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:
Murray Harris Kimmel (May 28, 1930 â October 28, 2013) was an American urologist who served our community.
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
Consumer reports
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:
Related pages:
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
Phone: +66 (0)2 8790300 Ext 1035Fax: +66 (0)2 8790395
Website: http://www.yanhee.net/serv_sexreass.htm
Email: [email protected] or [email protected]
Jirapong Poony is a Thai surgeon who has served our community. He was affiliated with Pattaya International Hospital.
Archival contact information:
Affiliated with Vichai Surawongsin.
General pages:
âąÂ 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.
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 AutĂłnoma 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 Childrenâs 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.
Exclusively Inclusive (exclusivelyinclusivepodcast.com)
The Gender Confirmation Center (genderconfirmation.com)
Published as:
James A (2006). A defining moment in our history: Examining disease models of gender identity. Gender Medicine. 3. S56. https://doi.org/10.1016/S1550-8579(06)80121-X
Abstract:
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:
Psychosexual pathology (Bailey-Blanchard-Lawrence [BBL] model)
Psychopathology (âgender identity disorderâ [GID] model)
Pathology (âbirth defectâ model)
Authorâs 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 âsinâ 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 itâs a sex-fueled mental illness). Though the idea has been around since the 19th century, new language for this âdisorderâ 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 âman who would be queen,â 1 âman without a penis,â 2 or âmen trapped in menâs bodiesâ 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 theyâve 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 âpolitically correct,â 4, 5, 6, 7 a term used by guardians of convention that signals a lack of intellect and contempt for scientific progress. For instance, Lawrenceâs opening salvo brags of being one of the âtroublesome people who are inclined to doubt the conventional wisdomâ about transgender eroticism, then just ten sentences later defends Blanchardâs use of the inaccurate and offensive term âhomosexual transsexualâ because it is âconventional usage in the psychiatric literature.â 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: âhomosexualâ (males aroused by males) and âautogynephilicâ (males aroused by the thought or image of themselves as women). Both categories efface our identities as women, but âautogynephiliaâ 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: âI love myself as a woman!â theyâll say. I do too, but thatâs not what this word denotes. When I say, ââAutogynephiliaâ is defined by its creator as a type of paraphilia,â some say, âWell, thatâs not how I use it.â Thatâs 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, âpedophileâ literally means âlove of childrenâ in Greek, and âautogynephileâ means âlove of self as woman,â but both terms are inexorably linked to their clinical origins as psychosexual pathologies.
Calling oneself or others âautogynephilicâ is participating in oneâs own pathologization, and it legitimizes this fake disease when people claim they donât have it. BBL are engaging in scientific McCarthyism, where they claim a hallmark of âautogynephiliaâ is that those afflicted will deny it. Any refutation becomes proof they are right, a no-win situation like asking âwhen did you stop beating your wife?â
When we say âautogynephiliaâ 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 âsexologyâ is similar to how a person of color might respond to âraceology.â 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 âscienceâ to reinforce socially constructed categories of ethnicity. As Anne Fausto-Sterling notes, âLabeling 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 genderânot scienceâcan define our sex. Furthermore, our beliefs about gender affect what kinds of knowledge scientists produce about sex in the first place.â 12
What kinds of knowledge about sex are BBL producing? They claim variously that homosexuality appears to be an evolutionary mistake 13 and a âdevelopmental errorâ 14, and gender variance is a âdefect in a manâs sexual learning,â 15 and a âsexual problem.â 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 âorderâ to which they adhere? They imply the âpurposeâ and âfunctionâ of sex and sex organs is procreation. Why, itâs so obviously true that the belief shouldnât 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 Lawrenceâs claim that sexual desire is âthat which moves us most.â 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 âidentityâ 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 âeugenics,â âgenetics,â âdegenerates,â and âgenderâ all derive from the same Greek root meaning âto produce or bring forth life.â 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 âundesirableâ traits. Should people with Down Syndrome or dwarfism be eliminated from the gene pool? How about intersexed people? If Baileyâs colleagues find the âgay gene,â 22 should we wipe out sexual minorities, too? What about gender minorities? Will we see a âtransgenocideâ? Who decides whatâs a disease or a degeneracy?
As evidenced by BBLâs 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 BBLâs ideas havenât evolved much from the influential works that shape their thinking. After Darwinâs Origin of the Species (1859) came Francis Galtonâs Hereditary Genius (1869). Following ideas in that book, Galton coined the term âeugenicsâ in 1883, which melded with the emerging fields of criminology and sexology. Though the term âeugenicsâ is now rightfully associated with Nazism, a few modern adherents hope to usher in an âAge of Galton.â 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 âtransvestiteâ and âtranssexualâ), who in 1897 founded Germanyâs Scientific Humanitarian Committee, whose motto was âjustice through science.â 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 doctorsâ âscientificâ 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, Hirschfeldâs institute had been destroyed, and persecuted minorities had been rounded up and murdered based on âscientificâ models that claimed groups like Jews, gays, and other persecuted minorities were âdegenerate,â biologically distinct, and a threat to âsocial hygiene.â
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 âunfit.â 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 Canadaâs top mental-health post. Clarke advocated eugenic policies to limit the immigration and marriage of the âdefective.â He also used psychiatric diagnoses to incarcerate new citizens. Foreign-born patients were 50% of his institutionalized population, including political activists, homosexuals, and other âdefectives.â 26
Clarkeâs 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 Freundâs 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 ânon-homosexual,â and later to do sex experiments on âmale gender dysphorics, paedophiles , and fetishists,â which they lumped together, yet divided into homosexual and ânon-homosexual.â 29
In historic diagnoses for sex problems, homosexuality and masturbation were âdiseasesâ that could strike either sex, but other problems were gendered degeneracy: women who had âtoo muchâ interest in straight sex had the now-discredited disease ânymphomania,â while men who had âtoo littleâ interest in it were inverts or perverts, a still legitimate disease category called âparaphilia.â
Dysphoria, disease, disorder, disability, defect
According to my medical records, I am mentally ill. The psychiatry industryâs Diagnostic and Statistical Manual of Mental Disorders (DSM) alleges that I am afflicted with âgender identity disorderâ (GID). Before that, I had âchildhood gender nonconformity,â from their special âkidsâ menuâ of mental disorders. Others with an interest in feminization get diagnosed with the âdisorderâ of âtransvestic fetishism.â 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 âpsychiatric diagnoses are stigmatizing labels, phrased to resemble medical diagnoses and applied to persons whose behavior annoys or offends others. âMental illnessâ is not something a person has, but is something [a person] does or is.â 31
I suppose I had a âdis-ease,â 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 âracial nonconformityâ or âreligious identity disorder.â
Disease models affect the kinds of knowledge produced by those who use them. Bem called sex researchersâ preoccupation with the causes of homosexuality âscientifically misconceived and politically suspectâ 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 âbiological apologistsâ 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 âgay geneâ and later a âgay germâ 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 âstraight geneâ or âstraight germ.â Like a good eugenicist who believes biology is destiny and genetics dictate human behavior, Bailey started linking gender roles to genetic discussions: âchildhood gender nonconformity does not appear to be an indicator of genetic loading for homosexuality.â 34 Is gender genetic?
Despite these problems, many in our community embrace a disease metaphor. Lawrence intones about âsymptomsâ of transsexualism, its âclinical course,â the benefits of âpalliative treatment.â 35 Lawrence then magnanimously claims that âeveryone has a right to self-define,â yet asserts that those who disagree with Lawrenceâs diagnosis arenât being very honest with themselves or others. A âpalliative treatmentâ 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 âassimilated their illnesses into their identities.â 36 Almost everyone who is attracted to the concept of âautogynephiliaâ identifies through metaphors of impairment. Many participants in the main ââautogynephiliaâ supportâ 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 âpalliative treatmentâ for shoe fetishists?
