ATHENE Series

General Editors
Gloria Bowles
Renate Klein
Janice RaymondConsulting Editor
Dale Spender

The Athene Series assum es that all those who are concerned withformulating explanations of the way the world works need to know andappreciate the significance of basic feminist principles.
The growth of feminist research internationally has called into
question almost all aspects of social organization in our culture. The
Athene Series focuses on the construction of knowledge and theexclusion of women from the process—both as theorists and subjectsof study—and offers innovative studies that challenge establishedtheories and research.

ATHENE, the Olympian goddess of wisdom, was honored by theancient Greeks as the patron of arts and sciences and guardian of
cities. She represented both peace and the intellectual aspect of war.
Her mother, Metis, was a Titan and presided over all knowledge. While
pregnant with Athene, Metis was swallowed whole by Zeus. Some saythis was his attempt to embody her supreme wisdom. The original
Athene is thus twice bom: once of her strong mother, Metis, and once
more out of the head of Zeus. According to feminist myth, there is a“third birth” of Athene when she stops being an agent and mouthpieceof Zeus and male dominance, and returns to her original source: thewisdom of womankind.

THE
TRANSSEXUAL
The Making of the She-Male

EMPIRE
Reissued with a New Introduction on TransgenderJ A N I C E G. RAYMOND

Teachers C ollege Press
Teachers C ollege, Columbia University
N ew York and London

Reprinted in 1994 by Teachers College Press, 1234 Amsterdam Avenue
New York, NY 10027
Originally published in 1979 by Beacon Press
Copyright © 1994 by Janice G. Raymond
All rights reserved. No part of this publication may be reproduced or trans­mitted in any form or by any means, electronic or mechanical, including pho­
tocopy, or any information storage and retrieval system, without permission
from the publisher.
Grateful acknowledgment is made to Little, Brown and Company for permis­
sion to reprint material from the following: Sexual Signatures: On Being a
Man or a Woman by John Money and Patricia Tucker. Copyright © 1975 byJohn Money and Patricia Tucker. By permission of Little, Brown and Com­pany.

Library of Congress Cataloging-in-Publication Data
Raymond, Janice G.
The tran ssex u al empire: th e m aking of the she-m ale / Janice G.
Raymond.
p.
cm. ---(Athene series - 39)
Reissue, with a new introduction, of the 1979 ed., published by Beacon
Press, Boston.
Includes bibliographical references and index.
ISBN 0-8077-6272-5
1. Sex change--M oral and ethical aspects. 2. Transsexuals. 3. Lesbi­
ans. 4. Sex role. I. Title. II. Series.
RC560.C4R38 1994
305.3---dc20

ISBN 0-8077-6272-5

Printed on acid-free paper
Manufactured in the United States of America
98 97 96 95 94
8 7 6 5 4 3 21

93-46

CONTENTS

Introduction to the 1994 Edition

xiii

Introduction: Some Comments on Method (forthe Methodical) 1I.

“Everything You Always Wanted to Know about
Transsexualism” 19

II.

Are Transsexuals Bom or Made—or Both?

II.

“Mother’s Feminized Phallus” or Father’s
Castrated Femme? 69

IV.

Sappho by Surgery: The TranssexuallyConstructed Lesbian-Feminist 99

V.

Therapy as a Way of Life: Medical Values versus
Social Change 120

VI.

Toward the Development of an Ethic of Integrity
154
Appendix: Suggestions for Change
Notes

187

Index

213

178

43

For Mary Daly
Who has moved me
to the Moors of the Mind. . .
Who has taught me
to feel with all my intellectand think with all my h e a rt. . .
With Gratitude, Awe, and LoveACKNOWLEDGMENTS

This book has been long in process. It began as a confer­ence paper delivered at the New England Regional Ameri­
can Academy of Religion Meeting in 1972. Much of it had
another life as my doctoral dissertation, which was fin­ished at Boston College in 1977. Finally, it metamor­
phosed into a book. There are many people to thank for
all of this.
My parents’ love, trust, and support have been an im­
portant source of encouragement. Many of my students
offered creative insights and critical commentary as thework was in progress. I would like to thank Jan Stiefel
who, in proofreading with me, read the entire manuscript
aloud. Amy Hines and Judy Gold were valuable search
assistants who found material for me often at short notice.
Chris Decker applied her creative and prestidigitatory tal­
ents to the index of this book, as well as to the proof­
reading of the galleys. Anne Dellenbaugh snooped out
many difficult-to-find sources, read over many of these
herself, offered original comments, and taught me how to
sail.
vii

viii

Acknowledgments

Some people read selected parts of my work, either inchapter or in article form, and made helpful suggestions.
Among these are Jackie Pritzen, Fern Johnson, and Lisa
Buck. Eileen van Tassell was particularly helpful in readingover Chapter II. Julia Stanley assisted in clarifying severalof my linguistic applications. Andrea Dworkin commented
on Chapter IV.
Mary Howell and Max Stackhouse served on my disser­
tation committee and read this manuscript in another oneof its lives. Mary Howell helped me to explain the medical
aspects of the issue and to integrate certain ethical aspects
with issues current in the women’s health movement. Max
Stackhouse assisted me in organizing the methodologicalaspects of my work. Michael Gross has been both a suppor­
tive colleague and critic. In reading the manuscript earlyon, he gave me invaluable suggestions on the sex difference
literature, Chapter II, and the history of medicine andscience.
For their friendship and support, I would like to thankKate Lehmann, Linda Scaparotti, Karin Krut, Kath Wetzel,
and Marcia Liebermann. For many years, Wilma Miley has
been a very special friend and supporter. Michelle Cliff gave
me many insights into the publishing world and encouraged,
in many ways, the publication of this book. I have known
Emily Culpepper since I first began work on this topic. She
has provided me with many resources and insights, and sheinvented the key phrase that I use throughout this book(male-to-constructed-female). Conversations with Linda
Barufaldi were always fun, and her friendship and creativ­
ity have been important in the process of this book. Nelle
Morton’s work, example, and friendship have profoundly
affected my life and work. Robin Morgan has encouraged
my work in this area for many years. Her writing, insight,
and counsel have been vital to me.
Nancy Sunflower gave an intelligent and careful typingof the manuscript. Mary Ann Lash made editorial sugges­
tions which helped to clarify the content and structure of
my book.
Adrienne Rich has been a very special friend and critic.

ix

Acknowledgments

She has read the manuscript through all of its stages andprovided resources, creative criticism, and constant en­
couragement. Her work, and her recognition of my work,
have meant a great deal to me in the process of this writ­ing.
I hope the dedication of this book adequately expresses
the gratitude I owe to Mary Daly. Her friendship, wisdom,
and creativity are enspiriting and, more than anyone, she
has sparked my creativity. It is difficult for me to separate
my words and ideas from her own.
Pat Hynes has been with this book in the deepest way.
She has read the manuscript and made detailed, discerning,and perceptive observations throughout. To her, I say that
“Friendship is a divine affection.” Be-ing with her, in all
ways, is a life-giving experience.

I N T R O D U C T I O N TO T H E
1994 E D I T I O NThis year, 1994, is the fifteenth anniversary of the publica­tion of The Transsexual Empire. Shortly after the book was
published in 1979, Johns Hopkins, which was the first U.S.
medical institution to perform transsexual surgery, phased
out the procedure and dismantled its Gender Identity Com­mittee. Although some of my friends credited The Transsex­
ual Empire as an important influence on the termination of
the surgery, I think the closing of Johns Hopkins’s doors hadmuch more to do with several other factors, some announced
and some not publicized.
The publicized reason was a study by Jon Meyer, psychia­
trist and director of the Johns Hopkins sexual consultation
program, which found that there was no difference in longterm adjustment for individuals who undergo the surgery
and those who do not. Meyer, after keeping follow-up records
on his patients’ postoperative acceptance of their new gen­der—using such indicators as employment status, maritaland cohabitation success, psychological and legal problems—concluded that the surgery served “as a palliative measure[but] it does not cure what is essentially a psychiatric distur­bance. "1 This was the public reason for discontinuing the sur-Introduction to the 1994 Edition

urgs ery, and it was accompanied by points of view to the con­trary from other transsexual experts and apologists who
disputed the study’s methodology and small sample popula­tion, and accused Meyer of drawing unwarranted conclu­
sions.2
It is my own hypothesis that other not-so-public reasons
were also influential in the demise of the Johns Hopkins pro­gram. John Money, founder and chief publicist for the Hop­kins program, member of the Gender Identity Committee,
and author of numerous articles and books on transsexualism
and intersexuality, had branched out into the realms of childpornography and incest. Money had lectured and written that
incest need not necessarily affect a child adversely, and thatthe law should differentiate between traumatic and nontraum
atic incest. “When the genuine pair-bonding of erotic lovehas existed between the two partners in incest, then the dis­covery and disbanding of their partnership, not the partner­
ship itself, may be the source of trauma.[! ]"3 In his work onchildren and sexuality, Money and co-editor Gertrude Wil­
liams went so far as to state that a man who commits incest
is a sexual deviant, which is “like being a religious deviant ina one-religion society. "4 Thus it could be construed that oppo­
sition to incest is comparable to religious intolerance. Mon­
ey's championing of good versus bad incest experiences fit
neatly with the pro-incest theorizing and lobbying supported
by many academics that began in the late 1970s and early
1980s. Money’s colleagues were reported to be uneasy withhis public statements and writings on incest, and increas­
ingly*over their alliance with him. Also during this same pe­riod, Howard Jones, one of the chief surgeons connected with
the Johns Hopkins program, left the Baltimore institution towork on in vitro fertilization (IVF) techniques and eventuallyto co-found his own fertility and IVF clinic in Norfolk, Vir­ginia.5
In spite of the closing of the Johns Hopkins program,other institutions have continued to perform the surgery.
During the last fifteen years, however, medical opinion has
become more critical of the previous rush to perform trans­
sexual surgery. A 1991 article in The Lancet, while acknowl­

Introduction to the 1994 Edition

xiii

edging that the surgery may benefit some individuals, never­theless warned about “medical collusion with unattainable
fantasy.. . . ” Despite the encouragement that has been given
to medical professionals over the years to continue perform­
ing sex reassignment surgery, The Lancet editorial issued“strong caveats” and pointed especially to health and safetycomplications from hormonal treatments. Although I had
written in 1979 about the danger of cancer resulting fromlifelong exogenous estrogens taken by male-to-constructedfemale transsexuals, today there is stronger evidence of therisks resulting from estrogen treatment.
Prescription of feminising or masculinising drugs carries consid­
erable dangers, which m ust be fully understood and agreed to by
the patient; the prescription should be continuously monitored byserum lipid m easurem ents in the biological female and liver functionin the male, together with assessment of hormonal function, includ­ing prolactin concentrations in the female, and regular physical ex­
amination.6

Despite these caveats, transsexual surgery continues to be
performed. Since the publication of The Transsexual Empire,
however, the number of sex reassignment clinics and centers
appears neither to have increased nor decreased but to be
maintained in a holding pattern. Because the records kept ontranssexual surgery, especially when done through private
clinics, are not easily accessible, it is difficult to obtain accu­
rate statistics.
Transsexualism remains, as in 1979, largely a male phe­nomenon. Female-to-constructed-male transsexuals are rela­
tively rare. For example, of the transsexual surgeries cur­rently performed at the University of Minnesota’s Programin Human Sexuality, the second U.S. institution to performthe surgery, 85 percent are male to female.7 More interesting
are the reasons why.
I still maintain that men, being freer to experiment than
women, seek out and submit to the surgery more often. The
discrepancy in numbers between men and women seeking
and obtaining the surgery may also signal what some men
may miscalculate as a way out of rigid gender roles. Womenxiv

Introduction to the 1994 Edition

have had a political outlet, that is, feminism, which has
helped change the distribution of power for women in society
and challenge sex role rigidification. There has been no com­parable “men’s movement” which has confronted, in an orga­
nized and political way, masculine gender roles, male sexual
identity, and manhood standards. In fact, many feminists
would argue that the current version of the men’s movement,
as exemplified in the writings of Robert Bly, maintains ahighly individualistic and superficial analysis of gender. In
Bly’s writings and in the “sweatlodge” pursuit of male libera­tion enacted in its reactionary and mythopoetic drumbeating
retreats, there is more antagonistic reaction to the demascu
linization of men and to the crisis in masculine identity sup­posedly fostered by feminism, than to any real questioning
and confrontation with male dominant power. At best, “IronJohn” embraces the standard of men’s newfound ability to cry
as a primary marker of male liberation.
There are not many female-to-constructed male transsex­
uals because, as Pat Hynes has pointed out, women havebeen saturated with different and more feminizing forms ofbody altering hormonal and surgical procedures.8 For many
women—mostly white, western, and middle class—the con­struction of gender dissatisfaction has been medicalized
through promotion of breast implants, hormone replacement
therapy, infertility hormones and reproductive procedures,and plastic surgery. As opposed to men who seek opposite
sex hormones and surgery, most women’s “gender dissatisfac­
tion” has been in not being feminine enough, or in not fulfill­ing their female role, e.g., motherhood. Thus medical sciencehas tended to direct women into conforming to maledominant images and roles of femininity.
Transsexual surgery is the invention of men initially devel­
oped for men. As I argued in 1979, female-to-male surgery ismore difficult, costlier, has less to offer women (“it’s easier toconstruct a hole than a pole”), and is less publicized. Simone
de Beauvoir gave us the insight that woman has been fabri­cated by man as “the other,” the relative being—relative tohimself as the norm. So it should not be surprising that men,

Introduction to the 1994 Editionxv

who have literally and figuratively, constructed women for
centuries, are now “perfecting” the man-made women out of
their own flesh.
Behind this construction of man-made femininity is also
the age-old patriarchal perception that women’s bodies should
be available to men. Transsexual surgery, I admit, is a pecu­
liar variation on this theme, but it points to the general ac­
cessibility of women, this time with men acquiring the female
body not only as sexual and/or reproductive property, but
through hormonal and surgical construction. Maleness is not
so easy to come by, especially because the majority of ven­dors (professionals) are males themselves and more discom­
fited in giving it away. For if maleness were as easily avail­able as femaleness, i.e., if men were as accessible, men too
would be treated like women.
THE MEDICAL MODEL

Key to the institutionalization of transsexual surgery is its
medical-psychiatric monopoly, its development as a clinicalentity—what has been called the transsexual syndrome.
Since transsexualism effectively has become a medical prob­lem, the medical model prevails as the legitimate and domi­
nant form of therapy, requiring psychiatric evaluation, hor­monal and surgical intervention, and often a host of countless
secondary cosmetic surgeries, all meant to adjust the artifac
tually evolving female body to the accepted feminine stereo­
types.
The medical model is also a disease model. And here ex­
actly is the rub. If transsexualism is treated as a disease,then does desire qualify as disease? As Thomas Szasz asked
in his New York Times review of The Transsexual Empire,
does an old person who wants to be young suffer from the“disease” of being a “transchronological,” or does a poor per­son who wants to be rich suffer from the “disease” of being a“transeconomical”? Does a Black person who wants to bewhite suffer from the “disease” of being a “transracial”?9 Allxvi

Introduction to the 1994 Edition

these questions, of course, raise larger social and political is­sues and remove these conjectural “diseases” from the medi­
cal/psychiatric framework.
In speculating why a hypothetical Black person mightwant a pigmentation change, the person himself might saythat he has always felt like a “white trapped in a Black body,”
as the transsexual commonly says that he is a “woman
trapped in a male body.” Yet it is only because transsexual­
ism is widely accepted as a condition requiring psychiatricand medical intervention—in effect as a disease or disease­
like—that the social and political questions surrounding why
a man might wish to be a woman are not primary. In thetransracial area, by contrast, would a Black person who des­perately wants to change skin color be so readily tracked
along the medical route, ignoring that his or her request is
encumbered by a society that discriminates against people on
the basis of skin color? This very comparison is weak since
there is no demand for transracial medical intervention pre­cisely because most Blacks recognize that it is their society,not their skin, that needs changing.
The medical framework and the plethora of professional
experts that have colonized so-called gender dissatisfaction
have been incapable of annexing race, age, or economic dis­satisfaction. Even the very word, dissatisfaction, individual­
izes rather than politicizes what causes the so-called dissatis­
faction. And so we talk about gender dissatisfaction in thetranssexual realm, rather than gender oppression; whereas
there is no comparable psychologizing of racial, age, and eco­nomic discrimination and oppression for which the individual
solution would be medical treatment.
The conglomerate of medical and other professional practi­
tioners who coalesce to institutionalize transsexual treatment
and surgery on the medical model—the transsexual em­
pire—become shapers of acceptable and permissible genderrelated behavior. For example, feminine and masculine
stereotypes have become clinically institutionalized in the re­quirement that transsexuals prove they are true candidates
for surgery by passing as members of the opposite sex.

Introduction to the 1994 Edition

xvii“Passing” standards evaluate everything from an individual’s
feminine dress, to feminine body language, to so-called femi­nine positions in intercourse. Most clinics require candidates
for surgery to live out culturally-fabricated opposite sex be­
havior and roles for periods of six months to two years. Al­
though some critics have claimed that this requirement has
been reevaluated and minimized in recent years, much of theprofessional literature published since The Transsexual Em­
pire still mentions ability to pass in the opposite sex role as aprerequisite for the surgery.10
Defining and treating transsexualism as a medical problem
prevents the person experiencing so-called gender dissatis­
faction from seeing it in a gender-challenging or feminist
framework. Persons who think they are of the opposite
sex are therefore not encouraged to see this desire as em­
anating from the social constraints of masculine and feminine
role-defined behavior. Thus a man who is emotional or nur­turing is encouraged to think of himself as a woman insteadof as a man who is trying to break out of the masculine
role. A primary effect of defining transsexualism as a med­
ical problem is to encourage persons to view other persons(especially children) who do not engage in normative sexrole behavior as potential transsexuals. Ultimately trans­
sexual surgery reinforces social conformity by encouraging
the individual to become an agreeable participant in arole-defined society, substituting one sex role stereotype
for the other. The medical solution becomes a. “social tran­
quilizer” reinforcing sexism and its foundation of sex-role
conformity.
With the increased medicalization of transsexualism, a cer­tain group of people are encouraged to channel gender dissat­
isfaction into surgery. As previously mentioned, there is acontinuum of surgeries, such as silicone breast implantation,
designed to treat other forms of gender dissatisfaction. Since
the 1950s, women who are dissatisfied with their bodies orparts of them, in this case the size of their breasts—in real­
ity their gender image—have been encouraged to have themaugmented by breast surgery and silicone implants, leadingxviiiIntroduction to the 1994 Edition

to disastrous health and safety consequences. In the 1980s
and 1990s, the plastic surgery industry, including the associa­
tion of plastic surgeons, led a campaign to convince womenthat having small breasts was actually a physical deficiency.
According to the American Society of Plastic and Recon­
structive Surgeons, small breasts are not only a deformity
but “a disease which in most patients results in feelings of in­adequacy.” 11Thus millions of women have been led to change
their breasts, not their image of themselves. Likewise, themedicalization of transsexualism promotes the ideology thatthe problem of gender dissatisfaction needs the interventionof the medical and surgical specialties to remedy the dissatis­
faction by constructing a body of the opposite sex.
CRITICAL RESPONSES AND RESPONSE TO THE
CRITICS
The reprinting of one’s book gives the author a golden op­
portunity to respond to reviews and criticisms of her work.
Instead of trying to address every point, I focus on recurring
themes in the reviews and criticisms.
A frequent question that people have asked is “What’s thebig deal?” Many want to know why, the issue of transsexual­
ism is of concern in the schema of pressing issues of femi­
nism. As I saw it then and see it now, transsexualism goes tothe question of what gender is, how to challenge it, and what
reinforces gender stereotyping in a role-defined society.
These questions have been raised subsequently in the context
of more recent debates defined by the current argot of“transgender.” Transsexualism is said to be a radical chal­lenge to gender roles, breaking the boundaries of gender andtransgressing its rigid lines. But if the transsexual merely
exchanges one gender role for another, if the psychiatric andmedical experts demand that transsexuals pass in the oppo­
site gender role before they can undergo surgery, and if theoutcome of such a sex reassignment is to endorse a femininity
which, in many transsexuals, becomes a caricature of much

Introduction to the 1994 Edition

xix

that feminists have rejected about man-made femininity, thenwhere is the challenge, the transgression, and the breakingof any real boundaries?
Many critics of The Transsexual Empire claimed that al­though I attack gender conformity, I do so by essentializing
sex and gender. This was surprising to me since a wholechapter of The Transsexual Empire was a critique of the theo­ries of biological essentialism that grounded the etiology oftranssexualism in biology—for example, in prenatal hor­monal or in genetic factors. The work of John Money andAnke Ehrhardt had been especially influential in theorizing
about prenatal hormonal factors, postulating the existence ofan early critical period in which a particular but unspecified
gender identity formation began (see Chapter II). Although
the professional literature continues to debate the causes oftranssexualism, a review of this literature in Psychoendoctri
nology concluded that no hormonal effect on human gender
identity formation has been established.12
The essentialism that I was accused of had more to dowith my unwillingness to accept that men could become“real” women. By repudiating the claim that men become
women through transsexual treatment and surgery, I wascharged with promoting gender essentialism instead of de­stroying it. Alice Echols was one of the first to sound this cri­tique, accusing me of being “committed to preserving rather
than annihilating gender distinctions.”13The critique wastaken further by Annie Woodhouse in a much misinterpreted
analysis of The Transsexual Empire. In her book, Fantastic
Women, Woodhouse contends that I assert there is somethingessential about femininity that cannot be changed, “some­thing which cannot be acquired or learned,” and thatcannot be constructed surgically or culturally.. . . In that case, ju stwhat is the point of engaging in struggle against gender divisions atall? If it all boils down to some innate, essential quality, any attem pt
to change this state of affairs would be futile. In fact Raymondstates th at as sex reassignment surgery cannot change chromosomal
sex, the transsexual does not really change sex at all. 14

xxIntroduction to the 1994 Edition

Woodhouse conflates two distinctly different issues here. I
did write that the transsexual does not really change sex atall. But this does not mean that gender is immutable; itmeans that men cannot become women via hormones andsurgery. My view is that, using Woodhouse’s own words, themale-to-female transsexual is a “fantastic woman,” the incar­
nation of a male fantasy of feeling like a woman trapped in a
man’s body, the fantasy rendered flesh by a further male
medical fantasy of surgically fashioning a male body into a fe­
male one. These fantasies are based in the male imagination,
not in any female reality. It is this female reality that the sur­gically-constructed woman does not possess, not because
women innately carry some essence of femininity but because
these men have not had to live in a female body with all thehistory that entails. It is that history that is basic to female
reality, and yes, history is based to a certain extent on female
biology.
Affirming that transsexual surgery cannot change the ba­
sic biology of chromosomal sex is not to say that chromo­
somal sex defines gender. But in some very real senses, fe­male biology shapes female history—a history that men don’t
have because of their sex—including the history of menstrua­tion, the history of pregnancy or the capacity to become
pregnant, the history of childbirth and abortion, the historyof certain bodily cycles and life changes, and the history offemale subordination in a male-dominant society. Note that I
keep saying history. To deny that female history is, in part,based on female biology is like denying that important as­pects of Black history are based on skin color. As with biolog­
ical skin color, female biology doesn’t confer an essential fem­
ininity; rather it confers a historical reality about what itmeans to be bom with XX chromosomes.
As Somer Brobribb has written, any mention of the female
body subjects the writer to the accusation of being dismissed
as a female essentialist. “Any reference to the female body,especially its reproductive aspects, means our condemnation
as 'biological determinists, ’ ‘dangerous essentialists’—veri­
table dinosaurs (mere egg-layers) outstripped by a postmod-

Introduction to the 1994 Edition

ernism so androgynous there are no longer any identities ordifferences at all.”15Yet any serious feminist should be able
to affirm the difference the body makes to one’s history with­out being accused of being a raging essentialist.
I was also branded as an essentialist for disallowing thatmale-to-constructed females could become lesbians. In writ­ing about this phenomenon of transsexed men who wereidentifying as lesbians and pressing to join feminist and les­bian groups, I had maintained that these men crave much
more than female biology—that transsexually-constr uctedlesbians seek to possess the creative power that is associatedwith female biology. My logic was that since lesbian feminism
signalled a total giving of women’s energy to women, it was
this woman-identified energy that the transsexual who claims
to be a lesbian wants for himself. Thus, certain men who
wanted to become women would want to assimilate this moreradical and total female being. Today, I would not use thisphrase, female energy, since it is too vague and ethereal.
Had I been more sociological in my description of what at­
tracted transsexuals to defining themselves as lesbians, had I
phrased this as an attraction to a sense of lesbian esprit decorps, or lesbian solidarity, rather than to lesbian creativity
and energy, perhaps I would have passed muster. But I doubtit.
The title of my book, The Transsexual Empire, bothered
another group of critics. The title was meant to convey the
primary thesis that transsexualism constitutes a sociopoliti­
cal program that is undercutting the movement to eradicate
sex-role stereotyping and oppression in this culture. When I
wrote this, many reviewers took it to mean that a vast maleconspiracy was afoot to eradicate “native-born” women—theultimate male plot to possess women totally. That was neverwhat I meant, nor was it what I intended to convey.
Rather the title, The Transsexual Empire, fixes attention
on the system of transsexual surgery and the professional
complexes and coalitions that create it in the name of therapy
for the suffering individual. In designating it as an “empire”
and calling it a “sociopolitical program,” my point was to fo-

xxiiIntroduction to the 1994 Editioncus on its institutional nature, i.e., its systemic dimensions,
not anything quite so neatly packaged as a conspiracy. In giv­
ing us the concept of “the banality of evil,” Hannah Arendt
reminded us that wrongdoing and destruction are not always
radically intentional or the result of planned conspiracies, butthey may be terribly ordinary. I never meant that transsex­
ualism was the result of male medical monsters or biomedical
conspiracies. Things are not so simple, and the objective of
The Transsexual Empire was to convey the complexity of its
institutionalized foundation.
The title of my book was satirized in “The Empire Strikes
Back; a Posttranssexual Manifesto,” an article written by
Sandy Stone. Stone, a male-to-constructed female transsex­
ual, was hired in the 1970s as a sound engineer by Olivia Rec­
ords, the all-women recording company. This set off a contro­
versy in feminist circles that I alluded to and commented onin The Transsexual Empire. Since then, it seems that Stone
has gotten himself a thorough postmodernist education, andhe now theorizes that, after all is said and done, the trans­
sexual is really text, or perhaps a full-blown genre. “In thetranssexual as text we may find the potential to map the refi­
gured body onto conventional gender discourse and thereby
disrupt it, to take advantage of the dissonances created bysuch a juxtaposition to fragment and reconstitute the ele­ments of gender in new and unexpected geometries.”16
In this postmodernist tour de force, Stone uses the lan­
guage of postmodernism to mystify and distract from the realmaterial and political questions of surgically turning men into
women. “Nothing Matters,” as Somer Brodribb so succinctly
put it, except “the peculiar arrangement of reality as Idea.”
Brodribb eloquently captures what lies at the heart of themale-to-constructed female transsexual project.
The rule is th at only man may appear as woman.. . . This is his
narcissistic solution to his problem of the Other. But to do this, tocreate her in his image, he must be able to take her image.. . . And
I have to make arguments that sound extravagent to my ears, th atwomen exist. That women are sensible.. . . And to contradict this,Introduction to the 1994 Editionxxiii

to speak against masculine culture, is so uncultured. The Masters of
discourse have also said th at it requires a great deal of sophistica­
tion to speak like a woman, clearly it’s best left to men. Their texts
play with and parade a hysterical femininity, in our best interest ofcourse, to help us transcend the category of woman we somehow got
into . 17

Transsexualism urges us to collude in the falsification of real­
ity—that men can be real women—all in the pretense thattranssexualism breaks down the barriers of sex repressive­ness, sex role rigidity, and gender itself.
As Stone would have it, the power of transsexualism is insimply acting. “The essence of transsexualism is the act ofpassing. A transsexual who passes is obeying the Derridean
imperative. . . to begin to write oneself into the discourses
by which one has been written.”18But transsexuals are notsimply acting, nor are they text, or genre. Unlike impersona­tors, transsexuals are not participating in a performance inwhich the audience suspends disbelief for the duration of theshow. They purport to be the real thing. And our suspensionof disbelief in their synthetic nature is required as a moral
imperative.
Stone pays The Transsexual Empire the ultimate backhanded compliment. “Here in 1991, on the twelfth anniversaryof its publication, it is still the definitive statement on trans­
sexualism by a genetic female academic.” Even a backhanded
compliment is too generous, so a footnote is in order. “Thereis some hope to be taken that Judith Shapiro’s work will su­
percede Raymond’s as such a definitive statement. Shapiro’s
accounts seem excellently balanced.. . .”19The balance ap­
pears to reside in the fact that Shapiro, in her 1991 essay ontranssexualism, has appropriated much of my critique while
taking pains to dissociate herself from it.
There is much in Shapiro’s work that I recognize as myown. Shapiro writes that transsexuals are “more royalist
than the king” in adhering to traditional gender norms andbehavior.20 She confirms the ways in which the attending pro­fessionals reinforce their own expectations of gender identity

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Introduction to the 1994 Edition

behavior in transsexuals. She acknowledges that surgery,while currently regarded as a “technologically sophisticatedstrategy,” can also be seen as “a crude and primitive ap­
proach to issues of personal and social identity.”21 And al­though she does not want to overdo a variation of what was
originally my transracial analogy, she states that “sex change
surgery is a bit like turning to dermatologists to solve therace problem.”22 It seems that when all is said and done,
what Shapiro objects to is my tone—“Raymond contem­
plated transsexualism with all the frustration and disgust ofa missionary watching prime converts backslide into pagan­
ism and witchcraft.”23 Shapiro steps back from the whole pol­itics of transsexualism, ransacking anthropological literature
for cross-cultural and historical validation, comparing trans­
sexuals to the gender crossing of the Native American berdache, the xanith in Oman, and the woman-to-woman mar­riages in Africa, and reducing The Transsexual Empire to“ethnographic data on the feminine mystique that has charac­terized much feminist writing over the past couple of dec­
ades.”24
Finally, there were some critics who charged me with in­tolerance. In my not accepting men as women, some critics
accused me of not tolerating the difference of others. As I
wrote in The Transsexual Empire, this kind of tolerance is avery passive position and only encourages the creation of
more medical victims to sex role conformity. What I do ac­
cept is that men, and some women, who undergo transsexual
surgery are terribly alienated from their bodies, so alienatedthat they think little of mutilating them. I accept the factthat transsexuals have suffered an enormous amount of phys­
ical and emotional pain. But I don’t accept the fact that some­one’s desire to be a woman, or a man, makes one a woman orman. Or that the instrumentality of hormones and surgery
creates a real woman or man. Certainly, male-to-constructedfemale transsexuals are entitled to the same humanity, thesame respect and dignity, as is every other member of thehuman race—but as male human beings, or as individuals
who have undergone transsexual procedures, not as women.

Introduction to the 1994 Edition
THE POLITICS OF TRANSGENDERISM
The opening sentence of The Transsexual Empire was “Trans­
sexualism has taken only twenty-five years to become ahousehold word.” Things were relatively simpler then, withnormatively-different sexual and gender behavior prettymuch encapsulated under the headings lesbian/homosexual,
transvestism, and transsexualism. Today, fifteen years later,
things are more complex, and a plethora of terms such as“transgendered,” “re-gendered,” “gender blending,” “genderbending,” “gender fucking,” and “transhomosexuality” havebeen added to the lexicon of so-called gender dissonant be­havior. The film tribute to certain aspects of the transgenderphenomenon is “Paris Is Burning” and, more recently, “TheCrying Game.”
The issue of transsexualism has been largely superseded
by debates over transgenderism or what has been called“sexuality’s newest cutting edge.” The term, transgender,
covers preoperative and postoperative transsexuals, trans­
vestites, drag queens, cross dressers, gays and lesbians, bi­
sexuals, and straights who exhibit any kind of dress and/or
behavior interpreted as “transgressing” gender roles. It is in­teresting that like transsexuals, the majority of transgenderists are men who, rather than transcending, i.e., dismantlingand going beyond gender roles, seek to combine aspects oftraditional femininity with aspects of traditional masculinity.
One side of the transgender phenomenon was written
about in an article entitled “The Next Wave” in The Advocate.
In this article, transgender was closely allied with transsex­
ualism. Referring to a bar called the Motherlode in San Fran­cisco, the majority of patrons were said to be “much more
evolved in their gender expressions [than cross dressers].
Hormones, breast implants, cosmetic surgery, and in somecases sexual reassignment surgery make dedication to being
female more than a dress-up game for these women [sic].”25
Although lamenting that “transgender” had been excluded
from the title of the 1992 gay and lesbian march on Washing­
ton, and faulting “radical feminists, the PC lesbians, and thexxvi

Introduction to the 1994 Edition

assimilationist gay men” for not accepting transgendered in­dividuals into the movement, the article nevertheless is abrief for the virtues of what is called Transgender Nation.
Many male transgenderists work as prostitutes in the sex
industry. The article notes that “a high percentage of trans­
gendered women [sic], primarily in the preoperative phase,
have at one time or another engaged in sex work.”26Althoughprostitution is described as an economic necessity for mosttransgendered individuals, there is also the admission that itis “part of the discovery process that a transgendered woman[sic] may go through. Some of it is acting out fantasies, ob­sessions, or compulsions. It’s a sort of coming-of-age, a partof the transition, an identifying and validation process.”27 So
we have here, an idealizing of sexual exploitation and prosti­
tution in the name of transgender transformation, identity,
and maturity.
This tale of transgender is also a rendition of how men are“turned on” by other men. According to The Advocate, the al­lure of gender ambiguity and the polymorphous sexuality ex­
uded by transgenderists, the “hyperfeminine and hypersexual,” “chick with a dick” scene, is said to be attractive to
many men.28What is described as transgression of bounda­
ries actually turns out to be conformity to sex roles once
more, with many men flocking to hormones and surgery to
attract other men as artifactual, ultrafeminine women. The
article’s author does admit that many transgendered individ­
uals, through surgery or hormones, try to become the imageof the perfect woman, i.e., the Cindy Crawford-like model,
and that disturbing “prefeminist” notions of femininity per­vade the transgendered community, pitting those who
undergo surgery (true transgenderists) against those who re­main on hormones.
Another variation on the transgender theme is what wasonce simply called cross dressing, transvestism, or drag.29
When Boy George accepted a Grammy award for Best New
Artist in 1985, he thanked his U.S. audience for recognizing
not only his music but “a good drag queen.” Perhaps the moreflamboyant U.S. version of Boy George is African-American

Introduction to the 1994 Edition

xxvii

RuPaul, whose musical act has become a highly successful
marketable commodity. Thriving on theatrical sexuality com­bined with pop music, RuPaul, as The New York Times
phrased it, is “an amalgam of two distinct sexual archetypes:
gender benders and soul divas.”30
In RuPaul’s act, both “archetypes” depend upon the assim
ilation of stereotypical femininity, in the first instance by ap­
propriating miniskirts, blond wigs, and platform heels and, inthe second, by exaggerating femininity as “a birthright.” For
this conformity, RuPaul is called a “gender illusionist” andclaims that what he is doing is more than men dressing in
women’s clothes. It’s really about “the way everybody looks.
Because what really counts is inside.. . . You’re bom naked,
and the rest is drag.”31 The New York Times article idealizes
RuPaul as “a de facto social activist” who brings drag into
the mature part of the twentieth century by not simply mim­icking the voice and movements, say, of a Marilyn Monroe but
rather by being “his own woman [sic].” It’s too bad “his own
woman” looks and acts so much like the woman of man-madefemininity. As Kathy Miriam writes, “While ‘transgenderism’
foregrounds the reality that femininity is a male construct, it
does so by preserving sex difference, i.e., the heterosexual in­stitution. . . in contrast to being a strategy of disempowering(politically destroying) the social system which generates thecategory.”32
There have been pleas from some feminist commentators
to recognize that cross dressing, drag, and transvestism areon a continuum of masculinity and to sympathize with theseways in which some men are deviating from acceptable mas­
culine gender behavior. And often men dressing as women iscompared to women who wear pants. There is a false symme­
try here. When most women put on pants, a necktie, combat
boots, or a business-looking blazer, they are not trying topass as men. Nor do most of these women stage theatricalperformances that call attention to their cross dressing. They
do not mimic, for profit, male behavior. Most women who
wear male clothing are not trying to be men, nor to imitate
men personally or professionally, nor do they expect to bexxviii

Introduction to the 1994 Edition

mistaken for men. And there is no significant number ofwomen who fetishize certain articles of male clothing for sex­
ual pleasure or gender relaxation.
The reason that women wear pants is mainly comfort andconvenience. Pants are practical in all types of weather anddon’t make women physically vulnerable or encourage sexual
harassment, as certain styles of feminine clothes do. Moresignificantly, a woman putting on a man’s clothes is, in asense, putting on male power status, whereas a man putting
on women’s clothes is putting on parody. That drag queens
and cross dressers can draw hoots and howls in audiences ofmostly men says more about how women were and are per­ceived than it does about the supposed boundary-breaking
behavior of gender-bending men who wear women’s clothes.
Cross dressers, drag queens, and heterosexual transves­
tites—who clandestinely parade around in ultrafeminine
dress while often retaining their public personas as straight,
white, male conservative pillars of the community—depend
upon a certain mimicry of women’s persons, roles, status, anddress. That some men may find gender relief, sexual plea­sure, and/or stardom and financial profit in this mimicry doesnothing to challenge the political power of the normative,
dominant, powerful class of men that the male gender bender
still belongs to. Cross dressing could be more accurately per­ceived as another form of male self-expression and exhibi­
tionism. Scratching the surface of masculinity by flaunting its
opposite conventions of femininity, whether in drag, crossdressing, or heterosexual transvestism, may incur the wrathof other men and expose the cross dressers to pain and pun­ishment. But pain and punishment do not necessarily chal­lenge the substance of masculinity that is male dominant po­
litical power. The mostly one-way traffic of men moving down
the transgender highway is not new. Males have been imitat­
ing women on the stage and in religious rituals since time im­memorial, but this has done nothing to change the realitythat men, including many of these men, are in power.
Going further than the one-dimensional femininity of thetransvestite and cross dresser, many transgenderists mix andmatch, blending as much femininity or masculinity with its

Introduction to the 1994 Editionxxix

opposite into new gender recipes. The recipes, however, are arepackaging of the old gender roles. Transgenderists still ad­
here to many self-selected ingredients of these roles, al­though mixed and matched in a supposedly gender defiant
way. But transgenderist defiance equals a kind of androgy­
nous humanism, an individualist assertion of androgynous
blending, rather than a political defiance of both roles. Manytransgenderists seem to see masculinity and femininity as en­tities in and of themselves, to be preserved and grafted onto
one another. This can take the form of switching back andforth, as in transvestism, or combining both. Much depends
on appearances. While transgenderists break through thesemblance of masculinity, they don't break through its politi­
cal reality, that is, its power. And so androgynous humanism
replaces feminist politics.
THE TRANSGENDERED LESBIAN
Although transgenderism is largely a male phenomenon,
there are women who claim it as their own. One of the moremoving and historically rich accounts of the complexities ofgender is the novel, Stone Butch Blues, by Leslie Feinberg.
Stone Butch Blues is basically a transgender odyssey of awoman growing up in the gay bars and working-class facto­ries of the 1950s and 1960s. Coming of age as a young “butch”
in Buffalo, Feinberg movingly describes the working-class re­ality of this historical butch world with a sharp consciousnessof its political aspects—a more powerful testimony to classpolitics than any Marxist analysis—but a less astute politicalanalysis of gender than many readers will look and hope forthroughout the book. In discussing the novel’s portrait of thebutch-femme bar scene, one lesbian friend commented thatthe book takes no account of those lesbians, who like herself,
inhabited the same bars but did not succumb to these fiercely
defining and confining gendered roles.
Feinberg’s accounts of the relationships between butches
and femmes, many of whom were prostitutes, are moving
and cogently described. Using the tools of eye and heart,xxx

Introduction to the 1994 Edition

Feinberg lifts this world of butch and femme to a humanistic
level, whereas straight history has consigned such individuals
to the dregs of society. Tender and protective partnerships
were forged often in the crucible of police brutality where, inthe constant raids on bars, butches and femmes were swept
into jail and made to pay for their gender transgressions
through unrelenting, deliberate, and demeaning strippings,
forced oral sex, and vicious gang rapes by the police.
The novel has many insights, especially in its initial pages,
into the world of gender dogmatism. Its disappointment is its
failure to extend these personal insights into a political analy­
sis of gender. A key turning point is when Jess, the butch
protagonist in the novel, undergoes hormone treatment andbreast surgery. Living and working as a butch has become
too painful and fraught with harassment and violence, but so
has the realization that Jess feels herself to be other than awoman—a “he-she,” feeling neither like a woman or man but“different.” “I don’t feel like a man trapped in a woman’s
body. I just feel trapped.”33
It is significant that the only woman in this novel who of­fers any real political challenge to the role-defined world of
butch-femme is Theresa. Stone Butch Blues begins with a let­ter to Theresa and ends with the acknowledgment that she is
the woman who “I [Jess] “still carry around in my heart.” In
the early 1970s, it was Theresa, Jess’s femme lover, who,
after becoming active in feminist groups and activities at thecampus where she worked, attempted to persuade Jess that
“Anything that’s good for women is good for butches”(p. 138); and that anytime Jess disparages or disidentifies
with other women, she is wounding herself. And when Jessmakes the final decision to begin hormone treatment,
Theresa responds, “Jess, I can’t go out with you in the world
and pretend that you’re a man. I can’t pass as a straightwoman and be happy” (p. 152).
One gets a sense in these passages of the tensions between
the old and the new gender-challenging worlds of two people
who love each other but who have radically disparate ideas
and thresholds of what it means to exist, or to reject exis­

Introduction to the 1994 Edition

xxxi

tence, as women in a gender-defined society and how best to
take on that society. And it is surprising that most of thestory takes place not in the pre-feminist 1940s or 1950s, but
in the emerging feminist consciousness and climate of the
1960s and 1970s, when other women are rejecting these roles
and many forms of body-mutilating medicine.
Some of the more insightful passages in the book illustrateJess’s understanding of the line she had crossed after taking
hormones to pass as a man: the differential treatment she re­ceived as a butch in contrast to her present passing as maleand the ways in which women regard men and men in turnregard women. Jess notes that women are now afraid of her
on the streets, that passing as a straight man makes her an
instant expert on motorcycles, and that straight women who
think she’s “cute” relate to her in a flirtatious parrying, akind of courtship fencing. Finally, Jess observes that this lat­ter behavior receives public encouragement and approval.
Quite swiftly, Jess comes to the realization that not much
has changed. “At first, everything was fun. The world
stopped feeling like a gauntlet I had to run through. But very
quickly I discovered that passing didn’t just mean slipping
below the surface, it meant being buried alive. I was still meon the inside.. . . But I was no longer me on the outside”(p. 173). After undergoing continuous hormone treatments,
her response to this disease is to proceed further with adouble mastectomy, but this additional bodily alteration
doesn’t resolve the question of who she really is. “I simply
became a he—a man without a past. Who was I now—
woman or man? That question could never be answered aslong as those were the only choices; it could never be an­swered if it had to be asked” (p. 222). And so, after living forseveral years as a man and undergoing both hormone treat­ment and radical breast surgery, Jess stops the hormone in­jections that had refigured her bodily contours and secondary
sex characteristics into a more masculine appearance, thus
arriving in a no-person’s land.
Stone Butch Blues is a personally moving but politicallydisappointing book. In the final part, there is a forsaking of

xxxiiIntroduction to the 1994 Edition

the political insights that marked the beginning pages ofJess’s life as a butch and, initially, of her life as a hormonallyand surgically-constructed male. As opposed to a priorgender-consciousness—an awareness that a woman wholooked like, acted like a man was subject to being brutalized
by men, was attractive to women, and was disgusting to soci­ety, there is now a kind of retirement to a gender-neutral oth­erness. The hormones, the surgery, the cessation of hormone
injections finally devolve into a long-suffering self-surrender
to being other—not a woman who is a butch and not a woman
who tries to pass as a man with the help of hormones andsurgery, but a transgendered individual who identifies as
simply other. In fact, Jess’s final transformation is from being
woman-identified, to being other-identified. And Jess’s most inti­
mate and personal relationships are no longer with women,
especially lesbians, but with men who are cross dressers andwho, like herself, presumably have undertaken hormones
and/or surgery. Jess’s ultimate identification with other­ness—in essence her disavowal of her own womanhood, notsimply the disowning of a rigid femininity that society has re­duced womanhood to—is at the heart of Feinberg’s final ver­sion and vision of transgenderism.

