is a less legitimate interest or identity. http://www.tsroadmap.com/info/wannabes.html
67 Swarns RL (2004). “African-American” becomes a term for debate. New York Times, 29 August 2004. http://query.nytimes.com/gst/abstract.html?res=F60614FA345A0C7A8EDDA10894DC404482
68 Lawrence AA (2000). Sexuality and transsexuality: A new introduction to autogynephilia [sic]. http://www.annelawrence.com/autogynephilia.html
69 Lawrence AA (2004). Posted as “autogynephile1,” 25 August 2004. http://groups.yahoo.com/group/autogynephiliasupport/message/3682
70 Lorde A (1984). The transformation of silence into language and action. Sister Outsider. The Crossing Press. p. 41. http://www.amazon.com/exec/obidos/tg/detail/-/0895941414/qid=1094418917/sr=8-1/ref=pd_ka_1/002-8778638-7938457?v=glance&s=books&n=507846
71 Bornstein K (1995). Gender Outlaw: On Men, Women, and the Rest of Us. New York: Vintage Books. e.g.: “Transsexuality is the only condition in Western culture for which the therapy is to lie.” http://www.amazon.com/exec/obidos/ASIN/0679757015/qid=1094418971/sr=ka-1/ref=pd_ka_1/002-8778638-7938457
72 Lawrence AA (1998). Absence of regrets after a “short real-life test.” http://www.annelawrence.com/shortrlt.html
73 Lawrence AA (1999). Autogynephilia [sic]: Frequently-asked questions. http://www.annelawrence.com/agfaqs.html
74 Lorde A (1984). The master’s tools will never dismantle the master’s house. Sister Outsider. The Crossing Press. p. 110. http://www.amazon.com/exec/obidos/tg/detail/-/0895941414/qid=1094418917/sr=8-1/ref=pd_ka_1/002-8778638-7938457?v=glance&s=books&n=507846
75 Tremmel PV (2003). Study suggests difference between female and male sexuality. Northwestern University press release, 12 June 2003. http://www.eurekalert.org/pub_releases/2003-06/nu-ssd061203.php
76 National Coalition for LGBT Health (2004). An overview of U.S. Trans Health Priorities. August 2004 update. http://www.lgbthealth.net/TransHealthPriorities.pdf (requires reader)
77 Vitale A (1997). Gender dysphoria: Treatment limits and options. http://www.avitale.com/treatmentoptions.htm
78 Roughgarden J (2004). The Bailey affair: Psychology perverted. http://ai.eecs.umich.edu/people/conway/TS/Reviews/Psychology%20Perverted%20-%20by%20Joan%20Roughgarden.htm
79 Conway L (2003-2004). An investigation into the publication of J. Michael Bailey’s book on transsexualism by the National Academies. http://ai.eecs.umich.edu/people/conway/TS/LynnsReviewOfBaileysBook.html
80 Burns C and 1,460 signatories (2004). J. Michael Bailey book petition. http://www.petitiononline.com/bailey/petition.html
81 Allison R (1998). Janice Raymond and autogynephilia [sic]. http://www.drbecky.com/raymond.html Reviewing Raymond JG. The Transsexual Empire: The Making of the She-Male. Beacon Press, 1979. http://www.amazon.com/exec/obidos/tg/detail/-/0807021644/qid=1094430439/sr=8-4/ref=sr_8_xs_ap_i4_xgl14/002-8778638-7938457?v=glance&s=books&n=507846
82 Conway L (2002). How frequently does transsexualism occur? http://ai.eecs.umich.edu/people/conway/TS/TSprevalence.html
83. Bailey JM (2003). The Man Who Would Be Queen, p. 179. http://books.nap.edu/books/0309084180/html/179.html
84 Letellier P (2004). Group rescinds honor for disputed book. PlanetOut.com Network, 16 March 2004. http://www.gay.com/news/article.html?2004/03/16/3
Please send all correspondence and reprint requests via feedback.
This independent research was funded by reader donations. If you found this useful or interesting and would like to see more articles of this sort in the future, please consider supporting transgender scholarship.
Peggy Cohen-Kettenis is a Dutch psychologist who helped found an important early clinic that served trans and gender diverse youth and adolescents.
Peggy T. Cohen-Kettenis was born in 1948 in Jakarta, Indonesia. Indonesia declared independence from the Dutch on August 17, 1945, and the family left in 1951 when it became dangerous for Dutch colonialists to stay, since Cohen-Kettenis’ seminal parent was a police commissioner. After arriving at The Hague, they moved to Rotterdam, then Utrecht.