As Lawrence notes, âThere are many human behaviors that look like the same thing, but really aren’t.â 37 Previous medical attempts to catalogue behavior like Lawrenceâs were not only pathologizing, but insulting: People like Lawrence were âtransvestitic applicants for sex reassignmentâ 38 who are âagingâ 39 and âdistressed,â 40 suffering from âpseudotranssexualismâ 41 a ânon-transsexualâ variant of âgender identity disorderâ (GIDAANT), 42 and âiatrogenic artifact.â 43 Many notable âborderlineâ cases are doctors: Renee Richards, Anne Lawrence, Gregory/Gloria Hemingway. They may epitomize these published observations. They all self-treated, vacillated, and âdetransitionedâ 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), wouldnât 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 âdiseaseâ? I have never heard Dr. Bowers have to assert sheâs a ârealâ 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 âexpertsâ who have no business in science or medicine. Some âexpertâ will probably diagnose my questioning âexpertsâ as âauthority nonconformityâ or some other made-up disease to undermine my credibility. After all, my questioning the legitimacy of âautogynephiliaâ is evidence Iâm afflicted with it. To refute that kind of argument, we need to contextualize the term.
âParaphiliaâ and âautogynephiliaâ
The term âparaphiliaâ 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 âillnesses that need treatment.â 46 âParaphiliaâ 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 âparaphiliaâ as ârecurrent, 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 personsâŠ.
The behavior, sexual urges or fantasies cause clinically significant distress in social, occupational, or other important areas of functioningâ 48
Some people who identify with the diagnosis of âautogynephiliaâ chime in at this point and say, âWell, then I donât have a paraphilia, because I donât think I have a problem.â The most recent version of DSM was revised just for themâit says this illness can be diagnosed even if the person does not experience any subjective distress or impaired functioning. 49 LeVay notes: âThis 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.â 50
âAutogynephiliaâ 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 âautogynephilesâ 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 âpartial autogynephilia.â 52 However, Blanchard and his colleagues had enough influence in this rarely-studied subspecialty to get âautogynephiliaâ mentioned in the DSM. 53 The work would have remained an obscure intradisciplinary skirmish until Lawrence found Blanchardâs articles in 1997, during a time of great need. A year earlier, Lawrenceâs erotic interest in ritualized genital modification led to indulging that interest. 54 Lawrence had taken âphysician, heal thyselfâ to heart previously, and after yet another failed âcureâ in the form of vaginoplasty, Lawrenceâs fascination did not wane. In 1997, a lack of social acceptance at work (described in one account as âbizarre behaviorâ) 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 âautogynephiliaâ in a longer essay elsewhere. 57
A scientific or reasonable discussion of âautogynephiliaâ is like a scientific discussion of horoscopes: thereâs 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.
âTranssexualâ defined
BBL have proposed several definitions for âtranssexualâ that include people not previously considered within that definition. Their definitions view gender variance through the lens of disordered sexual desire. Bailey defines âtranssexualâ as anyone who has âthe desire to become a member of the opposite sex.â 58 They do not have to act on this desireââonly serious thoughtsâ are enough to qualify. 59 This model reflects Baileyâs definitions of sexual orientation: someone is a homosexual whether they act on their desire or not. Lawrence believes transsexuality is âfundamentally about changing one’s anatomy, or sex; and that sometimes it may have little to do with gender identity, or with gender role.â 60 Some do this ânot primarily because they have a gender problem, but because they have a sex problem, and indeed a sexual problem⊠the expression of a paraphiliaâ 61Blanchard says heâs reluctant to label children as âtranssexual,â 62 which is reminiscent of the âpre-homosexualâ language used by his homophobic counterparts in âgay cureâ groups like NARTH. 63 Blanchardâs colleague Ken Zucker is a vocal advocate of reparative therapy for gender-variant children, and he considers transsexuality âa bad outcome.â64 In fact, Bailey has noted that unchecked, this disease could spread: a world tolerant of gender-variant children âmight well come with the cost of more transsexual adults.â 65
Echoing Lawrenceâs strict anatomical construction of âtranssexual,â a quaint aphorism claims, âIf you arenât a transsexual before surgery, you are after.â 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, âpeople of colorâ and âAfrican-Americanâ are terms debated by both ethnic separatists and conservatives. 67 In our community, pluralist concepts like âqueerâ or âtransgenderâ 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 âdo not declare ourselves sick.â 68 Not morally sick, anyway, but physically sick. Lawrenceâs self-descriptions have remarkable parallels with descriptions of binge-and-purge cycles among crossdressers who hate their behavior, or those âafflictedâ with âunwanted homosexualityâ: âThe 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 âdisorderâ) to many of us who experience it (and I’m including myself here) and not merely a âbenign variantâ form of human sexuality.â 69 Swap âautogynephiliaâ with the word âhomosexuality,â and Lawrenceâs comment would feel right at home in a NARTH publication. Lawrenceâs âproblemâ is not self-love, but self-hate.
For those of us who view âgenderâ and âsexâ as socially constructed, transsexualism canât 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 donât 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 âYour silence will not protect you.â 70 I say your anatomy will not protect you, either. Legal and medical models based on anatomical benchmarks for âmaleâ and âfemaleâ 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 ââreallyâ a man,â and some of the worst offenders are âhelping professionalsâ and people in our community. They echo the racists who came up with âscientificâ schemes to determine who was ââreallyâ black,â or heterosexists like BBL who create ways to determine who is ââreallyâ gay.â
Gatekeeping versus services on demand
Much of my early activism was informed by sex-positive, pro-choice feminism. We passed out condoms and âJust Say Yesâ 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 âsafe, free and on demand.â 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 oneâs 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 routeâpeople 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 âThe masterâs tools will never dismantle the masterâs house.â 74 Gatekeeping also appeals to those who donât 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 âbeating the systemâ is a status symbol, too (which might also explain the correlation between online ââautogynephiliaâ supportâ 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 âreligious identity disorder.â With gatekeeping, we end up with people like BBL controlling access to services in exchange for money or sex. âSexologyâ 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 âsexologistâ 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 donât feel itâs ethical or scientific for gatekeepers and sex researchers to have sex with clients and research subjects. I also donât 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 âhave the brains of men but the genitals of womenâ 75 or are prone to criminal activity and sexual promiscuity.
Hereâs 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 canât 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: âThere 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.â 76 The interest itself isnât the problem, itâs 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: âTheir bogus categories and made-up diseases are intended to subordinate, not to describe.â 78 Until we get away from this childlike dependence and deference to so-called âexpertsâ simply because they take our money or donât 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 donât 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 âFâ to âMâ 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. Iâll leave the definitive statements to those who fancy themselves âexpertsâ who claim they know âthe truth.â My thoughts here wonât 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 Baileyâs 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 isnât just evolution, itâs revolution. Weâre 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.