GENDER BENDING
Gender bending is a more recent version and vision of trans­
genderism, and k.d. lang is one of its more complex propo­
nents. “Gender bending has always been lang's stock-intrade. . . hers is a deeply subversive presence; after you
watch her for a while you realize how warped your own
stereotypes are.”34The gender bending that k.d. projects isdefinitely not the same as most male transgenderists who de­pend on surgery, hormones, passing as women, or mimicking
women on stage. Hers is a more dimensioned, savvy, andfeminist self-assertion that does not reduce gender bending
to the flaunting of sexuality, à la Madonna, but expands it topoint out the limits imposed upon both female gender andIntroduction to the 1994 Edition

xxxiiisexuality. However, there is a mixed message in her genderbending portrayals.
Featured in a photo spread in the August, 1993 issue of
Vanity Fair, k.d. lang does not define herself as a transgen
derist but, instead, prides herself “on being 100 percent
woman.”36There is much in the article that any feminist canidentify with: k.d.’s incredible talent and her rise up the pro­fessional ladder, defying any attempts to make her more fem­
inine and thus palatable to audiences; the kind of physicalfreedom with which she moves on stage, so unlike any otherfemale singer; the clothing she wears that doesn’t objectify or
exploit her body; her refusal to engage in performances fea­
turing her as a “heterosexual fantasy object”; her defense ofanimal rights and vegetarianism; her presentation of herself
as her self, never hiding her lesbianism or denying lesbian ru­
mors, culminating in her public “coming out.” “She takes
everything a woman is not supposed to be—big, funny, fear­
lessly defiant, physically powerful—and makes it not only
O.K. but glorious.”36
Why then capitulate to and capitalize on a role-defined,
and sexually objectifying cover photo that muddles this por­trait of gender resistance? If gender roles are challenged bya full-length cover spread in which a woman (k.d.) poses inmasculine vest, tie, pants, and boots as her face is being
shaved by a scantily dressed and provocatively positioned
Cindy Crawford, then aren’t we back to square one? The in­side photo shoot was even more gender defined, with k.d.
and Cindy somewhat stiffly acting up in what surely doesn’t
cut it as a realistic lesbian sex scene, with k.d. depicted as“checking] out the curves on supermodel Cindy Crawford.”37
Further, why pose for a picture that appears to depend uponsome association that the viewer will make between k.d. lick­ing a dish (?) and k.d. licking a prick, with the caption, “I
have a little bit of penis envy. They’re ridiculous but they’recool.”38 This is followed by a paean to male sexuality: “Asmuch as I hate it, I admire the male sexual drive because it’s
so primal and so animalistic.”39 A new version of no means
yes, “I want it, but not really,” and having it both ways?

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Introduction to the 1994 Edition

In the Vanity Fair portrait, we have another version of an­
drogynous humanism in which gender bending unfortunately
reduces to assimilation—transcending gender stereotyping
by assimilating aspects of it, such as sexual objectification.
Assimilationist behavior cannot fulfill political goals. Whenk.d. lang refuses to wear clothing or perform in ways that ob­
jectify her body on stage, she is issuing a real challenge tothe encouraged female role of flaunting sexuality. But whenk.d. lang's gender bending relies on being photographed witha woman whose body is sexualized in a way that lang herself
would not stand for, something is wrong, and the sexual ob­
jectification of women is hardly challenged.
Gender bending is gender identity condensed to the pointof little or no feminist or lesbian politics. Although k.d. langdefinitely does it better, she also conforms to the heterosexist
script, dissipating the political message that lesbianism at its
core, erodes rather than preserves hetero-roles. Taking
Kathy Miriam’s words and putting them in another context,
this kind of gender bending “works at eroding the landscapeof the lesbian by assimilating it [in this case, heterosexist
role-playing] into itself as a factor of patriarchal realism—byincluding it, rather than outright resisting it.” Seen throughthis lens, transgenderism can be viewed as “a plot where
even the ‘bad’ girls please men.”40
The language of sexual conformity as sexual rebellion has
come to dominate the public field. Transgenderism is the
product of a historical period that circumscribes any chal­lenge to sex roles and gender definitions to some form of as­
similating these roles and definitions. In much of the westernworld, the general effect of the 1980s has been to move backthe feminist gains of the 1960s and 1970s. It has encouraged
a style rather than a politics of resistance, in which an expres­sive individualism has taken the place of collective politicalchallenges to power. And in the process it has de-politicized
gender by de-politicizing feminism. The new gender outlaw is
the old gender conformist, only this time, we have men con­forming to femininity and women conforming to masculinity.
Or to be fair to another version of transgender, men andIntroduction to the 1994 Edition

xxxv

women mixing and matching but not moving beyond both.
The transgenderist assumes the posture of rebellion, but
only as restricted by the sex role scene, and going only as far
as a melding of both roles.
The ideal of transgender is provocative. On a personallevel, it allows for a continuum of gendered expression. On apolitical level, it never moves off this continuum to an exis­
tence in which gender is truly transcended. Its supposedly
iconoclastic rebellion against traditional gender confinement
is more style than substance. What good is a gender outlaw
who is still abiding by the law of gender?
The claim for tolerance, based on the notion that transgen­derism in all its forms is a form of gender resistance, is allur­ing but false. Instead, transgenderism reduces gender resist­ance to wardrobes, hormones, surgery, and posturing—
anything but real sexual equality. A real sexual politics says
yes to a view and reality of transgender that transforms, in­stead of conforms to, gender.
Janice G. RaymondMontague, Massachusetts
1994

INTRODUCTION

Some Comments
on Method(for the Methodical)

T r a n s s e x u a l is m highlights,
in a unique way, several key issues in feminist studies—among them sex-role socialization, “ nature versus nur­ture, ” and definitions and boundaries of maleness andfemaleness. Important issues in medical ethics, such as
bodily mutilation and integrity, “nature” versus tech­
nology, medical research priorities, unnecessary surgery,and the inevitable issue of the medical model, are involved
also.
Transsexualism touches the boundaries of many of theexisting academic disciplines in such a way as to raise fun­damental questions about the territorial imperatives of
biology, psychology, medicine, and the law, to name but
a few. Questions about the causes of transsexualism andthe proper methods of treatment have been hitherto re­stricted to the domain of psychology and medicine. But
as a feminist ethicist I maintain that these issues of cau­sation and treatment are imbued with male-defined values
and philosophical/theological beliefs—beliefs about theso-called natures of women and men. When John Money
1

2

The Transsexual Empire

states that the core of one’s gender identity is fixed by
the age of eighteen months, his statement is fraught withcertain normative beliefs about the changeability ofhuman existence. Such beliefs become invisible in the
mounds of supposed scientific data that Money offers
about sex differences. Or when transsexuals and trans­
sexual specialists relegate sex-role dissatisfaction and asubsequent desire for the qualities ascribed to the oppo­
site sex to the category of transsexualism, this very classi­
fication forms a type of medical belief system that re­sembles what has classically been called theodicy.
In this theodicy, as in all religious theodicies, the sur­render of selfhood is necessary to a certain extent. In the
medical theodicy, transsexuals surrender themselves tothe transsexual therapists and technicians. The medicalorder then tells transsexuals what is healthy and unhealthy(the theological equivalents of good and evil). Thus theclassification function of the term transsexualism analyzes
a whole system of meaning that is endowed with an extra­
ordinary power of structuring reality.
This book is concerned with how medicine and psy­chology, in particular, function as secular religions in thearea of transsexualism. Chapter II is devoted to an analysisof the scientific data on sex differences, especially thework of John Money and his associates. Chapter V pre­sents the “triumph of the therapeutic,” the “ medical
model,” and the medical-technical specialties as theyfunction to generate values and beliefs concerning thecause, diagnosis, and treatment of transsexualism.
My main point is to show how so-called health valuesof therapy, hormonal treatment, and surgery have replaced
ethical values of choice, freedom, and autonomy; howthese same “health” values have diffused critical awarenessabout the social context in which the problem of trans­
sexualism arises; how more and more moral problems havebeen reclassified as technical problems; and indeed how
the very notion of health itself, as generated by this medi­
cal model, has made genuine transcendence of the trans­
sexual problem almost impossible.

3

Introduction
LANGUAGE: “ SAY WHAT YOU MEAN
AND MEAN WHAT YOU SAY”

Words have meanings often undetected by those who use
them. One graphic example of this is the use of the words
masculinity and femininity, male and female, and he andshe as they appear throughout the medical and psycho­
logical literature on transsexualism. Medical literature ontranssexualism uses the words masculinity /masculine andfemininity /feminine to indicate what its authors perceive
to be real changes that take place, either through the ad­ministration of hormones and/or surgery. The psycho­
logical literature on transsexualism uses the same designa­
tions to talk about the gender identity and/or role of thetranssexual, one of which the transsexual rejects in orderto pursue the other, as if these stereotypes had some kindof ontological reality that was conferred by “feeling” that
one is, for example, a “woman trapped in a man’s body.”
I use the terms masculinity/masculine and femininity/
feminine to indicate that what really does take place when
the transsexual is encouraged to pass as a woman, or whenhormones and surgery are administered, is in fact thefeminization of a man, or the masculinization of a woman.
This is precisely what happens because masculinity andfemininity are social constructs and stereotypes of be­
havior that are culturally prescribed for male and female
bodies respectively, but that in the case of the transsexual,
have nothing to do with a male or female body. Thus themale-to-constructed-female goes from one stereotype tothe other. The words masculine and feminine are usedthroughout this work to indicate that a superficial, artifactual, and socially and surgically constructed change iswhat takes place rather than a deep intrinsic change thatencourages existential development. The stereotypicallanguage is used intentionally to highlight the superficialityof the transsexual process. To feminize or masculinize intoa cultural identity and role is to socialize one into a con­structed identity and role. Similarly, in the sex-conversion
surgery itself, what takes place is a surgical constructionof body appearance that is brought in line with the body

4

The Transsexual Empire

stereotype of what a masculine or feminine body shouldlook like in a gender-defined society; e.g., in a woman, a
big bust, a curvacious figure, a small frame, etc. And in­
deed, as we shall note in Chapter I, transsexuals undergo
an immense amount of polysurgery, much of it of a cos­
metic nature, to bring themselves into line with the stereo­
type of their newly acquired body.
Since I am highlighting that a superficial stereotyping
process of masculinization or feminization is precisely
what does take place in the transsexual situation, I shallomit putting the stereotypes in quotation marks or itali­
cizing them in order to grant these words their utmost
validity as the fabrications that they genuinely are. At thesame time, however, I have chosen to put the words “he”
or “she” and “male” and “female” in quotation marks
when they refer to a pre- or postoperative transsexual. This
is to indicate that, while transsexuals are in every way mas­
culine or feminine, they are not fundamentally male orfemale. Maleness and femaleness are governed by certain
chromosomes, and the subsequent history of being achromosomal male or female. Masculinity and femininity
are social and surgical constructs.
Aside from the language of masculinity/femininity,
male/female, and he/she in the medical and psychologicalliterature, the term transsexualism itself is also problemati­
cal and fraught with certain normative assumptions. The
term transsexualism was first used by Harry Benjamin in
a lecture at a meeting of the New York Academy of Medi­cine in 1953. It is interesting to note, however, that theIndex Medicus did not include a reference heading fortranssexualism until 1965. Before this, any works dealing
with surgical sex change were placed under the headings oftransvestism, homosexuality, or some other deviant sexual
category. But as transsexualism acquired its own termi­
nological existence and independent classification, many
normative assumptions began to gain ground.
First of all, the suffix ism is a clue to how transsexual­
ism functions. Some authors use the word transsexuality
as opposed to transsexualism, with a varied spelling of5Introduction

the latter as transsexualism. But I have chosen to con­sistently employ the term transsexualism, because it is
one of the main contentions of this work that transsex­
ualism operates as an ideology which the suffix ism ismeant to denote. Webster defines ideology in two ways,
both of which can be applied to transsexualism and theways in which it functions. The first definition Webster
gives for ideology is “visionary theorizing.” In this sense,transsexualism offers certain individuals a supposed futur­
istic vision of what they can become. (However, in reality,
instead of giving transsexuals an open and truly visionary
future, it restricts them unalterably to the present andvisionless context of cultural roles and stereotypes under
the guise of being ideologically visionary.) Webster’s
second definition of ideology is threefold: (a) “a sys­
tematic body of concepts especially about human life
or culture,” (b) “ a manner or the content of thinking char­acteristic of an individual, group, or culture,” and (c) “theintegrated assertions, theories, and aims that constitutea sociopolitical program. ” Transsexualism functions as
ideology by defining a portion of human life as trans­
sexual—using concepts such as “women trapped in men’sbodies,” and the classic mind-body dichotomy to form
“integrated assertions, theories, and aims that constitutea sociopolitical program.” A perusal of the literature will
indicate that a popular as well as specialized vocabulary
has been built up. Transsexualism at this point constitutes
a “sociopolitical program ” that is undercutting the move­
ment to eradicate sex-role stereotyping and oppression inthis culture. Instead it fosters institutional bases of sexism
under the guise of therapy.
Many definitions of transsexualism have been put forth,some differing from others in describing the phenomenon.
Benjamin states: “transsexualism is a sex and gender prob­lem, the transsexual being primarily concerned with his(or her) self only, a sex partner being of secondary al­
though occasionally vital importance.” 1 Donald Russell’s
definition is among the more neutral, in that it attempts
to describe and not posit causal hypotheses:

6

The Transsexual Empire

The term “trans-sexual” refers to a person who is said to believe
firmly, in spite o f all physical or genetic evidence to the contrary,that he (or she) is inherently of the opposite sex. The transsexual
has a fixed or apparently unalterable belief that he is of one sex“trapped” in the body of the other .2

Doctors Milton Edgerton, Norman Knorr, and James
Callison who comprise part of the interdisciplinary teamat the Johns Hopkins Gender Identity Clinic define trans­
sexualism in a similar manner.
The term “transsexualism” has now been widely accepted in the
medical literature as designating that psychiatric syndrome which
is characterized by the individual’s attempts to deny and change his(or her) biological sex and to thus achieve and permanently main­
tain the opposite gender identification . 3

It should be pointed out, however, that the phrase psy­
chiatric syndrome here does not refer to any psychotic
causation theory. The authors later state: “ Is any patient
who seeks castration by surgery, by definition psychotic?
We do not find this to be the case.”4 Rather the words
psychiatric syndrome probably indicate that the authors
do not consider transsexualism to be of biological origin.
Popular definition of transsexualism reveals a morevalue-laden content which raises a host of questions about
the reality of transsexualism. In popular terms, transsex­
ualism has come to mean a condition of “feeling trappedin the body of the wrong sex.” This inevitably raises thequestion, is it biologically possible to convert a person
surgically to the opposite sex? Is it possible to change sex—that is, to transsex? In order to answer this question, it
is first of all necessary to discuss various meanings of theword sex—a word that has both a dismaying multiplicity
and ambiguity of meanings.
The Six Sexes. John Money has distinguished various defi­
nitional levels of the word sex that are helpful in assessing
whether it is biologically possible to cross-sex.5
1. Chromosomal Sex. This kind of sex determines biologi­
cal maleness or femaleness, contrary to popular opinion

7

Introductionthat anatomical sex is determinative. Normal males havea chromosomal pattern of XY with normal females being
XX. In rare cases, chromosomal anomalies occur and con­stellations such as XXY or XXYY appear. The pattern ofsex chromosomes is present and unchangeable in every
body cell, including blood cells. Chromosomal sex can,however, conflict with anatomical sex, especially after
transsexual surgery.
2. Anatomical or Morphological Sex. This kind of sex in­cludes what are referred to as primary and secondary sex
characteristics. The primary dimensions of anatomical sex
are the testes in the male and the ovaries in the female.
Secondary anatomical sex characters include the penis,
scrotum, prostate, hair distribution, and a deeper voicein the male; and the clitoris, vulva, uterus, vagina, breasts,
a wide pelvis, female voice, and hair distribution in thefemale. In the case of transsexualism, it is anatomical sex
that is altered through hormonal and surgical procedures.
3. Genital or Gonadal Sex. This kind of sex is the col­lective term for the testes in the male or the ovaries in thefemale.
4. Legal Sex. Genital sex becomes the legal sex although
this is not actually defined in the codes. It is in this areathat errors of sex do occur and not too infrequently. By
merely determining sex on the basis of genital sex, theobstetrician or midwife may be deceived. Biological anom­alies, such as various hermaphroditic constellations, may
escape them. Consequently the legal sex designated atbirth is wrong, and complications often present themselves
at a future time.
5. Endocrine or Hormonal Sex. This is determined by an­
drogen in the male and estrogen in the female. Besides thesex glands, the pituitary or adrenal glands also supply hor­mones essential for both sexes. Endocrine sex is also mixed
to various extents. Testes, as well as male adrenals, pro­
duce certain amounts of estrogen. Likewise, various
amounts of androgen can be found in the ovaries and in
the adrenals of women. To a certain extent, therefore,
females and males are hormonally intersexed. Conse­

8

The Transsexual Empire

quently, hormonal products can be used to feminize amale or masculinize a woman. Hormonal treatments are
preliminary measures used to alter the sex of a transsexual
before the actual operation is undertaken.
6. Psychological Sex. Much of the literature uses this ter­minology to designate attitudes, traits, characteristics, andbehavior that are said to accompany biological malenessor femaleness. I would prefer the term psychosocial sex
to indicate the all-important factor that such attitudes,
traits, characteristics, and behavior are socially influenced.
Robert Stoller uses the term gender to distinguish thiskind of sex from biological sex. He differentiates between
sex and gender in the following way:
Dictionaries stress that the major connotation of sex is a biologicalone, as for example, in the phrases sexual relations or the male sex.
In agreement with this, the word sex, in this work will refer to themale or female sex and the component biological parts that deter­mine whether one is male or female; the word sexual will have con­notations o f anatomy and physiology. This obviously leaves tremen­dous areas o f behavior, feelings, thoughts, and fantasies that are
related to the sexes and yet do not have primarily biological con­notations. It is for some of these psychological phenomena that theterm gender will be used: one can speak of the male sex or thefemale sex, but one can also talk about masculinity and femininity
and not necessarily be implying anything about anatomy or physio­
logy. Thus while sex and gender seem to common sense to be prac­
tically synonymous, and in everyday life to be inextricably boundtogether, one purpose of this study will be to confirm the fact thatthe two realms (sex and gender) are not at all inevitably bound inanything like a one-to-one relationship, but each may go in its quite
independent way .6

The most striking example of sex and gender going in op­
posite directions is the transsexual. Transsexuals reject thegender that the culture has assigned to them and gravitate
toward the gender assigned to the opposite sex. The trans­
sexual literature stresses how confirmed the transsexualis in the gender identity of the opposite sex. “ In the truetranssexual there is no question of, or ambivalence about
the gender preference, for the identification has been com­

9

Introduction

pleted for some time at the point when they appear before
the physician requesting sex reassignment.” 7John Money and Anke Ehrhardt in Man & Woman, Boy& Girl, make a further distinction between gender identityand gender role.

Gender Identity: The sameness, unity, and persistence of one’s
individuality as male, female, or ambivalent, in greater or lesser
degree, especially as it is experienced in self-awareness and behavior;gender identity is the private experience of gender role, and genderrole is the public expression of gender identity.
Gender Role: Everything that a person says and does, to indicate
to others or to the self the degree that one is either male, or female,or ambivalent; it includes but is not restricted to sexual arousal
and response; gender role is the public expression of gender iden­tity, and gender identity is the private experience of gender role . 8
Thus they would distinguish between the psychologicaland sociocultural, or between private and public manifes­
tations of gender.
The word gender has certain problems for the feminist
critic. It gives the impression that there is a fixed set of
psychosocial conditions that determines gender identity
and role. When used in conjunction with other words suchas gender dissatisfaction, gender discomfort, or gender dys­
phoria, it conveys that these can only be altered by very
specialized therapy and/or sophisticated technical means.
Feminists have described gender dissatisfaction in very dif­ferent terms—i.e., as sex-role oppression, sexism, etc. It issignificant that there is no specialized or therapeutic vo­
cabulary of black dissatisfaction, black discomfort, or
black dysphoria that has been institutionalized in black
identity clinics. Likewise, it would be rather difficult andsomewhat humorous to talk about sex-role oppression
clinics. What the word gender ultimately achieves is aclassification of sex-role oppression as a therapeutic prob­lem, amenable to therapeutic solutions. Therefore, I pre­fer to use the word gender and the phrase, gender dys­
phoria and the like, when I am discussing the managementof the transsexual issue in the therapeutic and/or technical

10

The Transsexual Empire

contexts. However, because of the nature of the subjectof transsexualism, there were times, while writing thisbook, when I found the word unavoidable despite my“dissatisfaction.” In these places, I indeed used it withreservation.
What does this delineation of the various kinds of sex
say about the reality of transsexualism? The most signifi­
cant fact is that it is biologically impossible to change
chromosomal sex. If chromosomal sex is taken to be
the fundamental basis for maleness and femaleness, themale who undergoes sex conversion surgery is not female.
Anatomically, transsexualism does take place, butanatomical changes also happen in what is commonly
termed plastic surgery. Transsexualism most intrinsicallyaffects genital or gonadal sex. For example, it is possible
surgically to remove a woman’s ovaries, and it is also
possible to construct an artificial vagina in a man whose
penis and testes have been removed. The question thenbecomes how much value we would give to this kind ofalteration in terms of changing the totality of a person’ssex. Georges Burou, a Casablancan physician who has
operated on over 700 American men, expressed the super­
ficiality of sex-conversion surgery in these words: “ I don’tchange men into women. I transform male genitals into
genitals that have a female aspect. All the rest is in thepatient’s mind.”9 Moreover, the change in genital sex does
not make reproduction possible. Maybe with the develop­
ment of various forms of reproductive technology, thiswill be feasible in the future, but as yet, a change in genital
sex is not accompanied by reproductive capacity.
Endocrine or hormonal sex is the most susceptible toalteration. Change here, for the transsexual, occurs with­out any surgical intervention. Hormonal treatment for men
and women is the threshold of the transsexual odyssey.
These treatments have certain anatomical effects resulting,for example, in breast development for men or a redis­
tribution of body hair for both women and men. But thisreality requires constant hormonal treatments.
In law, transsexualism can occur. It is legally possible to11

Introductionchange sex. However, the whole area of legal sex has been
one of contention for the transsexual who wishes to havesex-conversion surgery validated. The postoperative trans­
sexual has often faced long and costly legal battles con­cerning amendation of birth certificates, social security
numbers, drivers’ licenses, and the like. There are a few
states that have promptly issued new birth certificates with
the name and sex changed accordingly. In other states, amore complicated procedure, namely a court order, is re­quired before official documents can be altered.
If it is impossible to change basic chromosomal struc­ture, then it is necessary to take a more in-depth look at
not only the terminology but also the reality of transsex­
ualism. Can we call a person transsexed, biologically speak­ing, whose anatomical structure and hormonal balance
have changed but who is still genetically XY or XX? If we
don’t recognize chromosomal sex as determinative, plus
the subsequent history that attends being chromosomal
female or male, what are we really talking about when wesay female or male? Is there any such enduring reality as
biological maleness or femaleness?
Words and More Words. Furthermore, what does the wordtranssexualism say to us? We use this word to speak ofboth pre- and postoperative individuals, but does it makesense to call a person transsexual if that person has notbeen anatomically altered in a surgical way? In applying
the word transsexual to both pre- and postoperative per­sons, credence is given to the fact that the mere desire tochange sex by surgical means determines transsexual status.
The transsexual experts, themselves, have been uncom­
fortable with the term transsexualism, although not for
the reason I mentioned previously. Within the past few
years, many have started to replace it with the term gen­der dysphoria. In 1975, for example, the Second Inter­national Conference on Transsexualism was renamed theSecond International Conference of Gender Dysphoria.
John Money and Paul Walker, in a review of the proceed­
ings, point out that the new symposium title represented

12

The Transsexual Empirea major concern of the participants regarding nomencla­
ture. Jon Meyer and John Hoopes state:
It must be recognized that the term “transsexual” is not an adequate
label. It does not represent the clinical variance to be found among
applicants for reassignment or allow for adequate description andclassification of the differences . 10

The authors go on the explain that the term dysphoria em­
phasizes the person’s difficulty in establishing an adequate
gender identification, and the pain and conflict surround­ing masculinity and femininity. It encompasses, but is not
restricted to, persons who request sex-conversion surgery.
Finally they propose abandoning the terms transsexual andtranssexualism, except to describe the postoperative per­son.11
I have chosen to retain the term transsexualism, how­ever, because: (1) most of the professionals and lay popu­
lace still call it that; (2) gender dysphoria obscures manyof the social and ethical issues that I wish to point to inthis work and, in my opinion, really does not name theintent of the medical empire that generates and perpetu­
ates the problem; (3) while the term gender dysphoria may
resolve some of the preceding definitional problems that
I have raised, such as the designation of the preoperativetranssexual, it restricts the reality behind “gender dys­
phoria”—i.e., sex-role oppression—to those who seek sex
reassignment. To make it the private property, so to
speak, of the transsexual empire and its professionals is tosuperficialize the depths of the questions that lie behind“gender dysphoria.” Therefore, I have chosen to retain theterm transsexual to describe persons who believe that they
are of the opposite sex, who desire the body and role ofthe opposite sex through medical intervention, who put
themselves into the hands of the transsexual experts, whohave started hormone therapy, and who have accepted theclassification of transsexual.
As an abstract noun the word transsexualism effectively
obscures the question of who is transsexing whom. In de­leting both agent and object, the word transsexualism also13

Introduction

becomes a state of being. It is granted the status of “state­hood” by its very terminological existence, perpetuating
the ideology that if such a state of being actually does
exist, there is a certain group of people who really needthis surgery. Until, of course, the surgery was popularized,
post-Christine Jorgensen, the specific need of surgery was
not evident, although some people may have felt that theywanted to change sex. To what extent the availability ofthe surgery has generated a wider need for it is again
masked by the terminology.
In deleting the agent, the word transsexualism cloaks
the power of the medical empire to generate a uniquegroup of medical consumers. Thus the actions of a primaryagent, the medical establishment, are rendered invisible,
and the so-called need of the transsexual, the patient, ishighlighted. Put succinctly, the terminology of transsexual­
ism disguises the reality that someone transsexes someone,that transsexuals “prove” they are transsexuals by con­forming to the canons of a medical-psychiatric institutionthat evaluates them on the basis of their being able to passas stereotypically masculine or feminine, and that ulti­
mately grants surgery on this basis.
Furthermore, by placing all the disordered experiencesof the gender-dissatisfied individual under the headingof transsexualism and giving it the force of statehood, thetranssexual therapists and technicians are able to order andcontrol that reality. All of this is accomplished by the in­herent power of a classification system that has been given
medical and psychological credibility. Once sex-role op­pression is given the name of transsexualism, and institu­
tionalized in the gender identity clinics, and realized byhormone and surgical treatment, the “condition” of trans­
sexualism itself explains why one would have the wrong
mind in the wrong body. Why? Because one is a transsex­
ual. This classification bestows sense on all the disparate
and atomic experiences that once seemed so unfathom­able. It functions to mask ethical issues and normative
statements that raise themselves very pointedly in the caseof transsexualism.

14

The Transsexual Empire

Two further notes about my own use of language. First,
in places where syntactical structure made it awkward touse the pronoun they when referrring to transsexuals, I
have chosen to emphasize the pronoun he. I do not in­tend this usage in the commonly accepted, pseudogenericsense. Rather the use of he is intended to reinforce thefact that the majority of transsexuals are men (see Chapter1). Transsexualism is originated, supported, institutional­
ized, and perpetuated primarily by males and it directly
affects mostly men. Second, I use the words patriarchal
society to define my view of the social context in which
the problem of transsexualism arises. Although in many
places I have used more general terms such as a roledefined society, or a gender-defined society, there areother places where I felt it necessary to avoid the ob­
scure and passive connotations of these more generalwords, especially as they have been developed in the idiomof the social sciences. These disciplines attribute the con­ditions of a sexist society to amorphous “roles” and“forces” that are unspecified. Nobody is blamed andeveryone is blamed. Such words delete the agents ofthese “roles” and “forces”—that is, the society and in­stitutions men have created.
Such words also lend credence to the idea that the
problem of transsexualism and other “role-controlled”
problems are so awesomely complex and due to suchvague “forces” that even the best intentions and strategies
won’t be able to comprehend, never mind solve, them.
This has the effect of taking the immediate focus and pres­sure off men and male-defined institutions. Additionally,
they say that “role-defined forces” are all that must
be coped with and not the agents who initiate and pre­serve those forces, and the institutions that reify them.
Thus it is that language generates reality. As Peter Ber­ger has noted: “Reality hangs by the thin thread of con­versation.” But the reality that language generates is per­petuated and upheld by the persons and institutions who
use that language. Thus we turn to the persons and in­stitutions involved in the transsexual realm.

15

Introduction
A TOUCH OF EMPIRICISM

I have used several kinds of empirical research. I talked
with transsexuals themselves, with doctors and psycholo­
gists who are involved in transsexual treatment and ther­apy, with directors of gender identity clinics, and withother individuals, such as clergy, who interact with trans­
sexuals. I also visited certain gender identity clinics andhospitals, where transsexual surgery is performed, and an
institution that funded transsexual research.
Writers on moral issues frequently do little or no in-thefield research. They understand their discipline as a “li­brary science,” or they limit their empirical research toinstitutions that “treat” the problem, rather than also in­cluding those persons and individuals who are most im­
mediately affected. (Daniel Callahan, for example, did
a comprehensive medical, legal, and ethical analysis ofabortion, yet nowhere in his study does he indicate thathe spoke extensively with women who were in the processof choosing or had chosen abortions.)12 It has been myexperience that talking with transsexuals themselves, aswell as with individuals involved in the study and treat­ment of transsexualism, especially in their occupational
milieu, made a vast difference in what I came to know
about transsexualism.
I spoke with fifteen transsexuals, thirteen of whom weremale-to-constructed-females. (This total is numericallycomparable to numbers of transsexuals who were inter­viewed in many other studies.) I used what sociologists
would call the “unstructured research interview” employ­ing open-ended questions.13 This approach maximizes dis­covery and description. I chose this method also because
I make no pretense of doing a “hard-core,” systematic,sociological study of transsexuals. (My own interview dataserves as back-up to other more formal studies.)
Besides transsexuals themselves, I interviewed many of
the active figures in the field of transsexual research andtherapy. At Johns Hopkins, I talked extensively with John
Money, Paul Walker, and Eleanor Bagby. I also spoke with

16

The Transsexual Empire

several persons involved in gender identity clinics. I talked
extensively with Zelda Suplee, director of the Erickson
Educational Foundation, which has funded much trans­
sexual research and activity. Finally, I interviewed several
doctors and counselors who are active in the area of trans­
sexual treatment and counseling on a private basis. All thishelped form my belief that the issue of transsexualism isbasically one of social ontology—that is, an issue of whatsociety allows and encourages its constituency to be.

THE ONTOLOGICAL ARGUMENT

My main conclusion is that transsexualism is basically asocial problem whose cause cannot be explained except
in relation to the sex roles and identities that a patriarchal
society generates. Through hormonal and surgical means,transsexuals reject their “native” bodies, especially theirsexual organs, in favor of the body and the sexual organsof the opposite sex. They do this mainly because the bodyand the genitalia, especially, come to incarnate the essenceof their rejected masculinity and desired femininity. Thus
transsexualism is the result of socially prescribed defini­tions of masculinity and femininity, one of which thetranssexual rejects in order to gravitate toward the other.
Thus I will argue, in Chapter III, that the First Cause oftranssexualism is a gender-defined society whose norms ofmasculinity and femininity generate the desire to be transsexed. Many will ask how an obviously “personal” prob­lem, such as transsexualism, can be primarily attributed toa social cause. Some will probably say that society cannot
be a cause and that as psychological advocates reducetranssexualism to personal causes, I am doing the reverseblaming society. I believe that the primary cause of trans­
sexualism cannot be derived from intrapsychic attitudes
and/or behaviors, or even from family conditioning pro­
cesses. One must begin with the roles of a gender-definedsociety, as the First Cause of transsexualism (that which,in the Aristotelian sense, sets all other causes in motion)

17

Introduction

to gain insight into its psychological manifestations. Only
through a societal starting point can we gain insight into
the real subjective meaning of the problem.
Transsexualism relates to what society allows and en­courages its constituency to be. Behind the transsexual
quest for the body and the sex role and identity of the
opposite sex is the quest for deeper selfhood. I would
ultimately call this the quest for transcendence or thequest for be-ing. However, be-ing cannot be separated
from the social context (as has been the case with muchtraditional ontology), and for this reason, it is perhaps
imperative that I explain further just what I mean byontology.
The ontological tradition has been rejected by many
philosophers and theologians because of its static dimen­
sions. Developed within a society that was encompassed
by a static world view, it is seen as offering little or nobasis for change. Yet the split between being and becoming
is not a necessary one, as Mary Daly has demonstrated.14
Be-ing is the initial power of everything, the beginning“structure,” if you will, of reality, not as unchanging but
as process. I have therefore chosen to talk about trans­
sexualism as most deeply a question of be-ing, which can­not be separated from the social context that generated
the problem to begin with. In discussing integrity in Chap­
ter VI, I attempt to demonstrate that what is needed isan ethic of total integrity grounded in be-ing. In this way
one can clarify the genuine personal-social issues involvedin transsexualism.
The words ontological and natural are very often usedas synonyms. But my own ontological method is not a
new natural-law approach. I am not arguing that what isnatural is good, I am not polarizing technology against
nature. Rather I am making an appeal to the integrityor harmony of the whole. Thus my development of an
ethic of integrity in Chapter VI is not meant to state thattranssexual treatment and surgery are violations of a static
biological nature of maleness or femaleness but that they
violate a dynamic process of be-ing and becoming that in-

18

The Transsexual Empire

cludes the integrity of the body, the total person, and thesociety. The chromosomal base of maleness or femalenessis one defining factor of bodily integrity. Chromosomes
contribute to bodily integrity, and one clue to their im­
portance is the fact that transsexuals must continually
suppress their anatomical and morphological consequencesby estrogen or androgen therapy. Yet my appeal here is
not that chromosomal maleness or femaleness is natural.
Rather, I am emphasizing that medicalized intervention
produces harmful effects in the transsexual’s body thatnegate bodily integrity, wholeness, and be-ing.
Furthermore, chromosomes are only one defining fac­
tor, in the context of the total history of what it means
to be a woman or a man, in a society that treats womenand men differently on the basis of biological sex. Thismeans that the integrity of the body must also be placedin the context of the integrity of the total person, which
includes the realization of such values as choice, awareness,
and autonomy. Finally, if the transsexual answer rein­
forces the foundation of sex-role oppression, which is
sex-role stereotyping, by encouraging the transsexual toconform to these stereotypes, then it is also violating the
integrity of the society.
Transsexualism is a half-truth that highlights the des­perate situation of those individuals in our society who
have been uniquely body-bound by gender constrictions,but it is not a whole truth. While transsexualism poses thequestion of so-called gender agony, it fails to give an an­swer. I hope to show that it amounts to a solution that
only reinforces the society and social norms that produced
transsexualism to begin with.

CHAPTER I“Everything
You Always
Wanted to Know
about Transsexualism”

T h e r e are many questions
that people often ask about transsexualism. When was thefirst transsexual operation performed? Where was it done?
How did transsexualism first gain public recognition? Whatis the cost of the surgery? How, medically speaking, is aperson transsexed? What are the legal ramifications of sex
conversion surgery? Is it possible to change birth certifi­
cates, drivers’ licenses, and the like? Has transsexualism
been a phenomenon throughout history?
Transsexual operations have been surgically possible
since the early 1930s. The hormonal and surgical tech­niques, however, were not refined and made public until
the early 1950s. Since then, thousands of transsexual
operations have been performed both here and abroad.
Largely due to the support of individuals such as Harry
Benjamin, M.D., and institutions such as the Erickson
Educational Foundation and Johns Hopkins, transsexual
treatment and surgery has become a legitimate medical
19

20

The Transsexual Empire

area of research and activity. The medical specialties thatit calls forth, or more correctly that call it forth, are varied
and complex, beginning with hormone therapy and often
ending in numerous operative procedures. Just as com­plicated are the legal intricacies of changing sex on birthcertificates, licenses, and other certificates of personhood
required to live one’s life. Other legal issues also affect theinstitutions performing the surgery.
As a medical category that enlists many surgical special­
ties and as a transformed state of being that requires legal
validation transsexualism is a relatively new phenomenon.
Historical antecedents are found in certain mythologicalaccounts, initiation rites, and certain modes of eunuchismand castration but, strictly speaking, transsexualism has
no historical precedents.

RECENT HISTORY

The word transsexualism did not become part of the
English language until the early 1950’s. It was invented asa medical term by Dr. D. O. Cauldwell, who used it toclassify a girl whom he described as obsessively wanting to
be a boy. He called her condition psychopathia transsexualis.1 Several years later, in 1953, Harry Benjaminused the English word transsexualism in a lecture before
the New York Academy of Medicine. Before 1967, theIndex Medicus did not list it as a subject heading. Prior tothis, it was subsumed under such categories as transvestism
and sex deviation. However, before the publication of thefamed Christine Jorgensen case in 1953, most people had
never heard of the word nor of the state of being that theword signified.
Christine, formerly George, Jorgensen was transsexed in
Denmark in 1952 by a team of Danish physicians headedby Christian Hamburger. Their findings were published ayear after the operation in the Journal o f the American
Medical Association, with the consent of Jorgensen. In
1967 Jorgensen wrote about “her” own experiences in21“Everything You Wanted to Know about Transsexualism”“her” autobiography.2 However, the first book to relate
a probable case of transsexualism in a popular-scientificstyle and content was Niels Hoyer’s Man Into Woman(1933). The fact that the introduction to this book was
written by a well-known British sexologist, Norma Haire,gave Hoyer’s book a certain scientific credibility. The bookis the story of a male Danish painter who became LiliElbe after several rather obscure operations.3
Although Christian Hamburger has been credited withbringing together many of the surgical specialties for thetreatment of the transsexual, he was not the first physician
to perform transsexual surgery. This title belongs to a
German, F. Z. Abraham, who, in 1931, reported the firstcase of sex-conversion surgery.4 In the years between 1931
and 1952 sporadic and piecemeal reports of transsexual
operations came forth, primarily from Germany and Swit­zerland. Hamburger, however, seems to have been the firstto make use of hormonal castration and to follow up on
his patients.
At the time Jorgensen was transsexed, there were few
places where one could go to obtain such surgery. Casa­
blanca, Istanbul, and countries such as Denmark, Ger­
many, and Switzerland, were the most frequent locations
to which transsexuals travelled, provided they could pay
the cost and were willing to risk little or no medical
follow-up. Today, however, the situation, at least in the
United States, is quite different.
In the late 1950s, Dr. Harry Benjamin of New York,funded by grants from the Erickson Educational Foun­dation, began treating transsexuals and publicizing his
research, hoping for professional and public under­
standing of what he entitled The Transsexual Phenome­
non. 5 Benjamin is the key American figure who aroused
the interest of medical and psychological professionals
especially, in the problems of the transsexual. With thefounding of the Harry Benjamin Foundation in 1964,
he brought together a group of professionals from many
specialties to do systematic research on transsexualism.
This research took the form of batteries of tests, studies

22

The Transsexual Empireof transsexuals’ sexual attitudes, and pre- and postopera­
tive evaluations.
A major expansion of transsexual research and activity
took place in 1967 with the formal opening of the Johns
Hopkins Gender Identity Clinic in Baltimore, Maryland.
The fact that a major medical institution, with the pres­tige of Johns Hopkins, had initiated a clinic of this naturecatapulted transsexualism into the public and professionaleye as a legitimate medical problem. It was not until Johns
Hopkins began performing the surgery and had initiatedits Gender Identity Center that sex conversion operations
gained acceptance and were begun in other respected medi­
cal institutions. When Benjamin began his work in thiscountry, there was no reputable hospital in America thatwould have permitted transsexual surgery. Now, postJohns Hopkins, there are estimated to be at least thirtysuch hospitals; among them, university hospitals at Minne­
sota, Stanford, Northwestern, Arkansas, Michigan, Ken­tucky, and Virginia.
The Johns Hopkins Clinic has served as a model forothers of the same nature. It consists of a team of psychia­
trists, psychologists, plastic surgeons, gynecologists, urolo­gists, and endocrinologists. It works in close concert withcertain legal and religious professionals who are called in
to offer relevant advice. The team has also devised meth­ods of evaluating preoperative transsexuals to judge theircandidacy for surgery and operates selectively on thoseindividuals who meet the criteria. It continues to review
criteria, mainly to determine whether surgery is warranted
in all claims of transsexualism. It also continues to refine
its methods of surgical treatment, and attempts to do sys­
tematic postoperative follow-ups. Various team members,
individually and in concert, have published many articles
about their work and are regarded as being in the fore­
front of transsexual research. Of all persons who have been
engaged in this work at Johns Hopkins John Money, now
Professor of Medical Psychology and Pediatrics at theJohns Hopkins Hospital, has been the foremost publicistof the transsexual phenomenon.