Cohen-Kettenis attended Stedelijk Gymnasium Utrecht and Johan de Witt Gymnasium Dordrecht and earned a doctorate from Utrecht University in 1973.
Professor of Medical Psychology VUmcVUmc Sep 2002 – Jul 2013
Professor UMC Utrecht Sep 1987 – Sep 2002
Nederlands Instituut van Psychologen (NIP) logo Voorzitter Sector G 1997 – 2000
Cohen-Kettenis served as Professor of gender development and psychopathology at the Department of Child and Adolescent Psychiatry, University Medical Center Utrecht.
Transgender research
In 1987, Cohen-Kettenis started the first outpatient clinic in Europe for children and adolescents with gender problems and intersex conditions.
Cohen-Kettenis was a member of the World Professional Association for Transgender Health’s Standards of Care Committee and of the Task Force of the Endocrine Society Clinical Practice Guideline on the endocrine treatment of gender-dysphoric/gender-incongruent persons.
Psychologist Peggy Cohen-Kettenis reacts less negative. She is, after reading parts of the book not surprised about the row, but “when Bailey says that sexual preference and gender identity are not two entirely independent dimensions, he is not necessarily wrong”, she says.
In contrast to Bailey, Cohen-Kettenis expresses herself very diplomatic. As no other she knows the sensitivity of this terrain and the ease with which a “conflict can be created around this issue”. The psychologist agrees that not all transsexuals are heavily gender-dysphoric in youth. She attributes the dominance of “the woman captured in a man’s body” image, to it’s endless repetition by the media.
[…] Gooren is scathing about Blanchard’s work. […] Cohen-Kettenis shares Gooren’s objections to terms like homosexual and non-homosexual transsexuals. She would rather differentiate between early and late onset transsexuals. But apart from the terminology, these groups are very similar to those of Bailey and Blanchard. Primary TSs are more often homosexual while secondary TSs usually have had straight relationships before entering treatment, Cohen-Kettenis explains. “In the second group, during puberty cross-dressing is often paired with sexual excitement ” she says. “When they enter treatment however, the cross dressing is very restful”.
Cohen-Kettenis estimates half the number of TSs are secondary TSs. Whether all secondary TSs have had a autogynephile history she cannot say. “Extreme gender dysphoria can, I think, come to be in all sorts of ways. Secondary TSs are a very diverse group. We also see people who still are autogynephile.”
Cohen-Kettenis thinks that patient care will not be influenced by this theory. TSs do not have to fear that Cohen would see autogynophilia as a disqualification for treatment. The decisive factor is the suffering of the client, and whether treatment can indeed help to relieve the pain. In this, Blanchard and Bailey agree and mention that autogynophiliacs do not have a higher rate of post-treatment regrets.
Vermij, Peter (September 27, 2003). Een man gevangen in een mannenlichaam.NRC https://www.nrc.nl/nieuws/2003/09/27/een-man-gevangen-in-een-mannenlichaam-7655797-a1162822 Translation: Arianne van der Ven.
Selected publications by Cohen-Kettenis
Dan J. Stein, Peter Szatmari, Wolfgang Gaebel, Michael Berk, Eduard Vieta, Mario Maj, Ymkje Anna de Vries, Annelieke M. Roest, Peter de Jonge, Andreas Maercker, Chris R. Brewin, Kathleen M. Pike, Carlos M. Grilo, Naomi A. Fineberg, Peer Briken, Peggy T. Cohen-Kettenis & Geoffrey M. Reed (2020). Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Med18, 21 (2020). https://doi.org/10.1186/s12916-020-1495-2
The community of sex and gender minorities covers the full political spectrum. The size and inclusiveness of the community is debated, but this project takes a very broad definition of who is included.
This project also covers some topics that overlap with sexual minorities as well, including:
Gay
Lesbian
Bisexual
Asexual
Polyamorous
Pansexual
Kink and unusual erotic interests
While all of these communities and identities have overlapping interests and political goals, it’s difficult to generalize. The majority of the community seeks legal protections from harm and discrimination:
This site also covers people who are connected to our community, including those who do not consider themselves part of it.
It includes people who support the community, as well as people who hold a wide range of views that many in the community consider oppositional to one or more aspects of our community’s political goals.
Use the search feature to look for a specific person. If you don’t find a profile, please send a suggestion!