1. Bailey JM (2003). The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism. Joseph Henry Press.
http://www.nap.edu/books/0309084180/html/ https://www.nap.edu/catalog/10530/the-man-who-would-be-queen-the-science-of-gender
2. Blanchard R (2004), cited in Armstrong J. The body within, the body without. Globe and Mail, 12 June 2004, p. F1.
http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20040612/COVER12/TPComment/TopStories https://www.theglobeandmail.com/incoming/the-body-within-the-body-without/article1000111/
3. Lawrence AA (1998). Men trapped in menâs bodies: An introduction to the concept of autogynephilia [sic].
http://www.annelawrence.com/autogynephiliaoriginal.html https://web.archive.org/web/19990128221339/http://www.mindspring.com/~alawrence/autogynephilia.html
http://home.swipnet.se/~w-13968/autogynephilia.html [archive]
4. Lawrence AA (2000). Sexuality and transsexuality: A new introduction to autogynephilia [sic]
http://www.annelawrence.com/autogynephilia.htmlÂ
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
7. Cantor J (2003). Book review: The Man Who Would Be Queen. APA Division 44 Newsletter, Summer, 2003.
http://www.apa.org/divisions/div44/vol19nu2.pdf (requires reader)
8. Lawrence AA (1998). Men trapped in menâs bodies.
http://home.swipnet.se/~w-13968/autogynephilia.html
9 Foucault M (1976). Il faut défendre la société [Society must be defended]. Gallimard/Seuil, Paris, 1987, p. 215-216., Chapter 11 (17 March 1976 lecture).
http://www.amazon.com/exec/obidos/tg/detail/-/0679724699/002-8778638-7938457?v=glance
10. McCloskey D (2000). Crossing: A Memoir. University of Chicago Press.
http://www.amazon.com/exec/obidos/tg/detail/-/0226556697/qid=1094414215/sr=1-1/ref=sr_1_1/002-8778638-7938457?v=glance&s=books
11. McCloskey D (2003). Queer Science [review of Baileyâs Man Who Would Be Queen]. Reason, November 2003.
http://www.findarticles.com/p/articles/mi_m1568/is_6_35/ai_109085443
12 Fausto-Sterling A (2000). Sexing the Body: Gender Politics and the Construction of Sexuality. Basic Books.
http://www.amazon.com/exec/obidos/tg/detail/-/0465077145/002-8778638-7938457?v=glance
http://www.symposion.com/ijt/gilbert/sterling.htm (excerpts)
13 Bailey JM (2003). KOOP radio interview.
http://www.donnarose.com/JMBInterview.html (transcription)
14 Bailey JM (1999). Homosexuality and mental illness. Archives of General Psychiatry. 1999 Oct;56(10):883-4.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10530627
15 Blanchard R (1991). Clinical observations and systematic studies of autogynephilia [sic]. Journal of Sex and Marital Therapy, 17(4) , 235-251.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1815090
16 Lawrence AA (1999). Lessons from autogynephiles [sic]: eroticism, motivation, and the Standards of Care.
http://www.annelawrence.com/1999hbigda1.html
17 The medical ideas of function, cause (etiology), and teleology conflict at times with evolutionary theory. See Wyndzen at:
http://www.genderpsychology.org/gender_queer/teleology.html
18 Lawrence AA (2000). Sexuality and transsexuality.
http://www.annelawrence.com/autogynephilia.htmlÂ
19 Wyndzen, MH (2003). Autogynephilia & Ray Blanchardâs mis-directed sex-drive model of transsexuality:
http://www.genderpsychology.org/autogynephilia/ray_blanchard
From Psychology of Gender Identity & Transgenderism:
http://www.genderpsychology.org/autogynephilia/ray_blanchard/anne_lawrence_identity.html
20 Roughgarden J (2004). Evolutionâs Rainbow: Diversity, Gender, and Sexuality in Nature and People. University of California Press.
http://www.amazon.com/exec/obidos/tg/detail/-/0520240731/qid=1094414737/sr=8-1/ref=pd_ka_1/002-8778638-7938457?v=glance&s=books&n=507846
21 Gould SJ (1996). The Mismeasure of Man. W. W. Norton & Company.
http://www.amazon.com/exec/obidos/ASIN/0393314251/qid=1094414821/sr=ka-1/ref=pd_ka_1/002-8778638-7938457
22 Dawood K, Pillard RC, Horvath C, Revelle W, Bailey JM (2000). Familial aspects of male homosexuality. Archives of Sexual Behavior. 2000 Apr;29(2):155-63.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10842723
23 Bierich H, Moser B (2003). Queer science: An âeliteâ 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 âbenignâ form of eugenics called positive eugenics, where âgoodâ traits are encouraged, but this inevitably leads to negative eugenics, where âbadâ traits are eliminated. For a Whoâs Who of the modern eugenics movement, see the full list at: http://www.tsroadmap.com/info/human-biodiversity.html
24 Black E (2003). War Against the Weak: Eugenics and America’s Campaign to Create a Master Race. Four Walls Eight Windows.
http://www.amazon.com/exec/obidos/tg/detail/-/1568582587/qid=1094414996/sr=8-1/ref=pd_ka_1/002-8778638-7938457?v=glance&s=books&n=507846
25 Buck v. Bell, 274 U.S., 200, 207 [1927]: Associate Justice Holmes: âIt 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.â
http://www.dnalc.org/resources/buckvbell.html (click “Court’s decision” and see page 3 for full text)
26 Dowbiggin IR (1997). Keeping America Sane: Psychiatry and Eugenics in the United States and Canada, 1880-1940. Cornell University Press.
http://www.amazon.com/exec/obidos/tg/detail/-/0801433568/qid=1094415314/sr=8-1/ref=sr_8_xs_ap_i1_xgl14/002-8778638-7938457?v=glance&s=books&n=507846
27 Though they have renamed themselves the Centre for Addiction and Mental Health (CAMH), Blanchard still works at the institution they call the Clarke Site.
http://www.camh.net/about_camh/Guide_CYGenderIdentitySvc.html
28 James AJ (2004). Plethysmograph: a disputed device.
http://www.tsroadmap.com/info/plethysmograph.html
29 Freund K, Blanchard R (1993). Erotic target location errors in male gender dysphorics, paedophiles, and fetishists. British Journal of Psychiatry 1993 Apr;162:558-63.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8481752
30 Zucker K, Blanchard R (1997). Transvestic fetishism: Psychopathology and theory. Sexual Deviance: Theory, Assessment, and Treatment, Guilford Press, New York.
http://www.amazon.com/exec/obidos/tg/detail/-/1572302410/qid=1094415488/sr=8-1/ref=sr_8_xs_ap_i1_xgl14/002-8778638-7938457?v=glance&s=books&n=507846
31 Szasz TS (1974). The Myth of Mental Illness. Perennial/HarperCollins p. 267.
http://www.amazon.com/exec/obidos/tg/detail/-/0060911514/qid=1094415537/sr=8-1/ref=sr_8_xs_ap_i1_xgl14/002-8778638-7938457?v=glance&s=books&n=507846
32 Bem D (1996). Exotic becomes erotic: A developmental theory of sexual orientation. Psychological Review 1996. Vol. 103, No. 2, 320-335.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11100261
33 Ordover N (2003). American Eugenics: Race, Queer Anatomy, and the Science of Nationalism. University of Minnesota Press, 2003.