23“Everything You Wanted to Know about Transsexualism”

Since 1967, many so-called gender identity clinics fortranssexuals have been established in various parts of thecountry. Some are directly associated with university hos­pitals where surgery is done, while others, separated physi­
cally from any hospital base, counsel transsexuals, start
hormone treatments, and eventually make selective re­ferrals of candidates to medical personnel who then pro­ceed with the surgery. Although reports conflict as to how
many transsexual operations have actually been performedin this country and how many persons seek the surgery,figures published in Newsweek magazine on November 22,
1976, indicated that there are about 3,000 transsexuals in
the U.S. who have undergone surgery and 10,000 more
who view themselves as members of the opposite sex. Be­
cause more Americans want surgery than are accepted bythose hospitals performing it, many transsexuals haveprobably continued to seek such surgery abroad. In thespring of 1973, the Erickson Foundation Newsletter re­ported that only 10 percent of those individuals who go
through evaluation for surgery eventually achieve it.
It is very difficult to obtain exact professional statis­
tics concerning the number of preoperative and/or post­
operative transsexuals. Various figures are given, at times,
but they often conflict. Zelda Suplee, former director of
the Erickson Educational Foundation and present headof the Janus Information Facility at the University ofTexas Medical Branch in Galveston, has attested to thislack of vital statistics on transsexualism.6 Money andWalker also confirmed this lack of statistics in a recent
book review in which they state: “ In the absence of any
national directory of sex-reassignment applicants, dataon patients for surgery are inconclusive.” 7 Thus the natureand incidence of transsexual activity is not clear. This lackof data is very significant in light of the fact that othermajor surgery statistics seem readily available.
With respect to the cost, the various procedures andsurgery involved differ from hospital to hospital. On the
average, the male-to-constructed-female operation andhospital stay alone can cost from $3,000 to $6,000. The

24

The Transsexual Empire

female-to-constructed-male operation involves a seriesof several operations before the results are achieved andcosts up to $12,000. There are, of course, many otherexpenses besides the surgery and hospital bills. For maletranssexuals, electrolysis to remove a heavy beard or
stubble can cost as much as the surgery.
Although many medical insurance policies do not cover
the cost of surgery on the grounds that such surgery is cos­
metic, many others consider it a “reconstructive” and“therapeutic” measure and will pay for it. In some states,
Blue Cross and Blue Shield will finance the surgery. In
other areas, for example New York City, courts have ruledthat transsexual operations are to be included in medical
assistance provided by the city and state for persons on
welfare. In New Jersey, Medicaid payments have beenauthorized in some cases.8 Since federal funds that had
been allocated for abortions have recently been with­drawn, feminists are struck by the inequity of this situa­tion. To paraphrase Jimmy Carter, life has been “fair”
to transsexuals.
A MALE PROBLEM

While it is clear that more men than women request andobtain sex-conversion surgery, various ratios have been
cited by researchers. The lowest ratio of women to men(one to eight) was reported by Benjamin in 1966. This was
based on his own clinical experience with 152 cases of maletranssexualism and twenty cases of female transsexualism.
The highest ratio (one to tw o) was reported by John Randell in 1959. Most reports fall in between these two. Ac­
cording to international medical literature the generally
accepted ratio is one to three or one to four.9 Recently,
it has been claimed that the incidence of female-to-con­structed-male transsexualism is rising. Canon Clinton Jonesof the Hartford Gender Identity Clinic and Dr. John
Money of Johns Hopkins both mentioned this increase
to me in personal interviews with them.10 Both said that25“Everything You Wanted to Know about Transsexualism”

they had seen, during the early seventies, almost as many
women as men seeking surgery. However, the number ofoperations performed on men is still substantially higher.
It is significant that this supposed increase has not beenverified in print with the exception of a somewhat vague
reference made by Dr. Anke Ehrhardt in a commentaryon the article, “Transsexualism and Surgical Procedures,”in which she states: “More and more females appear in
doctors’ offices and seek hormone and surgical treat­
ment. ” 11 What actual number “more and more” specifi­
cally refers to is, of course, anyone’s guess. Zelda Suplee
stated that from her personal contact with would-betranssexuals the preponderance is still male-to-constructedfemale.
In my own interview sampling, I talked with only two
female-to-constructed-male transsexuals. Often, when I
was given a female-to-constructed-male contact, I had
great difficulty finding the person. It is reasonable tospeculate that the extreme difficulty I had in finding
female-to-constructed-male transsexuals, plus the scantmention of them in the literature, may be indicative of
the fact that there are fewer of them than are claimed.
Christian Hamburger gives the more commonly claimed
ratio of one to three. He cites the letters he received andcontinues to receive in the aftermath of the famed Chris­tine Jorgensen case. Hamburger believes that the reason
for this one to three ratio “may be biological in nature,”
whatever this may mean. He also stated that a “contribut­
ing factor may also be that the case we reported involveda change from man into woman.” 12 John Money, however,has suggested that the preponderance of male transsexuals
reflects the fact that men are more vulnerable to “psychosexual disorders” than are women. A similar view held that:
It may be that transsexualism, like other forms of sexual variations,is actually more frequent in the male than in the female and thus
is in keeping with Kinsey’s hypothesis that the male is more prone
to conditioning by psychological stimuli in the sexual and gender
sphere than is the female . 13

26

The Transsexual Empire

There are many reasons male-to-constructed-femaletranssexualism is more predominant. Most obviously, thesurgery is easier, less costly, and more developed and publi­
cized. Second, but perhaps less obvious, is the fact that
men have been much freer to experiment than women.
Thus even in the area of transsexual treatment and surgery,it seems that men who desire to become female and tolive out the gender role that is culturally prescribed for
women are actually, in their assertiveness of seeking out
and enduring the surgery, conforming much more to themasculine stereotype. Women, through a cultural condi­
tioning that has generated less impulse to experiment,
are likely to be much more reticent.
Third, male transsexualism may well be a graphic ex­pression of the destruction that sex-role molding has
wrought on men. Thus it could be perceived as one of the
few outlets for men in a rigidly gender-defined society to
opt out of their culturally prescribed roles. Women, on
the other hand, since the recent rise of feminism, havebeen able to confront sex-role oppression on a sociopoliti­
cal, as well as personal, level. Thus women have realizedthat both masculine and feminine identities and roles aretraps.
Fourth, transsexual surgery is a creation of men, ini­
tially developed for men. The research and literature isoverwhelmingly oriented to the male-to-constructedfemale transsexual and also overwhelmingly authored bymen. I do not mean to say that women are not writingin the transsexual literature, are not working in the gender
identity clinics, are not counseling transsexuals, or are not
becoming transsexuals. It must be acknowledged thatwomen are present in token proportions in all of thesevarious areas. Many even happen to be in the foreground,directing gender identity clinics and co-authoring writings
on the topic. However, I would suggest that those women
who are engaged in transsexual legitimation, writing, andcounseling are functioning as tokens who promote theillusion of comprehensive female inclusion. In this re­spect, they are like the well-publicized women who are27“Everything You Wanted to Know about Transsexualism”

always present in some way to validate male-defined reali­ties. Women who write in support of transsexualism areusually co-authors (Anke Ehrhardt, Patricia Tucker), andfemale counselors of transsexuals are women who, forthe most part, “assist” in the gender identity clinics. Thus
the androcentric origin, control, maintenance, and legiti­
mation of transsexualism becomes obscured. The factthat the overwhelming research interest, number of publi­
cations and medical state of the “art” are concerned withmale-to-constructed-female transsexualism is also evidenceof the male-centered nature of the transsexual phenome­
non.
The female-to-constructed-male transsexual is the token
that saves face for the male “transsexual empire.” She is
the buffer zone who can be used to promote the universalist argument that transsexualism is a supposed “human”
problem, not uniquely restricted to men. She is the living“proof” that some women supposedly want the samething. However, “proof” wanes when it is observed thatwomen were not the original nor are they the present
agents of the process. Nor are the stereotypes of mas­
culinity that a female-to-constructed-male transsexual
incarnates products of a female-directed culture. Rather
women have been assimilated into the transsexual world,
as women are assimilated into other male-defined worlds,
institutions, and roles, that is, on men’s terms, and thus astokens. As Judith Long Laws has written: “Tokenism may
be analyzed as an institution, a form of patterned activity
generated by a social system as a means of adaptation toa particular kind of pressure.”14 I would maintain that,
under the pressure of having to demonstrate that trans­
sexualism is really not limited to men, the medical empire
assimilates female-to-constructed-male transsexuals, but
always on its own terms. “The Token is a member of anunderrepresented group, who is operating on the turf ofthe dominant group, under license from it. ” 15 In to­
kenism, the flow of outsiders into the dominant group is
usually restricted numerically but just enough so thatthe illusion of inclusion takes place. This is exactly what

28

The Transsexual Empire

happens with transsexuals. The accepted four to one ratioof male-to-constructed-females seeking and achieving trans­
sexual status is enough to register the appearance of suf­
ficient inclusion of women. Further, the token female
presence in all aspects of the transsexual world is enoughfor the transsexual experts to claim that transsexualism
is sex-blind.
Yet it is most important to note here that tokenism, as
Mary Daly has pointed out, is not merely a matter of nu­
merical restriction.16 For example, the United States Sen­ate could be composed of 50 percent women, and these
women senators would still be tokens if their conscious­
ness and legislation were still controlled by a patriarchal
ethos, if they did not initiate and legitimate activities, andif they did not have a controlling power. Thus if the in­cluded group is not the controller of its own ethos and theinitiator or legitimator of action, no matter how numeri­
cally present it may be, it is still a token group. Six million
Jews could go to their death in the Nazi camps, not be­cause there were too few of them but because they were
not in control and thus their numbers were impotent. In
the same way, the percentage of female-to-constructedmale transsexuals could be numerically increased to theextent where they would equal men, yet if they were still
being transsexed by a “transsexual empire” whose social
and body stereotypes were conceived by men, they would
still be tokens.
Part of the syndrome of tokenism is to make women
seem important. John Money, whose work will be dis­cussed in Chapter II, is very careful to co-author his arti­
cles and books with a woman. It is an irony that women
are getting authorship credit in the area of transsexualism
when they have gotten so little credit in other fields forwhat work they really have initiated.17
A fifth reason why more men want to be women, than
women men, can be hazarded from other feminist analysesof biomedical issues. Simply put, it is that men recognize
the power that women have by virtue of female biology
and the fact that this power, symbolized in giving birth,29“Everything You Wanted to Know about Transsexualism”

is not only procreative but multidimensionally creative.
Various observers have called this recognition by various
names. Karen Homey reversed Freud’s theory of penis
envy calling it womb envy.18 Ralph Greenson, in an ad­
dress to a clinical meeting of the A.M. A., gave this inter­esting analysis:
It is horrifying—a danger to the future of the human ra c e .. . . Our
only hope is that basic instincts will eventually win out, that a true
equality of the sexes will emerge. Always before people thought it
was the woman who envied the man. But we have found that morethan two-thirds of those who wanted to change their gender weremales. What is shocking is that this is more widespread than was be­lieved. These people are not psychotic; they are not crack-pots.. . .
Men have contem pt for women only on the surface. Underneath is a
repressed envy, and repressed envy arouses fe a r.. . . One reason themale envies the woman so much is that she is always sure of herself
as a woman. A man is never quite sure he is a man—he has to prove itover and over again. 19

Barbara Seaman and others have called this kind of envy
and desire “male mothering.”20 Barbara Ehrenreich andDierdre English in their ground-breaking works on the his­
tory of medicine in the West discuss the same phenomenon
on a more political level when they talk about the maletakeover of women’s healing functions, especially during
the medieval and Reformation periods (the obliteration of
the witch-midwife) and the modem period (the consolida­tion of orthodox medicine, particularly in this country). 21
Transsexualism can be viewed as one more androcentric in­terventionist procedure. Along with male-controlled clon­
ing, test-tube fertilization, and sex selection technology, it
tends to wrest from women those powers inherent in fe­
male biology. In a very real sense, the male-to-constructedfemale transsexual not only wants female biological capaci­ties but wants to become the biological female.
Finally, and I think most important, there are moremale-to-constructed-female transsexuals because men aresocialized to fetishize and objectify. The same socializationthat enables men to objectify women in rape, pornography,and “ drag” enables them to objectify their own bodies.

30

The Transsexual Empire

In the case of the male transsexual, the penis is seen as
a “thing” to be gotten rid of. Female body parts, specifi­
cally the female genitalia, are “things” to be acquired. Men
have always fetishized women’s genitals. Breasts, legs, but­tocks are all parts of a cultural fixation that reduces womennot even to a whole objectified nude body but rather tofetishized parts of the female torso. The Venus de Milosymbolizes this as well as the fact that it has never been re­stored to its original integrity. “Cunt,” “ass,” “ getting one’s
rocks off, ” “balling,” are all sexist slogans of this fetish­
ized worldview where even “chicks” and “broads” are re­duced to the barest essentials. Male-to-constructed-femaletranssexualism is only one more relatively recent variationon this theme where the female genitalia are completely
separated from the biological woman and, through surgery,come to be dominated by incorporation into the bio­
logical man. Transsexualism is thus the ultimate, and wemight even say the logical, conclusion of male possessionof women in a patriarchal society. Literally, men here pos­sess women.
Definitions of fetishism are revealing in this context.
Webster’s Dictionary defines fetish in several ways: First,
as an object believed among a primitive people to havemagical power to protect or aid its owner; broadly: a ma­
terial object regarded with superstitious or extravagant
trust or reverence; an object of irrational reverence or ob­
sessive devotion; an object or bodily part whose real or
fantasied presence is psychologically necessary for sexual
gratification and that is an object of fixation to the extent
that it may interfere with complete sexual expression. Sec­
ond, as a rite or cult of fetish worshipers. Third, fetish is
simply defined as fixation.
From these definitions, it is clear that the process of
fetishization has two sides: objectification, and what might
be referred to as worship in the widest sense. Objectifica­tion is largely accomplished by a process of fragmentation.
The fetish is the fragmented part taken away from thewhole, or better, the fetish is seen to contain the whole.
It represents an attempt to grasp the whole. For example,

31“Everything You Wanted to Know about Transsexualism”

breasts and legs in our society are fetish objects containing
the essence of femaleness. Thus the fetish contains and bycontaining controls.
However, the other side of fetishization is worship orreverence for the fetish object. In primitive religions, fetish
objects were worshiped because people were afraid of thepower they were seen to contain. Therefore primitive
peoples sought to control the power of the fetish by wor­
shiping it and in so doing they confined it to its “rightfulplace.” There was a recognition of a power that people
felt they lacked and a constant quest in ceremonies andcults to invest themselves with the power of the fetish
object. Thus to worship was also to control. In this way,
objectification and worship are two sides of the same coin.
In this sense transsexualism is fetishization par excel­
lence—a twisted recognition on the part of some men of
the creative capacities of the female spirit as symbolized
and incarnated in the usurped female biology. This usurpa­
tion of female biology, of course, is limited to the artifactsof female biology (silicone breast implants, exogenous es­
trogen therapy, artificial vaginas, etc. ) that modem medi­cine has surgically and hormonally created. Thus trans­
sexual fetishization is further limited not even to the realparts of the real whole, but to the artifactual parts of theartifactual whole.
In summary, then, since men have been socialized tofetishize women, it is not surprising that this fetishization
process is one more explanation of why there are moremale-to-constructed-female transsexuals. What could beperceived as an initial protest against sex-role stereotyping(i.e., the transsexual’s initial gender discomfort and gender
rebellion) becomes short-circuited.
THE MEDICALIZED “ FEMALE”

The medical procedures involved in transsexualism surepuzzling to laypersons; most cannot begin to imagine whatis physically involved in changing sex or how the change isaccomplished.

32

The Transsexual Empire

The medical odyssey of the transsexual is a long one, of­ten beginning years before surgery is completed. For men
it usually starts with the administration of the female
hormones estrogen and progesterone. This is referred toas “hormonal castration.” Hormonal treatment has two
effects: it suppresses the existing physiological sex charac­
teristics; and it develops and maintains the opposite ana­
tomical sex characteristics.22 Benjamin explains:
The feminization o f the male patient can be accomplished by female
hormones, both estrogen and progesterone, which develop thebreasts, soften the skin, reduce body hair, diminish erections and de­crease libidinous conflict by suppressing testicular androgen pro­duction .23

In addition, the gonads are inhibited, the testes atrophy,
the distribution of subcutaneous fat is changed in a female
direction, and muscular strength diminishes. Very often,
however, beard growth diminishes only slightly, and otherareas of male hair growth also remain generally unchanged.
For this reason, many transsexuals resort to electrolysis.
As far as voice is concerned, there is little change.24 (Manytranssexuals seek out speech therapy.)
Hormones are administered in various ways. For men,the estrogens of 17B-estradiol and estrone can be given
orally. Estradiol monobenzoate, another estrogen, can beinjected intramuscularly twice a week. Numerous artifi­
cial compounds with estrogenic activity have also beensynthesized for oral administration, besides the steroids.
DES (diethylstilbesterol), for example, has been widelyused. Estrogenic hormones can also be applied as oint­ments or alcoholic solutions and absorbed through theskin. Estradiol, in combination with progesterone, has also
been administered in the form of rectal suppositories. The
treatment of male transsexual candidates is almost totallydependent on estrogen to induce hormonal castration andfeminization. Such treatment is long-term—in many cases,
lifelong.
The next step is the surgery itself, which requires the
combined techniques of the urologist, gynecologist, and33“Everything You Wanted to Know about Transsexualism”

the plastic surgeon. The total procedure takes place in four
steps, although all of them may or may not be desired by aparticular patient. The four steps are penectomy, castra­tion, plastic reconstruction, and formation of an artificial
vagina (vaginoplasty). Some transsexuals have only the
first and second steps performed, and indeed, some writers
recommend this approach.25
The vagina is constructed by creating a cavity between
the prostate and the rectum. An artificial vagina is formed
from a skin graft from the thigh and lined with penile
and/or scrotal skin.26 Thus orgasmic sensation is possible.
The shape of the artificial vagina is maintained by a moldthat is worn continuously for several weeks following sur­gery. Once healing has occurred, manual dilation or penile
insertion two or three times weekly is necessary to prevent
narrowing, which can result through the contraction ofscar tissue.27
The next, most common, procedure is enlarging thebreasts, usually with inserted implants. This is often fol­
lowed up with increased estrogen therapy. However twocases of breast cancer that occurred about five years after
such treatment have been reported.28 The author suggeststhat the malignancy was entirely due to the hormonal im­balance created by excessive estrogen therapy and orchidectomy (removal of one or both testes). Leo Wollman hascommented: “The degree of risk may well be a function of
the amount of hormone used.. . . The most likely possi­
bility is that the hormonally feminized male transsexualconservatively treated with estrogen, runs the same risk ofbreast malignancy as does a normal female.”29 However, inlight of the recent evidence about estrogen replacement
therapy and also evidence linking cancer and birth control
pills, Wollman’s position is hardly reassuring. Normal
women, even on conservative doses of estrogen therapy,“run a great risk” of incurring cancer.30
Following surgery, transsexuals receive oral maintenancedoses of estrogen thus becoming medically managed indi­viduals. Usually, this treatment is administered biweekly,
although longer intervals do occur. The hormones used are

34

The Transsexual Empire

the same as those given preoperatively. Such hormones are
said to play an important role in general metabolism, par­ticularly with regard to bones, skin, blood vessels, andmuscles. Interestingly, it has been said that, “without
these hormones, postoperative patients would experience
climacteric symptoms, including hot flashes and deteriora­tion of general body tone. ”31 These are, of course, theclassic menopausal symptoms. It is now seriously sug­gested, in the light of evidence linking estrogen replace­ment therapy and cancer, that such symptoms, if indeed
they are really experienced by women, could best betreated by other means (e.g., calcium and phosphorous
replacement to prevent bone deterioration).
Surgery, however, often does not end with vaginal con­struction. Secondary operations are often sought by thetranssexual, usually for esthetic reasons and/or to correct
real or psychologically felt complications. This cosmetic
surgery frequently has nothing to do with refashioning the
genitalia themselves. It ranges from limb surgery, to eye
surgery, chin surgery, ear surgery, scar revision, and eventattoo excision. Some transsexuals also seek reduction of
the Adam’s apple. All these procedures are undertaken by
the transsexual in the hope of conforming more to the
fashionable, stereotypical feminine body image. Manytranssexuals go to great lengths to fit themselves to theprescribed body measurements and gestalt of a man-madewoman.
Surgery to correct complications centers on the breasts
and genitalia. Bleeding can be a problem in the breast area,
and care must be taken to control this completely. Other­wise, postoperative hematoma (extravascular collectionof blood, usually clotted and forming a mass) can occur.
Also, the lack of overlying breast tissue covering an im­plant offers little protection from even the slightest injury.
The breast is vulnerable to injury that may cause subse­
quent expulsion of the prosthesis, again requiring corrective
surgery. As far as the genitalia are concerned, correctional
problems can occur here also. It has been reported thatsurgical complications are not common, but the most re­

35“Everything You Wanted to Know about Transsexualism”

current ones include narrowing of the vagina, rectovaginal
fistulas, and narrowing of the urethra.
Overall, it has been said that “the final external appear­
ance of the genitalia varies—not only from patient to pa­
tient, but with the surgical technique employed. Few
patients are truly satisfied. Many seek further corrective
changes.” 32 Here, however, there is some conflicting evi­
dence. On the one hand, Milton Edgerton and his colleagues
have reported that of nine patients operated on by theirgroup all were dissatisfied with the surgery, although allstated that they “would do it again.”33 Conversely, FoghAndersen reported in his series that most patients weresatisfied with their surgery and did not regret having madethe change.
Several authors have commented on the surgical de­mands and needs of transsexuals. For example: “The sur­geon must be prepared to combat the tendency of thesepatients to desire ‘polysurgery.’”34 This can be responded
to in several ways. First of all, all transsexual surgery, fromthe primary operative procedures through the secondary
surgical adjustments and cosmetic procedures, can be re­garded as “polysurgery,” or “unnecessary surgery.” (I will
discuss the issue more extensively later in this book. ) Sec­
ondly, it is hard to see how the surgeon can “be prepared
to combat the tendency of these patients to desire ‘poly­surgery’” if surgeons are the ones who are creating all thedifferent varieties and kinds of polysurgery, by developing
the surgical specialties, which in turn create the demand.
THE MEDICALIZED “MALE”

The female-to-constructed-male transsexual also begins thesex conversion odyssey with hormone treatment. Andro­
gen is injected to arrest menstruation, to stimulate somehair growth on the face and body, possibly to lower thevoice slightly, and to accomplish some reduction of breast
tissue. This also causes the muscles and body appearance
in general to become progressively more masculine (e.g.,
the shoulders widen). Long-term administration of testos­36

The Transsexual Empire

terone often increases the size of the clitoris. However,
menstruation is not always suppressed by hormone treat­
ment. In some cases, radiation had to be used, because
breakthrough bleeding occurred after androgens were in­jected. In the medical literature, this is called radiation
menopause. 3S
One of the ill effects of long-term androgen therapy has
been attacks of acne. Some observers also report a libido
increase that they regard as undesirable and troublesome,
but whether or not this is caused by biological or socialpsychological influences is debatable. One of the more
serious consequences of androgen is that all its effects are
not always reversible. If a woman decides to stop hormone
treatment, her voice may retain its low pitch and her facial
hair may remain.
Surgery involves several steps, all of which are notnecessarily undertaken. Mastectomy, hysterectomy, andoophorectomy (removal of the ovaries) are surgical pro­cedures that most transsexuals undergo. As the penis is aconstant reminder to the male transsexual of his rejectedmale body, so are breasts and menstruation to the female.
The female transsexual patient, perhaps considerably more than themale, feels quite strongly that something is wrong internally. The
menses are regarded as loathsome and often are described as being
exceedingly painful. Many patients will seek and perhaps obtain
exploratory laparotomy and hysterectomy firmly convinced that
testes and other male organs will be discovered. 36

Since testosterone causes only a moderate reduction ofa woman’s breasts, female transsexuals usually obtain mas­
tectomies. Hysterectomies and removal of the ovaries con­stitute the second step in female-to-constructed-maletranssexual surgery.* The vagina remains. Phallus construc­*The removal of ovaries was used to tam e deviant women during thenineteenth and early tw entieth century rash of sexual surgery. Thismode of female castration has now been superseded by hysterec­
tom y. If one regards the fem ale-to-constructed-male as a potential
deviant, as a potential lesbian and woman-identified woman, thecomparison between these castrated women and female-to-constructed-male transsexuals is significant.

37“Everything You Wanted to Know about Transsexualism”

tion, when undertaken, begins in conjunction with a hys­
terectomy. It is technically possible to construct a penis
surgically by rotating a tube flap of skin from the left
lower quadrant of the abdomen and closing the vaginalorifice. A urinary conduit can be led through such a phal­lus, so that the constructed penis may be used for urina­
tion. However, because of complications, many surgeons
have decided against constructing the phallus so it can beused to urinate. Instead, the female urethra is maintainedin its existing position beneath the constructed penis. But
the new penis lacks sensitivity, and can become erect only
through the insertion of certain stiffening material that re­mains in the penis all the time, or can be put in and out
through an opening in its skin.37
Many female-to-constructed-male transsexuals, however,stop after obtaining hormone therapy, mastectomy, andhysterectomy, feeling that they do not wish to undergo
the multistaged procedures required for the constructionof a phallus, which is often also accompanied by scrotal
construction. Some transsexuals recognize that the phallus
will serve little, if any, role in sexual activity, since the tech­nique of creating an erect penis has not been developed.
Some female transsexuals, however, do undergo thenumber of hospitalizations required for phallus construc­tion. They are convinced that the rodlike stiffener, in­serted into the skin of the constructed member, can put
pressure on the original clitoris (which still remains) during
intercourse, making an orgasm possible. Therefore, sometranssexuals are willing to endure the multiple proceduresthat are necessary for this. One female-to-constructed-maletranssexual underwent thirty-three plastic operations to
obtain a satisfactory penis.38 Furthermore, the “fear of
discovery” becomes a strong pressure, pushing both maleand female transsexuals to undergo every possible kind of
surgery. All transsexuals express profound anxiety about
being placed in an uncontrolled environment, through acci­
dent or illness, and thereby being “unmasked.”39 For thefemale-to-constructed-male transsexual, “ toilet trauma,” as
Zelda Suplee calls it, is a particular fear. Public lavatory

38

The Transsexual Empire

facilities for men often require the kind of exposure thatwomen do not meet, and this alone increases the femaletranssexual’s anxiety about phallus construction.
THE LEGAL LANDSCAPE

Problems for the transsexual, however, are not limited tothe medical-surgical realm. For most transsexuals, there arelegal difficulties that must also be resolved, and a corres­
ponding legal journey that must be travelled. In fact thelegal odyssey, for most transsexuals, begins long before theoperation takes place.
Legally, there are many constraints on the transsexualand on both the institution and the doctors performing theoperation. In addition, there are several state statutes thathave been invoked against preoperative transsexuals who
have been caught in the act of cross-dressing. Many ofthese same statutes have been used against transvestites,
and in some cases against homosexuals, in the past. Section
887, subdivision 7, of the New York State Code of Crimi­
nal Procedure is typical of some state female impersona­tion statutes that have been used in the past against trans­
vestites and homosexuals, and are now being invokedagainst transsexuals. Although the preoperative transsexual
is not having sexual relations at the time of arrest, nor at­
tempting to solicit or defraud as a female, he is arrested on
the grounds of masquerading as female. In such situations,the transsexual has often presented medical certification
attesting to his transsexual status, and has still been ar­
rested and convicted under this statute. Furthermore, doc­
tors have been warned against issuing such certification on
the grounds that such documents might be judged illegal
and/or improper medical conduct by the local, unsym­
pathetic medical association.40
In many states, there is no hesitation on the part of thepolice to arrest under a disorderly conduct statute 41 Thisis done despite the fact that the transsexual was in no way
being disorderly at the time of arrest and does not perpe­
trate the usual acts (e.g., crowd-gathering, loud commotion,

39“Everything You Wanted to Know about Transsexualism”

etc. ) that cause disorderly conduct arrests. Various “catch­all” statutes are also invoked. Under these statutes, persons
can be taken into legal custody for acts that outrage public
decency and for which there are no other specific and cov­
ering statutes. Thus catchall statutes make it very difficult
to predict what kind of behavior is defined as criminal, andthey leave much discretion to the arresting officer.42 Un­
der catchall statutes, transvestite, homosexual, and trans­
sexual persons have been frequently arrested, and many
have been jailed, convicted, and fined.
Legal difficulties are not solved for the transsexual evenafter sex-conversion surgery has taken place. The post­
operative transsexual, in many states, faces long legal
battles in trying to change personal papers. Some states
have been quick to grant such changes; others have been
more gradual; and some have refused altogether.
In many areas, transsexuals and their advocates haveasked the courts to define sex, and to thereby set a prece­dent for other legal decisions on the matter. Johns Hopkins
Hospital followed a fundamentally different procedure.
The medical community there took the initiative on be­half of their clients to guide the city and state in setting an
administrative precedent for birth certificate changes. In
1967, one of the Johns Hopkins Gender Identity Commit­
tee members spoke with an official of Baltimore’s Bureau
of Vital Statistics. This official allowed that the name on atranssexual’s birth certificate could be amended and alsothat the sex could be changed to conform to the new legal
name. A shortened birth certificate with only new infor­
mation on it was then issued to the transsexual. The oldcertificate with emendation was kept in a sealed envelope
on record and could be produced, if necessary, to insure
continuity of legal identity, which might be needed for the
purposes of proving past schooling, social security, and in­
heritance rights. Most of the transsexual’s everyday needs
would be met by the short-form certificate carrying noevidence of sex reassignment.43
With respect to the surgery itself, there are several
statutes that may be invoked against both transsexuals

40

The Transsexual Empire

and the institution that performs the operation. Looming
largest is the threat of legal mutilation, which is embodied
in so-called mayhem statutes, still on the books in a major­
ity of states. These statutes forbid the willful and perma­
nent deprivation, crippling, and/or mutilation of a bodily
organ. They could be used to prosecute the transsexual
who undergoes sex-conversion surgery, the surgeons per­forming the operation, and the institution in which theoperation is done. Surgeons have been warned by district
attorneys’ offices throughout the country of impending
prosecution under this law, when they have inquired about
the legality of transsexual surgery.44
In contrast to the risk of criminal liability, a physician
may also be exposed to liability in tort, if the individual’s
consent to the operation should be declared invalid. (Acase in Argentina ruled that a transsexual’s consent to sexconversion surgery was unnatural, and therefore invalid,
and the surgeon became liable in tort for assault.)45
In the United States, however, where no such legal
decisions have been rendered concerning the operation
itself, the institutions that are performing such operations
have followed various legal courses. With a mayhem statutehovering over it, the U.C.L.A. Medical Center decided not
to initiate such operations on their own but instead asked
the law if it could find some legal precedent to guide them.
One of the university’s legal advisors cautioned against
what he termed a legally risky surgical venture. Thus the
U.C.L.A. Gender Identity Clinic presently performs sexconversion surgery on only those individuals who havedefinite and provable biological sexual anomalies.46
A second group of medical personnel at the Universityof Minnesota acted similarly to the U.C.L.A. team inasking the law for guidance in this area. However, theabsence of a mayhem statute in the state of Minnesota
was the key factor that encouraged its decision to proceedwith transsexual operations.47 Had they been faced withthe presence of a mayhem statute, it is likely that the
Minnesota group might have followed U.C.L.A.’s course.
Strikingly different from the preceding two cases is that

41

“Everything You Wanted to Know about Transsexualism”

of the Johns Hopkins Gender Identity Clinic. This group,
instead of asking the law for guidance, as we noted pre­viously in the birth certificate situation, again set a prece­dent for the law to look to. When the case of G. L., aseventeen-year-old boy, arose and transsexual surgery wassought by the boy and his parents, the specialists involved,
confident of their medical decision about sex-reassignment
surgery for the boy, proceeded on the basis of their own
medical judgment. The boy, the boy’s parents, his proba­tion officer (the boy had been involved in repeated delin­
quencies supposedly linked to sexual dissatisfaction withhis body), two specialists from the Hopkins Clinic, and ajudge joined together to form a liaison among the peti­tioners, medicine, and the law in the event that sex con­version should be challenged in the future. Furthermore,
the judge signed a court order for the surgery. This court
order would set no legal precedent unless challenged by ahigher court, but the very act of procuring a court orderplaced the whole procedure within the scope of the law.
The judge himself attended several meetings of the Johns
Hopkins Gender Identity Committee and said he would beavailable should his advice be needed. This, of course, is ahighly unusual procedure. The University’s lawyer also
worked closely with the team, discussing various legal
issues with them and advising them on such aspects as con­sent and legal name changes. Thus confrontation between
law and medicine was avoided so that no lawyer or judge
would be put in the position of interpreting Hopkins’s
policy. Acting on the basis of professional judgment, the
Hopkins medical group defined the problem as a medical
one and acted accordingly, getting the law to affirm its
judgment.48
In assessing the legal position of the transsexual, various
factors come into play. First of all, it can be demonstrated
that statutes invoked against the preoperative transsexual
who cross-dresses are plainly unjust, not applicable, or too
widely construed to be legitimately enforced. Section 887,
subdivision 7, of the New York State Code of Criminal
Procedure is a case in point. This statute expressly forbids

42

The Transsexual Empire

female impersonation, but should only be invoked whenimpersonation is used to defraud or solicit. As Robert
Sherwin has stated, there is no law that expressly forbids
males to wear female clothing, per se. There are laws thatforbid males from doing so for the purposes of defrauding
when, for example, one tries to gain illegal entry or at­
tempts to acquire money by such impersonation.49 How­ever, the statute has not been adhered to, and wide discre­tionary powers are given to arresting officers.
Arresting officers in some states have used also a wideand broadly applied disorderly conduct statute or othercatchall statutes to pull cross-dressers off the streets or outof public, and even private, places. Given the latitude ofapplication here, such statutes should be revised or elimi­
nated altogether. Impersonation statutes should be in­voked precisely for the purposes they were intended, i.e.,
to stop fraud; disorderly conduct should include only ob­
vious disorderly conduct. Transvestism cannot of itself bedemonstrated to be disorderly conduct.
At this point, the causes of transsexualism need to be
examined. The medical and psychological literature has
focused on two areas: (1) prenatal critical hormonal fac­
tors that supposedly set “the direction but not the extent
of sex differences” ; and (2) individual and family influen­
ces that are claimed to condition transsexual development.
Both theories warrant a close examination, yet, as I shallargue, both neglect the wider and more primary influenceof sex-role stereotyping in a patriarchal society, and both
ultimately conclude by blaming the mother.

C H A P T E R II

Are Transsexuals
Born or Made—or Both?

T h e causes of transsexualism
have been debated for years. Perhaps the earliest commen­
tator was Herodotus. He explained the origin of what he re­ferred to as “the Scythian illness” by resorting to divine
causation. Venus, enraged with the plundering of her
temple at Ascelos, changed the Scythian males and theirposterity into women as her divine punishment for theirmisdeeds.1
Herodotus notwithstanding, most theories fall into two
camps—biological and psychological. Biological theories
have tended to focus on neuro-endocrine factors. In thischapter I will mainly be concerned with these biologicalaspects, especially as they are developed as part of an interactionist theory in the writings of John Money and his
associates. Chapter III will be devoted to psychologicaltheories of transsexualism, which highlight factors of im­printing, family conditioning, and general psychoanalytic
hypotheses.
In both chapters I will demonstrate that while biologicaland psychological investigations seek different causes, theyboth utilize the same theoretical model—i.e., both seek
43

44

The Transsexual Empire

causes within the individual and/or interpersonal matrix.
In such investigations, social, political, and cultural pro­
cesses tend to be relegated to a subsidiary or nonexistentrole, because the model focuses attention on individual orinterpersonal gender differences and similarities rather
than upon the gender-defined social system in which trans­
sexual behaviors arise. For example, psychological theories
measure a transsexual’s adjustment or nonadjustment tothe cultural identity and role of masculinity or femininity.
They seldom question the social norms of masculinity andfemininity themselves.
This chapter will be concerned mainly with the work ofJohn Money and associates. There are many reasons I havechosen to do an extensive analysis of Money’s work. Firstof all, his theories on sex differences have gained wide ac­
ceptance, both in academic and lay circles. They have also
been widely cited by feminist scholars. No other researcher
in this area has developed any comparable body of re­search. Thus most discussions of sex differences refer toMoney’s work as a kind of bible. Second, no one hasdone a comprehensive analysis and critique of Money’s
work, especially as it relates to issues surrounding trans­
sexualism. For example, Money’s much-publicized theory
that core gender identity is fixed by the age of eighteenmonths forms one critical basis for the justification oftranssexual surgery, and therefore deserves special atten­
tion. Finally, inherent in Money’s proclaimed scientificstatements about sex differences are many normativeand philosophical statements about the natures of womenand men. Under the guise of science, he makes normativeand prescriptive statements about who women and men
are and who they ought to be. It is one task of this chapter
to expose these assertions.
Money’s theories about sex differences are based on the
supposition that the nature-nurture debate is obsolete. In­
stead he proposes an interactionist theory of sex differ­ences that claims to unite biological and environmental
factors into a unique, sophisticated gestalt. At times he

45

Are Transsexuals Bom or Made—or Both?

sounds like a biologizer and, at other times, like an en­
vironmental determinist. It is very difficult to get a precise
grasp on exactly what Money is stating. Thus while it may
seem that I am equivocating with the explanation and cri­tique of Money’s theories, this is because Money himself
consistently equivocates.
In discussing the importance of biology, Money is no
biologizer of the ancien regime in which, for example,
hormonal determinists linked anatomy directly withdestiny. (I am reminded here of theories about female
behavior that were based on “raging hormonal imbalances”[Edgar Berman] or male bonding theories based on reductionistic endocrinology and selective anthropology [Lionel
Tiger]. ) Rather, what makes Money’s theories on sex
differences so attractive to those who should know betteris that he claims to unite biological and environmental
factors into a unique, sophisticated whole.
On the environmental side, Money’s statements about
the effects of socialization or learning are just as deceiving.
Possibly to avoid the charge of biologizer, Money empha­
sizes that the socialization side of the coin is more signifi­
cant than the biological. In fact, it is so significant that“core” gender identity is fixed during the first eighteenmonths of life. Here the theme changes from “biology is
destiny” to “socialization is destiny.” Yet many of those
who accept Money’s theories seem not to notice thisswitch, which takes on all the force of a new natural law.
The seductiveness of Money’s work resides in the fact thathe comes close to the truth in postulating that the inter­action of biology and environment may explain certain
facets of sex differences. But it is my contention that hehas failed to show us that they do. Thus he tells us very
little about the origins of transsexualism.
THE NATURE-NURTURE DEBATE IS OBSOLETE

In my opinion, there are five main aspects to Money’s
theory of sex differences:

46

The Transsexual Empire

1. The distinction between nature and nurture, or innate
traits versus acquired traits, is obsolete. Biology combinedwith socialization determines sex differences.
2. A most critical period in the development of sex dif­ferences is the prenatal stage. At this point hormones
activate the brain and set the direction but not the extent
of sex differences.
3. The development of gender identity can be comparedto the development of native language.
4. The “locking tight” of gender identity occurs by theage of eighteen months. After this, it is very difficult, if
not impossible, to reverse psychosexual orientation.
5. Social change will come about, not by doing away with
cultural definitions of masculinity and femininity, but bybringing more flexibility to the stereotypes to meet pres­ent and future changes.
Money dissociates himself from early theorists of bio­
logical determinism by accusing them of using simplistic
methods. He purports to take a more solidly scientificapproach using new information. (One way in which hehas been able to escape the label of simplistic biologizing
is by what I have termed his pseudo-interactionism or
pseudo-organicism. )2 Compared to earlier theorists, Money
appears to be a very astute and careful researcher of gender
identity. For example, the earlier, more reductionistic
theorists linked anatomy directly to destiny. Straightfor­
ward links between hormonal factors and supposed be­
havioral results were simplistically set forth. In Money,
however, the connection between the two is indirect.
There is a mediating structure, the human brain—more
specifically, the hypothalamus—which when activiatedby specific sex hormones sets up neural pathways forgender identity that postnatal socialization later develops.
As early as 1963, Money was saying that the dichotomy
between innate and acquired traits was conceptually out­
dated.3 This assertion has continued to form the philo­sophical underpinning for all of his work on sex differ­ences and is reiterated as the basis of Man & Woman, Boy& Girl.

47

Are Transsexuals Bom or Made—or Both?

In the theory o f psychosexual differentiation, it is now outm oded
to juxtapose nature versus nurture, the genetic versus the environ­mental, the innate versus the acquired, the biological versus thepsychological, or the instinctive versus the learned. Modem genetic
theory avoids these antiquated dichotomies, and postulates a genetic
norm o f reaction which, for its proper expression, requires phyletically prescribed environmental boundaries. If these boundaries areeither too constricted, or too diffuse, then the environment is lethal,
and the genetic code cannot express itself for the cells carrying it
are nonviable .4

The interaction of biological and social factors is ex­
plained by using the concept of a program and by com­paring that program to the development of native language.
There are certain parts of the program that exert a deter­mining influence, particularly in the prenatal period, andleave a permanent imprint. These are hormonal influencesthat act on the brain to set up supposed neural pathways
to receive postnatal, social, gender identity signals. Afterbirth, the biological program shifts to one of psychosexual
conditioning, and gender identity now becomes largely amatter of biographical history, especially social biography.
Once written, the social biography program leaves its im­print, as did the biological. Money and Ehrhardt admitthat of the two, the social factors are the most influential
part of gender identity differentiation but that prenatal
hormonal factors are necessary to set the direction, if
not the extent, of sex differences. They “predispose.”
Such theories have an attraction because they seemingly
reconcile opposing factors. They achieve instant recon­
ciliation, so to speak. However, it is important to examine
organic theories, especially those that claim to have ascientific base, to see if the connection is made by fiat
rather than by demonstrable and credible evidence. I
believe that there is a series of missing links in Money’s
approach.
For example, let us examine the biological “program.”
Money and Ehrhardt’s assertions about the importanceof prenatal hormonal factors influencing behavior reston statements such as the following.

48

The Transsexual Empire

Testicular secretions, their presence or absence or their intrusionfrom exogenous sources, account not only for the shape of theexternal but also for certain patterns of organization in the brain,
especially by inference in the hypothalamus, pathways that willsubsequently influence certain aspects of sexual behavior. Thus
they pass on the program, dividing it between two carriers, namely
the genital morphology and that part of the central nervous system,
peripheral and intracranial, which serves the genital morphology[Italics mine ]. 5

Put simply, if a person, for some reason, has more an­drogen prenatally, it will take less stimulus to orient that
person toward strenuous physical activity (certain desig­
nated masculine activities) and more stimulus to evokea response to helpless children (and other designatedfeminine activities). To prove this, Money draws on datafrom animal experimentation and from certain groupsof females who were androgenized in utero.
There is something missing, however. How do hormonalsecretions account not only for physical genital formation
but for “certain patterns of organization in the brain”
which influence “certain aspects of sexual behavior”? The
connection between hormonal determinants and subse­
quent brain patterns is never made clear. How does thecentral nervous system, insofar as “prenatal hormonal
factors make it sexually dimorphic,” pass on its programin the form of behavioral traits, which are “culturallyclassified as predominantly boyish or girlish”?6 Moneyand Ehrhardt are cautious enough to say: “These traits
do not automatically determine the dimorphism of gen­
der identity, but they exert some influence on the ulti­
mate pattern of gender identity.” 7 This is precisely thequestion, however. How do they exert even “some in­fluence,” and what is the content of this specific influence?
Money admits that the precise answer to this question is
not yet known. “In human beings the pathways have notyet been anatomically identified.”8 If this is Money andEhrhardt’s ultimate conclusion, then it is reasonable toask why they spent so many pages discussing the prob­
ability, at best, of especially the animal findings being
extrapolated to human behavior. Money and Ehrhardt

49

Are Transsexuals Bom or Made—or Both?

appear to be forcing the parallel between animal behavior
and females androgenized in utero. It is just as crediblethat the so-called masculine behavior of the androgenized
girls could be entirely due to postnatal socialization.
In summary, the point is should any significance beclaimed for biological factors in the development of gen­
der identity? Just because Money and Ehrhardt pro­claim that the nature-nurture debate is outmoded andthat there is an organic interaction between biology andsocialization should not dissuade us from asking for the
specific evidence in a work that makes great pretensions
to using scientific modes of inquiry. Is science, in John
Money, reducible to hidden pseudometaphysical state­ments about the nature and behavior of men and women?
Or as Ann Oakley has pointed out, why do these alleged
prenatal hormonal factors that set the course for gender
identity differentiation so exactly parallel the course thatsociety sets for masculine and feminine gender identity
and role? Is what is at stake in Money’s work not science,but a world view, ideology, or faith commitment of an
ontological sort? It appears that Money has only negated
the idea that it is either/or, but has not proven the realitythat it is both/and.
HORMONAL HAPPENINGS IN THE WOMB

According to Money in the case of transsexualism possibly
something goes wrong during the prenatal critical period.
Specifically, Money and Ehrhardt list a number of prenatal
abnormal determinants, not all of which necessarily in­fluence the development of transsexualism.
The phyletic program may be altered by idiosyncrasies o f personal
history, such as the loss or gain of a chromosome during cell divi­sion, a deficiency or excess of maternal hormones, viral invasion,
intrauterine traum a, nutritional deficiency or toxicity, and so forth.
Other idiosyncratic modifications may be added by the biographi­
cal events o f birth .9

Of all such “idiosyncratic modifications,” however, Moneyand Ehrhardt devote themselves most explicitly to hor­

50

The Transsexual Empire

monal factors. They are careful to assert, nevertheless, thatthese hormonal factors and how they relate to transsexual­
ism are “imperfectly understood.”
There may well be an as yet undiscovered fetal metabolic or hor­monal component which acts to induce a predisposition to am­
biguity or incongruity of postnatal gender identity differentiation.
There may be a special disposition in the organization of the brain
toward the acquisition of roles and their dissociation in the mannero f multiple personality or fugue state. In either case, a prenatal
disposition is probably insufficient in itself, and needs to be aug­
mented by postnatal social history . 10

Thus the authors are careful to appeal again to their interactionist theory of sex differences, being cautious about
overstressing the hormonal.
The Overriding Effects of Androgen. According to Money,
male and female hormones are not equally significant in
affecting “the hypothalamic pathways that will subse­
quently influence certain aspects of sexual behavior.”
Rather, it is the presence or absence of androgen that ismost determinative. Until about the sixth week afterconception, the embryo does not begin to differentiate
sexually. (Or, as some would phrase it, all human fetuses
are female up to this point.) Biological femaleness resultsfrom the absence of androgenic hormones. Money andEhrhardt state it this way: “In the particular context of
neonatal (or prenatal) hormonal effects, the antithesisof androgen is not estrogen, but nothing.”11 In Money’s
opinion, androgen regulates both the development of
external genitalia and certain forms of behavior and in­telligence. As far as the external organs are concerned,“feminine differentiation requires only the absence of
androgen. It does not require the presence of a feminiz­
ing substance.”12
Likewise the presence or absence of androgen affects
behavior. Here again, “ the antithesis of androgen is not
estrogen, but no gonadal hormone at all—in fact no sub­stitute whatever.” 13 The absence of androgen either at
the prenatal critical period or at other critical periods

51

Are Transsexuals Bom or Made—or Both?

of development (whether absent normally as in the genetic
female, or artificially through castration or antiandrogen
treatment in the genetic male) results in a brain “orga­
nized” to produce so-called feminine behavior and re­sponse. Thus it is Money and Ehrhardt’s contention that
there is a fetal organization of neural structures essentiallyof the hypothalamus, which makes parts of the brain es­
sentially male or female. Portions of the fetal brain affectnot only hormonal and reproductive functions but also
behavior—especially lovemaking and coitus. However,other behavior patterns are affected as well. For example,
Money and Ehrhardt cite so-called tomboy conduct. Theircausal explanation of tomboyism is grounded in fetal hor­monal activity.
The most likely hypothesis to explain the various features of
tomboyism in fetally masculinized genetic females is that theirtomboyism is a sequel to a masculinizing effect on the fetal brain.
This masculinization may apply specifically to pathways, mostprobably in the limbic system or paleocortex, that mediate domi­nance assertion (possibly in association with assertion of explora­
tory and territorial rights) and, therefore, manifests itself in com­
petitive energy expenditure . 14

Originally the authors also made a positive correlation,although tenuously, between increased fetal androgenand increased I.Q. Money and Ehrhardt stated that there
is “some preliminary evidence to suggest that an abnor­mally elevated prenatal androgen level, whether in genetic
males or females, enhances I.Q.”1S The authors claim that
this finding of I.Q. elevation in females exposed to exces­
sive androgen was not a finding that was looked for. It wasa “serendipitous one” and one that also occurred in ge­
netic males similarly exposed.*♦E hrhardt has subsequently discredited the I. Q. findings herself.
In conjunction w ith Susan Baker, she has stated th a t it is highly
unlikely th a t increase in I. Q. is an effect of horm one treatm ent.
R ather it is a co nstruct of inadequately m atched controls. See
Anke A. E hrhardt and Susan W. Baker, “ Prenatal A ndrogen, In ­telligence, and Cognitive Sex D ifferences, ” in R. C. Friedm an,
R. M. Richart, and R. L. Vande Wiele, eds., Sex Differences in
Behavior (New Y ork: Wiley, 1974).