http://www.amazon.com/exec/obidos/tg/detail/-/0816635595/qid=1094415622/sr=8-4/ref=sr_8_xs_ap_i4_xgl14/002-8778638-7938457?v=glance&s=books&n=507846
34 Bailey JM, Pillard RC (1991). A genetic study of male sexual orientation. Archives of General Psychiatry. 1991 Dec;48(12):1089-96.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1845227
35 Lawrence AA (1999). Autogynephilia [sic]: Frequently-asked questions.
http://www.annelawrence.com/agfaqs.htmlÂ
36 Wyndzen MH (2003). Everything you never wanted to know about autogynephilia [sic] * but were afraid you had to ask.
http://www.genderpsychology.org/autogynephilia/index.html
37 Lawrence AA (1999). Autogynephilia [sic]: Frequently-Asked Questions
http://www.annelawrence.com/agfaqs.html
38 Wise TN, Meyer JK (1980). The border area between transvestism and gender dysphoria: transvestic applicants for sex reassignment. Archives of Sexual Behavior. 1980 Aug;9(4):327-42.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7416946
39 Lothstein LM (1979). Psychological treatment of transsexualism and sexual identity disorders: some recent attempts. Archives of Sexual Behavior. 1979 Sep;8(5):431-44
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=496624
40 Wise TN, Dupkin C, Meyer JK (1981). Partners of distressed transvestites. American Journal of Psychiatry. 1981 Sep;138(9):1221-4.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7270729
41 Wise TN, Lucas J (1981). Pseudotranssexualism: iatrogenic gender dysphoria. Journal of Homosexuality. 1981 Spring;6(3):61-6.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7341667
42 American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (DSM III-R).
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
43 Moser C, Kleinplatz PJ (2002). Transvestic fetishism: psychopathology or iatrogenic artifact? New Jersey Psychologist, 52 (2) 16-17.
http://home.netcom.com/~docx2/tf.html
44 Richards (see Second Serve, Madison Books, 1984) and Lawrence both went off hormones, married, and fathered children.Â
http://www.amazon.com/exec/obidos/tg/detail/-/0812880757/qid=1094417020/sr=8-1/ref=sr_8_xs_ap_i1_xgl14/002-8778638-7938457?v=glance&s=books&n=507846
Lawrence writes: âI tried to put aside my cross-gender leanings and to function as a normal male.âÂ
http://www.annelawrence.com/mytrans.html
Hemingway continued to appear at public events as a male years after vaginoplasty.
http://ai.eecs.umich.edu/people/conway/TS/GregoryHemingway.htmlÂ
45 Stekel W (1923). Der Fetischismus dargestellt fĂŒr Ărzte 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
46 LeVay S (2003). Human Sexuality. Sinauer, p. 454. Bailey teaches undergraduates from LeVayâs book, and LeVay calls Baileyâs book âabsolutely splendidâ on the front cover.
http://www.amazon.com/exec/obidos/ASIN/0878934545/qid=1094416806/sr=ka-2/ref=pd_ka_2/002-8778638-7938457
47 American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (DSM-III).
http://www.amazon.com/exec/obidos/ASIN/0890420181/ref=pd_ecc_rvi_2/002-8778638-7938457
48 American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
http://www.amazon.com/exec/obidos/tg/detail/-/0890420629/qid=1094416501/sr=1-13/ref=sr_1_13/002-8778638-7938457?v=glance&s=books
49 American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).
http://www.amazon.com/exec/obidos/tg/detail/-/0890420254/qid=1094416419/sr=8-1/ref=pd_ka_1/002-8778638-7938457?v=glance&s=books&n=507846
50 LeVay S (2003). Human Sexuality, p. 454.
http://www.amazon.com/exec/obidos/ASIN/0878934545/qid=1094416806/sr=ka-2/ref=pd_ka_2/002-8778638-7938457
51 Blanchard R (1989). The concept of autogynephilia [sic] and the typology of male gender dysphoria. Journal of Nervous and Mental Disease. 1989 Oct;177(10):616-23.
http://www.genderpsychology.org/autogynephilia/male_gender_dysphoria/ (full text)
52 Blanchard R (1993). Partial versus complete autogynephilia [sic] and gender dysphoria. Journal of Sex & Marital Therapy. 1993 Winter;19(4):301-7.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8308916
53 Bradley SJ, Blanchard R, Coates S, Green R, Levine SB, Meyer-Bahlburg HFL, Pauly IB, Zucker KJ. Interim report of the DSM-IV subcommittee on gender identity. Archives of Sexual Behavior, Vol. 20, 1991, No. 4, pp. 333-343.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1953325
54 Lawrence AA (1996). Taking Portlandiaâs hand: sex reassignment surgery in Portland.
http://www.annelawrence.com/portlandia.html https://web.archive.org/web/19981206232218/http://www.mindspring.com/~alawrence/portland2.html
55 State of Washington Department of Health (1997). Appendix G: Incident Activity Report.
http://www.tsroadmap.com/info/lawrence/anne-lawrence-report.html https://www.transgendermap.com/wp-content/uploads/sites/7/2019/10/anne-a-lawrence.pdf
56 State of Washington Department of Health (1997). Initial Review Panel Case Presentation.
http://www.tsroadmap.com/info/lawrence/anne-lawrence-case.html https://www.transgendermap.com/wp-content/uploads/sites/7/2019/10/anne-a-lawrence.pdf
57 James AJ (2004). âAutogynephiliaâ: a disputed diagnosis.
http://www.tsroadmap.com/info/autogynephilia.html
58 Bailey JM (2003). The Man Who Would Be Queen, p. 144.
http://books.nap.edu/books/0309084180/html/144.html
59 Ibid.
http://books.nap.edu/books/0309084180/html/144.html
60 Lawrence AA (1999). Lessons from autogynephiles [sic].
http://www.annelawrence.com/1999hbigda1.html
61 Ibid.
http://www.annelawrence.com/1999hbigda1.html
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. âBailey’s focus on femininity among pre-homosexual boys and homosexual men…â
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 âWannabes?â, 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 âjust a crossdresser,â as if that is a less legitimate interest or identity.
http://www.tsroadmap.com/info/wannabes.html
67 Swarns RL (2004). âAfrican-Americanâ 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 âautogynephile1,â 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.: âTranssexuality is the only condition in Western culture for which the therapy is to lie.â
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 âshort real-life test.â
http://www.annelawrence.com/shortrlt.htmlÂ
73 Lawrence AA (1999). Autogynephilia [sic]: Frequently-asked questions.Â
http://www.annelawrence.com/agfaqs.html
74 Lorde A (1984). The masterâs tools will never dismantle the masterâs 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
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Peggy Cohen-Kettenis is a Dutch psychologist who helped found an important early clinic that served trans and gender diverse youth and adolescents.
Cohen-Kettenis has also held harmful views about transgender people, particularly around disease models. Cohen-Kettenis published with many anti-trans psychologists, including J. Michael Bailey, Kenneth Zucker, Ray Blanchard, Stephen Levine, Susan Coates, and Richard Green.
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.
Cohen-Kettenis served as Professor of gender development and psychopathology at the Department of Child and Adolescent Psychiatry, University Medical Center Utrecht.
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.
Cohen-Kettenis was Chair of American Psychiatric Association’s DSM-5 “gender identity disorder” subcommittee. In 2009, trans people protested the APA convention after Cohen-Kettenis inlcuded “autogynephilia” activist Ray Blanchard and anti-trans conversion therapist Kenneth Zucker on the subcommittee.
I designed the poster, helped organize, and spoke at the protest against Cohen-Kittenis and the APA.
Cohen-Kettenis was also member of the WHO ICD-11 Working Group on Sexual Disorders and Sexual Health.
Below are critical reactions Louis Gooren and Cohen-Kettenis shared about sexologists J. Michael Bailey and Ray Blanchard, following publication of Baileyâs lurid 2003 book on sex and gender minorities, The Man Who Would Be Queen.
Psychologist Peggy Cohen-Kettenis reacts less negative. She is, after reading parts of the book not surprised about the row, but âwhen Bailey says that sexual preference and gender identity are not two entirely independent dimensions, he is not necessarily wrongâ, 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 âconflict can be created around this issueâ. The psychologist agrees that not all transsexuals are heavily gender-dysphoric in youth. She attributes the dominance of âthe woman captured in a manâs bodyâ image, to itâs endless repetition by the media.
[…] Gooren is scathing about Blanchardâs work. […] Cohen-Kettenis shares Goorenâs 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.
âIn the second group, during puberty cross-dressing is often paired with sexual excitement â she says. âWhen they enter treatment however, the cross dressing is very restfulâ.Cohen-Kettenis estimates half the number of TSs are secondary TSs. Whether all secondary TSs have had a autogynephile history she cannot say. âExtreme 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.â
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.
Navarro, Danielle (May 6, 2018). Nevertheless, she desisted: A brief review of Steensma et al (2013). https://djnavarro.net/desistance-essay/
Cantor, James (December 15, 2017). Statistics faulty on how many trans- kids grow up to stay trans-? http://www.sexologytoday.org/2017/12/faulty-statistics-on-how-many-trans.html
Singal, Jesse (July 25, 2016). Whatâs Missing From the Conversation About Transgender Kids. New York https://www.thecut.com/2016/07/whats-missing-from-the-conversation-about-transgender-kids.html
Serano, Julia (August 2, 2016). Detransition, Desistance, and Disinformation: A Guide for Understanding Transgender Children Debates. Medium https://juliaserano.medium.com/detransition-desistance-and-disinformation-a-guide-for-understanding-transgender-children-993b7342946e
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.
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 Med 18, 21 (2020). https://doi.org/10.1186/s12916-020-1495-2
E Coleman, W Bockting, M Botzer, P Cohen-Kettenis, G DeCuypere, … Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7 International journal of transgenderism 13 (4), 165-232
WC Hembree, PT Cohen-Kettenis, L Gooren, SE Hannema, WJ Meyer, … Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline The Journal of Clinical Endocrinology & Metabolism 102 (11), 3869-3903
WC Hembree, P Cohen-Kettenis, HA Delemarre-Van De Waal, LJ Gooren, … Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline The Journal of Clinical Endocrinology & Metabolism 94 (9), 3132-3154
Steensma, T. D., McGuire, J. K., Kreukels, B. P., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(6), 582â590.
ALC De Vries, JK McGuire, TD Steensma, ECF Wagenaar, … Young adult psychological outcome after puberty suppression and gender reassignment Pediatrics 134 (4), 696-704
ALC De Vries, TD Steensma, TAH Doreleijers, PT CohenâKettenis Puberty suppression in adolescents with gender identity disorder: A prospective followâup study The journal of sexual medicine 8 (8), 2276-2283
MSC Wallien, PT Cohen-Kettenis Psychosexual outcome of gender-dysphoric children Journal of the American Academy of Child & Adolescent Psychiatry 47 (12 âŠ
TD Steensma, R Biemond, F de Boer, PT Cohen-Kettenis Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study Clinical child psychology and psychiatry 16 (4), 499-516
CM Wiepjes, NM Nota, CJM de Blok, M Klaver, ALC de Vries, … The Amsterdam cohort of gender dysphoria study (1972â2015): trends in prevalence, treatment, and regrets The journal of sexual medicine 15 (4), 582-590
TD Steensma, JK McGuire, BPC Kreukels, AJ Beekman, … Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study Journal of the American Academy of Child & Adolescent Psychiatry 52 (6), 582-590
ALC De Vries, PT Cohen-Kettenis Clinical management of gender dysphoria in children and adolescents: the Dutch approach Journal of homosexuality 59 (3), 301-320
TD Steensma, BPC Kreukels, ALC de Vries, PT Cohen-Kettenis Gender identity development in adolescence Hormones and behavior 64 (2), 288-297
ALC De Vries, ILJ Noens, PT Cohen-Kettenis, IA van Berckelaer-Onnes, … Autism spectrum disorders in gender dysphoric children and adolescents Journal of autism and developmental disorders 40, 930-936
PT Cohen-Kettenis, LJG Gooren Transsexualism: a review of etiology, diagnosis and treatment Journal of psychosomatic research 46 (4), 315-333
PT Cohen-Kettenis, SHM Van Goozen Sex reassignment of adolescent transsexuals: a follow-up study Journal of the American Academy of Child & Adolescent Psychiatry 36 (2), 263-271
M Aitken, TD Steensma, R Blanchard, DP VanderLaan, H Wood, … Evidence for an altered sex ratio in clinicâreferred adolescents with gender dysphoria The journal of sexual medicine 12 (3), 756-763
J Drescher, P Cohen-Kettenis, S Winter Minding the body: Situating gender identity diagnoses in the ICD-11 International Review of Psychiatry 24 (6), 568-577
GM Reed, J Drescher, RB Krueger, E Atalla, SD Cochran, MB First, … Disorders related to sexuality and gender identity in the ICDâ11: revising the ICDâ10 classification based on current scientific evidence, best clinical practices, and human ⊠World psychiatry 15 (3), 205-221
SHM Van Goozen, PT Cohen-Kettenis, LJG Gooren, NH Frijda, … Gender differences in behaviour: Activating effects of cross-sex hormones Psychoneuroendocrinology 20 (4), 343-363
YLS Smith, SHM Van Goozen, AJ Kuiper, PT Cohen-Kettenis Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals Psychological medicine 35 (1), 89-99
PT Cohen-Kettenis, F PfÀfflin Transgenderism and intersexuality in childhood and adolescence: Making choices Sage
HA Delemarre-Van De Waal, PT Cohen-Kettenis Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects European Journal of Endocrinology 155 (Supplement_1), S131-S137
PT Cohen-Kettenis, F PfÀfflin The DSM diagnostic criteria for gender identity disorder in adolescents and adults Archives of sexual behavior 39 (2), 499-513
PT Cohen-Kettenis, A Owen, VG Kaijser, SJ Bradley, KJ Zucker Demographic characteristics, social competence, and behavior problems in children with gender identity disorder: A cross-national, cross-clinic comparative analysis Journal of abnormal child psychology 31, 41-53
PT CohenâKettenis, HA DelemarreâVan De Waal, LJG Gooren The treatment of adolescent transsexuals: changing insights The journal of sexual medicine 5 (8), 1892-1897
ALC de Vries, TAH Doreleijers, TD Steensma, PT CohenâKettenis Psychiatric comorbidity in gender dysphoric adolescents Journal of Child Psychology and Psychiatry 52 (11), 1195-1202
G Heylens, E Elaut, BPC Kreukels, MCS Paap, S Cerwenka, … Psychiatric characteristics in transsexual individuals: multicentre study in four European countries The British Journal of Psychiatry 204 (2), 151-156
W Meyer III, WO Bockting, P Cohen-Kettenis, E Coleman, D Diceglie, … The Harry Benjamin International Gender Dysphoria Association’s standards of care for gender identity disorders, sixth version Journal of Psychology & Human Sexuality 13 (1), 1-30
YLS Smith, SHM Van Goozen, PT Cohen-Kettenis Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: a prospective follow-up study Journal of the American Academy of Child & Adolescent Psychiatry 40 (4), 472-481
JF Strang, H Meagher, L Kenworthy, ALC de Vries, E Menvielle, … Initial clinical guidelines for co-occurring autism spectrum disorder and gender dysphoria or incongruence in adolescents Journal of Clinical Child & Adolescent Psychology