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The Transsexual Empire

In order to prove that androgen affects the kinds of
behavior referred to above, Money and Brennan cite
studies with two human control groups who were acci­
dentally androgenized in utero. The first was done ona group of girls with the so-called adrenogenital syndrome.
The second study researched another group of girls withthe progestin-induced syndrome. (These syndromes are
explained further in the following pages.) Money andBrennan connect both syndromes with transsexualism.
Basically, their words speak for themselves.
Tomboyishness in the progestin-induced and the adrenogenital
syndromes is a matter chiefly of physical energy expenditure andoutdoor athletic interests of the type customarily assigned tob o y s .. . . This description of tomboyishness in childhood applies
fairly well to what the transsexual patients reported of themselves,
except that they grew up to discover they were lesbian-oriented
in their erotic disposition. One may, therefore, legitimately posethe question of whether a tendency to tomboyish energy expendi­
ture is not a primary trait in incipient female transsexuals, and onethat somehow facilitates the subsequent differentiation of a trans­
sexual gender identity, provided various prerequisite postnatal
conditions. . . are encountered . 16

Always careful, however, never to stress the biological sideof the coin alone, Money and Ehrhardt explain transsexual
development further by reverting to their interactionist
approach.
These traits may interact with postnatal social influences that shapegender identity. Prenatally induced tomboyish traits, for example,
may make it easy for a genetic female to have not simply a tom ­boyish version of a feminine gender identity, but, if postnatal
circumstances so conspire, to differentiate a transsexual gender
identity and want a sex reassignment. The same might happen inreverse for a genetic male .17

One may legitimately ask, however, how many femaleto-constructed-male transsexuals have either the progestininduced or the adrenogenital syndromes and how many
“tomboys” become transsexuals. Anticipating these ques­
tions and others like them, Money and Brennan admit

53

Are Transsexuals Bom or Made—or Both?

that, after all is said and done, “The most economical con­clusion to draw from all the foregoing is that female trans­
sexualism is a disorder of psychosexual differentiationand is, regardless of its still unknown etiology, a psycho­
logic manifestation.” 18“Monkey See, Mammals Do. ” Much of Money’s theorizing
concerning hormonal activity in utero, specifically withrespect to androgen, is based on animal experimentation.
Rats, hamsters, and monkeys, in particular, who were androgenizd prenatally or neonatally, were studied undermating conditions.
Citing the so-called masculine behavior of the prenatally
androgenized, hermaphroditic, female rhesus monkey,
Money and Ehrhardt state that her activities are reminis­
cent of tomboyism in girls. Like male monkeys, she shows
an increased amount of play initiation, rough-and-tumble
activity, chasing behavior, and playful threats. It is impor­tant here to note that “ tomboyism” is never specificallydefined by Money, but always described in this kind of be­
havior. Mounting play is increased compared to other fe­
male monkeys, who present hind-end stances of sexual
invitation. Moreover, the patterns of mounting of such
masculinized monkeys also take on a masculine stance. Allof this is by way of demonstrating that the human clinicalsyndromes concerning the influence of prenatal hormoneson gender behavior that are reviewed in Man & Woman,
Boy & Girl, have their counterparts in experimental animal
data. The authors caution, however, that these prenatal
hormones only set “the direction” which later interaction
with the social environment completes. They also cautionthat in the final analysis, “little can be said regarding thevarious structures of the brain that supposedly are subject
to prenatal hormonal organizing influences.”
A Two-Way Critique. On a scientific level, several commen­
tators have made major criticisms of gender identity andbehavior theories that rely on animal findings, with par­ticular reference to Money’s work. Ann Oakley, for one,

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The Transsexual Empire

has stressed that animal research can only be applied hypo­thetically to humans. Particularly in the field of sexual
behavior, she has noted that animals are subject to a much
more direct control mechanism than humans. Humans im­pose an additional control of learning.
Oakley cites Rose’s work, which reached the conclusionthat although androgen may be significantly related to sex­
ual behavior the social context of the monkeys themselves
is of great importance. For example, female rhesus mon­keys injected with androgen show an increase in the“male” practice of “mounting,” but only if they are domi­
nant members of their group to begin with before they
are injected. If subordinate females are injected, theincidence of mounting behavior remains the same. Like­
wise, when dominant male monkeys who secrete tes­
tosterone in excess are placed in a social environment
where their dominance is not recognized, they become in­ferior members of the group and their testosterone output
lessens considerably.19
Thus it can be seen that the role of sex hormones ingenerating signals that are relayed to the brain and conver­ted into sexual arousal is clearly outweighed by environ­mental factors. In the latter example of the male monkeys(to reverse the Freudian adage), it is destiny that deter­
mines anatomy, or at least determines hormone levels.
The testosterone output itself varied enormously depend­ing on how the male monkey perceived his environmentand his place in it. Further research has shown how aggres­sive behavior in animals is significantly dependent on how
it is reinforced. Mice and dogs can be trained to relative
passivity by altering the type of reinforcement that aggres­sive behavior is usually activated by. But in the animal
world, study of the way in which environmental factors
may be able to affect behavior has been neglected.20
Elizabeth Adkins has pointed to a number of factors in
the animal experiments that make human comparisons or
extrapolations from animal data highly dubious. She rein­
forces the role of environment and its impact on rhesus
monkeys. Researchers have found that there are discrepan­cies between those animals reared in the laboratory and55

Are Transsexuals Bom or Made—or Both?

those reared in the wild. The latter are less aggressive, andthus Adkins suggests that some of the sex differences andearly hormone effects may have been influenced by theartificial social and physical environment of the mon­keys.21Furthermore, the majority of the animal experiments
use copulating behavior as an example of sex differences.
None of the human experiments do. 22
The primary effect of early exposure to androgen in the female rat
is that the capacity to display lordosis (the receptive posture) is
impaired. Yet there is no human behavior homologous to lordosis,
and in fact human female sexual behavior is not particularly control­
led by sex hormones at all. 23

It is also difficult to sex-type animal behavior from one
species to another, since there is marked species differen­
tiation. Adkins cites Kleiman’s findings, which showedthat in some mammals, males are more aggressive thanfemales; in others, females are more aggressive. Thus it isvery difficult to generalize anything about animal beha­vior, whether within a species, or cross species. The ana­logies to human behavior are all the more difficult to
make.
What do such findings ultimately indicate about thepertinence of animal behavior in assessing human behavior?
Humans, to an even greater degree, impose additional
controls on any hormonal experiments—that of socio­
cultural factors in general—and it is the human ability tolearn and to rationalize, or even to be affected by socio­
cultural factors that are not necessarily learned, that makegeneralizations from other species difficult and of dubious
value.
The analogy becomes increasingly ridiculous when we add that thenonhuman female primate has no hymen, menopause, [or] artifi­
cial feeding bottle.. . . The males of these species are dominant,aggressive, and show no desire or ability to give the female pleasure.
This is equally absurd in its application to human culture, enabling
the patriarchal world to be supported in its very foundation, justi­
fying the aggressive acts of the male, in the bedroom, by reference tothe jungle, and providing a rationale for aggressive acts in the dis­tinctly human world of social, economic, and political affairs . 24

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The Transsexual Empire

We might also add here that as it is absurd to extrapolate
human data from animal activity in the jungle, it is as ab­
surd to extrapolate such data from animals in cages.
The only human contexts where the effects of outside
androgen increase in females could be studied were theprogestin-induced syndrome and the adrenogenital syn­drome. Money and Ehrhardt studied both groups. In thefirst case, ten girls had been androgenized accidentally inutero as a result of the drug progestin, which their mothers
took during pregnancy. In the adrenogenital syndrome, theadrenal cortex in the normal XX female fails to synthe­
size cortisone and, instead, releases an incomplete productthat has the biological masculinizing properties of andro­gen. Money and Ehrhardt studied a group of fifteen girls
with this syndrome whose androgen level was reduced
gradually after birth. They ranged in age from four to six­teen years. In both groups (the progestin-induced andadrenogenital), each girl’s androgen excess levelled off postnatally. They developed normal-looking female genitalia
and appearance, and they were raised as females. However,Money and Ehrhardt found, in contrast to a control groupof females who had not been excessively androgenized inutero, that they showed so-called opposite sex behavior—e.g., tomboyism, rough-and-tumble play.
Elizabeth Adkins has asked, however, if this is the onlyinterpretation that can be made. Upon closer examination,
she finds many problems with the method and design usedby the experimenters. First of all, the adrenogenital girls
had been treated with cortisone since infancy, which it­
self can have behavioral effects that would differentiatethese girls from others. Adrenogenital girls who were notreceiving cortisone were never tested. More importantly,
parental treatment may have produced less sex-typed beha­vior, since such parents may have been more willing totolerate “tomboyish” actions because they knew their
girls were different. Most significant, Adkins states thatwhat then was looked upon as deviant girlish behavior is
now the norm.25
Finally, observers have pointed out that human hor­

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Are Transsexuals Bom or Made—or Both?

mone levels, as well as animal hormone levels, vary accord­
ing to environmental circumstances. For example, many
forms of stress have been correlated with a drop in testos­terone. 26 “Moreover, hormone levels in a given individual
vary according to environmental circumstances (a studyof American soldiers in Vietnam, for example, showed asharp drop in testosterone levels); we are apparently deal­
ing with a fluctuating process, not a fixed state. ”27
Aside from the critical commentary that has alreadybeen directed at Money’s work on sex differences from ascientific level, there is a more philosophical critique thatcan be made at this point. Money and Ehrhardt’s state­ments about the “ overriding effects of androgen” havestrong suggestions of Aristotelian/Thomistic biology. In
Aristotle and Thomas, the male principle was seen to be
the active power of generation and the female principle thepassive power, or worse, the totally nonaffecting power(read nonpower or even nonbeing). According to Thomas
Aquinas:Among perfect animals the active power of generation belongs to
the male sex, and the passive power to the fem ale.. . . As regards
the individual nature, woman is defective and misbegotten, for theactive force in the male seed tends to the production of a perfectlikeness in the masculine sex; while the production of woman
comes from defect in the active force or from some material indis­
position, or even from some external influence; such as that of asouth wind which is moist, as the Philosopher observes .28

Money and Erhardt say much the same thing in the lan­
guage they choose to describe the power of androgens:“the antithesis of androgen is not estrogen, but nothing.”
In Money’s theories of sex differences, androgen is theactivating principle—“ feminine differentiation requires
only the absence of androgen. It does not require thepresence of a feminizing substance.” (Italics mine.) How­ever, it is not only estrogen, or other female hormonessuch as progesterone, that are said to be passively present.
What remains obscured in Money and Ehrhardt’s work is
the initial female development of all embryos.
Money’s “overriding effects of androgen” statements

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The Transsexual Empire

can be thrown into bolder relief by contrasting his words
with those of endocrinologist Estelle Ramey, who phrases
the “androgen principle” in this way:
For the little it is worth as commentary on Adam’s Rib, it is the fe­
male sex that is primal. The early embryo is female until the fifthor sixth week of fetal life. A testicular inductor substance must be
generated at this point to suppress the growth of ovaries. No ovarian
inductor is required for female differentiation because all mam­malian embryos o f either genetic sex have the innate capacity forfemaleness. Eve and not Adam appears to have been the primeval
human that God had in mind .29

This wording projects quite a different picture than
Money and Ehrhardt’s assertion about the insignificanceof estrogen. Indeed Ramey presents the initial female
momentum of sex differentiation as being so powerfulthat it must be “suppressed.” Warren Gadpaille, M.D.,
states the same principle in this way:
Nature’s prime disposition is to produce females; maleness only
results from something added—androgen. In the absence of andro­
gens, whether the fetus is of XX or XY genotype, differentiation
will proceed as female (though in the genotype XY in mammalian
species at least, ovaries will not differentiate). The converse is nottrue; the absence of ovaries, and thus of estrogenic and progestinic
substances, does not interfere with female internal and external sex
structure development though such individuals will naturally beinfertile . 30

Thus initial embryonic female differentiation is so power­
ful that even without the presence of female hormones,
female internal and external sex structure will result
whether in an XX or XY genotype. Furthermore, as Eileen
van Tassell has pointed out, the male needs the X chromo­
some in order to survive. There is no YO chromosomal
anomaly. The female, however, does not need a second X,
and XO females have been bom and survived.31
Both Ramey and Gadpaille’s statements suggest that, in
opposition to Money and Ehrhardt’s interpretations, itwould be more correct to say that genetic XX-ness is the

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Are Transsexuals Bom or Made—or Both?

primordially activating substance. As Robert Stoller has
said: “The genital anatomic fact is that, embryologicallyspeaking, the penis is a masculinized clitoris; the neurophysiological fact is that the male brain is an androgenized
female brain.”32
Why is it then that Money and his associates have notpointed out that it is essentially a female anatomy and afemale brain that sets the course of biological developmentthat male hormones only turn in a different direction?
If there is a biological basis or force for masculine andfeminine behavior, as Money asserts, which sets “the direc­tion” but not the extent of sexual behavior and psycho­
sexual differentiation, then this biological force may beinitially female. Or more importantly, why pick an arbi­
trary period of androgen onset, and speculate that this is
the critical period when the equally critical period might
be the “original” fetal female state?
In the book Sexual Signatures, Money has taken noteof what he and Patricia Tucker call the “Eve base view.”(It is significant that this interpretation appears in Money’s
more popularized work on sex differences, and not in Man& Woman, Boy & Girl. )When it comes to male and female, the Bible tells of Adam as thebase with something—a rib—taken away to make Eve. In the lightof modern research you might take Eve as the base and think ofsomething—male hormone—added to make Adam, or you could keep
Adam as the base with something—again male hormone—decreased
to make Eve. We have adopted the Eve base view, and will refer tothe something that must be added for male differentiation as theAdam principle . 33

It is certainly not evident throughout Man & Woman, Boy& Girl that Money and Ehrhardt have “adopted the Evebase view.” Nor does Money follow through on the state­ment in view of his belief about the “overriding effects ofandrogen.”34
Money’s use of masculine, feminine, tomboy, sissy isrevealing. The language of masculinization and feminiza­tion is applied equally to biologizing processes and psycho-

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The Transsexual Empire

social processes. The explanation of tomboyism stands out
here very strikingly. For example, Money states: “Themost likely hypothesis to explain the various features of
tomboyism in fetally masculinized genetic females is that
tomboyism is a sequel to a masculinizing effect on the
fetal brain.”35
In several places, Money talks about genetic males andfemales failing to develop normal masculine or feminine
gender identities. Obviously, Money and his associates
accept the stereotypes to some extent. To consistently
term assertive and rough-and-tumble behavior on the partof girls tomboyish and to persist in naming certain be­havioral qualities as masculine or feminine is to support
patriarchal history’s assertion that such behavior and quali­
ties are and should be sex-specific. Here the language of in­adequate science becomes subtly transferred to the lan­
guage of ethics.
While it is true that many cultures define certain be­haviors, personality characteristics, tasks, and activities
as male or female, masculine or feminine (a point that
Money and associates highlight), these same cultures de­fine masculinity and femininity in vastly different ways,emphasizing various qualities, interests, and occupations
as sex-linked. (Anthropologists such as Mead, Malinowski,
and Devereux have written extensively on this subject.) It
appears that the language of masculinity and femininity
varies so widely throughout the world that the only reason
for maintaining it seems to be an implicit belief that so­cieties must link some behaviors and qualities to biologicalsex in order to be orderly and functional. This, as will be
developed later, is Money’s contention (within suitableboundaries of flexibility).
GENDER IDENTITY DEVELOPMENT COMPARED TO
DEVELOPMENT OF NATIVE LANGUAGE

A third main point in Money’s theory of sex differences
is an analogy with language. Money and Tucker remarkthat it is no accident that the years of language develop­

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Are Transsexuals Bom or Made—or Both?

ment (the first few years after birth) are also the years ofgender identity formation.
You were bom wired for language, so to speak, but not programmed
for any particular language.. . . The environmental trigger thatenabled you to start talking was the use of language by those aroundyou during that critical language-learning period, the first few years
after birth. It was the interaction between your prenatally pro­grammed disposition for language and the postnatal, socially pro­grammed language signals you heard that made it possible. You
couldn’t have become a talking person unless somebody talked alanguage to you. Furthermore, the language that was talked to you
then put its mark on the way you could think ever after. It becomes
your native language and will always be your native language, even
if you never use it afterward . 36

In the same way, Money and Tucker talk about the de­velopment of gender identity. Supposedly, persons arebom with “something that was ready to become yourgender identity. You were wired but not programmed
for gender in the same sense that you were wired but
not programmed for language.”37
The analogy between development of native language
and formation of gender identity is flawed. First of all,Money confuses a general ability to speak any language,
depending upon cultural factors, with a specific ability todifferentiate according to one gender only, i.e., either theso-called masculine or feminine gender. According to
Money, as we have seen, gender identity is predisposedby prenatal, rather specific, hormonal factors and later
added to by postnatal environmental influences. It is quite
a different thing to say that one is “wired” for language
and that one is “ wired” for gender. While we are not“wired” for any particular language, as Money readily ad­
mits, we are “hormonally wired” for a specific gender
identity—within flexible limits of the stereotype (if all goeswell).
A more suitable analogy would be that we are “wired”
to exercise a variety of behavioral qualities in the same
way that we are “wired” to speak a variety of languages,
both very dependent on postnatal learning and cultural

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The Transsexual Empire

factors. If Money simply said that we are “wired” to de­velop some sexual identity, i.e., some awareness of our­selves as sexual beings, then there would be no argumentwith him. It is ironic that Money should choose the anal­
ogy of native language when, in other instances, he has re­mained so insensitive to his own “syntactic exploitation.”
THE “ LOCKING TIGHT” OF GENDER IDENTITY

If biology begins the program of gender identity, social
factors set the direction of that behavior in an even moredetermined way. In Money’s work, the gender of assign­
ment and rearing transcends all other determinants. He
cites instances of children with identical genotypes, hor­mones, gonads, and other internal structures, some ofwhom were reared as girls and others as boys. In almost
every instance the child came to regard her or himself as
female or male, depending on the way in which she or he
was reared. The gender of rearing remained, even in theface of contradictory pubertal changes. Most dramaticof all are cases in which even the external genitalia were
obviously more similar to the opposite sex than the child
was assigned to and in which she/he was reared. Even inthese cases, gender identity remained unequivocably thatof assignment and rearing.
Money is very specific about the critical period forgender identity—that is, between the ages of twelve andeighteen months—asserting that gender identity is pretty
well fixed by the age of eighteen months. In the case ofhermaphrodites, “It is ill-advised to impose a sex reassign­
ment on a child in contradiction of a gender identity al­
ready well advanced in its differentiation—which meansthat the age ceiling for an imposed reassignment is, inthe majority of cases, around eighteen months.”38 Thisis so, because child-rearing in our culture is sexually dis­tinctive, and from the day that an infant is picked up outof a crib, that child begins to get gender identity signals(by the way she/he is touched, spoken to, etc. ).

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Are Transsexuals Bom or Made—or Both?

The minute you were born, society took over. When the drama of
your birth reached its climax, you were promptly greeted withthe glad ritual cry, “It’s a boy! ” or “I t’s a girl!” depending onwhether or not those in attendance observed a penis in your crotch.
. . . The label “boy” or “ girl,” however, has tremendous force asa self-fulfilling prophecy, for it throws the full weight of society
to one side or the other as the newborn heads for the gender iden­tity f o r k . . . . Parents react differently to the signal “son” or “ daugh­ter” from the first mom ent .39

There are some exceptions, of course, to this age ceiling,
but this is due to confused gender-rearing practices. For
example, when parents are given conflicting diagnoses of
their infant’s sex, perhaps by different physicians at dif­ferent times, they may express their uncertainty in con­fused gender-rearing practices. But on the whole, in the“normal” (read culturally prescribed) process of gender
identity and role development, the “locking tight” of thisprocess occurs at an incredibly early age. Furthermore,according to Money, once more girls are defined by theabsence of a penis, not by the presence of female genitalia.
This corresponds to his theory of prenatal development,
where it is the absence of androgen, not the presence of
estrogen, that is responsible for female differentiation.
This “locking tight” of gender identity almost takeson the tone of a new “natural-law” theory in Money.
“When the gender identity gate closed behind you itlocked tight. You knew in the very core of your conscious­
ness that you were male or female. Nothing short of disas­
ter could ever shake that conviction. . . ”40 Freudian “nat­ural law” dictated that anatomy was destiny, and Erik
Erikson, a more contemporary Freudian, polished this“simplism” into an inner- and outer-space analogy, where
the “inner” sexual apparatus of the female and the “outer”
sexual apparatus of the male were seen to be the prime
determinants of feminine “inner”-directed and masculine“outer’’-directed behavior. However, Money has reversed
the classical “ anatomy is destiny” theory into a “ neo­
natural law” theory of social determinism. He continues:“Once a sex distinction has worked or been pressured into

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The Transsexual Empire

the nuclear core of your gender schema, to dislodge it isto threaten you as an individual with destruction. The gate
is as firmly locked there as it is on your chromosomes andgonads.”41 Obviously, no one would deny that socializa­tion is a very powerful factor, but to make it deterministic,
as Money does, is to make it absolute and immutable. He
and his associates have constructed a pseudometaphysics,
which derives its “natural” value from societal processes
instead of from classical “nature.” In effect, they havecreated a new theory of the social “nature” of sex-role
differences that is just as immutable as older biologicalnatural law theories.
Money’s dismissal of the importance of social influence
after the stage of early childhood demonstrates that he has
not looked seriously at authors who write about socializa­
tion. As Berger and Luckmann point out: “Everything thathas been said so far on socialization implies the possibility
that subjective reality can be transformed. To be in society
already entails an ongoing process of modification of sub­jective reality.” 42 Money’s response to this would probably
be that while relative transformations are possible the“core” of one’s gender identity schema is “locked tight. ”
However, as Berger and Luckmann state: “there are
instances of transformation that appear total if comparedwith lesser modifications.” 43 They refer to such trans­
formation as “alterations,” and assert that they “radicallyreassign reality accents.”
The “ radical reassignment of reality accents” of “coregender identity” has become a lived reality in the past andpresent history of feminism. However, Money does notallow this history or its consequences to affect his “coregender identity” theories and their immutability. If women
had not been able to alter the nuclear “core” of our gender
programming, we would not be doing many of the things
that we are. One of the primary tenets of the women’s
movement has been that so-called gender identity differ­ences are not natural or immutable. And as such, they areamenable to change. However, as Time magazine reported:“Despite his evidence of the importance of environment in

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Are Transsexuals Bom or Made—or Both?

molding sex roles, Money holds out little hope to femi­
nists that there can be significant breakdown of sex-role
stereotypes in the current generation of adults.”44 What
Money does not see is that the hope of feminism is alreadybeing realized in feminists themselves, who are living con­tradictions of everything that Money is saying about theimmutability of “core gender identity. ”
Obviously, the theory that “ core” gender identity is“ locked tight” by the age of eighteen months has utmost
relevance for causation theories of transsexualism. It en­
ables Money to suggest that transsexual gender identity
is possibly fixed at a very early age.

FLEXIBLE STEREOTYPES

Although Money’s final position on gender identity ap­
pears to be ethically neutral, it has profound social andethical consequences, especially with respect to the wholeissue of transsexualism. In the last chapter of Sexual Signa­tures, Money and Tucker begin by stating that the stereo­
typed differences between the sexes will always remain.
They censure both the right and the left for respectively
wanting to keep the stereotypes rigidly circumscribed or
wanting to abolish them altogether. (Feminists might justi­
fiably wonder which leftist movement has ever wanted toabolish sex-role stereotypes altogether.) Seemingly, they
advocate the via media.
Many o f the pioneers maintain that the stereotyped differences
between the sexes should be done away with, and many nonpioneers
fear that relaxing gender stereotypes will do away with all differ­ences and homogenize the sexes. Both groups are tilting at wind­
mills. As long as there is a human race, there almost certainly will
be differences between the sexes in sexual behavior, work, andplay. 4s

What they stand for is flexibility. Individuals must “bringmore flexibility into the cultural stereotypes so that those
who are growing up today need not be handicapped by

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The Transsexual Empire

having obsolete sex distinctions driven into the core of
their gender schemas by the pressure of stereotypes thatare unnecessarily rigid.”46 Nevertheless, the stereotypes
themselves should remain. Abolishing them would violate
Money’s canon that socialization is destiny.
In Sexual Signatures, Money and Tucker assert: “Thehealthy society is one that tolerates experimentation witha variety of adaptive responses within its stereotypes.”47
The major criticism I would make of this “ adaptive re­sponses” or “flexibility” position, is that a “ flexible ste­reotype” is a contradiction in terms. Webster’s New Colle­
giate Dictionary defines stereotype as “to repeat without
variation.” A stereotype that admits a “variety of adaptive
responses” within it is no longer a stereotype. A fixed pat­tern admits no flexibility or else it is no longer fixed. Fur­thermore, it should also be noted that on a historical level,
it is within the nature of stereotypes to give the illusion offlexibility.
Interestingly, Money and Tucker state: “People can nomore be expected to decode behavior that has been locked
into the core of their gender schemas than a Chinese woman
whose feet were bound in childhood could be expected towalk naturally.”48 It would seem that the authors do notrealize that stereotypes do mutilate personal development,
just as foot-binding mutilated Chinese women’s develop­
ment. To advocate a flexibility within the range o f stereo­
types, yet not do away with the stereotypes completely, issimilar to giving a woman whose feet have been bound andmutilated crutches or a chair to be carried in, yet not theability to completely and freely move about.
The language of flexibility is deceiving. On the one
hand, it gives Money’s biologism and social determinism
the appearance of openness and variability. But, in fact, hemakes a hidden and rather subtle ontological assumptionthat social change cannot affect the core of gender identity
and is definitely limited to undefined parameters of “flexi­
bility.”However, the cannot changes to should not, the ontol-

67

Are Transsexuals Bom or Made—or Both?

ogy changes to ethics. From the position that adult in­dividuals cannot alter the nuclear core of their gender
schemas, Money moves to the stance that “if society or
your early environment drove that distinction into thecore of your gender schema so that it has become an in­tegral support for your gender identity, society has noright to demand that you drive it out again.”49 Would
Money assert that if “society” has driven racist attitudes
into the “core” of one’s identity, it has no right to expectthat one should drive them out?
Money’s ethics thus boil down to prescribing the con­tinuation of sexist roles, modified in some undefined andarbitrarily “flexible” manner. In fact, the sexist natureof his ethical prescriptions becomes evident in his advice
about child-rearing practices.
The ideal is for a child to have parents who consistently reciprocate
one another in their dealings with that child. Then a five-year-old
daughter is able to go through the stage of rehearsing flirtatious
coquetry with her father, while the m other appropriately gives recip­
rocal directives as to where the limits of rivalry lie; conversely forboys . 50

This is an incredible piece of sexist advice, advocatingsome of the worst aspects of sexual stereotypes. Why
should a five-year-old girl be encouraged to rehearse “flir­
tatious coquetry” with her father while her mother standson the sidelines permitting such behavior within suitable“limits of rivalry”? Once more, little girls are taught toidentify with men and men’s ideals of them while, at thesame time, learning to see other women as their rivals formale affection.
In conclusion, what does this advocacy of stereotyping,albeit “ flexible,” mean for transsexuals? If people not only
“cannot” but “ should n ot” change their core gender iden­tity, and if “ society has no right” to demand that they do,then transsexualism becomes an adequate and morally
right solution to so-called gender identity dissatisfaction
and confusion. In this perspective, if one cannot adjust the

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The Transsexual Empire

mind to the body, it becomes perfectly reasonable to ad­just the body to the mind. Since core gender identity isfixed by age two, in Money’s schema, then the body andnot the psyche must be changed.

CHAP TER III“M other’s
Feminized Phallus ”
or Father's
Castrated Femme?

T h e t i t l e of this chapter ismeant to suggest the distance between the alleged domi­
nant mothers blamed in the psychological literature forcausing transsexualism, and the truly dominating medical/
psychiatric fathers who create artificial women (femmes).
The distance is great. “Blaming the mother,” in the psy­chological literature, which proposes that transsexualism isthe result of “too much mother and too little father, ” ob­scures the real cause of transsexualism—patriarchy and thelegions of therapeutic fathers who create transsexuals ac­
cording to their man-made designs and specifications.
This chapter will consider major psychological theories
about the causes of transsexualism and suggest a more fun­damental cause. It is my contention that all of the causal
theories that have been discussed so far accept patriarchal
norms of masculinity and femininity. Many psychologicaltheories, for example, measure the transsexuals’ confor­
mity to, and deviation from, these stereotypes during
their process of maturing, or they assess family interac­tions, such as “dominant mother and absent father,”69

70

The Transsexual Empire“mother-son symbiosis,” only within the context ofthese same stereotypes. I believe that the First Cause,that which sets other causes of transsexualism in motion(such as family stereotypes and interactions), is a patri­archal society, which generates norms of masculinity andfemininity. Uniquely restricted by patriarchy’s definitionsof masculinity and femininity, the transsexual becomesbody-bound by them and merely rejects one and gravitates
toward the other. The sexual organs and the body of the
opposite sex come to incarnate the essence of the desiredgender identity and role,and thus it is not primarily the
body that is desired, but what a female or male bodymeans in this society.
According to these psychological theories, if the indivi­
dual fails to adjust to his native body and role, then she/heshould be treated. If all forms of personal and family ther­apy fail to adjust the would-be transsexual’s mind to thewould-be transsexual’s body, then the individual answer
is to adjust the transsexual’s body to his mind. In thisperspective, hormonal treatment and surgery become ahumane and logical solution to the transsexual problem.
Meanwhile, the social factors that continue to reinforce
transsexualism go “untreated.” And transsexual treatment
and surgery becomes the ultimate “Individual Solution.”
To understand how sexual stereotypes are the First
Cause of transsexualism, we should look at how trans­
sexuals think and speak of themselves and how they
“prove” they are “real” transsexuals by “passing” as mas­
culine or feminine. In fact, they must prove they are real
before they are accepted for treatment. Thus the role ofthe medical-psychiatric establishment in reinforcing sexrole stereotypes is significant, and one that affects thedeepest dimensions of the transsexual issue.

PSYCHOLOGY CONSTRUCTS THE CONSTRUCTED FEMALE

Robert Stoller, a psychoanalyst, has probably done themajor work in developing psychological theories about the71“Mother’s Feminized Phallus” or Father’s Castrated Femme?

causes of transsexualism in a study of nine cases of maleto-constructed-female transsexualism.1 Here he develops
his basic conditioning approach, which he refers to as“mother’s feminized phallus” or what can be more simply
phrased as “blaming the mother. ” In summary, Stoller at­
tributes male transsexualism to a classic mother-child rela­tionship that occurs within the context of a disturbed mar­riage. In the clinical cases as he relates them, the mothers
were generally unhappy women, who often in early life
wanted to be males themselves, and who in their marriages
were dominant and assertive. Indeed, Stoller claims thatsuch mothers suffer from a marked case of classic Freudian
penis envy. The child serves the mother as the phallus forwhich she has supposedly yearned. The child himself does
not pass through the “normal” male formative stage ofseparation from the mother and consequent individuation.
Masculinity is not developed in the transsexual boy, andthere is no fear of castration (which Freud posited as nec­
essary to developing masculinity). Transsexuals’ fathers
were allegedly passive men who were consistently absent
from their homes or, if present, were as good as absent.
They exerted little influence on their sons and had practi­
cally no father-son rapport. Given this state of affairs, themother turned to her son, for continuing fulfillment, con­centrating totally on him and encouraging the boy to iden­
tify with her and with her body by constant physical con­tact (involving continuous holding and touching, carrying
and cuddling).
According to Stoller, given this extreme mother-son
symbiosis, which sometimes lasted into prepubertal years,
the boy began to feel that he was a woman despite the evi­
dence of his senses that he was anatomically male. Having
developed a core feminine gender identity in the earlyyears of life, the boy cannot develop, later on, along cul­turally dictated masculine lines. Stoller sums up his evi­
dence from the clinical case studies in this way:
The similarities of the findings are probably beyond coincidence; itappears, as has been noted often before in other males with strong
feminine identifications, that the femininity of these males is the

72

The Transsexual Empire

result of too much mother and too little father. These data do not
point to a genetic, hormonal, or other physiological element signifi­
cantly contributing to the boy’s gender identity.. . . My thesis, tobe better tested in the future, is that the degree of femininity that de­velops in a boy and the forms it takes will vary according to exactly(not approximately) what is done to him in earliest childhood. 2

Stoller goes on to state the importance of searching for“detailed descriptions” of these mother-son relationships.
He emphasizes that while there are obviously males who
have had strong symbiotic relationships with their mothersin early childhood and who do not emerge as transsexuals,
the quality of the symbiotic relationship was quite differ­ent in the nontranssexual cases. Here the mother probably
did not have the same kind of physical relationship withher male child. And Stoller does relate, “in detail,” in casestudy after case study, the physical interactions of mothers
and sons—sons who were permitted to sleep with theirmothers well into prepuberty, sons who had visual andtactile access to their mothers’ bodies up to a relatively
late age, as well as mothers and sons who were continuallyin each other’s presence in other ways. The fathers ofthese boys were weak, passive, and distant, and fatherly
influence was usually absent in all ways. Most of thesemarriages were held together in name only. Divorce wasrare in transsexual families. However, although parents
existed under the same roof, the marriages were sexlessand generally emotionally empty.
In his latest book, The Transsexual Experiment, Stoller
also reveals a study of ten cases of female transsexuals.
While there are differences between male and femaletranssexuals, Stoller again focuses on blaming the mother.3
The female infant, who lacks feminine graces and is not“cuddly,” has a mother unable to show any emotional
tone due to depression. Again the father is rather passive
and has little or no emotional rapport with his wife andchild. As a result, the girl is used by both parents as afather-substitute to alleviate the mother’s depression. Her
acting out of masculine characteristics is encouraged by

73“Mother’s Feminized Phallus” or Father’s Castrated Femme?

both parents, and becomes self-perpetuating as a sense ofmasculine identity.
“ Blaming the mother” appears in theories even beyond
the psychological realm:
Typically, the m other keeps this male infant to herself. She grati­
fies his wishes instantly whenever possible. She enjoys and en­courages actions which keep the child close to her and discourages
attem pts to move away. However, as the child grows, the mothermay not be able to handle aggressive and active play and directs themale child to quieter activities and to quieter companions, possibly
girls. Gradually the child learns that feminine actions bring a positive
response from the m other and other members of the family.4

These authors go on to state that such actions may even in­clude cross-dressing as a female. They also discuss the ab­sent father syndrome, either in fact or in effect.
John Money also cannot avoid the charge of “blaming
the mother” in his discussion of transsexualism. He findsthat all available evidence on the subject points to the con­clusion that transsexualism is directed by “undercoversignals from society, usually represented in early postnatal
life by the mother.” 5
While accepting major premises of Stoller’s theoryof transsexualism in boys, Richard Green, a past associateof Stoller’s at U.C.L.A., and a former student of John
Money’s, puts much less emphasis on certain psycho­
analytic concepts, such as the symbolic meaning of theboy to his mother and her own supposed bisexuality.
Green gives more weight to peer-group interaction. Thus
his work, while certainly being primarily psychological,
acknowledges socialization factors outside of the intra­
family sphere. “Blaming the mother,” however, is apart of Green’s theorizing. He agrees with Stoller that amother’s response, physical contact, perceptions, andtime given to her son often contribute to transsexual
development. The father again is an absent figure and,as the son’s feminine proclivities develop, alienation be­
tween father and mother increases. The mother continues
to encourage her son’s cross-dressing while the emotional
distance between father and son widens.

74

The Transsexual Empire

Green is also sympathetic to biological causes. “Cur­rently the most provocative signpost is the linkage between
prenatal male hormone levels and postnatal masculine ac­tivity.”6 However, as we noted in examining Money’s
work, biological and psychological theories go well to­gether, and it is often difficult to decide where one leaves
off and the other picks up.
Green takes a more positive approach in the questions
he poses at the end of Sexual Identity Conflict in Children
and Adults. “What if the social consequences of evolving
in an atypical lifestyle were radically modified? Would
the motivation for sex-change surgery be as great for males
if the society were fully tolerant of their deviant sexual­
ity? ”7 He continues:
A question to be answered though, would be the degree to which thedesire for genital change in an adult male is derived secondarily fromsocial sanctions against homosexuality or femininity, or springs pri­marily from a female identity. If from the former, requests for sur­gery might be related to the extent to which the culture becomes
more tolerant. 8

These questions, however, when combined with his former
psychological hypotheses, seem contradictory. Signifi­
cantly, they are raised in question form and parentheti­
cally, whereas “blaming the mother,” peer interaction, andhormonal factors all seem to have the full force of facts.
The syndrome of “blaming the mother” in each of these
theories raises some fundamental critical responses. Most
important, each of these theories of “blaming the mother”
is indicative of a fundamental reversal. The biological andpsychological theorists blame the mother for both female
and male transsexualism. Neither asks who is actuallytransforming transsexual bodies into the desired sex and
instructing them in the rudiments of cultural femininity
and masculinity. The irony is that mothers are blamed,
yet it is transsexual “father figures” (the fathers of thepsychiatric and medical domains) who are performing theoperations and coaching into roles. One way of perceiving
this reversal is to view such “fathers”as “male mothers”

75“Mother’s Feminized Phallus” or Father’s Castrated Femme?

who see themselves redeeming the biological mothers’ de­fective handiwork, whether that defective process is re­garded as biological (failing to give enough of the righthormone or giving too much of the wrong hormone inutero), or as psychological (failing to rear the child cor­
rectly).* The inherent irony here is that the mother isblamed when in fact it is the psychological and medical
fathers who are the omnipresent agents of transsexualism.
The agency of such medical and psychological fathers ismuch more certain and dominating than the doubtful andpsychologized role of the supposed dominant mother.
Without them, transsexualism would not be a reality.9
Are we to suppose that it is mainly the mother who isconcerned with the stereotypical behavior of the child? Allof these theorists who blame the mother for the trans­
sexual behavior of their children do not even allude tostudies indicating that fathers are usually more concernedwith encouraging sex-typing than are mothers. Thesestudies suggest that fathers play a very significant role in
the gender identity development of their child, perhaps
in the case of the transsexual even coercing the boy into
masculine behavior which the child rejects because such
behavior has been forced upon him.
Three other theories should be noted concerning thecauses of transsexualism. N. Lukianovicz, like Stoller,
raises the whole issue of castration anxiety as one possible
cause of transsexualism. But, in contrast to Stoller, hemaintains that the transsexual does possess castration fear.
The male transsexual attempts to overcome the anxiety*“ Male m othering, ” discussed in Chapter I, is a very ancient andfamiliar them e in the history of patriarchal civilization in which men
have attem p ted , in various ways, to supplant the role of women inm othering. There are religious male m others who give spiritual re­birth in baptism ; the Dr. Spocks and other child-rearing specialists
who tell women the best means of bringing up their children; themale obstetricians who to o k over the function o f m idw ifery and“ deliver” the child into existence; and m ore recently the techno­
cratic progenitors who are attem pting to bring hum an life into
existence through genetic technology with little or no female
instrum entality.

76

The Transsexual Empireof castration by creating an imaginary “phallic woman”
and subsequently identifying with and becoming her. The
fantasy of a “ phallic woman” is a substitute for phallic
exhibition, which is inhibited by castration anxiety.10
Another psychoanalytic explanation gives weight toseparation anxiety. Transsexuals develop this anxiety earlyin life, before “ object differentiation” occurs.
To alleviate this anxiety, the child resorts to a fantasy of symbiotic
fusion with the mother. In this way, m other and child become one
and the danger of separation is nullified. We believe this reparative
fantasy to be the psychodynamic basis for transsexualism in themale, and the transsexual phenomena can be understood clinicallyas attem pts to ward off any threats to the psychic fusion with them other. 11

In this interpretation, the transsexual literally becomes themother. To sustain this fantasy, he attempts to reverse his
anatomical sex. Ovesey and Person cite clinical evidence
to support this causal hypothesis and distinguish between
a transsexual’s first experience of cross-dressing as opposed
to a transvestite’s. The transvestite often experiences sex­
ual excitement in cross-dressing. For the transsexual, how­ever, the mother’s clothes “ are a symbolic representationof the pregenital mother. Wearing them, he re-establishes
the early symbiotic relationship with her. It is no surprise,
therefore, that a frequent adult transsexual fantasy is of
mothering, particularly mothering a girl child.”12
Finally, we consider the psychological hypothesis ofHenry Guze, who speaks of “experience deprivation” dur­
ing critical periods of childhood development. Guze thinks
that, as a rule, boys will psychologically develop in a femi­nine direction unless a male model is present in some way.
“ Thus a boy child is superficially more like a girl child or awoman until he reaches pubescence.”13 (Note the parallel
here to prenatal biological male differentiation, in thesense that all fetuses are originally female until androgen
activates male morphological development.) Guze seems to
be saying that nature’s disposition is to orient genetic males
in a female behavioral direction until male role model in­fluence is added. Thus, as Guze reiterates, “I should like to77“Mother’s Feminized Phallus” or Father’s Castrated Femme?

hypothesize that during the periods when a boy child is least
developed in the masculine direction, he needs both con­tact and identification with a male in a manner that is not
exploitative.”14 The same holds true for girl children, ex­
cept that girls escape the severe gender problems, on thewhole, that occur in the male.
In examining the various theories of psychological cau­sation, one factor becomes very evident. All of them mea­
sure the degree of conformity to culturally defined normsof masculinity and femininity. In most of these theories,
male transsexuals who were feminized and failed to be­come masculine were assessed by prevailing norms ofmasculinity and femininity. The psychological literatureobviously regards this as not only deviant behavior but as
undesirable for “healthy” male development. A negative
judgment is attached to so-called feminine qualities ex­pressed by boys and men. The stereotypes, the cultural
norms of masculinity and femininity themselves, are nevercriticized.
If the stereotypes themselves are not confronted but are
only frowned upon when acted out by persons of the“wrong” sex, then the origins of transsexualism will be in­dividualized and psychologized. What will go unexaminedis patriarchy’s norms of masculinity and femininity andhow these norms, if allowed to contain persons withinsuch rigid boundaries, may generate such a phenomenonas transsexualism.
TRANSSEXUALISM AND SEX-ROLE STEREOTYPES

It is important to examine the web of patriarchally pre­scribed stereotypes that surround all facets of the trans­
sexual issue: the way transsexuals speak about themselves
and the reasons they give for wanting surgery; the accountsof family interaction; the gender identity clinic require­ments that prescribe “passing” as masculine or feminine
to “prove” transsexual status; psychological advice andtreatment of adjudged child transsexuals; and testimony
from acknowledged “experts” in the field, regarding thestereotypical behavior of transsexuals.