KJ Zucker Gender identity disorder in children and adolescents Annu. Rev. Clin. Psychol. 1 (1), 467-492
J Olson-Kennedy, PT Cohen-Kettenis, BPC Kreukels, … Research priorities for gender nonconforming/transgender youth: gender identity development and biopsychosocial outcomes Current Opinion in Endocrinology, Diabetes and Obesity 23 (2), 172-179
T F. Beek, PT Cohen-Kettenis, BPC Kreukels Gender incongruence/gender dysphoria and its classification history International Review of Psychiatry 28 (1), 5-12
B Kuiper, P Cohen-Kettenis Sex reassignment surgery: a study of 141 Dutch transsexuals Archives of sexual behavior 17, 439-457
HEH Pol, PT Cohen-Kettenis, NEM Van Haren, JS Peper, RGH Brans, … Changing your sex changes your brain: influences of testosterone and estrogen on adult human brain structure European Journal of Endocrinology 155 (Supplement_1), S107-S114
TC Van de Grift, E Elaut, SC Cerwenka, PT Cohen-Kettenis, … Surgical satisfaction, quality of life, and their association after gender-affirming surgery: a follow-up study Journal of sex & marital therapy 44 (2), 138-148
BPC Kreukels, PT Cohen-Kettenis Puberty suppression in gender identity disorder: the Amsterdam experience Nature Reviews Endocrinology 7 (8), 466-472
D Slabbekoorn, SHM Van Goozen, J Megens, LJG Gooren, … Activating effects of cross-sex hormones on cognitive functioning: a study of short-term and long-term hormone effects in transsexuals Psychoneuroendocrinology 24 (4), 423-447
E Coleman, W Bockting, M Botzer, P Cohen-Kettenis, G DeCuypere, … & Zucker, K.(2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7 International journal of transgenderism 13 (4), 165-232
SHM Van Goozen, PT Cohen-Kettenis, LJG Gooren, NH Frijda, … Activating effects of androgens on cognitive performance: Causal evidence in a group of female-to-male transsexuals Neuropsychologia 32 (10), 1153-1157
MSC Wallien, H Swaab, PT Cohen-Kettenis Psychiatric comorbidity among children with gender identity disorder Journal of the American Academy of Child & Adolescent Psychiatry 46 (10 âŠ
YLS Smith, SHM Van Goozen, AJ Kuiper, PT Cohen-Kettenis Transsexual subtypes: Clinical and theoretical significance Psychiatry research 137 (3), 151-160
TC van de Grift, PT Cohen-Kettenis, TD Steensma, G De Cuypere, … Body satisfaction and physical appearance in gender dysphoria Archives of sexual behavior 45, 575-585
PT Cohen-Kettenis, SHM Van Goozen Pubertal delay as an aid in diagnosis and treatment of a transsexual adolescent European child & adolescent psychiatry 7 (4), 246-248
BPC Kreukels, IR Haraldsen, G De Cuypere, H Richter-Appelt, L Gijs, … A European network for the investigation of gender incongruence: the ENIGI initiative European Psychiatry 27 (6), 445-450
PT Cohen-Kettenis, SEE Schagen, TD Steensma, ALC de Vries, … Puberty suppression in a gender-dysphoric adolescent: a 22-year follow-up Archives of sexual behavior 40, 843-847
ALC de Vries, TD Steensma, PT Cohen-Kettenis, DP VanderLaan, … Poor peer relations predict parent-and self-reported behavioral and emotional problems of adolescents with gender dysphoria: a cross-national, cross-clinic comparative analysis European child & adolescent psychiatry 25, 579-588
TF Beek, BPC Kreukels, PT CohenâKettenis, TD Steensma Partial treatment requests and underlying motives of applicants for gender affirming interventions The journal of sexual medicine 12 (11), 2201-2205
J Drescher, PT Cohen-Kettenis, GM Reed Gender incongruence of childhood in the ICD-11: controversies, proposal, and rationale The Lancet Psychiatry 3 (3), 297-304
KJ Zucker, PT Cohen-Kettenis, J Drescher, HFL Meyer-Bahlburg, … Memo outlining evidence for change for gender identity disorder in the DSM-5 Archives of Sexual Behavior 42, 901-914
TC Van De Grift, E Elaut, SC Cerwenka, PT Cohen-Kettenis, … Effects of medical interventions on gender dysphoria and body image: a follow-up study Biopsychosocial Science and Medicine 79 (7), 815-823
SEE Schagen, PT Cohen-Kettenis, HA Delemarre-van de Waal, … Efficacy and safety of gonadotropin-releasing hormone agonist treatment to suppress puberty in gender dysphoric adolescents The journal of sexual medicine 13 (7), 1125-1132
TO Nieder, M Herff, S Cerwenka, WF Preuss, PT Cohen-Kettenis, … Age of onset and sexual orientation in transsexual males and females The journal of sexual medicine 8 (3), 783-791
PT Cohen-Kettenis Gender identity disorder in DSM? Lippincott Williams & Wilkins
TD Steensma, PT Cohen-Kettenis Gender transitioning before puberty? Archives of sexual behavior 40, 649-650
LJJJ Vrouenraets, AM Fredriks, SE Hannema, PT Cohen-Kettenis, … Early medical treatment of children and adolescents with gender dysphoria: An empirical ethical study Journal of Adolescent Health 57 (4), 367-373
PT Cohen-Kettenis, TD Steensma, ALC De Vries Treatment of adolescents with gender dysphoria in the Netherlands Child and Adolescent Psychiatric Clinics 20 (4), 689-700
I Becker, TO Nieder, S Cerwenka, P Briken, BPC Kreukels, … Body image in young gender dysphoric adults: a European multi-center study Archives of sexual behavior 45, 559-574
PT Cohen-Kettenis, SHM Van Goozen, CD Doorn, LJG Gooren Cognitive ability and cerebral lateralisation in transsexuals Psychoneuroendocrinology 23 (6), 631-641
BPC Kreukels, B Köhler, A Nordenström, R Roehle, U Thyen, C Bouvattier, … Gender dysphoria and gender change in disorders of sex development/intersex conditions: results from the dsd-LIFE study The Journal of Sexual Medicine 15 (5), 777-785
PT Cohen-Kettenis, D Klink Adolescents with gender dysphoria Best Practice & Research Clinical Endocrinology & Metabolism 29 (3), 485-495
TD Steensma, J Van der Ende, FC Verhulst, PT CohenâKettenis Gender variance in childhood and sexual orientation in adulthood: A prospective study The Journal of Sexual Medicine 10 (11), 2723-2733
SHM Van Goozen, D Slabbekoorn, LJG Gooren, G Sanders, … Organizing and activating effects of sex hormones in homosexual transsexuals. Behavioral neuroscience 116 (6), 982
AL De Vries, TA Doreleijers, PT Cohen-Kettenis Disorders of sex development and gender identity outcome in adolescence and adulthood: understanding gender identity development and its clinical implications.Pediatric endocrinology reviews: PER 4 (4), 343-351
AS Staphorsius, BPC Kreukels, PT Cohen-Kettenis, DJ Veltman, … Puberty suppression and executive functioning: an fMRI-study in adolescents with gender dysphoria Psychoneuroendocrinology 56, 190-199
C Schneider, S Cerwenka, TO Nieder, P Briken, PT Cohen-Kettenis, … Measuring gender dysphoria: a multicenter examination and comparison of the Utrecht gender dysphoria scale and the gender identity/gender dysphoria questionnaire for ⊠Archives of Sexual Behavior 45, 551-558
SEE Schagen, FM Wouters, PT Cohen-Kettenis, LJ Gooren, SE Hannema Bone development in transgender adolescents treated with GnRH analogues and subsequent gender-affirming hormones The Journal of Clinical Endocrinology & Metabolism 105 (12), e4252-e4263
MSC Wallien, R Veenstra, BPC Kreukels, PT Cohen-Kettenis Peer group status of gender dysphoric children: A sociometric study Archives of Sexual Behavior 39, 553-560
MSC Wallien, KJ Zucker, TD Steensma, PT Cohen-Kettenis 2D: 4D finger-length ratios in children and adults with gender identity disorder Hormones and Behavior 54 (3), 450-454
R Blanchard, KJ Zucker, PT Cohen-Kettenis, LJG Gooren, JM Bailey Birth order and sibling sex ratio in two samples of Dutch gender-dysphoric homosexual males Archives of Sexual Behavior 25, 495-514
E Hoekzema, SEE Schagen, BPC Kreukels, DJ Veltman, … Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain Psychoneuroendocrinology 55, 59-71
ALC De Vries, PT Cohen-Kettenis, H Delemarre-Van De Waal Clinical management of gender dysphoria in adolescents International Journal of Transgenderism 9 (3-4), 83-94
SB Levine, GR Brown, E Coleman, PT Cohen-Kettenis, JJ Hage, … The standards of care for gender identity disorders Journal of psychology & human sexuality 11 (2), 1-34
L Cohen, C De Ruiter, H Ringelberg, PT CohenâKettenis Psychological functioning of adolescent transsexuals: Personality and psychopathology Journal of clinical psychology 53 (2), 187-196
SR Vance Jr, PT Cohen-Kettenis, J Drescher, HFL Meyer-Bahlburg, … Opinions About the DSM Gender Identity Disorder Diagnosis: Results from an International Survey Administered to Organizations Concerned with the Welfare of ⊠International Journal of Transgenderism 12 (1), 1-14
NM de Graaf, PT Cohen-Kettenis, P Carmichael, ALC de Vries, K Dhondt, … Psychological functioning in adolescents referred to specialist gender identity clinics across Europe: a clinical comparison study between four clinics European child & adolescent psychiatry 27, 909-919
TC Van de Grift, PT Cohen-Kettenis, E Elaut, G De Cuypere, …A network analysis of body satisfaction of people with gender dysphoria Body image 17, 184-190
AJ Kuiper, PT Cohen-Kettenis Gender role reversal among postoperative transsexuals International Journal of Transgenderism 2 (3), 1-6
SL Bungener, TD Steensma, PT Cohen-Kettenis, ALC De Vries Sexual and romantic experiences of transgender youth before gender-affirmative treatment Pediatrics 139 (3)
KJ Zucker, R Green, S Coates, B Zuger, PT CohenâKettenis, GM Zecca, … Sibling sex ratio of boys with gender identity disorder Journal of Child Psychology and Psychiatry 38 (5), 543-551
TD Steensma, PT Cohen-Kettenis, KJ Zucker Evidence for a change in the sex ratio of children referred for gender dysphoria: data from the center of expertise on gender dysphoria in Amsterdam (1988â2016) Journal of Sex & Marital Therapy 44 (7), 713-715
LJJJ Vrouenraets, AM Fredriks, SE Hannema, PT Cohen-Kettenis, … Perceptions of sex, gender, and puberty suppression: A qualitative analysis of transgender youth Archives of sexual behavior 45, 1697-1703
S Cerwenka, TO Nieder, P Cohen-Kettenis, G De Cuypere, … Sexual behavior of gender-dysphoric individuals before gender-confirming interventions: a European multicenter study Journal of sex & marital therapy 40 (5), 457-471
Archief Gedragswetenschappen (ADNG) (October 4, 2021). Peggy Cohen-Kettenis (1948) Oral History ADNG. https://www.youtube.com/watch?v=ZDO4FkI5F9o
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Milton Thomas “Milt” Edgerton, Jr. was an American plastic surgeon who served our community. Edgerton is widely considered one of the most important American plastic surgeons of the 20th century.
Edgerton was born in Atlanta on July 14, 1921 and earned a bachelor’s degree in chemistry from Emory University in 1941. Edgerton earned a medical degree from Johns Hopkins University in 1944. Following a surgical residency, Edgerton joined the United States Army and operated on injured World War II veterans.
Edgerton joined the Johns Hopkins faculty in 1951 and got tenure in 1962. In 1970 Edgerton was recruited to the University of Virginia to found the Department of Plastic Surgery, working and teaching there until retiring in 1994.
Edgerton had many students and colleagues who served our community as well, including Howard W. Jones, Jr. and John Gale Kenney. Edgerton was author of four books and over 500 scientific papers on plastic surgery. As shown in the selected bibliography below, Edgerton’s articles when read from earliest to latest read like an unfolding of the history of our community.
Edgerton died at age 96 on March 17, 2018. The Milton T. Edgerton, M.D. Professorship in Plastic & Reconstructive Surgery at Johns Hopkins is named in Edgerton’s honor.
Edgerton MT. Plastic surgery: its roots and rewards. Ann Plast Surg. 2003 Mar;50(3):240-3. PMID: 12800898
Edgerton MT. Early plastic surgery at the Johns Hopkins Hospital. Plast Reconstr Surg. 2002 Jul;110(1):229-33. PMID: 12087260
Edgerton MT. Plastic surgery: the rainbow profession. Ann Plast Surg. 1997 Mar;38(3):197-201. PMID: 9088453
Edgerton MT, Langman MW, Pruzinsky T. Plastic surgery and psychotherapy in the treatment of 100 psychologically disturbed patients. Plast Reconstr Surg. 1991 Oct;88(4):594-608. PMID: 1896531
This paper reviews the senior author’s long-term experience with the surgical-psychiatric treatment of 100 aesthetic surgery patients with significant psychological disturbances. Patients with psychological disturbances of a magnitude generally considered an “absolute contraindication” for surgery were operated on and later assessed to determine the psychological impact of surgery. Patient follow-up averaged 6.2 years (maximum follow-up 25.7 years). Of the 87 patients who underwent operation (7 patients were refused surgery and 6 voluntarily deferred surgery), 82.8 percent had a positive psychological outcome, 13.8 percent experienced “minimal” improvement from surgery, and 3.4 percent were negatively affected by surgery. There were no lawsuits, suicides, or psychotic decompensations. Patients with severe psychological disturbances frequently benefited from combined surgical-psychiatric treatment designed to address the patient’s profound sense of deformity. This study suggests that plastic surgeons are “passing up” a significant number of patients who may be helped by combined surgical-psychological intervention. Comment in: * Plast Reconstr Surg. 1992 Aug;90(2):333-5.* Plast Reconstr Surg. 1992 Jun;89(6):1173-5.
Edgerton MT Jr, Langman MW, Pruzinsky T. Patients seeking symmetrical recontouring for “perceived” deformities in the width of the face and skull. Aesthetic Plast Surg. 1990 Winter;14(1):59-73. PMID: 2330857
This article describes plastic surgery patients who sought symmetrical recontouring of the width of the face and skull. The basic demographic and personality characteristics of these facial width deformity (FWD) patients and the surgical procedures performed on them are discussed. Details of the surgical and psychological management of three representative cases are given. Speculative conclusions regarding the general characteristics of the FWD population are offered. Suggestions are proposed for a combined surgical-medical psychotherapeutic collaboration in managing these patients.Comment in: * Aesthetic Plast Surg. 1990 Fall;14(4):299-300.