78

The Transsexual Empire

How transsexuals think and speak of themselves is very
revealing. In preparation for this writing, I personally inter­viewed a sampling of fifteen transsexuals. In the inter­views, thirteen of which were with pre- and postoperative
male-to-constructed-female transsexuals, I consistently
asked why they wanted to be women. How, in otherwords, did they define themselves as female? Most of thetranssexuals responded in terms of the classic feminine
stereotype. Some wanted to be women because all theirlives they had “ felt” they were women trapped in men’sbodies. One expressed this “feeling” in terms of “absoluteknowledge” as opposed to mere desire. More specifically,
many transsexuals said they viewed themselves as passive,
nurturing, emotional, intuitive, and the like. Very often,
many expressed a preference for female dress and make-up.
Others saw their feminine identification in terms of femi­nine occupations: housework, secretarial, and stewardesswork. Some expressed feminine identification in terms ofmarriage and motherhood—wanting to “ meet the rightman,” “have him take care of me,” “ adopt kids,” and“bring them up. ” One expressed very definite views onchild-rearing that were quite ironic in this context: “Iwould definitely teach my kids that boys should be boys
and girls should be girls.”
These kinds of overt stereotyped statements have beenreiterated by many of the more well-known transsexuals(e.g., Jan Morris, Christine Jorgensen) who have been inter­viewed on the talk shows and in other media. Allen Raysdon, in the process of undergoing hormonal treatment in
preparation for surgery, states: “When I was a child, allI could think about was the [girls’] clothes and parties
and things and that I didn’t like sports and fighting andthings like that. ” He added that women are more emo­
tional and sensitive; men are more cold and insensitive.
Men play more active roles usually, he said, and called
himself passive.15 Paula, formerly Paul, Grossman has
sketched a similar portrait of himself. Previously married
and the father of three children, Grossman recently losta test case in the New Jersey courts to postoperatively

79“Mother’s Feminized Phallus” or Father’s Castrated Femme?

retain his former public-school teaching status. According
to a newspaper reporter:
In many ways—and in the traditional sense of the word—Paula Gross­man is extremely feminine. She is proud of her impressive bustline,
a result of her monthly hormone shots. She has her hair done regu­
larly at a beauty shop, and wears bright red lipstick and matching
nail polish. (“ I only wear eye-shadow at night.” ) She prefers dark
sleeveless blouses with a single strand of pearls worn with tailoredskirts. Her favorite shoes are Mary Janes, size 13.16

Sexual objectification becomes a recurring theme also in
the interviews and case studies. A male prisoner who re­quested a sex-change operation revealed his stereotype offemininity to be at this level: “I have this problem, like all
women do. I flirt a lot. ” 17 For others, prostitution be­comes related to their new feminine status. Many, in orderto pay the medical costs, turn to this source of income.*“ Frequently, they cannot get jobs as women, or cannot
keep them; the street becomes the breadwinner, and prin­cipal place of social contact.” 18 Several transsexuals in myown survey were prostitutes both before as well as after
their operations.
It is significant that very little of the transsexual litera­ture has highlighted the stereotyping problem as either
causally or therapeutically important. Very little notice
has been paid to the fact that most transsexuals conform
more to the feminine role than even the most feminineof natural-born women. One of the few exceptions to thisis Thomas Kando’s study, Sex Change: The Achievemento f Gender Identity among Feminized Transsexuals.
THOMAS KANDO’S STUDY OF SEX CHANGE

Thomas Kando investigated seventeen postoperative maleto-constructed-female transsexuals who had received sur♦R ecently a m ale-to-constructed-fem ale transsexual charged w ith
prostitutio n had “ h er” case dismissed in New Orleans. It was foundth a t “ sh e” had been a man and, in Louisiana, only a natural-born
wom an can be convicted o f pro stitu tio n . (Ms., January 1978, p. 2 1 . )80

The Transsexual Empire

gery at the University of Minnesota Gender Services. His
methods included open-ended interviews, structured ques­tionnaires formally submitted and conducted in the hos­pital offices, and participant observation of the Minnea­
polis transsexual subculture, which included visits to bars,
stripjoints, and nightclubs, “ first to contact transsexuals
known to circulate or to work there, later to fraternize andobserve the milieu.” 19 Kando also visited several trans­
sexuals at home and thus became acquainted with theirfamily contexts.
In contrast to the psychological and biological theorists,
Kando spotlights the social problem immediately. “Unlike
the feminists who argue that the social structure is unjust
with respect to women and therefore needs reform, trans­
sexuals decide to alter their own physical sex in order tolegitimately conform to cultural expectations” (p. 5). He
affirms that transsexuals aim primarily to achieve the de­sired sex roles and not merely the anatomy of the opposite
sex. In answer to the question of what is the “ultimate
criterion of being a woman,” transsexuals emphasized
mostly “ social-psychological” criteria. (Ten out of seven­teen mentioned such things as “being attracted to men,”“being loved and needed by the family,” and “behaving
like a woman.” ) It is significant here that most of thetranssexuals questioned did not see biological criteria,that is, the female organs themselves, as ultimate reasonsfor changing sex.
In examining the attitudes of these seventeen trans­
sexuals, Kando compared them with “normal” females
and males. Using such a comparison, he found that trans­
sexuals are more what the culture expects women to bethan are those who were bom female. Kando measured
this cultural conformity by using questionnaires that in­cluded a “masculinity-femininity” scale. The transsexuals
were questioned in several areas:
1. Attitudes toward cultural definitions o f masculinity
and femininity. Certain questions measured the trans­
sexuals’ endorsement of society’s dominant sex and gendernorms. Male, females, and transsexuals were asked to agree

81“Mother’s Feminized Phallus” or Father’s Castrated Femme?

or disagree with normative statements such as: “Ulti­mately, a woman should submit to her husband’s deci­
sions.” Here, Kando found that transsexuals were moreconservative in their support of traditional sex-role ascrip­
tions than either the men or the women (pp. 22-24).
2. Role strain. Transsexuals were asked about the con­flict between the sex roles one is expected to play in so­ciety and the roles one is most willing and most able toplay. Again, transsexuals experience very little role strain
with respect to sex roles. In comparison, Kando notedthat natural-born women experienced great role strain in
relation to the cultural demands placed on them. Men ex­
perienced very little role strain. Thus although transsexuals
acted out a feminine stereotype that was more feminine
than most women, they were more like men in not expe­
riencing much role strain.
These are interesting observations when compared withfemale-to-constructed-male transsexuals. Although femaleto-constructed-male transsexuals conformed to many
aspects of the masculine stereotype (in childhood they
had no girlish interests, were “tomboys,” etc. ), a studyof five female-to-constructed-male transsexuals revealed
some significant data. Money and Brennan found that,“as compared to normal males, only two patients ob­
tained an average rating for masculinity. The other threewere rated less malelike in their responses than the normal
male.”20 Although this writer interviewed only two female-to-constructed-male transsexuals, my assessment
was that they were much less masculine than were themale-to-constructed-females feminine. Since roles havebeen male-created, and evidence points to the fact that
men are relatively comfortable in their self-created mas­
culine roles, then one would expect that male-to-constructed-female transsexuals would experience little rolestrain.
A person experiences role strain only if she or he has
a self that is separate from the role. Put differently, rolestrain can be a healthy phenomenon. Using Peter Berger’s
definition of alienation as “the process whereby the dia-

82

The Transsexual Empire

lectical relationship between the individual and his world
is lost to consciousness,”21 we might say that men andmale-to-constructed-female transsexuals are most alienated.
They become the role, and in so doing lose their indi­viduality and self-definition. Berger’s use of the word
alienation, of course, is different from that of some exis­
tentialists who regard alienation as a basic split with thenorms and mores of a culture. However, Berger’s defini­tion seems more adequate in understanding the deeper
meaning of alienation—that is, “the individual ‘forgets’that this world was and continues to be coproduced byhim.”22 Women have not been so quick to “ forget” thatsociety has been created by men, and it is noteworthy
that female-to-constructed-male transsexuals have also
had a difficult time “forgetting,” at least to some ex­tent. 23
A sampling of some of the statements of Kando’s
interviewees bears out the strong role conformity of
male-to-constructed-female transsexuals.
Elizabeth: “I feel that everything should be distinctly
masculine or feminine. My boy friend has to look likea real man.”Elinor: “The ultimate criterion of being a woman is be­
ing a good wife, being able to make a man happy.”
Maryjo: “I feel that a man should make more than awoman!” (pp. 24-26).
This latter statement contradicted many of my own
interviews where the “equal pay for equal work” ethic
was generally subscribed to, not for any feminist reasons
but because of the economic straits in which many trans­
sexuals found themselves. Two transsexuals in my survey,
R. and S., were willing to join “women’s lib” only tothis point. However, many of the transsexuals in Kando’s
sample seemingly would not even go this far in deviatingfrom traditional feminine norms. Jane, for example,
didn’t want women to be in business at all. “Woman
has no business being in business, unless there is some­thing wrong with her.. . . Men should be the leaders”(P. 25).

83“Mother’s Feminized Phallus” or Father’s Castrated Femme?

Kando makes the important point also that, for trans­
sexuals, most feminine socialization is anticipatory. Little
postoperative coaching into feminine mannerisms and eti­
quette is required. One transsexual in Kando’s study
passed so effectively as a female that even “her” husband
did not know. Not even the sex act betrayed “her” true
identity (p. 41).
An occupational breakdown of Kando’s sample re­vealed that among seventeen transsexuals interviewed,
four proudly proclaimed being housewives and nothing
but housewives. Of those who worked outside the home,most had stereotypical feminine jobs: secretaries (three),waitress (one), dancers (four), hairdressers or beauticians(two), actresses (two), university-affiliated research scien­tist (one).
As John Money has admitted: “Most transsexuals em­
brace the stereotype of their identity, even a person as
sophisticated as Jan Morris.”24 Transsexuals “cling to theconventional stereotypes; they seek only the right to ex­change one stereotype for the other. ”25 Yet, as we haveseen, Money does not follow through on this insight. He
continues to encourage transsexual role behavior, which
requires preoperative transsexuals to “pass” as feminine
before they can be admitted for surgery.
Kando has evolved a typology of transsexuals thatbreaks down into four categories: housewife type (over­whelming orientation to straight, middle-class values andliving); show business type (includes strippers, dancers,
prostitutes); aspiring housewife type; and career woman
type. My own data, as well as that of others, supports
this breakdown.
The three factors most important to the transsexuals
in Kando’s study were marriage, nonemployment, and“ passing.” All male-to-constructed-female transsexuals
shared middle-class ambitions as well as exhibitionistic
tendencies. These findings confirmed my own interview
data, particularly the factor of exhibitionism. Those maleto-constructed-female transsexuals I interviewed were
only too happy to talk with me about all of the details

84

The Transsexual Empireof their transsexual odyssey, including a live demonstra­tion of the results of surgery. This exhibitionism was indirect contrast to female-to-constructed-male transsexuals
whom I contacted—who did not want to talk about theirexperiences, even in confidence (hence the inclusion of
only two female-to-constructed-male transsexuals in myown interviewing).
Most of the transsexuals perceived their sexual relation­
ships (even preoperatively) as heterosexual. One trans­
sexual, Sally, phrased this in rather direct language. “Ihate homos! I never wanted sex with them. I had homo­sexual affairs in grade school and in high school, but onlywith normals.” As Kando summarizes, “transsexuals arereactionary, moving back toward the core-culture rather
than away from it. They are the Uncle Toms of the sexual
revolution. With these individuals, the dialectic of socialchange comes full circle and the position of greatest de­viance becomes that of greatest conformity” (p. 145).
Thus far, I have noted overt acting out of stereotyped
behavior by transsexuals. Kando’s study, however, ex­amines other not-so-commonly noted aspects of sex-rolesocialization and patriarchal values. For one thing, Kando
noted transsexuals’ attitudes toward women and men.
Sally, for one, expressed a dislike toward women that was
not expressed toward men. “Women. . . are more fearful of
us than men. They fear that we’ll be able to please a man
better than they would, since we were men ourselves”(p. 41). Both male-to-constructed-females and female-toconstructed-male transsexuals strongly identify with men;this is one of the major similarities between both groups.
A recent article on transsexualism in the Boston Phoenix
quoted a female-to-constructed-male transsexual who, in
speaking of “his” preoperative life as a woman said:“ I had no hostilities toward men. I liked men—99% of myfriends were men.”26
Some of the transsexuals that Kando interviewed felt
also that women were more intolerant of them than men.
Why women tend to be less tolerant of the transsexual
phenomenon is an interesting question. It is my belief that

85

“Mother’s Feminized Phallus” or Father’s Castrated Femme?

this is because more women than men perceive the destruc­tiveness that is inherent in sex-conversion procedures.
Having experienced on an everyday existential level the de­structive elements of sex-role stereotyping in a patriarchal
society, many women perceive that transsexualism doesnothing to alter this society but merely reinforces it.
Robin Morgan, in her speech to the Lesbian Conferencein Los Angeles in 1973, addressed herself to this issue
in responding to transsexual intrusion into the conference.
“If transvestite or transsexual males are oppressed, thenlet them band together and organize against that oppres­sion, instead of leeching off women who have spent en­
tire lives as women in women’s bodies.”27 Such a critique,of course, proceeds from a feminist perspective. However,what is important to note here is that what many trans­
sexuals are saying, in stating that women are less tolerantof them than men, is that many women who probably
would not call themselves feminists have an instinctual
understanding of the destructiveness of transsexualism.
Another reason transsexuals identify strongly with men
may be because it is men who have been helpful to trans­
sexuals in their attempts to cross-sex. For the most part,these men were what Kando called “professional coaches.”
All of them—priests, counselors, psychiatrists, psycholo­
gists, M.D.s, surgeons—had played a professional role in
the transsexual’s sex passage, “ not only when they sought
out the operation but also at the earlier stages of theiralienation” (p. 101).
“Blaming the mother” also functions to identify trans­
sexuals with men. In noting that many of the transsexuals
blamed others for what had happened to them, Kando
states that the mother was by far the most frequent target.
Many have worked out an etiology for their gender condition, often
borrowing vulgarized psychoanalytic motives that stress faulty child­hood socialization, particularly the alleged unresolved Oedipal rela­tionship. The m other may then alternatively be described as reject­ing or overly protective, as either too feminine or too masculine. The
main point is that she is given an im portant role in the sad series of
events that lead to transsexualism.28

86

The Transsexual Empire

However, Kando also points out the contradiction between
this “constructed etiology” of one’s transsexualism andthe insistence that one has always been a “woman.” This
repetition of “sad tale” accounts only reveals that trans­
sexuals do, in fact, consider themselves victims of faultysocialization and not healthy women who need nothing
but corrective surgery.29
There is, however, one major shortcoming in Kando’s
study. It is not clear that Kando recognizes the significanceof his own findings. While he perceives that transsexuals
incarnate role-defined behavior and subscribe to culturalstereotypes, he never makes clear that these same norma­tive roles and stereotypes generate transsexualism to begin
with.
TRANSSEXUAL REARRANGEMENTS OF THE STEREOTYPES:JAN MORRIS AND OTHERS

Not all transsexuals reveal their acceptance of stereotypicalroles and behavior in the same obvious way as these ex­amples. Some transsexuals, for example, deny identifica­tion with the stereotypes on a verbal level but their actions
or subsequent contradictory statements betray them.
Perhaps the most publicized version of this kind of con­tradictory evidence is the Jan Morris case. Morris denies
the stereotypes, yet, on the other hand, lives them out.
Morris also deviates from most transsexual accounts in that
he found the masculine role exhilarating before he wastranssexed. As a top correspondent for The London Times,
Jan, then James, Morris accompanied the Mt. Everest
climbing team and scooped the story. He describes thatexperience in a remarkable variation on the theme of“anatomy is destiny.”
There is no hardship to it, for it is not imposed upon him. He is them aster.. . . It is this feeling of unfluctuating control, I think, thatwomen cannot share, and it springs of course not from the intellector the personality, nor even so much from upbringing, but specifi­
cally from the body ----- I look back to those moments of supreme87“Mother’s Feminized Phallus” or Father’s Castrated Femme?

male fitness as one remembers champagne or a morning swim.. . .
I was brilliant with my knowledge of the event, brilliant with mus­cular tautness, brilliant with conceit, brilliant with awareness of thesubterfuge, amounting very nearly to dishonesty, by which I hoped
to have deceived my competitors and scooped the w o rld . . . . I nevermind the swagger of young men. It is their right to swank, and I
know the sensation.30 (Italics mine.)

What such words basically illustrate is the contradiction
between Morris’s claim that he was always a woman, andhis quite overt revelling in his male body and masculinity.
By the same token, if “women cannot share” such feelingsof “unfluctuating control, ” then how is it that Morris who
claimed to have always been a woman—who had “nodoubt about my gender since that moment of self-realiza­tion beneath the piano,” while listening to his motherplay Sibelius—could have experienced the sensations of“supreme male fitness,” “muscular tautness,” and theswank and swagger of young men?
Henry Guze’s insight may be of some interest here. He
notes that the male-to-constructed-female transsexual insome ways puts masculinity on a pedestal. In doing so,
he responds as if he were unworthy of this esteemed role.
Since he feels he does not really fit the cultured conceptof a male, a concept he fears but also loves and admires,
he must be a female. I would add to this that he must bea female in order to participate in what is basically a male,heterosexual culture, and that sex-conversion suigery is
his only entrance into this world that he basically loves
and admires but doesn’t totally fit into as a man. This
also explains his repugnance against homosexuality, which
would prohibit his fitting into the “straight” world. Fur­thermore, in order to identify completely with this world,
he must identify with everything that men have defined
this world to be, among which is the gender identity androle behavior of a woman. Thus Rebecca West, in her re­view of Morris’s Conundrum, notes that the author sounds
not like a woman, but like a man’s idea of a woman. And,of course, this is what is basic to the whole cultural stereo­

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The Transsexual Empire

type of femininity itself; that is, it is a male-imposed defi­
nition of femaleness.*
After describing the heights to which masculinity cansoar, almost in the very next paragraph, Dr. Jekyll (James)
becomes Ms. Hyde (Jan). It is, of course, somewhat con­fusing to read in Conundrum that it was this very puttingof one’s masculinity to the test that deepened Morris’s
desire for sex transformation. With all the fervor used toespouse the masculine, he now espouses the feminine.
“Her frailty is her strength, her inferiority is her privilege”(pp. 167-68). Thus in one surgical stroke, Morris accepts
the woman-on-a-pedestal myth. “ She” extolls eternal
womanhood in the same way “she” extolls “male swank
and swagger.” Now it seems only “ common sense” towant to be a woman rather than a man. Not only does“she” like being a woman, but “she” likes all of the pro­claimed “benefits” of womanhood. “ I like being a woman,
but I mean a woman. I like having my suitcase carried.. . .
I like gossiping with the lady upstairs.. . . And yes, I liketo be liked by men.” 31“ Her” first experience of “being liked” by a man was
in a London taxi cab where the driver “boldly” kissed her“ roughly and not at all disagreeably on the lips,” after
which he said, “There’s a good girl,” and “ patted herbottom . ” “She” loved it because it gave “her” a first ex­perience of what it was to be loved and “cherished” bya man as a woman.
♦Zelda Suplee, in the same personal interview cited earlier, had aninteresting insight, which applies in this context. In trying to explain
to me why male-to-constructed-female transsexuals talk to the pointof exhibitionism about their transsexual odyssey, and female-to-constructed-m ale transsexuals seldom grant interviews or w ant to talkabout their sex changes, she noted the following. Male-to-constructed-fem ale transsexuals “ go dow n” on the social scale when
they become women. They basically realize this and thus constantly
talk about their new status and the journey involved. Such talk is
em otional com pensation for the change downward. To carry thisa bit further, constant extolling of the feminine stereotype is one
more self-validating act th a t confirm s th a t transsexuals “ fit in ” toa male world th at has constructed these stereotypes.

89“Mother’s Feminized Phallus” or Father’s Castrated Femme?

I’m 4 7 . 1 think most women of my age, if they’re honest, really
accept the idea of helping men, and of being cherished by them.
I’ve always had that feeling. If I could have my life over I suppose
I would have been happiest being someone’s second-in-command.
Lieutenant to a really great man—th at’s my idea of happiness.32

This from the man who scaled Mt. Everest and basked
in the glory, competition, and vigor of stereotyped mas­
culinity. On the other hand, there is no real contradiction
here, because if one finds one’s identity in stereotypicalbehavior, it is very logical to switch from one stereotype
to the other.
As a final apparent contradiction, Morris adds a noteof disdain for those who would treat women as inferior.
Here, Morris claims to be a “militant feminist.”
I have seen life from both sides, and I know what prejudice survives.
I know that by the very fact of my womanhood. . . I am treatedin many petty situations as a second-class citizen—not because I
lack brains, or experience, or character, but purely because I wear
the body of a woman.33

Yet this feminist sentiment is rare in this book, for again,in the very next paragraph, Morris admits to frankly enjoy­
ing the compensations for being thought inferior—that is,“the small courtesies men now pay me, the standing up
or the opening of doors, which really do give one a cher­ished or protected feeling” (p. 178). What Morris neverseems to recognize is that the “second-class citizenship,”the inferior position in which women are put by men, isthe logical consequence of their acceptance of femininity
as a stereotype and mode of relating.
Another way of viewing Morris’s acceptance and seem­
ingly contradictory extolling of both stereotypes is to saythat Morris squeezed out of his male status all the vigor ofyoung manhood. However, at the age of forty-seven—in the
decline of his male vigor—he latched on to the status of awoman. Since women are often more vigorous when they areolder and the cultural pressures have subsided, Morris cap­
tures “the best of both worlds,” so to speak. Transsexualism
thus allows him to fully exploit both stereotypes.
Furthermore, what Morris and other transsexuals ex-

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The Transsexual Empire

hibit in their acceptance of both identity and role artifacts
is not unique to transsexual males. This psychology ofacceptance has been noted in other male contexts. For
example, Susan Brownmiller in her ground-breaking work,
Against Our Will: Men, Women, and Rape, cites rape inmale prisons as a means of transforming tough and mascu­
line men into what are called “ gal-boys.”34 Brownmiller,
in her section on male rape in prison, gives us one more ex­ample of how the change from one role to another ismanaged in an astonishingly brief time.
Precisely what Morris and other transsexuals depict, ina most graphic way, is the easy replacement of one roleby the other. Ernest Becker made the important observa­
tion that the sadistic and masochistic postures can beeasily interchanged because they are “terms which de­scribe one and the same thing: weakness and felt lim­
itation in oneself; sharp duality of spirit and matter inpeople.”35 Likewise, the stereotypes of masculinity andfemininity are similarly related. Each can exist, in fact,
only in relationship to the other. Neither has anythingessentially to do with maleness or femaleness. Because
the split is so artifactual and because one cannot exist
without the other, it is not difficult to understand how
essentially to do with maleness or femaleness. Because
the split is so artifactual and because one cannot exist
without the other, it is not difficult to understand how aperson may easily flip from one to the other. This is pre­cisely what the transsexual does. Instead of moving out ofboth roles, the transsexual, as Jan Morris expresses so well,substitutes one for the other, under the illusion that she/heis entering into a state that is radically different from therole she/he rejects.
Another recent example of the apparent contradictions
that Jan Morris represents is described in an article thatappeared in the Gay Community News,36 reporting on
three male-to-constructed-female transsexuals—Carolyn,
Heather, and Sandy. Most of the questions that were asked
in this interview seemed devised to judge the degree ofstereotypical identification of the three with dominant

91“Mother’s Feminized Phallus” or Father’s Castrated Femme?

feminine norms. The contradiction in Carolyn’s statements
about sex-role stereotyping is fairly obvious. Carolyn
identified “herself’ as a feminist. When asked what at­tributes “ she” would ascribe to a woman, “she” refused
to comment on the grounds that it was sexist to limit
certain characteristics to a certain sex. However, whenpushed further on what is essential to being a woman,“ she” responded with a classic stereotyped answer: “be­ing willing to be sincere and loving and being able toju s t. . . give a great d eal. . . get it back, too. . . care forsomebody. . . put together a nice home.” A second trans­
sexual, Sandy, rejected macho men but then admitted
that “she” desired to be dominated by men in bed. The
third, Heather, also considered “herself” a feminist, dis­
liked macho men, considered “herself” aggressive andindependent but on the other hand, was reduced to sell­ing “her” body to men.
My own interview data confirms the same kind ofcontradictions. R., for example, said “she” didn’t believein part of the stereotypic ally feminine role, such as doinghousework, wanting kids, staying around the house, but“she” delighted in wearing profuse make-up and frilly
feminine clothes. R. also made the very important pointthat one of the reasons transsexuals may seem to conform
exaggeratedly to the stereotype is that they have to proveto the gender identity clinics that they can pass (i.e., live,
work, dress, and be accepted) as women. This, of course,
raises the significant issue of to what extent the medical
and psychiatric professions contribute, perpetuate, andreinforce the stereotyping syndrome.
GENDER IDENTITY CLINICS AND SEX-ROLE STEREOTYPINGThe role of the gender identity clinics and the medicalpsychiatric establishment in general in reinforcing sex-role
stereotypes is a significant one. Gender identity clinics
have been instituted to counsel and to refer for surgery
those candidates judged to be “real” transsexuals. Oneof the criteria in evaluating “ true” transsexualism at
Johns Hopkins, among other clinics, is an assessment of

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The Transsexual Empire

the patient’s current sociocultural role status and a con­sideration of the vocational and economic transformations
she/he is making preoperatively.
The transsexual cannot have accurate knowledge or feeling of theexperience of living and being treated as a member of the opposite
sex until he spends sufficient time living in that ro le .. . . Present
data indicate that the length of time spent by the patient in actual
experience in the opposite sex role prior to surgery is of critical im­
portance in our determining the extent of possible future crises.37

While this requirement is made for supposedly practicaland humanitarian reasons, it is important to point out thatits social effect is to reinforce conformity to certain cul­tural norms of masculinity and femininity, since it eval­uates everything from dress to body language and topositions in intercourse.
At Johns Hopkins, candidates for surgery are required
to live out opposite-sex roles for at least six months. Manytimes, however, a longer period is required, and the average
length of time demanded by the clinics is two years. Dur­ing this time, hormonal treatments usually begin.
Harry Benjamin has written that in evaluating the“true” transsexualism of persons who came to him, “Mostimportant for my own satisfaction and consent to theoperation was the belief that a reasonably successful‘woman’ could result.”38 It is precisely here that doctors’
views of the cultural stereotypes are revealed, and trans­
sexual candidates are judged on the basis of what a man’sview of a “real woman” is. Concomitantly, of course,
female transsexual candidates are also judged on the basisof what a man’s view of a man should be. But either way,
men are perpetuating, judging, and reinforcing the culturalstereotypes. Consider, for example, this account:
Marriage is the foremost ambition of a converted transsexual. Thisis easily understood when one realizes that it is the most complete
affirmation of femininity. Prostitution sometimes becomes atempting substitute for marriage. There is no greater confirmationof femininity than that of having normal heterosexual men again
and again accept her as a woman and even pay her for sex services.39

93“Mother’s Feminized Phallus” or Father’s Castrated Femme?

The sexual objectification of such a perspective is obvious.
Or consider the following view of womanhood: “A true
feminine identification, for instance, would result in warmand continued relationships with men, a sense of maternity,
interest in caring for children and the capacity to work
productively and continuously in female occupations.”40
In an advice column to transsexuals that was publishedin Sexology Magazine, the following was specified:
You have to learn how to behave like a woman, how to walk, how
to use your hands, how to talk, how to apply make-up, and how
to dress.. . . Finally, but highly important, how do you know you
can make a living as a woman? Have you ever worked as a woman
before? I assume that so far, you have only held a man’s job andhave drawn a man’s salary. Now you have to learn something en­
tirely new.41

What this “advice” conveys, aside from confirming the
economic oppression of women in a patriarchal society,is uncritical acceptance of this situation—distinguishing a“man’s job” and earnings from a woman’s, encouraging
transsexuals to also accept this distinction, and indeed re­quiring that they do so before they are recommended forsurgery. Moreover, this conformity on the part of thetranssexual is often labeled by doctors, psychiatrists, andclinics as “high motivation.”
The Erickson Foundation has published several pam­phlets about transsexualism that attempt to inform thepublic about the subject in a readable and nonacademic
way. In one of these, “Counseling the Transsexual, ” fivemale therapists are interviewed. Dr. R. strongly empha­
sizes the importance of cross-dressing consistently, gettinga job in the new gender role, and seeing how people react
to the transsexual in his new gender role.
These reactions, positive and negative, are part of his education:
they reinforce convincing behavior and stimulate him to modify
behavior that elicits doubtful or negative responses from others.
. . . Any conscientious doctor will require that prior to surgery
and while receiving hormone therapy the patient submerge himself
in the chosen role for a considerable time—and I would recommend

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The Transsexual Empire

the full two-year term—until he is absolutely at ease in it, personallyand socially.42

In the same pamphlet, Dr. N. talks about the necessity to
explore the gender stereotypes with transsexuals. What itreally means to be a man or a woman should be talked
about to assure that the transsexual’s conception is not
idealized, exaggerated, or distorted in one way or another.
Dr. N. indeed recognizes the more superficial aspects ofof stereotypical behavior and attempts to dissuade hisclients from such. For example, he would ask:
Does femininity mean going to the supermarket drenched in per­fume and wearing gauzy organdies and make-up an inch thick—now
this sounds like a caricature, but very frequently this is the maletranssexual’s honest conception of appropriate feminine attire. 43

However, Dr. N’s criticism of the stereotype is merely“skin-deep.” In the next paragraph, he maintains that“being a woman” has to do more with “an inner quality,
a way of feeling: something less obvious, more intan­
gible.”44
The web of stereotyping is woven also on the hospitalward following surgery. A nurse’s account of “The Trans­
sexual Patient After Surgery” advises that nurses should
serve as feminine role models for transsexuals and that in­deed it may be the demeanor of nurses and their inter­action with transsexual patients on the wards that is mostimportant to the future of the postoperative transsexual.
The nurse who is comfortable with her feminine role can be a non­threatening female role model for her p atien t.. . . The nurse canoffer the way she walks, talks, sits, and dresses as a resource for her
patient. 45

Here, of course, we have the ultimate form of sex-role op­pression. The woman herself becomes the funnel throughwhich men’s ideas of women are perpetuated and rein­
forced.
What is most disconcerting is the treatment of what is
termed childhood transsexualism. Here again, the roles ofthe doctor, psychiatrist, and gender identity clinics in so­

95“Mother’s Feminized Phallus” or Father’s Castrated Femme?

cializing young children—this time to the prescribed roleof their anatomical sex—id disturbing. The Gender Identity
and Research Program at U.C.L.A. is working with a num­
ber of preadolescent boys who are termed “effeminate”
and are judged to have many of the childhood patterns
described by adult transsexuals. “Young boys with normal
male physical status who manifest feminine gender role
behavior and verbalize a cross-gender identity are high risk
for later adult sexual adjustment problems, e.g., trans­
sexualism and homosexual conflicts.”46 The aim of the
program and treatment has been to work intensively withthe boys and their families so that the boys may cometo “voluntarily” accept themselves as masculine. An in­terim report47 divulged the following treatment measures:(1) Development of a relationship of trust and affection
between the male therapist and the boy; (2) heightening
parental concern about the problem so that parents begin
to disapprove of feminine48 interests and no longer co­vertly encourage them; (3) Promotion of the father’s ora father-substitute’s involvement in the boy’s life; (4) sen­sitization of the parents to the interpersonal difficulties
which underlie the tendency of the mother to be overly
close with the son and for the father to emotionally di­vorce himself from family activities.
The development of the therapist-boy relationship illus­
trates some of the worst aspects of masculine sex-role so­cialization. The authors describe a nine-year-old boy whose
feminine propensities began to look like a case of boyhoodtranssexualism. After two years of treatment, the boy
began to emulate his male therapist. The first sign of the
boy’s conversion to masculinity was his narration of horror
stories in which murder and physical aggression took place.
Gradually the therapist began to point out to the boy his
own fear of aggressiveness, and eventually he became
more aggressive. At home, the boy acted this out by strik­
ing both his sister and his mother. “ The development was
supported by the therapist and the m other’s fears of it
were allayed. (If the therapist had not intervened strongly
at this point, it is likely that the mother’s covert pressure

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The Transsexual Empire

against such behavior would have resulted in the boy again
returning to a passive posture.)”49
Another case is related which involved sessions with theparents. This mainly consisted of coaching the mother intoa more passive familial position and assisting the father toemerge as the dominant parent. Prior to therapy motherand son spent great amounts of time together. The father’sbusiness commitments took him away from the family
constantly and when he was home, his exhaustion pre­cluded spending time with the boy. Moreover, the authors
state that the father’s image was frequently underminedby his wife. The parents, with the help of therapy and a“high motivation” to change and help their son, gradually
reversed roles. The father became increasingly active withhis son. The mother “channeled her assertiveness” else­
where.
In both of these cases, each boy made a considerable
shift in his gender-role orientation to a much more mas­
culine posture. This shift was termed “appropriate gender
behavior” by two doctors at Johns Hopkins.
Involvement of the parents in the treatment program may be help­
ful, if one can get their approval and support of appropriate gender
behavior by the child, and a continuous effort by the parent of thesame sex toward bolstering the correct sex role of the dysfunctioning child.50

A focus on the family and the father as dominant is by
no means a new idea, of course, nor is it restricted to thefield of psychology. The idea of the family as the locus
of behavior and the father as instructor was legitimatedin the philosophy of ancient Greece. Aristotle, for ex­
ample, justified the family as a school of conduct andpreparation for the larger world, particularly for the state.
He saw the father as inspiring his children (and slaves)
toward a life of virtue. Indeed, as Ernest Barker remarks,“There are times when Aristotle seems almost ready tothink that the father may suffice for the moral instruc­tion of his children.”51 In the family counseling sessions
and practices of the gender identity clinics, we witness a

97“Mother’s Feminized Phallus” or Father’s Castrated Femme?

modem variation on this Aristotelian theme as the trans­
sexual counselors attempt to nip the transsexual conditionin the bud. Having faulted the mother for her fostering of
the syndrome in her child, transsexual family therapy fo­
cuses on the father as the redeemer of his son’s mascu­
linity. Employing father substitutes (male therapists
as role models) and encouraging the “real” father toassert his “rightful” fatherly and masculine role in thefamily, the transsexual experts motivate and educate thedeveloping deviant boy to be culturally masculine.
Both the U.C.L.A. and Johns Hopkins professionals de­fend the use of a male therapist. “By the nature of his
authority, prestige, and capacity for providing approvaland disapproval, he will be available to the boy as an ap­
propriate object for identification.” 52 The Johns Hopkins
group merely asserted that, “treatment of such a child
may be done best by a psychiatrist of the same sex, toserve as an appropriate gender model.” What is never ana­lyzed is “ appropriate” by whose standards? Such judg­
ments are based on an invisible, yet culturally accepted,
standard of sex roles.53 The therapists/authors cited neveronce question the “ appropriateness”54 of behavior suchas the physical abuse of one’s mother or sister. Indeed
many men, as evidenced by the incidence of rape, sexual
abuse, wife-beating, and violent crimes, do believe thatthe perpetuation of violence against women is “appro­
priate” behavior. But perhaps, finally, there is a certain
uneasiness about the ultimate appropriateness of such
behavior:
Lest it be misunderstood that we have ascribed an inherently higher
value to masculine over feminine behavior, in closing, we will em­
phasize that it is rather the deleterious effect on social interaction,with the considerable resultant distress emanating from a cross­gender identity which motivates us. 55

Thus, sympathy for the boys’ social unacceptance becomesthe professed reason for the advocacy of certain thera­
peutic measures. This is reminiscent of the disapproval ofinterracial marriages on the ground that the children of

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The Transsexual Empire

such a union would be socially unacceptable in a whitesociety. More important, the authors do not choose torecognize that while social unacceptance may be given asa reason, the therapeutic context itself conveys to theseboys that there is an “inherently higher value” to mas­
culine behavior. Moreover, another “deleterious effect onsocial interaction” results—the encouragement and per­petration of male violence against women.
In conclusion, while the authors admit that society’s at­
titudes toward cross-gender behavior may be wrong, theycreate a social-individual split and opt for an individualistic
ethic.
While privately, one might prefer to modify society’s attitudes
toward crossgender behavior, in the consultation room with an un­
happy youngster, one feels far more optimistic about modifying
the behavior of that one child than the entire society. 56

Thus the task of social change becomes relegated to a “pri­vate preference” and has no significant place in therapeutic
situations. Changing society’s attitudes becomes secondary
in the immediacy of the therapeutic moment.
In the final analysis, it is imperative to note that what
has been termed an individualist or personalist position
does not foster genuine individualism The kind of indi­vidualism that transsexual therapy promotes is really an
individualism that serves a role-defined society and thus
it is more realistic to say that it is an ethic of social con­formity.57

C H A P T E R IV

Sappho by Surgery:
The Transsexually Constructed
Lesbian-Feminist

T r a n s s e x u a l is m ismultifaceted. From all that has been said thus far, it isclear that it raises many of the most complex questions
feminism is asking about the origins and manifestationsof sexism and sex-role stereotyping.* While regarded bymany as an obscure issue that affects a relatively minuteproportion of the population, transsexualism poses very
important feminist questions. Transsexually constructedlesbian-feminists show yet another face of patriarchy. As
the male-to-constructed-female transsexual exhibits theattem pt to possess women in a bodily sense while actingout the images into which men have molded women, themale-to-constructed-female who claims to be a lesbianfeminist attempts to possess women at a deeper level, thistime under the guise of challenging rather than conforming
to the role and behavior of stereotyped femininity. As♦For a long tim e, I have been very hesitant about devoting a chaptero f this book to w hat I call the “ transsexually constructed lesbianfem inist. ” In the order this book was w ritten, it was actually the

99

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The Transsexual Empire

patriarchy is neither monolithic nor one-dimensional,
neither is transsexualism.
All men and male-defined realities are not blatantly
macho or masculinist. Many indeed are gentle, nurturing,feeling, and sensitive, which, of course, have been the
more positive qualities that are associated with stereo­
typical femininity. In the same way that the so-called
androgynous man assumes for himself the role of femi­
ninity, the transsexually constructed lesbian-feminist
assumes for himself the role and behavior of feminist.
The androgynous man and the transsexually constructedlesbian-feminist deceive women in much the same way,
for they lure women into believing that they are truly
one of us—this time not only one in behavior but one inspirit and conviction.
last chapter I wrote. The recent debate and divisiveness th a t thetranssexually constructed lesbian-feminist has produced within
feminist circles has convinced me that, while transsexually con­structed lesbian-feminists may be a small percentage of transsexuals,
the issue needs an in-depth discussion among feminists.
I write this chapter with the full realization th a t feminists lookat the issue o f the transsexually constructed lesbian-feminist fromthe vantage point o f a small com m unity in which transsexuals havebeen able to be very visible—n o t because there are th at many ofthem, b u t because they immediately have center stage. Thus focus­
ing atten tio n on this particular aspect of the transsexual issue may
only serve to inflate the issue and their presence all the more. It may
also distract attention from the more central questions th a t trans­
sexualism raises and the power of the medical empire th at createstranssexualism to begin with.
Because the oral and w ritten debate concerning the transsexuallyconstructed lesbian-feminist seems to be increasing o ut of proportion
to their actual num bers, I think th at feminists ought to consider
seriously the am ount of energy and space we wish to give to this
discussion. However, if any space should be devoted to this issue, it
is in a book th at purports to be a fem inist analysis of transsexualism.
Furtherm ore, m ost of the com m entary thus far has been lim ited toletters to the editor and editorial com m ents in feminist papers, aswell as a few scattered articles in various journals. Because of lim itedspace, these analyses are necessarily restricted. I would like, there­
fore, to provide an extensive and intensive analysis of the issue andto address the deeply m ythic dimensions th a t the transsexually con­structed lesbian-feminist represents.

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Sappho by Surgery
CONTRADICTIONS OR CONFIRMATIONS?

It is not accidental that most male-to-constructed-femaletranssexuals who claim to be feminists also claim to belesbian-feminists. In fact, I don’t know of any transsex­ually constructed feminists who do not also claim to belesbians. It is this combination that is extremely impor­tant. Lesbian-feminists have spent a great deal of energy
in attempting to communicate that the self-definition oflesbian, informed by feminism, is much more than justa sexual choice. It is a total perspective on life in a patriar­
chal society representing a primal commitment to womenon all levels of existence and challenging the bulwark ofa sexist society—that is, heterosexism. Thus it is not amere sexual alternative to men, which is characterized
simply by sexually relating to women instead of men,but a way of being in the world that challenges the malepossession of women at perhaps its most intimate and sen­sitive level. In assuming the identity of lesbian-feminist,
then, doesn’t the transsexual renounce patriarchal defini­tions of selfhood and choose to fight sexism on a mostfundamental level?
First of all, the transsexually constructed lesbian-feminist may have renounced femininity but not masculinity
and masculinist behavior (despite deceptive appearances).
If, as I have noted earlier, femininity and masculinity are
different sides of the same coin, thus making it quite
understandable how one could flip from one to the other,
then it is important to understand that the transsexuallyconstructed lesbian-feminist, while not exhibiting a femi­nine identity and role, still exhibits its obverse side—stereo­
typical masculinity. Thus the assumption that he has re­nounced patriarchal definitions of selfhood is dubious.
Masculine behavior is notably obtrusive. It is significant
that transsexually constructed lesbian-feminists have in­serted themselves into the positions of importance and/or
performance in the feminist community. The controversy
in the summer of 1977 surrounding Sandy Stone, the102

The Transsexual Empire

transsexual sound engineer for Olivia Records, an “all­women” recording company, illustrates this well. Stone
is not only crucial to the Olivia enterprise but plays avery dominant role there.1 The national reputation andvisibility he achieved in the aftermath of the Olivia con­troversy is comparable, in feminist circles, to that attained
by Renee Richards in the wake of the Tennis Week Open.
This only serves to enhance his previously dominant roleand to divide women, as men frequently do, when they
make their presence necessary and vital to women. Having
produced such divisiveness, one would think that if Stone’s
commitment to and identification with women were gen­uinely woman-centered, he would have removed himself
from Olivia and assumed some responsibility for the divi­
siveness. In Boston, a transsexual named Christy Barsky
has worked himself into a similar dominant position, thistime coaching a women’s softball team, coordinating a
conference on women and violence, staffing a women’s
center, and performing musically at various all-womenplaces. Thus, like Stone, he exhibits a high degree of visi­
bility and also divides women, in the name of lesbianfeminism.
Pat Hynes has suggested that there is only an apparent
similarity between a strong lesbian, woman-identified self
and a transsexual who fashions himself in a lesbian-femi­nist image.2 With the latter, his masculinity comes through,although it may not be recognized as such. Hynes es­
pecially points to the body language of transsexuals where
she notes subtle but perceptible differences between, forexample, the way lesbians interact with other women andthe way transsexuals interact with women. One specificexample of this is the way a transsexual walked into a
women’s restaurant with his arms around two women, one
on each side, with the possessive encompassing that ischaracteristically masculine.
Mary Daly in explaining why this difference is percep­
tible points out that the transsexually constructed lesbianfeminist is able to deceptively act out the part of lesbianfeminist because he is a man with a man’s history; that is,

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he is free of many of the residues of self-hatred, self-depreciation, and self-contradiction that attend the history of
women who are bom with female bodies—all of which iscommunicated both subtly and not so subtly in gestures,body language, and the like.3 Thus it is precisely because
the transsexually constructed lesbian-feminist is a man,and not a woman encumbered by the scars of patriarchy
that are unique to a woman’s personal and social history
that he can play our parts so convincingly and apparently
better than we can play them ourselves. However, in the
final analysis, he can only play the part, although thepart may at times seem as, or more, plausible than the real
woman (as is also the case with the male-to-constructedfemale transsexual who appears more feminine than mostfeminine women).
What is also typically masculine in the case of the trans­
sexually constructed lesbian-feminist is the appropriationof women’s minds, convictions of feminism, and sexuality.
One of the definitions of male, as related in Webster’s, is“designed for fitting into a corresponding hollow part. ”
This, of course, means much more than the literal signifi­
cation of heterosexual intercourse. It can be taken tomean that men have been very adept at penetrating all of
women’s “hollow” spaces, at filling up the gaps, and of
sliding into the interstices. Obviously, women who arein the process of moving out of patriarchal institutions,consciousness, and modes of living are very vulnerable andhave gaps. I would imagine that it would be difficult, forexample, for Olivia Records to find a female sound engi­
neer and that such a person would be absolutely necessary
to the survival of Olivia. But it would have been far morehonest if Olivia had acknowledged the maleness of Sandy
Stone and perhaps the necessity, at the time, to employ
a man in this role. As one woman wrote of Sandy Stoneand the Olivia controversy: “ I feel raped when Olivia
passes off Sandy, a transsexual, as a real woman. Afterall his male privilege, is he going to cash in on lesbian
feminist culture too? ”4
Rape, of course, is a masculinist violation of bodily in-

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tegrity. All transsexuals rape women’s bodies by reducing
the real female form to an artifact, appropriating this bodyfor themselves. However, the transsexually constructedlesbian-feminist violates women’s sexuality and spirit,
as well. Rape, although it is usually done by force, canalso be accomplished by deception. It is significant thatin the case of the transsexually constructed lesbian-femi­
nist, often he is able to gain entrance and a dominant posi­tion in women’s spaces because the women involved do
not know he is a transsexual and he just does not happen
to mention it.
The question of deception must also be raised in thecontext of how transsexuals who claim to be lesbian-femi­
nists obtained surgery in the first place. Since all trans­
sexuals have to “pass” as feminine in order to qualify forsurgery, so-called lesbian-feminist transsexuals either had
to lie to the therapists and doctors, or they had a con­version experience after surgery.5 I am highly dubious ofsuch conversions, and the other alternative, deception,raises serious problems, of course.
Deception reaches a tragic point for all concerned if
transsexuals become lesbian-feminists because they regret
what they have done and cannot back off from the effectsof irreversible surgery (for example, castration). Thus they
revert to masculinity (but not male body appearance) bybecoming the man within the woman, and more, within
the women’s community, getting back their maleness ina most insidious way by seducing the spirits and the sex­
uality of women who do not relate to men.
Because transsexuals have lost their physical “members”
does not mean that they have lost their ability to pene­
trate women—women’s mind, women’s space, women’s
sexuality. Transsexuals merely cut off the most obvious
means of invading women so that they seem noninvasive.
However, as Mary Daly has remarked, in the case of thetranssexually constructed lesbian-feminists their wholepresence becomes a “member” invading women’s presence
and dividing us once more from each other.6
Furthermore, the deceptiveness of men without “mem-105Sappho by Surgery

bers,” that is, castrated men or eunuchs, has historicalprecedent. There is a long tradition of eunuchs who wereused by rulers, heads of state, and magistrates as keeperso f women. Eunuchs were supervisors of the harem inIslam and wardens of women’s apartments in many royalhouseholds. In fact, the word eunuch, from the Greek
eunouchos, literally means “keeper of the bed.” Eunuchs
were men that other more powerful men used to keep
their women in place. By fulfilling this role, eunuchs also
succeeded in winning the confidence of the ruler and se­curing important and influential positions.
Moreover, the word eunuch is also related to the word
scheme. (Eunuchs schemed to obtain political power.)
In Mesopotamia, many eunuchs became royal officers
and managers of palaces, and “ others emerge on the pagesof history as important and often virile figures.” 7 Somewere famous warriors and statesmen, as well as scholars.
One finds eunuchs associated with temples dedicated to
the goddesses from at least 2000 B.C. until well into the
Roman period.8 In fact the earliest mention of eunuchs
is in connection with the Minoan civilization of Crete,
which was a transitional period from an earlier gynocentric society. It thus appears that eunuchs, to some extent,
always attached themselves to women’s spaces and, mostfrequently, were used to supervise women’s freedom of
movement and to harness women’s self-centeredness andself-government. “It is stated that entree into every poli­tical circle was possible for eunuchs even if barred toother men.”9Will the acceptance of transsexually constructed lesbianfeminists who have lost only their outward appendagesof physical masculinity lead to the containment and con­trol of lesbian-feminists? Will every lesbian-feminist spacebecome a harem? Like eunuchs, transsexuals have gained
prominent and dominant access to feminist political cir­cles “barred to other men.” 10 Just because transsexuallyconstructed lesbian-feminists are not only castrated men,but have also acquired artifacts of a woman’s body andspirit, does not mean that they are un-men, and that

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they cannot be used as “ keepers” of woman-identified
women when the “ real men,” the “rulers of patriarchy,”
decide that the women’s movement (used here as bothnoun and verb) should be controlled and contained. In
this way, they too can rise in the Kingdoms of the Fathers.
The political implications of historical eunuchism and its
potential for female control should not be lost upon
woman-identified women.
MYTHIC DIMENSIONS OF TRANSSEXUALISM

Transsexuals are living and acting out a very ancient myth,that of single parenthood by the father. This myth wasprevalent in many religious traditions, including the Jew­ish, Greek, and Christian. Eve was bom of Adam; Dionysus
and Athena were bom of Zeus; and Jesus was generated
by God the Father in his godly birth. (Mary was a mere
receptacle used to conform Jesus to earthly birth stan­dards.) When this myth is put into the context of trans­
sexualism, the deeper dimensions of how transsexuallyconstructed lesbian-feminists reinforce patriarchy can beperceived.
Simone de Beauvoir has remarked that “if [woman] did
not exist, men would have invented her. They did invent
her. But she exists also apart from their inventiveness.”11Men, of course, invented the feminine, and in this sense
it could be said that all women who conform to this in­vention are transsexuals, fashioned according to man’s
image. Lesbian-feminists exist apart from man’s inventive­
ness, and the political and personal ideals of lesbian-feminism have constituted a complete rebellion against the
man-made invention of woman, and a context in which
women begin to create ourselves in our own image. Thus
the transsexual who claims to be a lesbian-feminist seems
to be the man who creates himself in woman’s image. This,
however, is deceptive, for note that he is still created inman’s image since he is essentially a child of the Father(in this case, the medical fathers), renouncing his moth­ered birth.

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Sappho by Surgery

Mary Daly has written at length in her most recent
work, Gyn/Ecology: The Metaethics o f Radical Feminism,
about the myth of Dionysus.12 She also cites various ver­sions of the myth along with some scholarly commentaries
on it. These can shed much light on the mythic implica­
tions of the transsexually constructed lesbian-feminist.
First of all, Philip Slater points out the very interesting fact
that, “Instead of seeking distance from or mastery over themother, the Dionysian position incorporates her. ”13 In themost popular version of the myth, Semele, the motherof Dionysus while pregnant with him, is struck by Zeus
with a thunderbolt and is thus consumed. Hermes saves
the six-month fetal Dionysus, sews him up in Zeus’s thigh,and after three more months, Zeus “births” him. Thus
Zeus exterminates the woman and bears his own son, andwe have single-parent fatherhood (read motherhood). More­over, Jane Harrison has pointed out that “the word Diony­
sus means not ‘son of Zeus’ but rather Zeus-Young Man,i.e., Zeus in his young form.” 14 Thus Dionysus is his own
father (read mother) and births himself into existence.
Whether we are talking about being bom of the father,or the self (son), which in the myth are one and the same
person (as in the Christian trinity), we are still talking
about male mothering. At this level of analysis, it mightseem that what men really envy is women’s biologicalability to procreate. Transsexuals illustrate one way inwhich men do this, by acquiring the artifacts of female
biology. Even though they cannot give birth, they acquire
the organs that are representative of this female power.
However, it is the transsexually constructed lesbian-feminist who illustrates that much more is desired than female
biology—that much more is at stake than literal womb
envy. He shows that female biology, whether exercisedin giving birth or simply by virtue of its existence, is repre­
sentative of female creativity on a profound mythic level.
Thus the creative power that is associated with female
biology is not envied primarily because it is able to givebirth physically but because it is multidimensional, bearing
culture, harmony, and true inventiveness.15

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The Transsexual Empire

The transsexually constructed lesbian-feminist feeds
off woman’s true energy source, i.e., her woman-identified
self. It is he who recognizes that if female spirit, mind,
creativity, and sexuality exist anywhere in a powerful way,
it is here, among lesbian-feminists. I am not saying that thelesbian-feminist is the only self- and woman-identified
woman. What I mean to express is that lesbianism-feminism signals a total giving of women’s energy to women,
and that it is this total woman-identified energy that thetranssexual who claims to be a lesbian-feminist wants forhimself. It is understandable that if men want to become
women to obtain female creativity, then they will also
want to assimilate those women who have withdrawn
their energies from men at the most intimate and emo­
tional levels.
This, of course, is not the usual way in which lesbianliving has been harnessed. Most often, lesbian existence issimply not acknowledged, as evidenced in the laws against
homosexuality, which legislate against male homosexuals,
but not lesbians. It has been simply assumed that all womenrelate to men, and that women need men to survive. Fur­thermore, the mere labeling of a woman as “lesbian” hasbeen enough to keep lesbian living harnessed or, at best,in the closet. “ Lesbian is the word, the label, the condi­tion that holds women in line. When a woman hears thisword tossed her way, she knows that she. . . has crossed
the terrible boundary of her sex role.”16 (Italics mine.)
Whereas the lesbian-feminist crosses the boundary ofher patriarchally imposed sex role, the transsexually con­structed lesbian-feminist is a boundary violator. This vio­
lation is also profoundly mythic, for as Norman O. Brown
writes of Dionysus, he as the “mad god who breaks downboundaries.” 17 Thus exhibiting qualities that are usuallyassociated with femininity, he appeared to be the oppositeof the masculine Apollo.
While the super-masculine Apollo overtly oppresses/destroys withhis contrived boundaries/hierarchies/rules/roles, the feminine Diony­
sus blurs the senses, seduces, confuses his victims—drugging them

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into complicity, offering them his “ heart” as a love potion that
poisons.18

It is, however, the feminist Dionysus who appears in thetranssexually constructed lesbian-feminist. But he “blurs
the senses, seduces, and confuses” in much the same way
as the feminine Dionysus. He not only violates the bound­aries of women’s bodies but of our minds and spirits.
What is more tragic, however, is that he is able to makewomen break down our boundaries of self-definition.
Elizabeth Rose in a letter in response to my article inChrysalis, “Transsexualism: The Ultimate Homage to
Sex-Role Power,” illustrates well this tendency of femi­
nists to be seduced by Dionysian boundary violation.
Raymond’s article encourages us to set our “ bottom line” (about
whom we will allow the privilege of self-definition).
I am upset that a magazine “of women’s culture”. . . is basicallyencouraging the elitist/separatist attitude that self definition [is]. . . subject to the scrutiny and judgments of those who, in thename of political purity, claim the power to define who is allowed
entry into the feminist community. . . and, now, who is or is not
female.19

Rose would encourage us to set no boundaries by employ­
ing the analogy of how boundaries have been used oppres­sively against lesbians in the past/present. “There are somany painful parallels between how the world has treatedstrong women and lesbians and how Raymond and others
categorize and discount transsexuals.” 20 But the analogy
is false. The boundaries that have been and are used against
lesbians are the boundaries of the Fathers:
The contrived Apollonian boundaries—such as the false divisions of“ fields” of knowledge and the splits between “mind” and “ heart. ”
But in this process we do not become swallowed up in male-centered(Dionysian) confusion. Hags find and define our own boundaries,
our own definitions. Radical feminist living “ on the boundary”
means this moving, Self-centering boundary definition. As we move
we mark o ut our own territory. 21

Rose and other women who have been confused/se­
duced by Dionysian transsexually constructed lesbianfeminist boundary violation would have us believe that

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all boundaries are oppressive. Yet if feminists cannot agree
on the boundaries of what constitutes femaleness, thenwhat can we hope to agree on? The Dionysian “ Final
Solution,” as Daly points out, produces confusion in
women—“inability to distinguish the female Self and her
process from the male-made masquerade.”22 It encourages
the leveling of genuine boundaries of self-preservation andself-centering.
THE SEDUCTION OF LESBIAN-FEMINISTS

It is not hard to understand why transsexuals want to be­come lesbian-feminists. They indeed have discovered
where strong female energy exists and want to capture
it. It is more difficult to understand why so many femi­
nists are so ready to accept men—in this case, castrated
men—into their most intimate circles. Certainly Dionysian
confusion about the erasure of all boundaries is one rea­
son that appeals to the liberal mind and masquerades as“sympathy for all oppressed groups.” Women who believethis, however, fail to see that such liberalism is repressive,
and that it can only favor and fortify the possession of
women by men. These women also fail to recognize that
accepting transsexuals into the feminist community is
only another rather unique variation on the age-old themeof women nurturing men, providing them with a safe
haven, and finally giving them our best energies.
The question arises: are women who accept transsexuals
as lesbian-feminists expressing gratitude on some level tothose men who are finally willing to join women and pay
for their male privilege with their balls? Gratitude is a qual­
ity exhibited by all oppressed groups when they think thatsome in the class of oppressors have finally relinquishedtheir benefits to join them. But, of course, it is doubtfulthat transsexuals actually give up their male privilege. As
one woman put it: “A man who decides to call himself awoman is not giving up his privilege. He is simply using it
in a more insidious way.”23 Furthermore, a man who de­cides to call himself a lesbian-feminist is getting a lot. The

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Sappho by Surgery

transsexually constructed lesbian-feminist is the man who
indeed gets to be “the man” in an exclusive women’s clubto which he would have otherwise no access.
Women who think that these men are giving up maleprivilege seem to be naive about the sophisticated ways inwhich it is possible for men to co-opt women’s energy,
time, space, and sexuality. Transsexually constructed les­bian-feminists may be the first men to realize that “if you
can’t fight them, join them.” In a short story entitled “The
Women’s Restaurant,” by T. C. Boyle, which appeared
recently in Penthouse, this point is well made.
The story begins by setting the scene in and around
Grace & Rubie’s Restaurant and is written from the pointof view of the voyeuristic narrator. “It is a women’s res­taurant. Men are not permitted.. . . What goes on there,
precisely, no man knows. I am a man. I am burning to findout. ”24 The narrator then proceeds to caricature Graceand Rubie as butch and femme, as well as to relate his
several attempts to gain entrance. After two unsuccessful
endeavors, he goes to a department store, buys a pinkpolyester pantsuit, a bra, pantyhose, and cosmetics withwhich he makes himself up to pass as a woman. He gains
entrance and is able to experience what he has been miss­ing.
Here I was, embosomed in the very nave, the very omphalos of fur­
tive femininity—a prize patron of the women’s restaurant, a member,
privy to its innermost secrets.. . . There they were—women—chew­
ing, drinking, digesting, chatting, giggling, crossing, and uncrossing
their legs. Shoes off, feet up. Smoking cigarettes, flashing silverware,tapping time to the music. Women among women. I bathed in theirsoft chatter, birdsong, the laughter like falling coils of hair. I lit acigarette and grinned. No more fairybook-hero thoughts of rescuing
Rubie—oh no, this was paradise.2s

Having drunk six tequila sunrises and a carafe of dinner
wine, the male intruder/narrator finds it necessary to re­lieve himself, but forgets to sit down when he urinates in
the rest room, at which point he is discovered by Grace.
The story ends with his savoring of the triumph of tem­porary infiltration and a plan for permanent invasion.

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The Transsexual Empire

I have penetrated the women’s restaurant, yes, but in actuality it
was little more than a ra p e .. . . I am not satisfied. The obsession
grows in me, pregnant, swelling, insatiable with the first taste of ful­
fillment. Before I am through, I will drink it to satiety. I have plans.
. . . The next time I walk through those curtained doors at Grace& Rubie’s there will be no dissim ulation.. . . There are surgeons
who can assure it. 26

That this story appeared in Penthouse is no surprise. It
is obvious that its editors thought it would be of interest
to their readers, whether budding or closet transsexuals.
In spite of the ludicrous details and caricatures, one cansee that the narrator was primarily attracted to the womancenteredness of the restaurant. “Women among women. . .
this was paradise.” Such an attitude is representative ofthe transsexually constructed lesbian-feminist who indeed
gets his “ paradise,” because there were surgeons who could“assure it. ” Ironically, the would-be transsexual narratorof the story says that the next time he walks through thedoors, “there will be no dissimulation.” Transsexualism,
however, is dissimulation. As I have shown previously, tonot acknowledge the fact that one is a transsexual in a
women’s space is indeed deception. Finally, “penetrating”
the women’s restaurant was “little more than a rape.”
Little more than a rape, indeed! What “little more” isthere to such an act, unless it is the total rape of our femi­nist identities, minds, and convictions? The transsexuallyconstructed lesbian-feminist, having castrated himself,
turns his whole body and behavior into a phallus that canrape in many ways, all the time. In this sense, he performs
total rape, while also functioning totally against women’s
will to lesbian-feminism.
We have seen three reasons why lesbian-feminists are se­
duced into accepting transsexuals: liberalism, gratitude,
and naivete. There is yet another reason—one that can beperhaps best described as the last remnants o f male iden­tification. This is a complex phenomenon, which hasvarious ingredients.
On the one hand, there is fear of the label “man-hater.”
Are women who are so accepting of the transsexually con-

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Sappho by Surgery

structed lesbian-feminist trying to prove to themselves thata lesbian-feminist (she who has been called the ultimate
man-hater) is really not a man-hater after all? As Adrienne
Rich has pointed out, one way of avoiding that fearedlabel, and of allowing one’s self to accept men, is to ac­
cept those men who have given up the supposed ultimate
possession of manhood in a patriarchal society by self­
castration.27
On the other hand, there is a second component to this“last remnant of male identification”—i.e., attraction tomasculine presence. As Pat Hynes has suggested, there isan apparent similarity between a strong woman-identified
self and a transsexual who fashions himself in a lesbian
image. Because there is an apparent similarity, some lesbian-feminists may allow themselves to express the resi­
dues of their (buried) attraction to men or to masculine
presence, while pretending to themselves that transsexuallyconstructed lesbian-feminists are really women. This allows
women to do two things: to express that attraction, yetalso to decide themselves.
SELF-DEFINITION

One of the most constraining questions that transsexuals,
and, in particular, transsexually constructed lesbian-feminists, pose is the question of self-definition—who is awoman, who is a lesbian-feminist? But, of course, theypose the question on their terms, and we are faced withanswering it. Men have always made such questions ofmajor concern, and this question, in true phallic fashion,is thrust upon us. How many women students writing onsuch a feeble feminist topic as “ Should Women Be Truck
Drivers, Engineers, Steam Shovel Operators? ” and the like,have had their male professor scribble in the margins: “Butwhat are the real differences between men and women? ”
Men, of course, have defined the supposed differences thathave kept women out of such jobs and professions, andfeminists have spent much energy demonstrating how
these differences, if indeed they do exist, are primarily

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The Transsexual Empire

the result of socialization. Yet there are differences, andsome feminists have come to realize that those differences
are important whether they spring from socialization, from
biology, or from the total history of existing as a woman
in a patriarchal society. The point is, however, that theorigin of these differences is probably not the importantquestion, and we shall perhaps never know the total an­
swer to it. Yet we are forced back into trying to answer
it again and again.*Transsexuals, and transsexually constructed lesbianfeminists, drag us back to answering such old questions
by asking them in a new way. And thus feminists debate
and divide because we keep focusing on patriarchal ques­
tions of who is a woman and who is a lesbian-feminist.
It is important for us to realize that these may well be non­questions and that the only answer we can give to them isthat we know who we are. We know that we are women
who are bom with female chromosomes and anatomy, andthat whether or not we were socialized to be so-called
normal women, patriarchy has treated and will treat us
like women. Transsexuals have not had this same history.
No man can have the history of being bom and locatedin this culture as a woman. He can have the history ofwishing to be a woman and of acting like a woman, but
this gender experience is that of a transsexual, not ofa woman. Surgery may confer the artifacts of outward
and inward female organs but it cannot confer the historyof being bom a woman in this society.
What of persons bom with ambiguous sex organs or
chromosomal anomalies that place them in a biologicallyintersexual situation? It must be noted that practicallyall of them are altered shortly after birth to become ana­
tomically male or female and are reared in accordance*A parallel is the abortion issue, which can also be noted in this con­te x t The key question, asked by m en for centuries, is “ when does
life begin? ” This question is posed in m en’s term s and on their turf,
and is essentially unanswerable. Women to rtu re themselves trying
to answer it and thus do n o t assert or even develop our own ques­
tions abo u t abortion.

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Sappho by Surgery

with the societal gender identity and role that accom­
panies their bodies. Persons whose sexual ambiguity is
discovered later are altered in the direction of what theirgender rearing has been (masculine or feminine) up tothat point. Thus those who are altered shortly after birth
have the history of being practically bom as male or fe­
male and those who are altered later in life have theirbody surgically conformed to their history. When and ifthey do undergo surgical change, they do not become theopposite sex after a long history of functioning and being
treated differently.
Although popular literature on transsexualism implies
that Nature has made mistakes with transsexuals, it isreally society that has made the mistake by producing
conditions that create the transsexual body/mind split.
While intersexed people are bom with chromosomal or
hormonal anomalies, which can be linked up with cer­tain biological malfunctions, transsexualism is not of thisorder. The language of “Nature makes mistakes” only
serves to confuse and distort the issue, taking the focus
off the social system, which is actively oppressive. It suc­
ceeds in blaming an amorphous “ Nature” that is made toseem oppressive and is conveniently amenable to directcontrol/manipulation by the instruments of hormonesand surgery.
In speaking of the importance of history for self-defi­
nition, two questions must be asked. Should a person
want to change his/her personal and social history and if
so, how should one change that history in the most honest
and integral way? In answer to the first question, anyone
who has lived in a patriarchal society has to change per­sonal and social history in order to be a self. History can­not be allowed to determine the boundaries, life, andlocation of the self. We should be change agents of ourown history. Women who are feminists obviously wish tochange parts of their history as women in this society;some men who are honestly dealing with feminist ques­
tions wish to change their history as men; and transsexuals
wish to change their history of wanting to be women. In

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The Transsexual Empire

stressing the importance of female history for female
self-definition, I am not advocating a static view of suchhistory.
What is more important, however, is how one changes
personal history in the most honest and integral way, if
one wants to break down sex-role oppression. Should
nontranssexual men who wish to fight sexism take on
the identity of women and/or lesbian-feminists while
keeping their male anatomy intact? Why should castrated
men take on these identities and self-definitions and be
applauded for doing so? To what extent would concerned
blacks accept whites who had undergone medicalizedchanges in skin color and, in the process, claimed that they
had not only a black body but a black soul?
Can a transsexual assume the self-definition of lesbianfeminist just because he wants to, or does this particular
self-definition proceed from certain conditions endemic tofemale biology and history? Women take on the self­
definition of feminist and/or lesbian because that defini­tion truly proceeds from not only the chromosomal factof being bom XX, but also from the whole history of whatbeing bom with those chromosomes means in this society.
Transsexuals would be more honest if they dealt with their
specific form of gender agony that inclines them to want atranssexual operation. This gender agony proceeds fromthe chromosomal fact of being bom XY and wishing that
one were bom XX, and from the particular life history
that produced such distress. The place to deal with thatproblem, however, is not the women’s community. The
place to confront and solve it is among transsexuals them­selves.
One should be able to make choices about who one
wants to be. But should one be able to make any choice?
Should a white person attempt to become black, for ex­
ample? The question is a moral one, which asks basically
about the rightness of the choice, not the possibility of it.
Should persons be able to make choices that disguise cer­tain facets of our existence from others who have a right

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Sappho by Surgery

to know—choices that feed off others’ energies, and rein­
force oppression?
Jill Johnston has commented that, “many women are
dedicated to working for the ‘reconstructed man.’”28 This
usually means women gently or strongly prodding theirsignificant men into androgynous behavior and action.
Women who accept transsexually constructed lesbianfeminists say that these men are truly “reconstructed”
in the most basic sense that women could hope for—i.e.,they have paid with their balls to fight against sexism. Ul­
timately, however, the “reconstructed man” becomes the“reconstructed woman” who obviously considers himself
equal to and a peer of genetic women in terms of his“womanhood.” One transsexual openly expressed that hefelt male-to-constructed-female transsexuals surpassed
genetic women.
Genetic women cannot possess the very special courage, brilliance,
sensitivity and compassion—and overview—that derives from thetranssexual experience. Free from the chains of menstruation andchild-bearing, transsexual women are obviously far superior to
Gennys in many ways.
Genetic women are becoming quite obsolete, which is obvious,and the future belongs to transsexual women. We know this, andperhaps some o f you suspect it. All you have left is your “ ability”
to bear children, and in a world which will groan to feed 6 billion
by the year 2000, th at’s a negative asset.29

Ultimately, women must ask if transsexually con­structed lesbian-feminists are our peers. Are they equal tous? Questions of equality often center on proportional
equality* such as “equal pay for equal work,” or “equal
rights to health care.” I do not mean equal in this sense.
Rather I use equality to mean: “like in quality, nature, or
status” and “capable of meeting the requirements of a sit­uation or a task. ” In these senses transsexuals are not equal
to women and are not our peers. They are neither equalin “quality, nature of status” nor are they “capable ofmeeting the requirements of the situation” of women who
have spent their whole lives as women.

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The Transsexual Empire

Jill Johnston has written of lesbian-feminism: “Theessence of the new political definition is peer grouping.
Women and men are not peers and many people seriously
doubt whether we ever were or if we ever could be. ”30
Transsexuals are not our peers, by virtue of their history.
It is perhaps our mistrust of the man as the biological aggressor
which keeps bringing us back to the political necessity of powerby peer grouping. Although we are still virtually powerless it is only
by constantly adhering to this difficult principle of the power in­herent in natural peers (men after all have demonstrated the successo f this principle very well) that women will eventually achieve anautonomous existence.31

The transsexual does not display the usual phallic aggres­sion. Instead he violates women’s bodies by taking on theartifactual female organs for himself. The transsexuallyconstructed lesbian-feminist becomes a psychological andsocial aggressor as well.
Transsexually constructed lesbian-feminists challenge
women’s preserves of autonomous existence. Their exis­
tence within the women’s community basically attests tothe ethic that women should not live without men—or
without the “reconstructed man.” How feminists assess
and meet this challenge will affect the future of our genu­
ine movement, self-definition, and power of be-ing.
In the final analysis, transsexually constructed lesbianfeminists are in the same tradition as the man-made,made-up “lesbians” of the Playboy centerfolds. Every sooften, Playboy and similar magazines feature a “Sappho
Pictorial.”32 Recently, male photographers have entered
the book market by portraying pseudolesbians in all sortsof positions, clothing, and contexts that could only be
fantasized by a male mind.33 In short, the manner inwhich women are depicted in these photographs mimics
the poses of men pawing women. Men produce “lesbian”
love the way they want it to be and according to theirown canons of what they think it should be.
Transsexually constructed lesbian-feminists are in thistradition of pseudolesbian propaganda. Both the Playboy

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Sappho by Surgery

pseudolesbian and the transsexual pseudolesbian spreadthe “correct” (read male-defined) image of the lesbian,which in turn filters into public consciousness through themass media as truth. By thus mutilating the true self­
definition of the lesbian, men mold her image/reality ac­
cording to their own. As Lisa Buck has commented, trans­
sexualism is truly “their word made flesh!”34
Transsexually constructed lesbian-feminists attempt
to function as image-makers of the lesbian-feminist—
not only for the public-at-large, but also for the women’scommunity. Their masquerade of the lesbian filters into
women’s consciousness through the feminist media as “thereal thing.” The ultimate tragedy of such a parody is thatthe reality and self-definition of lesbian-feminist becomesmutilated in women themselves. Lesbian-feminists who
accept transsexually constructed lesbian-feminists as otherselves are mutilating their own reality.
The various “breeds” of women that medical sciencecan create are endless. There are the women who are
hormonally hooked on continuous doses of estrogenreplacement therapy. ERT supposedly will secure for thema new life of “eternal femininity.”35 There are the hys­
terectomized women, purified of their “potentially lethal”
organs for “prophylactic” purposes.36 Finally, there is
the “she-male”—the male-to-constructed-female trans­
sexual. And the offshoot of this “breed” is the transsex­ually constructed lesbian-feminist.
What all of these events point to is the particularly in­strumental role that medicine has played in the control ofdeviant or potentially deviant women. “The Transsexual
Empire” is ultimately a medical empire, based on a patriar­
chal medical model. This medical model has provided a“sacred canopy” of legitimations for transsexual treatment
and surgery. In the name of therapy, it has medicalized
moral and social questions of sex-role oppression, thereby
erasing their deepest meaning.

CHAPTER V

Therapy
as a Way o f Life:
Medical Values
versus Social Change

T h e medical model is at theheart of the transsexual empire. It serves as the “new the­ology” for the therapeutic and medical priests. From time
to time there are “in-house” debates about certain ele­ments of the model, but on the whole, it functions at an
established and consistent level of orthodoxy. (I use theterm medical model to mean an ideology that stresses:
freedom from physical or mental pain or disease; the loca­
tion of physical or mental problems within the individual
or interpersonal context; an approach to human conflicts
from a diagnostic and disease perspective to be solved by
specialized technical and professional experts.)
This approach has a profound influence on the study
and treatment of transsexualism. For example, if one’s
basic approach to the problem of transsexualism is from a
psychological and medical basis, then many moral issues,
as well as sociopolitical, economic, and environmental
problems, are transformed into technical problems. Thismeans also that critical awareness, choice, and responsi120

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Therapy as a Way of Lifebility are not perceived as “curative” but are replaced bytechnical “cures.”
Ultimately, one must ask if the transsexual problem isreally amenable to surgery and thus to a medical model.
Is the biomedical imperative that has functioned in otherareas, such as genetic technology and psychosurgery, re­ducible to presuppositions about the nature of womenand men? If, as argued in Chapter III, transsexualism is ofsociopolitical origins, can it be understood and treated bya medical model?
THE MEDICAL MODEL AS THEORETICAL
AND ETHICAL CONSTRUCT

Since the nineteenth century, especially, problems ofalienation have been individualized. With the advent of
Freudian psychoanalysis, which was later incorporated
into medical psychiatry, “health” values began to take theplace of ethical values of choice, freedom, and under­
standing.
With the transformation of the religious perspective on man into
the scientific, and in particular into the psychiatric, which became
fully articulated during the nineteenth century, there occurred aradical shift in emphasis away from viewing man as a responsible
agent acting in and on the world and toward viewing him as aa responsive organism being acted upon by biological and social“ forces.” In this process, the imagery and vocabulary of morality
were replaced by biological fantasy and psychiatric m etaphor. 1

The medical model has gradually yet consistently
treated problems of social alienation in the therapy ofclosed rooms, and more recently in the small group coun­
seling sessions of family clinics and community mental
health centers. Ernest Becker has contended that initially,“the psychoanalytic cure began its work by focusing on
the individual; now, it is broadening out to the study and‘therapy’ of the family.”2 I have noted in assessing thetheories of Robert Stoller that much of his work involves
not only individual, but family therapy, as well.

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The Transsexual Empire

By thus treating the problem of transsexualism, themedical-psychiatric professionals have consistently used a
medical model as remedy. Failing in their attempts tocounsel preoperative transsexuals to “ adjust” to the nor­mative gender identity and role of their anatomical sex,transsexual clinics and therapists (after extensive evalua­tions, of course) succeed in “adjusting” transsexuals to thenormative gender identity and role of their desired and op­
posite anatomical sex. Armed with the medical model, andoperating on the basis of the narrow “health” values it gen­erates, therapists speculate about the causes of transsex­
ualism and make therapeutic diagnoses within the same
framework that generated the problem to begin with (thatis, within a role-defined society and its definitions of mas­
culinity and femininity).
The goal in this “triumph of the therapeutic” is sup­posedly good “health,” but good “health” achieved at theexpense of critical awareness and exploration of the op­pressiveness of the roles themselves. This goal of good“health” is particularly ironic in light of the fact that theword health originally meant “whole.”3 As defined by
the medical model, “health” values come to mean partial
solutions, which go against total integrity of the body, theindividual concerned, and society in general.
The proponents of the medical model, who have ex­tolled the professional goal of therapy, have given them­selves the mandate to manipulate in the interests of re­
duced suffering for the transsexual. And in so doing, they
have forced transsexuals back into a social system whosebasic sexist norms and values remain unquestioned. Many
persons express the urgency of their desire to be transsexed in terms of “normalizing” their self-perceived mas­
culine or feminine psyche in a male or female body. The
abhorrence of homosexuality, expressed by many trans­
sexuals, and their unwillingness to be identified as such,
indicate their desire to “normalize” their sexual relation­
ships as heterosexual by acquiring the appropriate geni­
talia. Many express also their desire to be married, have(adopted) children, and function as part of a society where

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Therapy as a Way of Life

these roles and functions are both normal and normative.
Thus the transsexual is generally no advocate of social
criticism and change.
The medical model itself promotes this so-called nor­malization and in so doing limits the quest for self-tran­
scendence. The kinds of “health” values it generates do
not encourage the transsexual to recognize that such“health” may be unhealthy in the long run. “Health values
are all of a piece again with our philosophy of adjustment,
spurious individualism, and unashamed and thoughtless
self-seeking.”4 Such notions of “health” make true indi­vidualism and autonomy unachievable, rendering the indi­vidual passive, acquiescent, and medically manipulatable.
They deprive the individual of the possibility of transcen­dent activity and center him/her on false goods (gods). As
Phillip Rieff has said,
By this time men have gone too far beyond the old deception ofgood and evil to specialize at last, wittingly, in techniques that are
to be called. . . .“ therapeutic, ” with nothing at stake beyond amanipulatable sense of well-being.s

The present counseling and treatment of transsexuals,
based on the medical model I have described, give thetranssexual no real moral options. Failing to analyze oursociety’s definitions of masculinity and femininity, suchtherapy offers little encouragement and advice to help thetranssexual live beyond both these containers of personhood.
Consider the possibility of counseling that encouraged
the transsexual to break both stereotypes. Here, the trans­
sexual would be encouraged to become the agent of her or
his own energies and to strive for more varied modes ofbeing and becoming. In a very real sense, at this point, thetranssexual would become a social critic. All of us are insome way constricted by sex-role socialization. One wayof viewing transsexuals is that they are uniquely constric­
ted by the rigidified definitions of masculinity and femi­
ninity. The general cultural constrictions, from which we
all suffer, become body-laden with them. However, de­124

The Transsexual Empire

prived of an alternative framework in which to view the
problem, the transsexual is unable to express the problem
clearly. The gender identity clinics have a vested interestin suppressing criticism, and may collude with the trans­
sexual to solve the problem in an ultimately uncriticalway. Given a different mode of therapy where “conscious­
ness-raising” is the primary modus operandi, the trans­
sexual might not find it as necessary to resort to sexconversion surgery.*A society that encourages identity and role confor­
mity based on biological sex will naturally turn to sexconversion surgery rather than accept what it sees as athreatened obliteration of these roles. Until the problems
that psychiatry has claimed for itself are broadened intoa general criticism of patriarchal society, transsexualism
will not be understood as a medical manipulation of social
and individual action and meanings. Meanwhile, the medi­
cal model and its empire continue to domesticate therevolutionary potential of transsexuals. The potential
stance of the transsexual as outsider to the conventionalroles of masculinity and femininity is short-circuited.
Health values and goals hide the possibility from trans­
sexuals themselves of being “history-bearing individuals”
who, instead of conforming to sex roles, are in a uniqueposition to turn their gender agony into an effective
protest against the very social structures and roles thatspawned the dilemma to begin with. Rieff has pointed outthat therapies and, by extension, I would say the medical
model in general, consist “ chiefly in participation mys­tiques severely limiting deviant initiatives.”6 Individuals
are trained through what Rieff calls “ritual action” to ex­press fixed wants. “The limitation of possibilities [is] thevery design of salvation.”7♦There is no simple definition of “ counsciousness-raising,” which
will be discussed in the Appendix. Briefly, and in this context, it canbe defined as a mode of counseling that places so-called personal
problems within the larger arena of a patriarchal society. At theheart of such a process is the recognition that “ the personal is politi­cal. ”

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Therapy as a Way of Life

Thus be-ing is reduced to well-being (therapy), andethical choices are reduced to health values.

THE DE-ETHICIZING OF PROBLEMS AND BEHAVIOR

One of the major effects of the medical model has been
the de-ethicizing of problems and behavior. De-ethicization
occurs when problems that have moral implications aredefined as if they had none, or are redefined or reclassi­
fied, for example, as “therapeutic considerations,” or“ health issues,” or “psychiatric management” problems.
The “triumph of the therapeutic” has made transsexualism
the “territorial imperative” of the psychologist, psychia­
trist, and/or mental-health worker.
Thomas Szasz has noted that the conquest of human ex­
istence by the mental-health professions started with theidentification and classification of so-called mental ill­
nesses, and has culminated in our day with the claim that“all of life is a ‘psychiatric problem’ for behavioral scienceto ‘solve.’” 8 Szasz has attempted to show that persons,by seeking relief from the burden of what are actuallymoral responsibilities, mystify and “technicize” t h e i r“problems in living.” In turn, this hunger for help andhealth is fed by a behavioral technology ready and willingto free such persons of their moral burdens. Indeed, Szasz
contends that the “mandate” of the contemporary psy­
chiatrist is precisely “to obscure,” and moreover “todeny” the ethical dilemmas of life, and to transform these
into medical and technical problems susceptible to theirsolutions.9 In this same way, transsexualism has been categ­
orized as a medical and technical problem that is only
resolvable by medical and technical specialties.
Mystification is at work throughout the transsexual
odyssey. It operates in a variety of areas: in the claim that
one is, for example, a man trapped in a woman’s body; inthe obscuring of the social components of the problem;in the hidden political dimensions of therapy; in the var­ious individualized explanations; and in the very language

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The Transsexual Empireof transsexualism itself. As demonstrated earlier, it is bio­
logically impossible to change chromosomal sex, and thus
the transsexual is not really transsexed. As Dr. Georges
Burou, a French physician who specializes in male-toconstructed-female transsexualism phrases it: “I don’tchange men into women. I transform male genitals into
genitals that have a female aspect. All the rest is in thepatient’s mind.” 10 Or as Jan Morris inadvertently stated:“ I wear the body of a woman.” 11
De-ethicization, of course, is defended in the name ofscientific knowledge and neutrality. However, neutrality
is a myth and the politics of diagnosis and therapy remain.
So too do the philosophical-ethical dimensions of the psy­chological craft. Under the guise of science, psychologicalexplanations often include value judgments. For example,
when John Money and Patricia Tucker assert: “Once a sex
distinction has worked or been pressured into the nuclear
core of your gender schema, to dislodge it is to threaten
you as an individual with destruction,”12 they are using
popularized pseudoscientific language where the “ oughts”
have been deleted, yet where they permeate the sentence.
Thus the reader translates: “Once a sex distinction has
worked or been pressured into the nuclear core of yourgender schema, one should not dislodge it, else the indivi­
dual is threatened with destruction.” One might also ask
here, destruction by whom? by what? Once more, theagent is deleted.
The process of the de-ethicization of behavior by psy­chology and psychiatry has particular relevance for dis­cussions of transsexualism and the consequences which
follow. By attributing transsexualism to biological or psy­chological causes, scientists, as stated previously, are con­veying that there are only two choices: (1) adjustment to
one’s body-role; or (2) surgery and counseling to transform
one’s body and role. In effect, both of these choices arebiomedical—choice number one adds up to biology-isdestiny, and choice number two states that, this failing,hormonal and possibly surgical treatment (contingent
upon one’s “ passing,” of course) are indicated. Either way,

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Therapy as a Way of Lifethe transsexual cannot really make an ethical choice be­cause there are no choices to make. The only “choices”
represented are those that bio-medicine dictates in thisculture. The wider range of choices and the discovery of
meanings that would be available to one who could live
beyond sex roles, but in one’s native body, are not madeavailable. Such reductionism and restricted counseling
fetishize the transsexual issue.

THERAPEUTIC FETISHIZATION

In discussing the various theories of transsexualism, I
often noted that both biological and psychological theories
reduced the issue of transsexualism to individual or inter­
personal causes. Another way of viewing this, and thus un­derstanding the reductionism more clearly, is to consider
these theories as fetishizations of the social. Not only thetheories, but the whole gamut of psychologizing, restrict
the issue to a very superficial area.
Ernest Becker, in The Structure o f Evil, discusses thefunction of fetishization. He views it as an attempt, insome manageable way, to come to grips with a portion ofreality which is substituted for the whole. Fetishization,for example, is one explanation why law-enforcement offi­
cials in our society are so obsessed with issues of traffic
violations, marijuana, and the like, but cannot cope withthe much more serious problems of rape and murder. As
Becker contends, the lesser problems, and the attention
they receive, are social fetishizations of the problem of
morality in modem times.13 In the case of transsexualism,
it would be an overwhelming burden to attack the problem
of sex-role socialization on an individual, never mind so­
cial, level. Therefore, it is easier, applying a fetishized
logic, to confront the problem within patriarchal identity
and role limits, thereby making use of a ready-made sys­
tem of knowledge and therapy that treats the problem in­dividually on a post-hoc basis.
Moreover, the fetish object is precisely the one that

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The Transsexual Empire

presents itself to our eyes in the most striking and compel­ling way. Obviously in the case of transsexualism, thatwhich is most directly and immediately expressed (fromthe perspective of the transsexual, especially) is the feel­ing/knowledge that one is a woman “ trapped” in the bodyof a man. Subsequent behavior and dress reinforce this“ felt” identity and role. Evaluating whether or not a trans­
sexual can “pass successfully” in the role of his or her de­sired sex monopolizes the attention and energies of those
professionals in the gender identity clinics who should be
evaluating the culturally prescribed roles themselves. In
this same context, the reality of transsexualism is ex­
plained by the supposed effectiveness of sex-conversion
surgery as the ultimate cure. These are all examples ofwhat Becker calls “fetishizing the field,” or “creating a lo­
cus of meaning in a very narrow sense, in order to be able
to have some reality that calls upon one’s adaptive ener­
gies.”14
Transsexuals and transsexual “ experts” focus on the
genitalia of the opposite sex—the desired breasts andvagina, or the construction of an artificial phallus. These
artifacts come to incarnate the essence of femaleness ormaleness which the transsexual so urgently desires. The
medical literature on transsexualism is filled with photo­graphs, plates, and anatomical drawings of sexual organs
that have been constructed “onto” the postoperativetranssexual, in such a way as to highlight the “naturallook” that the knife has wrought. Interestingly, thesephotographs seldom show the whole person. With a zoom
lens effect, they center upon the breasts or phallus. Thus
the photographs themselves illustrate the fetishizing oftranssexualism The medical-surgical solution begins toassert control in the narrow area of the chemical and sur­gical specialties. Attention becomes focused upon con­structing the vagina, for example, in as aesthetic a way as
possible.
What Becker amplified in his discussion of fetishism,
Seymour Halleck discusses under the heading of “thepolitics of symptoms.” Halleck points out that treatment

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Therapy as a Way of Life

which focuses on symptoms rather than on broad social
or existential issues is very likely to be efficient. In thecase of transsexualism, we see that 90 percent of trans­
sexuals report satisfaction postoperatively.IS However, as
Halleck explains, this kind of satisfaction is achieved at theexpense of exploring the social meaning of the symptoms.
By the instrumentality of hormones and surgery, thesymptom is certainly removed but so is the indirect evi­
dence provided by the symptom that something is amisson a deeper level. Therefore, after medical intervention,transsexuals may have less power to cope with the forcesof oppression than before they started treatment, sinceat this point, they fit into a role-defined world almost
completely. Any critical awareness is thus diffused. Since
the result of hormonal and surgical treatment is that thetranssexual becomes an agreeable participant in a society
which encourages sexism, primarily by sex-role oppression,then the moral and political implications of that treatment
must be questioned. In this sense, transsexual surgery is a“social tranquilizer.” For the sake of “health” and “well­being,” the status quo of patriarchy is strengthened.

THE POLITICS OF TRANSSEXUAL THERAPY

Value freedom and political neutrality have long been ad­
vocated in psychiatry and the professions in general. But
Seymour Halleck, in 1971, asserted what is by now a com­monplace—that any kind of psychiatric or counseling inter­
vention will have an impact upon the distribution of powerin society. Psychiatric neutrality, in this perspective, is a
fiction. Implicit in Halleck’s position, of course, is theassertion that the psychiatrist or counselor is a social en­gineer, because any counselor has some preconceived ideasof what is good for people, whether these be implicit or
explicit. Such values are transmitted to the person seeking
help. Whatever route the counselor goes, she/he will either
encourage the person to accept or to change the existing
distribution of power.