Pauly IB, Edgerton MT. The gender identity movement: a growing surgical-psychiatric liaison. Arch Sex Behav. 1986 Aug;15(4):315-29. PMID: 3741090
The evaluation and treatment of individuals with gender identity problems has resulted in an interesting and productive collaboration between several specialties of medicine. In particular, the psychiatrist and surgeon have joined hands in the management of these fascinating patients who feel they are trapped in the wrong body and insist upon correcting this cruel mistake of nature by undergoing sex reassignment surgery. Over the last two decades, some 40 centers have emerged in which interdisciplinary teams cooperate in the evaluation and treatment of these gender dysphoric patients. The model for this collaboration began at The Johns Hopkins Hospital, where the Gender Identity Clinic began its operation in 1965 (Edgerton, 1983; Pauly, 1983). This “gender identity movement” has brought together such unlikely collaborators as surgeons, endocrinologists, psychologists, psychiatrists, gynecologists, and research specialists into a mutually rewarding arena. This paper deals with the background and modern era of research into gender identity disorders and their evaluation and treatment. Finally, some data are presented on the outcome of sex reassignment surgery. This interdisciplinary collaboration has resulted in the birth of a new medical subspecialty, which deals with the study of gender identification and its disorders.
Edgerton MT. The role of surgery in the treatment of transsexualism. Ann Plast Surg. 1984 Dec;13(6):473-81. PMID: 6524842
The increasing use of surgery for sex reassignment in the treatment of transsexualism is described. The author’s early experience over a twenty-year period with the Gender Identity teams at The Johns Hopkins University and The University of Virginia is summarized. Many of the reasons for slow acceptance of this type of surgery by many members of the medical profession are analyzed. The satisfactory subjective results described by patients who have received sex reassignment continue to exceed the results obtained by other methods. The author concludes that further study of surgical treatment is justified, but that it should be limited to established multidisciplinary teams working in academic settings. Physicians are urged to withhold judgment on the role of surgery in gender disorders until they have had significant personal experience with these desperate and complex patients.
Edgerton MT Jr, Langman MW, Schmidt JS, Sheppe W Jr. Psychological considerations of gender reassignment surgery. Clin Plast Surg. 1982 Jul;9(3):355-66. PMID: 7172587
Edgerton MT, Sheppe WM Jr, Turner UG 3rd, Thorup OA. Transsexualism. An insight into the power of psychologic gender–a panel discussion. Pharos Alpha Omega Alpha Honor Med Soc. 1978 Oct;41(4):31-6. PMID: 724795
Turner UG 3rd, Edlich RF, Edgerton MT. Male transsexualism–a review of genital surgical reconstruction. Am J Obstet Gynecol. 1978 Sep 15;132(2):119-33. PMID: 356612
Transsexualism is a poorly understood, uncommon, and controversial entity of recent interest to the lay public and medical profession. Important features of the condition are discussed, surgical procedures for genital conversion in male transsexuals are compared, and our experience at the University of Virginia where 53 patients have been treated surgically is presented. All patients have made satisfactory postoperative psychosocial adjustment despite a surgical complication rate approaching 50 per cent. It is concluded that alternative (better) surgical procedures for male transsexuals should be explored.
Bralley RC, Bull GL, Gore CH, Edgerton MT. Evaluation of vocal pitch in male transsexuals. Commun Disord. 1978 Sep;11(5):443-9. PMID: 730836
A 49-year-old male-to-female transsexual was administered voice therapy following surgery. Tape recordings were made of her speech prior to and each week during therapy. Selected sentences from these reocrdings were analyzed. Results indicate that changes in both fundamental frequency and perceptual judgments of femininity were statistically significant and supportive to the client. The voice of the client was still discernible from that of a female speaker, although less so than before therapy. It is suggested that a composite treatment program combined with laryngeal modification through surgical intervention may be necessary.
Thomson JA Jr, Knorr NJ, Edgerton MT Jr. Cosmetic surgery: the psychiatric perspective. Psychosomatics. 1978 Jan;19(1):7-15. PMID: 622436
Edgerton MT. Liquid silicone injections to improve scars: is this a solution to the problem? Clin Plast Surg. 1977 Apr;4(2):311-9. PMID: 852228
Edgerton MT. The surgical treatment of male transsexuals. Clin Plast Surg. 1974 Apr;1(2):285-323. PMID: 4609668
Edgerton MT. Transsexualism–a surgical problem? Plast Reconstr Surg. 1973 Jul;52(1):74-6. PMID: 4713823
Edgerton MT, Bull J. Surgical construction of the vagina and labia in male transsexuals. Plast Reconstr Surg. 1970 Dec;46(6):529-39. PMID: 4923947
Edgerton MT, Knorr NJ, Callison JR. The surgical treatment of transsexual patients. Limitations and indications. Plast Reconstr Surg. 1970 Jan;45(1):38-46. PMID: 490284
Knorr NJ, Hoopes JE, Edgerton MT. Psychiatric-surgical approach to adolescent disturbance in self image. Plast Reconstr Surg. 1968 Mar;41(3):248-53. PMID: 5644617
Knorr NJ, Edgerton MT, Hoopes JE. The “insatiable” cosmetic surgery patient. Plast Reconstr Surg. 1967 Sep;40(3):285-9. PMID: 6037160
Turner, Edlich & Edgerton, 1978
Dept. of Obstetrics, Gynecology and Plastic Surgery, University of Virginia Medical Center, Charlottville, VA, USA
In structure and representation this publication is closely related to the one of Edgerton & Meyer (1973), that is, it is no follow-up study with reliable data. Related are mostly surgical techniques for MFTs and surgical complications. Under historical viewpoints it is an interesting statement that Edgerton was already in 1963 the director of the Johns Hopkins Gender Identity Clinic in Baltimore, MD, while everywhere else the founding of this institution is generally dated two years later. Also it is interesting that a psychologist is given a key role or a veto right to the indication to surgery. For the rest, the necessity for a successful one-year-long “Real-Life-Test” as it was already in Edgerton & Meyer (1973), the experimental surgical breast enlargement is recommended as a step if the patient and treatment provider are insecure regarding the stability of the female identity of the patient. In how far the statement: “The only justification for the ongoing evaluation of surgery as a definite treatment entity is that patients with this condition have proved resistant to psychotherapy and drug therapy” (p. 121) is a general postulate or if the corresponding possibility has been tested with those who underwent surgery is not to be discerned by the publication.
It is reported about 53 gender reassignment surgeries of MFTs that Edgerton made after changing from Baltimore to Virginia.
Forty seven females came to the follow-up study in the first year after surgery. Globally it is said that all were subjectively happy and self-secure and socially better adjusted. “Psychological testing has substantiated these subjective claims” (p. 128). Suicide attempts after surgery or desires to role re-reversal were not observed. Eighteen females had gotten married and six had adopted children.
In the series of the first 20 surgically treated, 14 females required corrective surgery; in the series of the second 20, only eight. The most frequent complication was the stenosis of the vagina. Injuries of the urethra or rectum with corresponding fistulae did not occur.
Smith, Harrison (July 16, 2018) Milton Edgerton, trailblazing plastic surgeon for children and transgender patients, dies at 96. Washington Post. https://www.washingtonpost.com/local/obituaries/milton-edgerton-trailblazing-plastic-surgeon-for-children-and-transgender-patients-dies-at-96/2018/07/16/28bcae0a-8836-11e8-8aea-86e88ae760d8_story.html
American Society of Plastic Surgeons (May 22, 2018). Craniofacial groundbreaker Milton Edgerton, MD, passes at age 96. https://www.plasticsurgery.org/for-medical-professionals/education-and-resources/publications/psn-extra/news/craniofacial-groundbreaker-milton-edgerton-md-passes-at-age-96
Morgan RF, Morgan EA (2019). Milton T Edgerton, MD: A Pioneer of Surgery of the Hand. Journal of Craniofacial Surgery: March/April 2019 – Volume 30 – Issue 2 – p 303â305 https://doi.org/10.1097/SCS.0000000000005063
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