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The Transsexual Empire

As Halleck further points out, there is a strange ten­dency among counseling professionals to assume that any
counseling intervention that is not explicitly political orthat does not change the status quo is neutral. Whereas
any professional activity that is explicitly change-oriented
is designated as “political.” Szasz formulates this same idea
in a somewhat different way, emphasizing the social andethical dimensions of a counselor’s therapeutic stance.
Difficulties in human relations can be analyzed, interpreted, andgiven meaning only within specific social and ethical contexts. Ac­
cordingly, the psychiatrist’s socio-ethical orientations will influence
his ideas on what is wrong with the patient, on what deserves com­ment or interpretation, in what directions change might be desirable,
and so forth. 16

In our society, political power is based on sex. Kate
Millett stated this most effectively back in 1970 in her
work aptly titled Sexual Politics. By politics, she does notmean the word in the narrow sense but is referring to“power-structured relationships, arrangements whereby
one group of persons is controlled by another.”17 The
title, Sexual Politics, implies that the sex into which one
is bom and all that goes with biological maleness or
femaleness create a category with political implications.
The personal is recognized as political, and personal inter­action between women and men is thereby seen to bepolitical.
What goes largely unexamined, often even unacknowledged (yet isinstitutionalized nonetheless) in our social order, is the birthrightpriority whereby males rule females. Through this system a mostingenious form of “ interior colonization” has been achieved. It is
one which tends to be sturdier than any form of segregation andmore rigorous than class stratification, more uniform, certainly more
enduring. However its present appearance may be, sexual dominion
obtains nevertheless as perhaps the most pervasive ideology of ourculture and provides its most fundamental concept of power.18

Whereas any therapy affects the distribution of power insociety, the relationship between transsexualism and sex­

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Therapy as a Way of Lifeual politics is a unique one. The encouragement that isgiven to transsexuals in therapy to conform to society’sroles of masculinity and femininity supports the very
bulwark of sexual politics—that is, sex-role socialization.
Furthermore, such therapy is not only political but
morally manipulative. Therapy not only affects the distri­bution of power, but also brings about the alteration ofvalues. What we have here is a very sophisticated form of
behavior control and modification, on both the individual
and the social level.
TRANSSEXUALISM AS BEHAVIOR CONTROLAND MODIFICATION

Transsexualism, as a proclaimed form of therapeutic sur­gery for nonphysical disorders, is located on a historicalcontinuum of similar medical ventures, all of which legiti­
m a te ^ ) bodily intervention for purposes of improving
behavior. In the nineteenth century, clitoridectomy forgirls and women, and to a lesser extent, circumcision forboys were accepted methods of treatment for masturba­
tion and other so-called sexual disorders.19 In the 1930s,
Egas Moniz, a Portuguese physician, received the Nobel
Prize for his “ ground-breaking work” on lobotomies.
Moniz operated on state mental hospital inmates, using
lobotomy for everything from depression to aggression.
The new terminology for brain surgery of this nature
today is psychosurgery, which its proponents have at­
tempted to disassociate from the cruder procedures of
Moniz and others by pointing to its more “refined” sur­gical techniques. But call it lobotomy or psychosurgery,
surgeons continue to intrude upon human brains on thebasis of tenuous localization theories that supposedly
pinpoint the area of the brain where the “undesirable”
behavior can be found and excised.20 Finally, transsexual
surgery is justified on the basis of adjusting a person’s
body to his/her mind.
What each of these surgical ventures has in common is

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The Transsexual Empire

that they derive their therapeutic legitimacy from a medi­
cal model which locates behavioral problems within certain
affected organs. Surgery then alters, intrudes, removes and,in the case of transsexualism, adds organs. In each venture,a surgical fetishizing takes place, reducing the social com­ponents of the problem to the most tangible and manage­
able forms.
Further, what each of these surgical ventures has incommon is the modification and control of behavior.
Clitoridectomies modify sexual behavior or fantasied
sexual behavior; psychosurgery modifies the gamut of
behavior from hyperactivity in preteen children to socalled manic depression in dissatisfied housewives; trans­
sexual surgery modifies everything that comes under
the heading of masculine and feminine in a patriarchal
society—thus practically everything.
In the case of transsexualism, behavior modification isboth a prerequisite for and an effect of the surgery. Prior
to the operation, gender identity clinics and professionals
require that transsexuals alter their behavior to conformto the prescribed gender role the person desiring transsex­
ual surgery wants. In this context, it can also be pointed
out that sex-role conditioning itself is a form of behavior
control (i.e., the control that a patriarchal society exer­
cises over its members). Yet, with a good number ofpeople, this form of social control has been unsuccessful.
This has happened with the transsexual, who has not beenadequately conditioned into the role/identity that accom­
panies his or her body. Instead of seeing this unsuccessful
conditioning and gender dissatisfaction as a “signal of tran­
scendence,” however, the transsexual seeks out (with thehelp of the transsexual technicians) another mode of be­
havior modification, which is transsexual treatment andsurgery. This latter form of behavior modification andcontrol then reinforces, for the transsexual, in several
hormonal and surgical strokes, the behavior that it took
years of sex-role conditioning to impose upon persons who
belong to the sex that the transsexual desires. Thus wehave a multiplication of modes of behavior modification:

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Therapy as a Way of Life

1. Sex-role conditioning that accompanies a male or female
body and, which, in the case of the transsexual, fails.
2. Sex-role reconditioning which accompanies and is a pre­requisite for the body that the transsexual seeks and which
the transsexual technicians (psychological and surgical)
encourage and reinforce.
3. Transsexual treatment and surgery which solidify thepresurgical conditioning.
Reinforcement is a key word for behaviorists. One of
the central claims of B. F. Skinner is that the immediacyof reinforcement is what shapes successive behavior in
all “learning animals.” Skinner differs from classical con­ditioning theorists (e.g., Pavlov) in saying that behavior
is shaped by what follows it rather than by what precedes
it. In the past, most psychologists of this persuasion had
assumed that new attitudes were necessary to develop new
behavior. Skinner turned this around and said that new
attitudes follow or accompany changed behavior.21
In the case of the male-to-constructed-female trans­
sexual, however, feminine behavior is shaped by thepromise of what is to follow—that is, a changed body. En­
couraged by the gender identity clinics to prove transsex­
ual status by their ability to pass as feminine, transsexuals
seek hormone treatments and ultimately sex-conversion
surgery as positive reinforcement of further stereotypicalbehavior. Thus transsexual counseling and clinics sire very
good examples of Skinner’s “operant conditioning” philos­
ophy: the controller, using a series of carefully plannedschedules of positive and/or negative reinforcements(shortening or lengthening the “passing” time) brings
about desired responses (stereotypical behavior) from thetranssexual.
However, the most significant point in Skinner’s philos­
ophy is that the controller will exert hardly any control,
because the controlled will control themselves voluntarily.
Coercion, in the traditional sense, will not have to be em­
ployed. Skinner creates a utopia where people “will” tolive. (Somewhat contradictorily, however, freedom is a

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The Transsexual Empire“mentalistic concept” in the Skinnerian schema.) It isclear that voluntarism is a very deceptive construct in a
behaviorist framework.
In like manner, the concept of voluntarism is decep­
tively highlighted in the transsexual literature. Sex-conver­sion surgery is not forced upon transsexuals. The trans­
sexual researchers and clinicians emphasize that persons
who desire to change sex seek such treatment eagerly.
Like the benevolent behaviorism in Skinner, transsexual
surgery is presented as something thousands request,
many of whom are turned away.
To use another example: Many oppressed people use
heroin to make life tolerable in intolerable conditions.
Heroin usage is a highly effective yet dangerous treatment
for dissatisfaction and despair. Recently, for example,
black leaders have drawn attention to heroin as a pacifierof black people. As Jesse Jackson has phrased it: “We havecome from the southern rope to the northern dope.” Ina strict sense, one cannot say that the drug is forced upon
its users. Indeed they seek it eagerly. But in the long run,the willing use of the drug strengthens the position of the
oppressors and the oppressed. The contentment and eu­
phoria produced by the drug diffuses the militancy, or
potential militancy, of the user. Thus heroin is a tool of
behavior control and modification.
Transsexual surgery, in much the same way, produces
satisfaction and relief for the transsexual. In contrast to
more overt, coercive forms of behavior control and modi­
fication, such as involuntary commitment in prisons ormental institutions, or “informed consent” obtained whilein these same institutions, transsexualism appears to beblissfully and freely chosen. Yet just as commentators haveasked how a truly “informed consent” can be obtained ina coercive context, such as a prison or mental institution,
I would pose the question: how can transsexuals truly give“informed consent” and freely choose to convert to the
opposite sex anatomy and role when the coercive power of
sex-role socialization is filtered through all institutions in

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Therapy as a Way of Lifea patriarchal society? Not that such socialization is deter­
ministic, but rather that it deeply conditions one’s choices
as well as one’s motivation to choose. In a traditional
sense, no one forced the transsexual to change sex. No one
forced the transsexual to start hormone therapy. No one
forced the transsexual into opposite-sex roles and be­
havior. But in a society where masculinity and femininity
accompany a male or female body, the options are limited,
if one does not have a context of support to transcendthese roles. When the transsexual experts maintain thatthey use transsexual procedures only with people who ask
for them, and who prove that they can “ pass,” they ob­
scure the social reality. Given patriarchy’s prescription that
one must be either masculine or feminine, free choice isconditioned.
What is significant here is that either way—by outrightcoercion or by employing an individual’s “voluntarism”
against herself or himself—the coercive impact is the same.
As Willard Gaylin has noted in a different context: “Its[society’s] coercive impact, incidentally, is just as great
whether it was designed to produce the effect, or whether
the effect was an accidental historic and developmental
spin-off.”22
We are at a point in the history of behavior control andmodification where we must be very aware of its more
subtle forms. Most people recognize the manipulation ofhuman behavior and emotions at its most extreme—whenthat manipulation is organized, or when physical agentsare used. Many people, however, would not perceive trans­
sexual surgery as a form of behavior control and modifica­tion, even though physical instrumentation is used, be­cause the concept of voluntarism has taken hold, and thecoercion of a role-defined environment is not recognized
as an influential factor. Furthermore: “It may be that thegeneral population resists the idea of seeing emotional co­
ercion in the same terms as physical coercion because it
threatens basic beliefs about man’s autonomy, because
one likes to think of himself as a logical individual under

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The Transsexual Empire

the control of intellect rather than emotion.”23 But, ofcourse, social controllers have been well-known for con­vincing the individual that she/he is in control.
Thus it is important, in the transsexual context, to ex­
amine the whole issue of control. Who is controllingwhom? Presently, the controllers are the gender identity
clinics and the transsexual experts who staff them. It is
not far-fetched to conceive of a “gender identity busi­
ness,” as such institutions proliferate, functioning as
centers of social control. We now have violence control
centers, such as Vacaville, which, in the words of its mainorganizer, has been designed to focus on the “pathologi­
cally violent individual” and is aimed at “altering unde­sirable behavior.”24
As the gender identity clinics expand and the tolerance
for transsexual surgery grows, it is not inconceivable thatsuch clinics could become sex-role control centers, fordeviant, nonfeminine females and nonmasculine males, aswell as for transsexuals. Such gender identity centers are
already being used for the treatment of designated childtranssexuals. The use of behavior modification and control
is presently very widespread. It is fast becoming a tool ofAmerican law enforcement, and funding for it from stateand government sources has been documented.25 Further­more, we can safely predict, on the basis of past andpresent CIA and FBI activities, that if gender identity
facilities became government controlled, some gendermodification activities would be reported while others
would be repressed from public view; only those offeringa therapeutic rationale would be revealed. Moreover, suchcontrollers and centers for control (such as Johns Hopkins
and U.C.L.A.) would continue to have a very specific phi­losophy about what women and men should be, how theyshould act, and what functions they should perform insociety. In fact, gender identity clinic research and treat­ment has already been funded by grants from the National
Institute of Mental Health and other government-affiliatedfunding sources. All this is happening, and will continue
to happen, of course, in the name of science and therapy,

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Therapy as a Way of Lifeand with the denial that any social engineering is taking
place. Here we have institutional sexism at its most func­
tional capacity.
A dystopian perspective, some will say, but such per­spectives have a way of highlighting present and future
reality by daring to predict what most persons do not, or
choose not to, perceive. The point is that sex roles alreadydo not have to be “ forced” upon people; most quickly
give “informed consent.” But feminism has been fast
chipping away at the institutions of sex-role conditioning
in this society. Threatened commentators from a patriar­
chal perspective have been quick to call feminism “sex­ual suicide.”26 Just as Drs. Vernon Mark, William Sweet,
and Frank Ervin suggested in the Journal o f the American
Medical Association that psychotechnology could be used
for the repression of violence in the Detroit ghetto rebel­lion of 1967,27 it is not inconceivable that Drs. X, Y, andZ could propose sexual technology for the repression of
sex-role deviancy. It has been done before (e.g., clitoridectomies) and it can be done again. It would all be partand parcel of present “voluntaristic” therapies for the
repression of deviancy. Individuals undergo psychosurgery
giving “informed consent” ; parents, on advice of school
administrators and physicians, sign “ informed consent”
papers to have Ritalin administered to their children in
public-school centers; women “ consentingly” undergo un­necessary hysterectomies for prophylactic reasons such as
the vague “ threat” of uterine cancer (imagine a prophylac­
tic penectomy!)
The potential for the benevolent control of sex-role
behavior is enormous. It is my contention that it has al­
ready begun in the gender identity clinics. But control
here has entered with a whimper, not with a bang. And
conformity is being enforced in the name of therapy, atthe individual’s request, and with the effect of 90 percent“satisfied customers.” If behaviorist philosophers such as
B. F. Skinner are right, and behaviorist technicians such as
Jose Delgado remains active, then future social controllers
can replace control-through-torture with control-through-138

The Transsexual Empire

pleasure. What is becoming possible with Delgado’s elec­
tronic brain stimulation (ESB) is also becoming possible
with transsexual surgery. The following two observations
are not all that different. From Delgado:
Electrodes were implanted in her right temporal lobe and upon
stimulation of a contact located in the superior part about thirty
millimeters below the surface, the patient reported a pleasant tin­gling sensation in the left side of her body “ from my face down tothe bottom of my legs.” She started giggling and making funnycomments, stating that she enjoyed the sensation “very much. ”
Repetition of these stimulations made the patient more communi­
cative and flirtatious, and she ended by openly expressing her
desire to marry the therapist.. . . The second patient expressed her
fondness for the therapist (who was new to her), kissed his hands,
and talked about her immense gratitude for what was being done
for her. 28

And in the case of transsexuals:
Typical comments after the operation included feelings of deep
satisfaction at having achieved, as they felt, a true female status,
despite admission that they were in fact only castrated, feminizedmales. They reported an absence of self-consciousness and a feelingof being at ease and of having ultimately achieved a happy state withmore peace of mind. Increased feelings of femininity occurred alongwith the development of a sense of identity with all women. They
began to think of themselves as women rather than as disabledmales. The fear of detection and of being suspected disappeared
despite the fact that several were not entirely credible as females.
Several described a sense of release and a change of mental attitude;
they felt that it was now impossible to prove that they were not
women. Most expressed a level of satisfaction in their new castrated
status far superior to anything they had experienced as men. Ac­
ceptance as women by other women and by the world at large wastheir ultimate satisfaction. The possession of a female vulva was ofsecondary importance to this. 29

In both examples, we see expressions of sweet, intense,and protracted satisfaction or, as one commentator has
called it, “total body orgasm.” Humans have been known
to withstand even the most intense torture. It is doubtful,

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Therapy as a Way of Life

however, that we could withstand the most intense plea­sure.* As William Irwin Thompson has noted:
If the momentary “total orgasm” experienced when a drug addict
injects Methedrine is sufficient to alter the personality, then it isobvious that a total body orgasm protracted over a period of hours
or days would be sufficient to alter a person’s perception of time,
his perception o f his own life history, and the self-image and charac­
ter structure derived from these. From the point o f view of the beha­vioral scientist, this would be pleasant work in what could be ami­able surroundings.30

The transsexual counselors’ and technicians’ apparent
purpose, of course, is neither to control nor to create
massage parlors of pleasure, but to provide therapeutic
relief for those persons who feel themselves burdened with“the wrong mind in the wrong body. ” However, the final
irony, as Thompson has stated, is that “at the end of
humanism, it is the human body that has become thebattleground.”31 I would add further than the real final
irony is that at the nemesis of patriarchal civilization, all
the silicone breasts and artificial vaginas cannot put man
back together again!

TRANSSEXUALISM AS MEDICAL EXPERIMENTATION

Therapy has historically covered a multitude of medical
sins. The welfare of the individual or the welfare of society♦Adrienne Rich has suggested in contrast to this interpretation, th a t
w hat really happens is th a t control works through the co ntroller’s
pow er to cut off pleasure at any point, rather than through his
pow er to confer pleasure. She also points o u t th a t there is a “ social
situation o f pleasure” to which persons are conditioned. For ex­
ample, a w om an who is socialized to identify orgasmic pleasure withbeing handled and controlled by a man will more easily be stim u­
lated to pleasure by electrode brain im plants than a woman whose“ social situation o f pleasure” does n o t include such handling andcontrol. W hat Rich is saying is that, for such wom en, ESB wouldn o t be pleasurable in any sense they could identify as free hum an
beings.

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The Transsexual Empire

has often provided a camouflage for the worst forms ofexperimentation. We have seen how therapy relates to be­havior control and modification. What also becomes ob­
vious is that therapeutic goals can mask experimentation.
First of all, the nature of transsexual surgery is experi­mental on physical grounds alone. There is a substantial
amount of evidence that transsexual hormone therapy andsurgery cause cancer.32 Transsexual treatment is far fromestablished as a safe medical procedure and as such is still
experimental. Secondly, transsexuals are “volunteering”
for surgery that they hope will relieve their sex role“dis-ease” of gender dissatisfaction and dysphoria. But
there is no evidence to prove that transsexual surgery“cures” what is basically a problem of transcendence. In
other words, sex-conversion surgery cannot bestow upon
the transsexual the sense of self that she/he lacks. Further­more, there is evidence, at least in some postoperative
cases, that transsexuals themselves have come to realize
this, but too late.33 Third, and most importantly, we have
yet to see the total “ fall out” effect of transsexualism inenforcing the further institutionalization of sex roles.
Until this is obvious, transsexual surgery is still experi­mental in terms of what effects it will have upon an al­
ready rigidly gender-defined society. And if it is true thatthe female-to-constructed-male transsexual is merely atoken who provides the “illusion of the inclusion” ofwomen into the transsexual context,* then one hypothe­
sis that is being tested in the transsexual “laboratories” iswhether or not it is possible for men to diminish the num­
ber of women and/or to create a new “breed” of females.
Again, I would emphasize that this is not a mere feminist
flight of fantasy. Scientists have already stated their“scientific” interest in diminishing the numbers of women.
Take, for example, the words of the well-known biolo­
gist John Postgate in his ringing defense of sex-selection
technology. Postgate defends what he calls a “male child”
pill by offering it as a proposed panacea for world popula♦See Chapter I.

141

Therapy as a Way of Lifetion problems. In words that, upon first reading, appear
to be satire, we quickly come to realize that Postgate isdeadly serious (deadly to women, that is).
Imagine what would happen if a male child pill became freely avail­able throughout the world through the World Health Organization.
Even in developed countries there is surprising prejudice among
ordinary people in favour of having male children; among mostAfrican, Asian, Central and South American peoples, this prejudice
amounts to almost an obsession. Countless millions of people would
leap at the opportunity to breed male: no compulsion or even pro­paganda would be needed to encourage its use, only evidence of suc­cess by exam ple.. . . I hope, incidentally, that it is obvious why I
specified a “ man child” pill; one selecting for females would notwork. 34

As far as the leftover women would be concerned, Postgate
has thought of everything.
All sorts of taboos would be expected and it is probable that a formof purdah would become necessary. Women’s right to work, evento travel alone freely, would probably be forgotten transiently.
Polyandry might well become accepted in some societies; somemight treat their women as queen ants, others as rewards for themost outstanding (or most determined) m ales.. . . Whether theworld would come to resemble a giant boy’s public school or a hugemale prison is difficult to predict. 35

Finally, the social results and economic consequences of
all this, Postgate predicts, would be “self-regulating.”
Some of the ethical issues that have been discussed in
the biomedical literature on human experimentation takea different turn when applied to transsexuals.36 One issue
that recurs in the literature on human experimentation
again and again is that of weighing the integrity of an indi­vidual experimentee’s rights against the benefits that may
accrue to society. This issue has often been discussed in
the context of an individual who risks her/his health inan experiment designed to acquire knowledge about aspecific disease thereby benefiting society, but not neces­sarily directly benefiting the individual concerned. How­ever, there is a reversal of these priorities in the transsexual

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The Transsexual Empire

situation, which focuses on the alleged benefits that accrue
to the individual. In this instance, it is the ill effects that
accrue to society that must be questioned. Transsexual
surgery is professedly done to promote the individualtranssexual’s right of synchronizing body and mind. Yet
what society “gains” is a role conformist person who rein­
forces sex roles.
Pleasure and Pain: Medical Theodicies. A second issue thathas been discussed in the wider medical context of humanexperimentation is whether medicine is obliged to alleviate
all suffering, that is, whether it should make the world“disease-free.” In the case of transsexualism, there aremany ethical objections to alleviating individual gendersuffering at the expense of reinforcing, qualitatively andquantitatively, sex-role conformity. Ivan Illich’s words
are applicable: “Medical civilization teaches that suffering
is unnecessary, because pain can be technically elimi­
nated.. . . The subject is better understood when the social
situation in which pain occurs is included in the explana­tion of pain.”37 However, my main point has been to showthat the social situation has not been “included in the
explanation of pain.” Instead transsexual technicians
and therapists and, by extension, transsexuals, engage
in smothering the intrinsic question mark that gender“dis-ease” produces about the society in which it arises.
Medical theodicies, however, unlike many religious ones,
are not passive but proclaimedly curative. One’s reward is
not in the next life but in this life. The ethic is reversed;
do not suffer now but seek ye another body! The activityof this medical theodicy involves several steps. First ofall, the transsexual therapists relate the anomic expe­
riences of the gender-dissatisfied individual to a condition“known” as transsexualism Once named and institution­
alized in gender identity clinics, the “condition” of trans­
sexualism explains why one would have the wrong mind in
the wrong body. Secondly, like all theodicies, the medical
theodicy is undergirded by an attitude of the surrender ofself to the ordering power of the transsexual therapists

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Therapy as a Way of Lifeand technicians. The medical order confronts transsexuals
with a meaningful reality that comprehends them and alltheir experiences. It bestows sense on all their experiencesthat once seemed so unfathomable. It enables someone
like Jan Morris to order, in chronological fashion, the steps
in his transsexual odyssey from the age of three when he
first “realized he was a woman” as he sat under his
mother’s piano listening to Sibelius, to his conquest of
Mt. Everest and last fling with masculinity. As Peter Berger
has noted:
The individual who adequately internalizes these meanings at thesame time transcends himself. His birth, the various stages of his
biography. . . may now be interpreted by him in a manner thattranscends the unique place of these phenomena in his experience.38

More importantly, the denial and surrender of the self
is facilitated by the transsexual order. “This is the attitudeof masochism, that is, the attitude in which the individual
reduces himself to an inert and thinglike object vis-a-vis his
fellowmen.. . . In this attitude, pain itself, physical ormental, serves to ratify the denial of self to the point
where it may actually be subjectively pleasurable.”39
What has been scarcely noted in many commentaries
on transsexualism is the immense amount of physical painthat the surgery entails. Generally, this fact is totally mini­
mized. Most postoperative transsexuals interviewed seldomcommented on the amount of physical pain connectedwith their surgery. Are we to suppose no pain is involved?
Anyone who has the slightest degree of medical knowledge
knows that penectomies, mastectomies, hysterectomies,
vaginoplasties, mammoplasties, and the like cannot be
painless for those who undergo them. There is also thepain of anxiety about possible consequences of surgerysuch as cancer or faulty healing. It seems that the silence
regarding physical pain, on the part of the transsexual, canbe explained only by an attitude of masochism, where oneof the key elements of the transsexual order is indeed thedenial not only of self but of physical pain to the point“where it may actually be subjectively pleasurable,” or atleast subjectively negligible. At least one medical team

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The Transsexual Empire

has recognized this, although in muted and partial form.
Categorizing primary clinical types who request sex reas­
signment, they label one type as masochist (or sado­
masochists
The masochists find that sexual arousal is facilitated by the expe­
rience of pain prior to sexual activity: they look upon the sur­gical excision of the genitalia (albeit unconsciously) as a form ofmasochistic adventure with the surgeon.40

Ernest Becker has stated that masochism is anotherword for “poverty of behavior,” as is sadism.
The sado-masochist is someone who has trouble believing in thevalidity and sanctity of people’s insides—their spirit, personality, or
self. These insides could be his own or others’; if they are his own hetends to be masochistic, if they are others’ he tends to be called asadist41

Transsexuals, as masochists, have great difficulty in be­lieving in the validity and sanctity of their own insides.
They are attempting to gain a sense of self not only
through the acquisition of a new body, but through thepain involved in this process. Physical pain is a constantreminder to transsexuals that they are finally coming
alive.
In the transsexual’s quest for what may be regarded as a
deeper self, pain provides the illusion of profound change.
Pain is necessary to confirm what is regarded by the trans­
sexual as more than a superficial change. This, in one way,
explains why transsexuals do not settle for cross-dressing.
Transvestism, for them, is too superficial and does notprovide the bite or the painful experience of true con­version. Transsexuals, in their experience of pain, feelthey have thus reached the essence of female or male exis­
tence.
There is also the element of sadism which is, of course,
the other side of the masochistic coin.
The esthetics of the sadist is thus partly due to the deficiencies of
his own self: in order for reality to be convincing, in order for him
to feel his maximum powers, he wants the world to be peopled with

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Therapy as a Way of Life

concrete manipulatable objects, with objects that do not have any
elusive insides. This is the reason that he expends all his effort on
manipulating the flesh: either he cannot deal with the insides ofothers or he will not recognize these insides as valid.42

The transsexual therapist—in adjusting the transsexual
mind and behavior to the stereotype of the desired sex—
and the medical specialists—in adjusting the transsexual
body to the desired body-type of the opposite sex—are
dealing with transsexuals as manipulatable objects and re­ducing them to the world of appearances. “Here we canunderstand the inter-changeability of the sadistic andmasochistic postures. These are terms which describe one
and the same thing: weakness and felt limitation in one­
self; sharp duality of spirit and matter in people.” 43 The
sadist, as well as the masochist, cannot relate to the in­finite possibilities of the spirit and confines these spiritualpossibilities to the world of matter. Thus the potentiality
for infinite be-ing is reduced to static being, where it canbe rendered safe and deprived of its power to transformthe gender-defined self and the gender-defined society.
It is in this way that religious theodicies have restricted
not only the selfhood but the social protest capacity of
their believers. In so doing, of course, they have also di­rectly legitimated the institutional order in question. As
Berger has noted, “the theodicy constitutes an essentiallysado-masochistic collusion, on the level of meaning, be­tween oppressors and victims.”44 On both sides, the result
is one of “world-maintenance,” and in the transsexual
context, the maintenance of the particular institutional
order of patriarchal society.
A not-so-incidental by-product of this particular medical
theodicy is the enlargement of medical knowledge about
manipulating organs of the body which specifically func­tion to define biological sex. This, of course, works to theultimate benefit of the sadistic side of the theodicy, en­abling medical research and technology to acquire a spe­cialized body of scientific knowledge on the manipulationof human sexuality that probably could not be acquiredby any other accepted medical procedure. At least two re­

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The Transsexual Empire

searchers have admitted this, although the admissions, ofcourse, are mixed with therapeutic qualifications. Richard
Green has stated:
To a considerable degree, the medical profession itself is responsible
for the limited extent of knowledge which currently exists abouttranssexualism and sex reassignment. While the current availabilityof gonadal hormones and the refinement o f surgical techniques havemade it possible to partly realize the fantasies and aspirations of
the transsexual and have brought about an increasing demand forsex reassignment, medicine , by closing the door to these patients forstudy and treatment, has cast away a population from whom con­siderable information about gender identity and human sexuality
could have been obtained. Particularly in the United States, untilvery recently, sex reassignment has been nearly unobtainable. Thus
transsexuals sought treatm ent elsewhere. Consequently, neither pre­operative screening nor postoperative evaluations were made. Rejec­tion of the transsexual’s request, rather than preventing him fromobtaining surgery, resulted in the highly motivated, affluent patient
still being able to obtain his reassignment, but, in the process, being
virtually lost to scientific study.45 (Italics mine.)

In a similar manner, Milton Edgerton has stated:
The current availability of reputable physician teams who offer
sincere efforts to understand and treat the transsexual patient may
represent the greatest progress that medicine has made over the past
decade in dealing with human gender disorders.. . . Certainly it

offers doctors an unrivaled opportunity to study and understandthe dynamics of gender as it relates to human function and self­
imagery. Plastic surgeons are beginning to realize that it is more

important to correct the patient’s “ sense of deform ity” or selfimage than to correct his external or objective deformity. 46 (Italics
mine.)

Thus transsexualism is made to appear as an “acceptable”
medical venture in which scientific opportunism is admit­
ted but only as linked to therapeutic and humanitarian
goals.
A third issue to consider is just how informed consent
can be attained, especially in the face of so many unknown
hazards about the experiment. First of all, a truly in­formed consent would highlight, for the transsexual, the147

Therapy as a Way of Life

whole issue of sex roles and gender definitions themselves.
It would reveal to him how moving from one stereotype
to its opposite does not even minimally alter the social
basis of sex-role conformity in this culture and how thetranssexual, in undertaking surgery, is reinforcing this con­formity. These are what might be called the social hazardsof the transsexual experiment. My survey of the literatureand first-hand interviews with transsexuals and transsexual
clinicians thus far have revealed that these social hazards,
or even their possibility, are not explored.
Furthermore, it has generally been recognized that thewithholding or distortion of any relevant knowledge thatbears upon the experiment constitutes a violation of in­formed consent. It is questionable whether even the phy­sical hazards of transsexual treatment and surgery are
explained to the would-be transsexual.
Finally, the issue of informed consent enters again in
the context of the ethics of experimentation. Discussions
on medical experimentation have focused on the questionof whether a truly informed consent can ever be obtained
from a “captive population.”47 As I have shown, trans­
sexuals are just such a captive population within a patriar­
chal society. Otto Guttentag has written:
It is generally agreed in our culture, experimental subjects must be
volunteers. What is meant by the word is, first, that the experimental
subjects who agree to volunteer are judged by society as free in thepsychological sense, as experiencing themselves ultimately as centerso f autonomy, whatever the contingencies; and second, that they are
free in the sociological sense, that is, not dependent upon the ex­perimenter to satisfy their spiritual or physical needs.48 (Italics
m ine. )First of all, how are would-be transsexuals free “in the psy­chological sense”? How can they be ultimately “centers ofautonomy” if their motivation to choose differently isheld captive by a patriarchal society, so that even what
they finally do choose (i.e., transsexual surgery) binds
them even more firmly to that society? Secondly, how
are transsexuals free in the “ sociological sense” when in-

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The Transsexual Empire

deed they do depend upon the experimenters to “satisfy”
their “spiritual needs” (the conviction and fulfillment of,for example, finally becoming a woman) and “physi­
cal needs” (e.g., acquiring the hormones and body of awoman)?
Learning from the Nazi Experience. Much of the litera­ture on medical experimentation has focused on thevarious captive populations of prisoners and mental pa­
tients, but the most notorious example of unethical medi­
cal experimentation on a captive population is the Nazi
concentration camps. The example of the Nazi camps hasoften been cited in ethical arguments that attempt to sen­sationalize and disparage opposing views. Furthermore,
ethicists especially have used these experiments to throwsand in people’s eyes about such issues as abortion andeuthanasia, and to create ethical arguments based on akind of domino theory. In mentioning the Nazi experi­ments, it is not my purpose to directly compare trans­
sexual surgery to what went on in the camps but rather todemonstrate that much of what did go on there can be ofvalue in surveying the ethics of transsexualism.
The specter of unethical medical experimentation
loomed large after the publicity that was given to the
Nazi concentration camps during World War Two. In
fact, one of the first comprehensive codes of medical
ethics, specifically dealing with the ethics of experimenta­
tion, emerged from the Nuremberg trials in the wake ofthe famous “Doctors Trial” or, as it is sometimes called,the “Trial of the Twenty-Three.”49 The Nazi medical
experiments read like a series of horror stories. The ex­periments were quite varied. High-aititude tests were doneon prisoners to observe the point at which they stopped
breathing. Inmates of the camps were subjected to freezing
experiments to observe the changes that take place in aperson during this kind of slow death, and also to deter­mine the point of no return. Experiments in bone-grafting
and injections with lethal viruses were commonplace. The

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Therapy as a Way of Lifemuch-publicized sterilization experiments were carried out
on a massive scale at several camps, primarily by radiationand surgical means, for the purpose of seeing how manysterilizations could be performed in the least amount oftime and most “economically” (thus anaesthesia was notused). However, the point of all this background is not
merely to recite a list of atrocities, but to highlight sev­
eral points that apply to the situation of transsexualism.
As Thomas Szasz has noted: “The activities of the Nazi
physicians. . . were, unfortunately, not the aberrations ofa holy healing profession imposed upon it by the terrors ofa totalitarian regime, but, on the contrary, were the char­acteristic, albeit exaggerated, expressions of the medical
profession’s traditional functions as instruments of social
control.” 50 Historically, many physicians aided the Inqui­sition, actively supported the military efforts of all na­
tions, and today serve as an “extralegal police force” tocontrol deviance, especially in the realm of psychiatry,which wields vast political powers. Today especially, it
is no longer the alliance of church and state that should befeared, that is, theocracy, but rather the alliance between
medicine and the state, that is, pharmacracy. 51 It is medi­cine that presently functions as the new secular religion,
with the continuous aid of sustained government support.
Not so incidentally, some transsexual research has been
funded by federal grants.
The Nazi doctors undertook many of their experimentsin the name of science but for the purpose of supposedly
gaining racial knowledge (e.g., how did skull measurements
differ between Aryans and non-Aryans?). The doctors whotreat transsexuals undertake many of their experiments inthe name of therapy but for purposes of gaining sexual
knowledge (e.g., is it possible to construct a functional
vagina in a male body? ). What we are witnessing in thetranssexual context is a science at the service of a patriar­
chal ideology of sex-role conformity in the same way thatbreeding for blond hair and blue eyes became a so-called
science at the service of Nordic racial conformity.

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The Transsexual Empire

This leads into the second point to be learned fromthe Nazi experience—the questionableness of detachedscientific fixation and so-called objective knowledge. It
must be remembered that such fixation and “objectivity”
led to one of the most profound inhumanities that theworld has ever witnessed. It is this kind of fixation, accom­
panied by a cult of objective truth, which helps to explain
why the Nazi doctors did what they did. “A profound in­humanity had long been presaged. This is the alchemy of
the modem age, the transmogrification of subject into
object, of man into a thing against which the destructive
urge may wreak its fury without havoc. ”52 One must
remember that many of the Nazi physicians whose experi­ments were the most brutal refused to recognize in the end
that they had done wrong. Dr. Karl Brandt, for example,
during his trial at Nuremberg, offered his living body for
medical experiments like those he had conducted.53 Be­
fore Brandt met his death at the side of the gallows, hemade a final speech, which included these words: “It is
no shame to stand on this scaffold. I served my Fatherland
as others before me.” 54
It is this kind of scientific fixation, among other things,
that impels doctors to pursue transsexual surgery when
there are so many more pressing concerns: when our ma­
ternal morbidity and infant mortality statistics are out­
rageously high; when there are still no adequate or fool­
proof means of birth control; and when breast cancer
ranks as one of the greatest killers of women. In otherwords, transsexual surgery is unnecessary surgery, per­formed in part because of the “objective” knowledge that
it offers to researchers and technicians on a subject thatis not knowable from other sources; it diverts time, atten­
tion, energy, and research money away from other medical
areas that are more pressing and need attention; it provides
a “marketplace,” so to speak, for the surgical talents ofdoctors; and it fattens doctors’ wallets. Transsexual sur­gery is not cheap. Prices range from $3000 to $12,000. As
stated previously, it is significant also that both govern-

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Therapy as a Way of Lifement and private medical insurance plans cover the costof surgery in some cases. This has always been a financial
incentive for doctors in performing surgery.
Unnecessary surgery is spiraling, especially during thelast quarter of a century. A House of Representatives sub­committee reported in July of 1975: “If the scalpels of
American surgeons remain as active as they are today,
nearly half the women in the country will undergo hys­
terectomies by the time they’re 70, and one of every three
men will have hernia surgery.” 55 The same committee
reported that at least one third of these operations was un­necessary and concluded that money was a basic factor in
their performance. “The business of surgery has boomed in
the last decade to become a $25 billion pursuit involving
more than 18 million operations a year.” s6 It is not incon­
ceivable that transsexual surgery (and various modifica­
tions of it), although it is being done on a minimal level
presently, could also skyrocket to high numbers, and thatthe medical labeling of a condition “known” as trans­
sexualism will increase the number of people with excep­
tional medical consumer status.
The third point to be learned from the Nazi experi­ments concerns the information that accrued to medical
science because of them. This is not a factor to whichmost commentators refer. William Shirer, author of The
Rise and Fall o f the Third Reich, claims that, “in the useof concentration camp inmates and prisoners of war as
human guinea pigs, very little, if any, benefit to science
was achieved.” 57 However, there is other evidence that
explicitly states that certain medical experiments thatwent on in the camps were later taken up and used byscience, although the origins of such research were gen­erally hidden from publication. Guttentag remarks that“contrary to general belief, some of the experiments thatthose men performed were scientifically valuable and arequoted in Western literature.” 58 One example of this is
the low temperature and freezing experiments.
While a medical procedure or experiment should not

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be determined by its origin, nevertheless its origin is in­structive. Applying this to the transsexual context, it issignificant that the first physician on record to perform
sex-conversion surgery was a German by the name of F. Z.
Abraham, who reported the first case in 1931. Further­more, Benjamin relates that the Institute of Sexual Sciencein Berlin did much work on transvestism (and probablytranssexualism before it was named such) under the leader­
ship of Dr. Magnus Hirschfeld. Benjamin states that it hada “famous and rich museum, clinic, and lecture hall.”In 1933, he says, it was destroyed by the Nazis because,“The Institute’s confidential files were said to have con­tained too many data on prominent Nazis, former patientsof Hirschfeld, to allow the constant threat of discovery topersist.”59 Benjamin visited Hirschfeld and his Institutemany times during the 1920s.
We also know that at least one transsexual operation
was done in the camps. Joseph Wechsberg in his editing of
The Murderers Among Us: The Simon Wiesenthal Memoirs
recounts Wiesenthal’s recollection of a victim of thecamp’s experimental surgery.
I met another boy whom the scientists of Auschwitz, after several
operations, had successfully turned into a woman. He was thenthirteen years old. After the war, a complicated operation was
performed on him in a West German clinic. The doctors restored
the man’s physical masculinity, but they couldn’t give back his
emotional equilibrium.60

By this comparison, I do not mean to exploit the very
real difference between a conditioned “voluntary” medical
procedure performed on adult transsexuals and the deliber­
ate sadism performed on unwilling bodies and minds in thecamps. However, it is important to understand that sometranssexual research and technology may well have been
initiated and developed in the camps and that, in the past,
as well as now, surgery was not performed for the present
professed goal of therapy, but to accumulate medical
knowledge.
At this point, it is the task of this book to suggest

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Therapy as a Way of Lifedifferent, and what I regard as more adequate, answers to
the questions that transsexualism raises. In Chapter VI, I
place transsexualism in a more philosophical context by
discussing an ethic of integrity. It is my hope that this dis­cussion will not be regarded as abstract, or as distracting,but that it will form the basis for viewing the deeper andmore mythic aspects of the transsexual phenomenon.

C H A P T E R VI

Towardthe Developmento f an Ethico f Integrity

T h o s e who advocate trans­
sexualism emphasize certain values. Primarily, the transsex­
ual empire promotes integration. In this chapter, I propose
an ethic of integrity. There is a crucial distinction between
integration and integrity.
Briefly, integration means putting together a combina­
tion of parts in order to achieve completeness or whole­ness. In contrast, the word integrity means an original
wholeness from which no part can be taken away. It is mycontention that, in a deep philosophical sense, transsexual
therapy and treatment have encouraged integration solu­
tions rather than helping individuals to realize an integrityof be-ing.
In its emphasis on integration, much of the recent
psychological, medical, and medical-ethical literature ontranssexualism, and the solutions they propose, resemble
theories of androgyny. In many ways, contemporary trans­
sexual treatment is a modem version of medieval, androgy154

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Toward the Development of an Ethic of Integrity

nous alchemy where stereotypical femininity is integrated
with a male genotype to produce a transsexually construc­ted woman. As alchemy treated the qualitative as quanti­tative in its attempts to isolate vital forces of the universe
within its laboratories of matter, transsexual treatment
does the same by reducing the quest for the vital forces ofselfhood to the artifacts of hormones and surgical ap­
pendages. Transsexualism is comparable to the theme ofandrogyny that represents biological hermaphroditism, be­cause ultimately the transsexual becomes a surgically con­structed androgyne, and thus a synthetic hybrid. Further­more, the transsexual also becomes a sex-stereotyped
hermaphrodite, often unwittingly displaying his former
masculine gestures, behavior, and style while attempting
to conform to his new feminine role.
The first drafts of this chapter were entitled “An Ethicof Androgyny.” But as I examined the androgynous tradi­tion and its uses in recent literature, problems of ety­mology, history, and philosophy arose that were not evi­
dent at first glance. These necessitated the choice of adifferent ethical vision, which I have called integrity. The
word integrity means an original unity from which no partcan be taken away—thus an original wholeness of personhood not divided by sex-role definitions. Androgyny, incontrast, connotes integration—putting together the partsof masculinity and femininity in order to complete thatwhich is supposedly incomplete. This gives a clue to thereality of the transsexual process, which can be viewed asadding the desired body and role parts to the “nativeborn” self, while discarding other parts, yet never going
beyond the parts themselves to a more intrinsic unity of
personhood. Thus, what I call an ethic of integrity is anattempt to discuss an original unity before the Fall of
sex-role stereotyping. Until those contemplating trans­
sexual surgery come to realize that such a step doesnothing to promote this integrity on both a personaland social level, they will continue to settle for many of
the false and partial modes of androgynous integration.

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The Transsexual Empire
THE ANDROGYNOUS TRADITION

The androgynous tradition in theology and philosophy re­presents many varied but also many similar themes.* Firstof all, and most often, androgyny symbolizes primal personhood or original humanity, in its bisexual or asexual
condition. Maleness and femaleness were perceived as divi­
sions resulting from the Fall and not originally intended tobe part of primordial personhood. Thus, for example,
Adam in the Garden of Eden is represented as originallycombining and/or transcending maleness and femaleness.
Such androgynous notions are present in the rabbinic
commentaries on Genesis, in the Gnostics, in the Jewish
Cabala, and in John Scotus Erigena. In this same context,
androgyny became a salvation or reunification theme,
bringing divided personhood, maleness and femaleness,back into its original and divinely intended unity of either
biological bisexuality (i.e., biological hermaphroditism
where maleness and femaleness are incorporated) or asexuality (i.e., beyond biological combinations of malenessand femaleness). In some descriptions, this original unified
condition approximates an angelic state of personhood
beyond biological sex differences and limitations.
In this sense, androgyny represents a partial recognitionof an integrity that goes beyond male and female bodies.
Many writers see Jesus as the unique bearer of androgy­
nous humanity. This conception of Jesus, implicit in someof the Gnostic literature, is developed by Erigena in his
portrayal of the Resurrected Jesus, and reaches its apex
in Jacob Boehme. Other writers see the very nature of God
as an androgynous unity, sometimes referred to as theDivine Androgyne, and sometimes portrayed as both male♦For an extensive and specific delineation o f the androgynous tradi­tion in theology and philosophy, from its prepatriarchal origins,through Plato, the Midrashim, th e Gnostics, and others, up throughnineteenth-century French philosophy and social theory, see: Janice
G. Raym ond, “ Transsexualism: An Etiological and Ethical Analysis”(Unpublished Ph. D. dissertation, Boston College, 1977).

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Toward the Development of an Ethic of Integrity

and female in its manifestations. This conception of God
is most evident in the Cabala and in Jacob Boehme.
However, there is very often an undercurrent of male
mothering in connection with androgyny. Although theprimal Adam is written about as androgynous or hermaph­
roditic, one is still left with the impression that the originalhuman was more male than female. This undercurrent isconveyed in the language of the Cabala: “ [Eve] existed in
Adam, in potentiality from the first.” The language here
is most important, for if anything, biologically speaking,it was Adam who was contained in Eve from the begin­ning. Other statements imply that it was Eve (woman) who
separated from man, giving the impression that the female
part of the original androgyne was more fragmented andless perfect than the male, so that even though the primal
person was supposedly androgynous, this creature wascomposed of one distinctly more perfect part and one
distinctly less perfect part. Thus the male portion ofandrogyny remains steady and constant, while the female
is the wayward, unsteady half. In the Gnostics, moreover,the female must make herself male before a salvific an­
drogyny can be reached.
As a result of this original division of the sexes, andro­
gyny came to symbolize also completeness by reunifica­tion in love and sexual expression. In most authors, hetero­sexual love was seen to be an androgynous theme, unitingthat which was originally separated (female and male) in
the life and act of love. This heterosexual love was per­ceived as the bringing together of external complements.
But in other authors, especially Plato, homosexual love
also functioned as a form of androgyny needing no female
half to complete itself, but finding the “female” within theself through loving another who was like the self.
Further, the theme of androgyny is often meant tosymbolize the overcoming of all dichotomies. Here, theintegration of female and male represents the overcomingof other dualisms, such as spirit and matter. However, this
explanation of androgyny implies that male-female sym­

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The Transsexual Empire

bols are only representative of larger issues. Such an ex­
planation still begs the question and does not adequately
explain why these particular sexual symbols were chosen,
and why female-male is seen as the archetypal dualism
in which other dualisms participate. It fails to look at theconcrete and specific symbol of the division between
female and male.
Androgyny is often used to imply misogyny; that is, its
attainment requires the denigration of women. Misogyny
takes many forms. In the Gnostics, the female must firstmake herself male before becoming androgynous, but nocomparable process was necessary for the man. The male,it seems, had a direct route to androgyny but the female,by virtue of her inferior starting point of femaleness, had
to pass through the supposed higher level of maleness be­fore she could reach the highest level—androgyny. In Plato,
androgyny is mixed with misogyny to support male homo­sexuality which is regarded as the superior form of love.
Intimacy can only occur between two equals—that is, be­tween two men. Plato implies that an equal relationship is
not possible between a woman and a man. John Scotus
Erigena, who uses androgyny as a reunification theme, also
maintains that, in the Fall, mind (man) was led astray bysentience or corporeality (woman). Therefore the manmust rule woman, since soul must rule sense, as it will doin the restored life. Nikolai Berdyaev mingles androgyny
and misogyny by reducing woman to procreation and up­
lifting man to creation, neither of which, he says, is com­plete without the other.
Androgyny often refers to the incorporation of the socalled feminine principle (sometimes called the female
principle) within the male or within the dominant maleethos. This conception of androgyny is evident in Greek
drama, especially in such plays as Lysistrata and Oedipus,
and also in Comte and the SaintrSimonians. It should beemphasized that this is not comparable to the Gnostic
injunctions which state that a woman must make herself
male. Where men are exhorted to incorporate the feminine

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Toward the Development of an Ethic of Integrityor female principle, it is clear that they do not have to
make themselves female (as the females in the Gnostic
literature were exhorted to do), but rather they can
assimilate the female principle and thus get the best ofboth worlds while still remaining male. In no writing on
androgyny is the male exhorted to make himself female
before he can become androgynous.
Lastly, in the nineteenth century, androgyny becomes atheme of social reform. Where it had previously been ap­
plied to individual conceptions of personhood, it now be­comes a way of talking about an ideal society. Beginningwith Auguste Comte and up to the Saint-Simonians, andro­
gyny comes to symbolize human progress, universal unity,
and the removal of social oppression, especially that offemale and class oppression.
The androgyne is a myth and like all myths is constantly
reinterpreted, depending on different preoccupations andexperiences. But a primary, common element in all of thevarious usages of androgyny is the notion of integration ascompletion.

INTEGRATION VERSUS INTERGITY

The word androgyny is formed from integrating the Greek
aner and gyne (with the male classically coming first). This
gives the impression that if one puts the archetypal mas­
culine and feminine together, one will somehow arriveat an adequate whole—but a whole that is formed from
two inadequate halves. The question thus becomes, how
can two inadequate halves form an adequate whole? As
Mary Daly has phrased it, androgyny connotes “scotchtaping John Wayne and Brigitte Bardot together.”1 Fur­ther evidence of this pseudo-organicism can be notedwhen perusing dictionary definitions of androgyny,
where there is reference to plant or human hybrids.
The latter, throughout the androgynous tradition, be­comes synonymous with physical hermaphroditism.

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The Transsexual Empire

Nor would the term gynandry be adequate. Although
the female root of the word comes first, the primary
image is still one of the sexual sphinx.
In appearance, the words androgyne and androgen arequite similar. In fact, androgyny is sometimes spelled androgeny. Thus to speak of androgynizing humanity comes
dangerously close to androgenizing or “male-izing” hu­manity. This, of course, was one mode of androgyny thatwas expressed in the Gnostic tradition. However, an androgenous or male-ized humanity is no mere myth, nor is it
simply a clever play on words, in light of some of thestatements in John Money’s work on sex differences.
In Man & Woman, Boy & Girl, “ fetally androgenized
females” develop not only physically male characteristics(perhaps an enlarged clitoris or excessive body hair) but
also supposedly have the propensity to develop psychosocially conditioned, masculine behavior.
On a mytho-metaphorical level, the Gnostics exhorted
women to attain the androgynous state of unified hu­
manity by first making themselves male. “ For every
woman who makes herself male will enter the Kingdomof Heaven.”2 No comparable process of making one’s
self female is necessary for men to attain androgynous ac­
tualization and salvation. Once more, now in the scientific
literature on sex differences, androgenizing—or making
one’s self male—becomes normative for androgyny.
The split-level hybrid or integration model of andro­
gyny prevails currently. The basic notion of androgyny
in Carolyn Heilbrun’s Toward a Recognition o f Andro­
gyny is, as the book jacket acknowledges, “the realizationof man in woman and woman in man.” Heilbrun is in goodcompany here. Unfortunately even the brilliant Virginia
Woolf had a similar notion of androgyny in A Room o f
One's Own. She wrote:
And I went on amateurishly to sketch a plan of the soul so that ineach o f us two powers preside, one male one female; and in the
man’s brain, the man predominates over the woman and in the
woman’s brain the woman predominates over the man. The normal
and comfortable state of being is when the two live in harmony to ­

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Toward the Development of an Ethic of Integrity

gether, spiritually cooperating. If one is a man, still the woman parto f the brain must have effect; and a woman also must have inter­course with the man in her. Coleridge perhaps meant this when hesaid that a great mind is androgynous.. . . It is when this fusion
takes place that the mind is fully fertilized and uses all its faculties.3

Likewise Betty Roszak has a hybrid or integration modelof androgyny. In an essay entitled “The Human Con­tinuum, ” which takes great pains to stress that if we even“think of ourselves as ‘a woman’ or ‘a man’ we are alreadyparticipating in a fantasy of language,” Roszak concludes:“Perhaps with the overcoming of women’s oppression,
the woman in man will be allowed to emerge.”4
Obviously, Heilbrun, Woolf, and Roszak are each at­
tempting to go beyond stereotyped definitions of mas­
culinity and femininity. Yet it also ought to be obviousthat if this is the desired goal, then writers cannot use thelanguage of oppression nor incorporate oppressive defini­tions of the self to talk about a nonoppressive ideal of thesame self. For in reality, the language and imagery of an­
drogyny is the language of dominance and servitude com­bined. One would not put master and slave language orimagery together to define a free person. Therefore, any
serious effort to describe an androgynous ideal must takeissue with Heilbrun’s assertion that “so wedded are we tothe conventional definitions of ‘masculine’ and ‘feminine’that it is impossible to write about androgyny without
using these terms in their accepted, received sense.”5
Heilbrun fails to perceive here the eminent co-optabilityof this kind of language.
The co-optive potential of androgyny lies in its ability
to integrate, assimilate, or absorb almost anything, parti­
cularly any sexual issue. Androgyny is not only a wordthat lends itself to co-optation. The vision it attempts todescribe is equally susceptible to co-optation.
The most blatant example of this kind of co-optation
appeared in a Ramparts article in December 1973. Here,androgyny was identified with what was called “The Third
Sex.” This “new androgyny” was supposedly released bytechnological culture. This freeing, together with “the162

The Transsexual Empire

deep exploration of our psyches by acid and meditation,”gave persons permission to explore “our true androgynous
natures, the anima and the animus, both of which we allpossess.” Men are coming to realize their feminine side andwomen are “excavating their masculine identities.”6 As
models for the “new androgyny,” James Nolan, theauthor, gives us “pansexual rock images” of David Bowie,
Janis Joplin, Mick Jagger, and Bette Midler. “David andMick and Janis and Bette: consider the possibilities.”7
A fuller notion of “The Third Sex” emerges, “fer­tilized” by Women’s and Gay Liberation, “both of whichbegan with strains of either man-hating or woman-hating,”
according to the author.
It seemed for awhile that Women’s Liberation, for all the deepseated misanthropy it generated, was becoming with a lot o f pushy
verbalizing and hard-edged power struggling, a caricature of the very
masculine traits which the women despised. Gay Liberation, with its
indigenous misogyny, had taken to playing house in the superficial
deco-parlor on narcissism and taste, a realm traditionally ruled overby the very women the gay mentality found so ludicrous. But
perhaps these two militant liberation movements were just awkward
and adolescent phases we all had to pass through, pimply and selfconscious and blatantly extreme, to arrive at a more whole type ofsexual identity: a way of seeing how the other half (of ourselves)
lives.8

Here we have the ultimate co-optation of the Women’s
Movement—an “adolescent stage” that we have alreadypassed through. Androgyny becomes the great leap for­ward, a synonym for an easily accessible human liberationthat turns out to be sexual liberation—a state of being thatmen can enter as easily as women through the “cheap
grace” of the “wider” countercultural revolution. Whatandrogyny comes to mean here, in fact, is sexual revo­
lution, phrased in the language of “The Third Sex.”
Sex (fucking), not power, becomes the false foundationof liberation.
Given the difficulties with the word and its eminent
susceptibility to being co-opted, is it worth even trying
to talk about whatever was intended by the word andro­

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Toward the Development of an Ethic of Integrity

gyny. The questions were and are still real, but the term
androgyny obscured the reality. In fact, my intention is
not to integrate the feminine and the masculine but totranscend them.
The word integrity more adequately conveys possibili­ties of transcendence. First of all, it is a word/vision thatavoids the pitfalls of the integration model of androgyny.
There are various and subtle meanings of the word integ­
rity that render it more adequate to express a meaningful
vision of what many of us previously wanted androgyny
to convey.
In comparison to integration, which is defined in the
Oxford English Dictionary as “the making up or composi­tion of a whole by adding together or combining the sepa­
rate parts or elements” and in comparison to integrate,
which means “to complete or perfect (what is imperfect)by the addition of the necessary parts,” integrity is de­scribed in the following way: “The condition of having nopart or element taken away or wanting; undivided or
unbroken state. . . something undivided; an integral
whole.. . . The condition of not being marred or violated;
unimpaired or uncorrupted condition; original perfectstate; soundness.” Integration gives a certain validity tothe parts themselves and to the process of putting thoseparts together. In contrast, integrity reverses this connota­tion and validates an original unity from which no partmay be taken. Integrity gives us a warrant for laying claim
to a wholeness that is rightfully ours to begin with andthat centuries of patriarchal socialization to sex roles andstereotyping have eroded.
Thus an intuition of integrity, in this sense, is charac­
teristic of the texture of be-ing (becoming) and prior tocultural definitions of masculinity and femininity. It is an
original state that does not reside in a static historical past.
Rather, integrity is the constant unfolding of a personaland social process that has the potentiality of generating
for all of us a future vision of becoming, beyond a genderdefined society.
This original state of be-ing, this condition of integrity,

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The Transsexual Empire

may indeed have been what the androgynous myths of the
primal person were pointing toward. That is, proponents
of androgyny may have dislocated what was really revela­
tory about the androgynous vision by speaking about it on
a biological or hermaphroditic level. The real mythohistorical memory may have been that of an original
psychosocial integrity where men were not masculine,
nor women feminine, and where these definitions and pre­scribed norms of personhood did not exist.
The real Fall may not have been the division into bio­
logical sexes but the separation into oppressive sex roles
and stereotypes. Such a separation has cleft humanity into
two static states of being. What the myths of the Fall from
androgynous humanity into maleness and femaleness may
more fully tell us about is humanity’s initial loss of the in­tuition of integrity in which human development has beenchanneled into a two-track system of masculinity andfemininity. Thus “ salvation” is not achieved by the unionof the two but by transcending masculinity and femi­
ninity. Until those contemplating it come to realize thattranssexualism will dislocate the basic sense of unity
within themselves, which I have called the intuition of
integrity, they will continue to settle for false and partial
modes of androgyny.

ANDROGYNY, INTEGRITY, AND TRANSSEXUALISM

Many of the false and partial modes of androgyny give
us clues to why transsexualism is a stunted attempt in
the quest for integrity. First of all, it could be said thatthe transsexual, like the biological androgyne, is a physi­
cal hybrid. Of course transsexuals do everything pos­sible to disguise the hybrid nature of their bodies.
Constant electrolysis is used to remove the telltale re­mains of male beard stubble and localized hair residues.
Cosmetic surgery is continuously sought to promote
the aesthetic appearance of the post-operative body.
In spite of all these measures, however, the chromo-

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Toward the Development of an Ethic of Integrity

somes remain that of one’s native-born sex, and theireffects constantly remind transsexuals, in various un­
expected physical ways, that they are really not the de­sired opposite sex but rather surgically constructed an­
drogynes.
Instead of developing genuine integrity, the transsexual
becomes a synthetic product. Synthetic parts, such as
chemical hormones and surgical artifacts of false vaginas
and breasts, produce a synthetic whole. Furthermore, thefact that transsexuals are synthetic products is one clue totheir future demise. There have been some cases of cancer
reported in the literature; much dissatisfaction with arti­
ficial breasts that slip, artificial vaginas that contract, andartificial penises that don’t function sexually; and some re­ports of suicide, attempted suicide, and despondency after
surgery has taken place.9 This is not to say that whateveris natural is necessarily good, but rather that it is the har­mony or integrity of the whole that is good.
As hormonally and surgically constructed androgynes,
transsexuals are radically at odds with their internal en­
vironment or “bio-ecosystem” Initially, Rachel Carson
demonstrated that chemical pesticides were disastrous
to the planet. Barry Commoner followed by showing how
so-called technological “advances” have debilitated our
ecosystems, because everything is related to everythingelse. In a similar manner, evidence is beginning to provethat hormone treatment and surgery are destructive in­trusions of the total “bio-ecosystems” of transsexuals.
That is, one cannot expect to alter sexual organs without
in some way negatively altering the rest of the body. Suchdebilitation may be the body’s defense and retaliation forthe disruptive hormonal and surgical changes.
As well as being surgical hermaphrodites, transsexuals
are also sex-stereotyped hermaphrodites, in such things as
gestures, behavior, and style. Many articles on transsexuals
have testified that, while assuming the gender identity androle of the opposite sex, transsexuals have not entirely left
their native-born gender identity and role behind. The ex­ample of Paul(a) Grossman, discussed in Chapter III, is a

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The Transsexual Empire

case in point. Earlier we noticed the same androgynous
mix in Jan Morris’s case. And this is precisely what it is—androgynous. Transsexuals often betray this sociallyconstructed hermaphroditism.
Insofar as the androgynous ideal was based upon an op­
position of supposed opposites, so too is transsexualism.
Just as the androgynous tradition accepted the oppositionof masculinity and femininity, positing them as dualisms
in order to reconcile them in the androgynous ideal, so
too does transsexualism accept these basic dualisms in or­der, however, to reject one and gravitate toward the other.
With androgyny and with transsexualism, the categories ofmasculinity and femininity are accepted on their own
ground, either to be united in an androgynous motif or,in the case of transsexuals, to be divided so that one can be
accepted and the other rejected. Both androgynous andtranssexual advocates fail to understand that the basic
point is not to accept the dualisms for the sake of reunifi­
cation or, in the transsexual’s case, for the sake of conver­sion, but to go beyond and transcend both.
This is a central point, and this is precisely where integ­
rity must serve as an ethic rather than androgynous inte­
gration. One cannot take two false or inadequate halvesand put them together, or reject one in order to accept theother. Rather one must transcend the dualisms to begin
with, by not accepting them as adequate descriptions ofreality.
It is precisely in this realm that the transsexual unwit­
tingly settles for androgyny instead of integrity. He latches
on to what is perceived as the “ other half” of humanity,
for example, femininity, and credits it with an adequacy
and integrity of its own, without asking deeper questions.
Instead of realizing that femininity has only an artificial
and socially constructed status, he accepts it as an ade­quate definition of personal and social integrity.
A genuine integrity would not support an integration ofthis sort, based upon the acceptance of false dualisms anda false opposition of opposites. It would not “help” trans­
sexuals to integrate their gender suffering into a “meaning­

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Toward the Development of an Ethic of Integrityful” conformity where deeper questions of social andpersonal reality are not confronted. Instead it would
genuinely help the transsexual to interpret pain and de­viance, thus bringing about more genuine changes. For
example, counseling based on an ethic of integrity would
supply the language needed to understand transsexualism
within the social context of sex-role stereotyping and con­formity. In other words, it would meet the problem on its
deeper ground, that is, the social, and not dislocate it toanother level, that is, the medical-technical level. It would
not replace gender suffering with an artificially prolonged
and synthetic maintenance of the problem so that thetranssexual becomes an uncritical and dependent spectatorof his deeply decaying self.10 Thus interpretation is a key
element of an ethic of integrity, especially in the coun­
seling situation.
The therapeutic ethic that presently governs transsexual
counseling and surgery does not genuinely promote either
personal or social integrity. An intrinsic element of per­sonal integrity is autonomy. As Ivan Illich has pointed out,anyone who “becomes dependent on the management of
his intimacy. . . renounces his autonomy, and his healthmust decline.” 11 Transsexual surgery promotes the ethicthat the problem of transsexualism cannot be confronted
on an autonomous level but needs the intervention of the
medical and surgical, as well as psychological, specialities.
Nor is social integrity enhanced by transsexual surgery.
An ethic that promotes sex-role conformity is hardly con­tributing to the integrity of the social system. Transsexual
surgery turns into an antisocial activity that promotes theworst aspects of a patriarchal society by encouraging adap­
tation to its sex roles. Gender identity clinics can be per­ceived as future centers of “ sex-role control,” where thepotential social planners might well encourage, facilitate,
and maintain sex-role conformity for nontranssexuals.
Another perspective that the androgynous tradition
offers on the phenomenon of transsexualism is its built-in
misogyny. In many of the writings on androgyny, thefemale half of the hybrid was regarded as inferior. Thus

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The Transsexual Empire

females who were striving for androgyny were first ex­
horted to make themselves male. However, in transsex­
ualism, we might say that the misogyny theme is appar­
ently inverted into a kind of philogyny (love of woman),this time by the male making himself female. But whatreally happens is that the biological female is no longer
even necessary. Thus misogynism is escalated.
TRANSSEXUALISM AND TRANSCENDENCE

The transsexual odyssey can be viewed as a quest fortranscendence, an effort to go beyond the limits of the self
(symbolized by the acquisition of a new body). But fromthe perspective of transcendence, transsexualism’s greatest
weakness is its deflection of the “ courage to be, ” and its
short-circuiting of existential risk, creativity, worldbuilding, and social healing—all of which are elements ofgenuine transcendence. Transsexualism achieves this de­flection and short-circuiting by drawing up body bound­aries to the ever-present and future quest for fuller andmore authentic becoming.
There is no doubt that selfhood presupposes embodi­
ment and that our bodies cannot be ignored in any authen­tic development of selfhood. However, even many persons
who have been wracked with severe physical pain or de­formed by natural or imposed crippling agents have beenable to transcend these conditions. Our bodies are truly
ourselves, but are preconditionally intrinsic to our being
persons. As Mary Daly has pointed out, the spirit can al­
ways contain the body but the body cannot always con­tain the spirit. She notes that a radical feminist analysis
will see the problem to be one of overcoming the contain­
ment of spirit by body.12 In contrast to the transsexual
who embodies transcendence, I suggest that we “enspirit. ”
Daly explains this word further:
The process of the Self enspiriting the Self is Dis-possession. The
enspiriting Self is not anti-matter, but pro-matter, freeing m atterfrom its restricting/restricted role of vessel/container, unfreezing
m atter so that it can flow with spirit, fly with spirit. 13

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Toward the Development of an Ethic of Integrity

This is to say that who we are should not be defined by
exclusive reference to our bodies. Our existence tran­
scends, in important ways, the limitations imposed upon
us by our bodies.
Transsexuals, however, move totally in the realm of the
body while thinking that they are transcending the body.
To use Daly’s terminology, they are “possessed” by theirbodies and cannot confront and transcend that possession.
Transsexuals are thus saying that who they are is irrevo­
cably determined by what body they are bom with and by
what body they surgically convert to. This is only a partial
truth. We are, of course, our bodies, but we are not domi­
nated by them
We might say that the body is part of the creative
ground of existence, but we are not bound by that struc­ture in the full creative sense. Our spirit is bound to ourbodies, as its creative ground, but surpasses it throughfreedom and choice. The body is present in all our choices,
but as total persons, we have the freedom to be other thanwhat culturally accompanies a male or female body.14
Instead, however, transsexuals become enfettered by boththe unwanted body they reject and the desired body theytake on, in the sense that the former dictates that it is notpossible to live without the latter.
Transsexualism is thus an inadequate “myth of tran­
scendence.” Herbert Richardson has written of three
myths of transcendence: separation and return, conflictand vindication, integrity and transformation.15 Trans­
sexualism could be said to be representative of the firsttwo myths, both of which Richardson perceives as inade­quate. The first is the myth of separation and return.
Transsexualism is a cyclic event—an ever-recurring exitus
and reditus. The transsexual leaves masculinity only to re­turn to femininity, which are different sides of the same
coin and which ultimately reduce him to the same povertyof behavior. This sameness is attested to by the facile inter­changeability o f roles.
Furthermore, in embarking on the surgical journey, thetranssexual will very often return for more and more sur-

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The Transsexual Empire

gery of a “ corrective” or “cosmetic” variety. The tendency
toward polysurgery, on the transsexual’s part, and its
willing dispensation by the transsexual technicians, is one
more example of the exitus-reditus myth of transsexual“transcendence.” In a very real sense, the first act of sur­gery is permission to return for more and more tran­
scendence by surgery. The transsexual, therefore, seeks
the illusion of transcendence at the hands of the surgeon.
Instead of becoming a more genuine self and overcoming
cyclic existence, the transsexual short-circuits transcen­
dence by taking false leaps and by endowing his or her self­
hood with artificial reality. The falseness of this lies not in
the desire for a different selfhood, nor in the uncertaintyof the quest, but rather in the fact that transcendent be-ing(what Richardson would call integrity and transformation)is sought where only cyclic and static being (separation
and return) can be found. Thus transsexuals are thrownback against those same societal norms and stereotypes
that caused the problem to begin with.
The second myth of transcendence is that of conflictand vindication. On an individual level, the transsexualmust struggle with a continuing opposition to his “nativeborn” body. On a social level, the transsexual becomes aliving opponent of a gender-free society by virtue of his
uncritical acceptance of and comfortable conformity to
the stereotypes of masculinity and femininity. Further
conflict may result if transsexuals come to realize that
their surgery is a Band-Aid approach to their individual
gender suffering. Meyer and Hoopes have admitted:
In a thousand subtle ways, the reassignee has the bitter experiencethat he is not—and never will be—a real girl but is, at best, a con­vincing simulated female. Such an adjustment cannot compensate forthe tragedy of having lost all chance to be male and of having, in the
final analysis, no way to be really female.16

The third myth of transcendence, that of integrity andtransformation, has been talked about in this work as an
ethic of integrity. Richardson maintains:

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Toward the Development of an Ethic of Integrity

The kind of transcendence correlated with the myth of integrity
and transformation is that of self-transcendence, expanded con­sciousness, spiritual rebirth, and divinization.. . . In our integrity,
we can experience transcendence as our own potentiality to become
more, as the demand for self-transformation.17

In the transsexual’s mere process of integration, he can be­come no more than what the society has determined as
masculine or feminine. Becoming a surgically constructedmasculine or feminine person does not free one’s spiritualenergies for larger ventures of becoming, but circumscribes
these vitalities within stereotypes and role boundaries. The
transsexual has indeed set up a false ultimate concern,taking a short-cut to a perceived but illusory transcendenceof the instant salvation variety. For the transsexual, thesurgery is a false signal of transcendence—false because therole and identity it conveys cannot point beyond itself andthe society’s limits. Except in some narrowly achievable
sense, transcendence and integrity cannot be won by ele­
vating individual well-being over individual and societal
be-ing and becoming.
INTEGRITY AND THE INTUITION OF BE-ING

Various philosophers, most notably Jacques Maritain, havewritten about the intuition of being. Integrity, at its depth,
is an intuition of the power of be-ing.
The notion of being was originally developed withina society enclosed by a static world view, lacking any senseof process or change. Being was unchanging, and there wasliterally “nothing new under the sun.” Static being is pre­cisely what is achieved by the transsexual. In changing sex,
and in being assimilated into the opposite sex roles, thetranssexual settles for the static state of masculinity or
femininity that a patriarchal culture has attached to a maleor female body, and short-circuits the diversity of genuine
be-ing and transcendence. In so doing, sex-conversion sur­gery measures the transsexual’s transcendence by an un­changing state of masculine or feminine well-being that
does not point beyond itself.18

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The Transsexual Empire

Transsexual supporters appeal to standards of well­being, when they justify transsexualism. They attest to its
efficacy in the life process of those individuals afflicted,
pointing out that most transsexuals are happier andfunction better after surgery. I maintain, however, thatthe efficacy they attest to is one-sided and does notmeasure total integrity. In order to assess the total in­
tegrity of the transsexual situation, the following questions
must be asked and answered:
1. Is individual gender satisfaction achieved at the price ofindividual role conformity and the enforcement of role
stereotypes on a social level—thus at the price of en­
couraging a sexist society whose continued existence
depends upon the perpetuation of those roles and stereo­
types?
2. Does transsexual treatment and surgery repress thetranssexual’s capacity for social protest and restrict her or
his potential as a social critic in the sexist society thatcaused the problem to begin with?
3. Is the well-being that the transsexual achieves throughsurgery dependent upon an integration of false opposites?
4. In connection with the former question, is transsexualwell-being confined to the body that one is either bom inor out of? Therefore, does it restrict the infinite possibili­ties of be-ing that cannot be contained by either the“ native-born” or surgically constructed body?
5. Are transsexuals radically at odds with their “bio­ecosystems,” and are there enough deleterious effectsof treatment and surgery (for example, breast cancer)
reported in the medical literature to question transsexualwell-being on a biological level alone?
6. Could transsexual surgery really be called artificiallyprolonged maintenance? Transsexual existence initiallydepends upon the questionable notions of passing, syn­thetic hormone injections, surgery which often becomespolysurgery, and lifelong sustenance from exogenous
sources. Thus the transsexual becomes dependent almost
totally for his or her well-being on the medical profession.

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Toward the Development of an Ethic of Integrity

Autonomy is at a minimum, and dependence is at a
maximum
7. Is transsexual surgery a male-defined, male-perpetuated,and male-legitimated mode of happiness? (The female-toconstructed-male transsexual, as I have argued, is in a mostdefinite sense the disguise that obscures the patriarchal
character of the transsexual empire.) Can one view thetranssexual “solution” as the beginning of a world where
men not only dominate women but become women andtry to surpass the biological woman and her creative capa­
cities on all levels?
All this is to say that the supposed satisfaction of thetranssexual is a narrow mode of well-being, and a partialand short-circuited glimpse of be-ing. Integrity or true
be-ing leads to the unfolding of process, and movement
beyond the false opposition of opposites. Instead of re­stricting individuals to a static state of being or to partial
modes of be-ing, integrity leads to, and resides in, tran­
scendent Be-ing.
Dynamic and true be-ing ultimately poses the questionof Be-ing Itself—or what some have called the Source orPower of Be-ing. As Mary Daly has shown, the experienceof be-ing is a theological experience (in the best sense of
the word theological), because it is experienced as force,
power, ground, and source of Be-ing. While expanding theself into more self-realization, an intuition of Be-ing is also
experienced as transcending the self. This experience issomething that the static and anthropomorphic symbols
for God could never capture. Such symbols may have con­veyed personality and personalism, but they failed to con­vey the fact that transcendence is Be-ing. Be-ing is hardly
an abstraction but eminently personal when it is recog­
nized that the force or power of one’s be-ing is within,
while paradoxically still without, attainable yet unattain­
able. As Daly has further pointed out, there is an indwell­ing of the goal as yet unattained, but unfolding itself—“ thefinal cause that is movement is in our imaginative-cerebralemotional-active-creative be-ing. ” 19

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The Transsexual Empire

Thus it is that the realization of integrity comes back to
the intuition of Be-ing, for such an ethic can only be ulti­
mately grounded in this intuition. The quest for integrity
is a major part of the intuition of Be-ing, for it pushes one
beyond limits of selfhood into an ever-expanding process.
When this intuition occurs, one suddenly realizes thata given entity exists and exercises its highest activity of
be-ing in its own way, which is total. Furthermore, al­though Maritain and others spoke about this intuition of
being as an intellectual experience, it is clear that it is asso­
ciated with profound emotion. It may, in some cases, havethe appearance of mystical grace.20 Maritain explains that
this intuition would be most likely to occur in a person
who feels profoundly, who has a good sense apparatus, andwho can enter into the depth of her/his existence by her/
his sensitivity. Such a person will be one who is vividly
alive, who suffers existential conflicts.21
While transsexuals suffer poignant existential conflicts,
they do not enter into the depths of their own experienceby getting beyond the role-bound and body-bound crisis.
The pain of unnecessary surgery is mistaken for being
vibrantly alive. As stated earlier, physical pain is a con­stant reminder to transsexuals that they are finally coming
alive. The quest for integrity, transcendence, or the true,
deep, becoming self—for Be-ing—is short-circuited, withpain providing the illusion of life.
One final word about the intuition of Be-ing. At times,
Maritain’s conception of the intuition of being is too indi­vidualized and thus loses its social impact, minimizing theissue of political power. In contrast, the intuition of integ­
rity of which I have written takes political power very
seriously, and has a definite social source and emphasis. It
is aimed at destroying the power of patriarchal society,which has spawned the sex roles that have engendered theloss of the power of be-ing for all who have been afflictedby these roles. Moreover, it proceeds from a feminist, so­cial, consciousness of be-ing. I stress this social origin, be­cause, as Tillich has pointed out, being is partly known
from nonbeing. “The question of being is produced by the175

Toward the Development of an Ethic of Integrity‘shock of non being.’ ”22 Women have recognized this basic
nonbeing, stunting, alienation, and loss of power, because
women have felt most heavily the weight of sex-role op­pression. Perhaps it will be possible for transsexuals, with
their unique victimization by these same roles, to movefrom false and static being to the total Be-ing of integrity
through a rejection of both roles.

“ REPRESSIVE TOLERANCE” AND SENSITIVITY

It is my deepest hope that this book will not be viewed as
an unsympathetic treatment of the anguish and existential
plight of the transsexual. What I have tried to present isa different vision of where to focus sympathy and sen­sitivity.
Focused sensitivity should ask the why behind trans­
sexual suffering and propose ways of dealing with such
pain that confront the total situation, thus effectingchange on the deepest levels involved. To focus sensi­
tivity is to not allow it to become short-sighted or shortcircuited. To encourage would-be transsexuals to handover their bodies to the transsexual empire hardly seems to
be an adequate or genuinely sensitive response to the ques­
tions that transsexualism raises. Those who advocate medicalized transsexualism as the answer to a desperate emer­
gency situation of profound sex-role agony only serve, in
my opinion, to prolong the emergency. They seem sensitive
only to Band-Aid solutions that ultimately help to makemore medicalized victims and to enhance the power of the
medical empire. This kind of sensitivity is the outgrowthof “the triumph of the therapeutic” and can only mire
its believers and transsexuals in the immediacy of “thepersonal solution” in which therapy becomes a way oflife.
Any woman who has experienced the agony of sex-role
oppression in a patriarchal society is hardly insensitive tothe suffering that transsexuals experience. Like transsex­
uals, many women have felt hatred of their bodies and its

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The Transsexual Empire

functions, and have found themselves in a psychically dis­jointed state because they could not accept their role.
Through feminism, however, many women have come tounderstand this physical and psychic fragmentation inpolitical/social terms—i.e., as the product of a patriarchal
society that has imposed images and definitions of female
existence. Thus feminists have become social critics andhave organized, as feminists, around issues of sexism andsex-role oppressioa
Isn’t it possible for persons who desire sex-conversion
surgery, and who have also experienced sex-role oppression
and dissatisfaction with their bodies, to band together
around their own unique form of gender agony—especiallythose who claim to have a deep commitment to feminism?
Many will say that this is too much to ask of transsexuals.
Yet it is no more than women have asked of ourselves—
those who have taken feminism seriously and have tried
to live unfettered by gender in a gender-defined society.
This book will, no doubt, be dismissed by many trans­
sexuals and transsexual advocates as intolerant. Tolerance,
however, can easily become repressive, as Marcuse haspointed out. It is often a variation on the “poverty ofliberalism,” functioning as sympathy for the oppressed.
I strongly believe that one of the tasks of those who would
be truly open and sensitive to transsexualism is to takestands that are informed, honest, and sensitive to all theissues involved. Obviously, those who take a critical posi­tion will be subjected to accusations of dogmatism and in­tolerance, when in fact those who are unwilling to take astand are exercising the dogmatism o f openness at any
cost. This time, the cost of openness is the solidificationof the medical empire and the multiplying of medical
victims.
Those who advocate tolerance of medicalized trans­
sexualism are expressing a false sympathy which, in boththe immediate and ultimate context, can only facilitate
and fortify the possession of women by men. Such sym­pathetic tolerance will only strengthen a society in which
sex roles are the norm, and where deep existential choices

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Toward the Development of an Ethic of Integrity

become subject to medicalization. When tolerance serves
mainly to protect the fabric by which a sexist society isheld together, then it neutralizes values. It is important tohelp break the concreteness of oppression by showing its
theoretical inconsistencies and by stretching minds tothink about solutions that only appear to be sensitive andsympathetic.
Tolerance also fosters a laissez-faire attitude to prob­
lems—“different strokes for different folks.” Social control
flourishes under this ideological umbrella, whether it iscalled “ free choices,” “radical solutions,” and/or “liber­
ating boundaries.” Furthermore, tolerance is essentially apassive position. Marcuse, in his essay “ Repressive Toler­
ance,” has written:
The political locus o f tolerance has changed: while it is more or lessquietly and constitutionally withdrawn from the opposition, it ismade compulsory behavior with respect to established policies.
Tolerance is turned from an active into a passive state, from practice
to non-practice.. . . It is the people who tolerate the government,
which, in turn tolerates opposition within the framework deter­
mined by the constituted authorities. 23

Many feminists are opposed to transsexualism. Yet that
opposition, having moved outside the limits of tolerance
set up by the medical authorities, will often be decried as
intolerant. What is happening here is a fundamental rever­sal. “Tolerance toward that which is radically evil now
appears as good because it serves the cohesion of the wholeon the road to affluence or more affluence.”24 It is not
only tolerance in the service of medical affluence that we
witness in the transsexual situation, but tolerance in theservice of medical control—specifically the control ofwomen.
It is a critical time for woman-identified women. Medicalized transsexualism represents only one more aspect of
patriarchal hegemony. The best response women can maketo this is to see clearly just what is at stake for us withrespect to transsexualism and to assert our own power ofnaming who we are.

APPENDIX

Suggestionsfor
ChangeI h a v e argued that the issueof transsexualism is an ethical issue that has profound poli­tical and moral ramifications; transsexualism itself is a
deeply moral question rather than a medical-technicalanswer. I contend that the problem of transsexualism
would best be served by morally mandating it out ofexistence.
Does a moral mandate, however, necessitate that trans­
sexualism be legally mandated out of existence? What is
the relationship between law and morality, in the realmof transsexualism? While there are many who feel that
morality must be built into law, I believe that the elimina­tion of transsexualism is not best achieved by legislationprohibiting transsexual treatment and surgery but rather
by legislation that limits it—and by other legislation thatlessens the support given to sex-role stereotyping, which
generated the problem to begin with.
178

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Appendix: Suggestions for Change
THE RELATIONSHIP BETWEEN LAW AND MORALITY

Many see a very definite connection between social moral­
ity and its preservation in law.1 They would argue that if
there were a broad social consensus about the immoralityof transsexual surgery, then the law should incarnate thatsocial morality. Others, of course, would argue that toground issues of law in the social conscience is not always
protective of individual rights and may, in fact, be destruc­tive of those rights. They would say that the law can only
legislate against individual rights when they can be shown
to be directly harmful to another’s rights.
I do not wish to argue either of these positions. Rather,
I would contend that the more that can be left out of thelaw, the better. The prevention of transsexual surgery, andthe social conditions that generate it, are not achieved bylegislation forbidding surgery. In the case of transsexual
surgery, the good to be achieved, that is, the integrity of
the individual and of the society, does not seem best
served by making transsexual surgery illegal. Rather it
is more important to regulate, by legal measures, thesexist, social conditions that generate transsexual surgery,and also legally to limit the medical-institutional complex
that translates these sexist conditions into the realm oftranssexualism. Thus I am advocating a limiting legislative
presence, along with First Cause legislation, which, insteadof directing legal action to the consequences of a genderdefined society (in this case, to transsexualism), directs
action to the social forces and medical institutions that
produce the transsexual empire.
Legislation dealing with First Causes would concern itself
with the network of sex-role stereotyping that produces
the schizoid state of a “female mind in a male body.” Theeducation of children is one case in point here. Images ofsex roles continue to be reinforced, at public expense, inschool textbooks. The message is that such roles are as­signed to male and female bodies in our society. Anotherexample of First Cause legislation is the legal mandating

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The Transsexual Empireof programs and funds for the promotion of nonsexist
physical education in schools receiving federal money.
This has been initiated, to a certain extent, with Title IX
legislation, but still has not been implemented extensively.
Building up women’s bodies in the active way to which
men have been accustomed would also build a body image
and role that is quite different from the objectified, weak,
and passive image that women and men now have of
women. This would help to eliminate the bodily stereo­
type to which the transsexual wishes to convert.
These, of course, are but a few examples of First Causelegislation where it would be possible for the law to step inat the beginning of a destructive sexist process that leads
ultimately to consequences such as transsexualism Al­
though this is not the place to delve into a lengthy listingof all the social contexts in which the law might possiblyintervene to prevent the sexist supports of the transsexual
phenomenon, it is my contention that it is at the begin­ning and not at the end of the transsexual process thatlegislation is imperative.
Along with First Cause legislation to stop the “pro­creation” of transsexualism, limiting legislation is also
necessary to inhibit the massive medical-technical complex
of institutions that promote and perform more treatment
and more surgery. Such institutions have a built-in growth
power and thus legal limits should be placed on theirability to multiply. I would favor restricting the numberof hospitals and centers where transsexual surgery could
be performed.
CONSCIOUSNESS-RAISING COUNSELING

Nonsexist counseling is another direction for change thatshould be explored. The kind of counseling to “pass”
successfully as masculine or feminine that now reigns ingender identity clinics only reinforces the problem oftranssexualism. It does nothing to develop critical aware­ness, it makes transsexuals passive spectators of their own
decline, it manages transsexuals’ intimacy, and ultimately

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Appendix: Suggestions for Change

it makes them dependent upon the medical-technical solu­
tion. Such counseling destroys integrity and the potentialof transsexuals to deal with their problem in an autono­
mous, genuinely personal, and responsibly social way. The
transsexual becomes a kind of acolyte to his doctor andpsychiatrist, and learns to depend upon these professionals
for maintenance. The baptism of “passing” behavior that isconferred upon the transsexual, plus the administration ofexogenous hormones, along with constant requests for cor­
rective polysurgery, turn him into a lifelong patient. Ivan
Illich has called this cultural iatrogenesis.
Cultural iatrogenesis. . . consists in the paralysis of healthy re­sponses to suffering, impairment, and death. It occurs when people
accept health management designed on the engineering model, when
they conspire in an attem pt to produce, as if it were a commodity,
something called “better health. ” This inevitably results in the
managed maintenance of life on high levels of sub-lethal illness.2

What I advocate, instead of a counseling that issues ina medicalization of the transsexual’s suffering, is a coun­
seling based on “consciousness-raising.” In the early stagesof the current feminist movement, consciousness-raisinggroups were very common. These groups were composedof women who talked together about their problems anddirections as women in a patriarchal society. Gradually,
these groups came to the insight that “the personal is po­
litical,” thus providing the first reconciliation between
what had always been labeled the “personal” and the “po­litical” dimensions of life. Women, who had felt for years
that the dissatisfaction they had experienced as women
was a personal problem, came to realize in concert withother women that these problems were not peculiar tothem as individuals but were common to women as a caste.
Until feminism focused attention on the debilitating socialpolitical framework of sexism, most women had catego­
rized their dissatisfaction as “merely personal.” Fromthese consciousness-raising groups came much of the initialpolitical action of the women’s movement.
Five elements or processes appear repeatedly, under

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The Transsexual Empire

different names, in literature about consciousness-raisinggroups.
1. Self-revelation. This involves each individual talking
about her attitudes and life.
2. Sharing. Experiences and attitudes revealed often weave
a tapestry of similarity so that the commonality of per­sonal experiences becomes obvious, and its political char­acter is revealed.
3. Analysis. Recognition of the reasons and causes for thecommonality of such personal experiences with an exten­
sive analysis of the social-political, economic, and moral
forces that support such experiences.
4. Abstracting. Theorizing about concrete experiences andabout social forces and sources, while drawing on the in­sights of others for perspective.
5. Action. Concretizing analysis into appropriate tasks,
goals, projects, and the like.3
Would it be possible for these elements of consciousnessraising to be transplanted into a one-to-one counselingsituation where they could be used to explore the social
origins of the transsexual problem and the consequences ofthe medical-technical solution? Counseling of this nature
would raise the kinds of questions that I advocated pre­viously, such as: is individual gender suffering relieved at
the price of role conformity and the perpetuation of role
stereotypes on a social level? In “changing sex,” does thetranssexual encourage a sexist society whose continued
existence depends upon the perpetuation of these roles
and stereotypes? Does transsexual treatment repress thetranssexual’s capacity for social protest and criticism?
Does it act as a social tranquilizer? These and similar ques­
tions are seldom raised in transsexual therapy at present.
However, aside from this one-to-one form of counseling,
the model of consciousness-raising emphasizes the groupprocess itself. As women have analyzed their own prob­
lems as women in consciousness-raising groups, it is ex­tremely important that transsexuals, as persons wishing tochange sex, take their particular manifestation of gender

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Appendix: Suggestions for Change

oppression into their own hands. Transsexuals are not
women. They are deviant males, and their particular mani­
festation of gender deviancy needs its own unique context
of peer support.
Peer support has been one of the crucial aspects ofconsciousness-raising in feminist groups. Given the supportof other women, it became possible for many to break thebonds of so-called “core” gender identity. In the sameway, peer support could be extremely insightful for trans­
sexuals. It could help surface the deeper issues that lie be­hind the problem of why one finds one’s self with, forexample, a “female mind in a male body.” It could thenassist in exploring whether indeed this is the proper label
for the transsexual’s unique form of sex-role oppression.
Such counseling and group interaction would be far
more honest than the present forms of therapy that pro­
mote passing. I am not so naive as to think that they will
make transsexualism disappear overnight, but they would
at least pose the existence of a real alternative to be ex­plored and tried. Given peer encouragement to transcend
cultural definitions of both masculinity and femininity,
without changing one’s body, persons considering trans­
sexualism might not find it as necessary to resort to sexconversion surgery.
DEMYSTIFYING AND DISMANTLING THE
MEDICAL-TECHNICAL HEGEMONY

People concerned about sex-role oppression must work totake the transsexual problem out of the hands of the trans­
sexual professionals and the gender identity clinics. One
way of doing this is through the legal measures suggested
previously; another way is through public education.
Up to this point, the transsexual and the transsexual
professionals have been the sources of information for thegeneral public. The mere existence of the postoperativetranssexual, moreover, and the mere availability of trans­

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The Transsexual Empire

sexual counseling and surgery, permit people to restrict
their thinking about sex-role dissatisfaction to these
medical/surgical boundaries. In addition, the transsexual
professional becomes a force in the community at large,
defining his constituency, and generating a clientele ofpersons with this unique medical consumer status.
One way in which education about transsexualism hasreached the general public is through the media Articles
on transsexualism, especially in the aftermath of public
exposure of famous transsexual personages such as Jan
Morris or Renee Richards, appear in the weekly news mag­azines. Several times a year, transsexuals and transsexual
professionals appear on various television talk shows. Thus
the transsexual empire has become “media-ized.”
However, I would suggest that different perspectives on
the issue of transsexualism need to receive more attention
and publicity. We have seen enough of those transsexuals
and professionals in the media who are in favor of trans­
sexual surgery as the solution to so-called gender dissatis­
faction and dysphoria. We need to hear more from thosemen and women who, at one time, thought they might betranssexuals but decided differently—persons who success­fully overcame their gender identity crises without re­sorting to the medical-technical solution. We need to hearmore also from professionals such as endocrinologist
Charles Ihlenfeld who, after helping one hundred or more
persons to “ change their sex,” left the field. Ihlenfeld
decided that “ we are trying to treat superficially some­thing that is much deeper.”4 And finally we need to hearmore from persons, such as feminists and homosexual
men, who have experienced sex-role oppression but ulti­
mately did not become transsexuals.
In the final analysis, however, it is important to remem­
ber that transsexualism is merely one of the most obvious
forms of gender dissatisfaction and sex-role playing in apatriarchal society. It is one of the most obvious because,in the transsexual situation, we have the stereotypes onstage, so to speak, for all to see and examine in an alien

185

Appendix: Suggestions for Change

body. What can be overlooked, however, is that thesesame stereotypes, behaviors, and gender dissatisfactions
are lived out every day in “native” bodies. The issues thattranssexualism can highlight should by no means be con­fined to the transsexual context. Rather they should be
confronted in the “normal” society that spawned the
problem of transsexualism to begin with.

NOTES

1994 INTRODUCTION, PAGES xiii-xliv
1. The Johns Hopkins Medical Institutions News, Press Release,
August 13, 1979, p. 2.
2. Jane E. Brody, “Benefits of Transsexual Surgery Disputed as
Leading Hospital Halts the Procedure, ” The New York Times, Octo­
ber 2, 1979, p. Cl.
3. John Money in John Money and Gertrude J. Williams, Trau­
matic Abuse and Neglect of Children at Home (Baltimore: The Johns
Hopkins University Press, 1980), p. 412.
4. Money, p. 412.
5. It is curious th at several physicians who initially performed
transsexual surgery or worked on the medical teams are now en­
gaged in human in vitro fertilization research and procedures.
6. Editorial on “Transsexualism,” The Lancet 338 (Sept. 7,
1991):604. The Lancet editorial cites several mortality and morbidity
studies, especially relating to the intake of hormones in transsexual
patients.
7. Karin Winegar, “The Ultimate Passage, ” Minnesota, March/
April, 1992, p. 24.
8. Conversation with Pat Hynes, August 9, 1993.
9. Thomas Szasz, “Male and Female Created He Them,” The New
York Times Book Review (Review of Janice G. Raymond, The Trans­
sexual Empire ), June 10, 1979, pp. 11 and 39.

187

188

The Transsexual Empire

10. Brian Tully, Accounting for Transsexualism and Trans­
homosexuality (London: Whiting & Birch Ltd., 1992), see especially
pp. 214-33; the University of Minnesota’s Program in Human Sex­
uality requires th at persons seeking sex reassignment, prior to sur­gery, “live a minimum of one year in the role of the opposite sex.”See Winegar, p. 24.
11. Formal Comments of the American Society of Plastic andReconstructive Surgeons filed with the FDA on July 1, 1982, andquoted in Felicity Barringer, “Many Surgeons Reassure Their Pa­
tients on Im plants, ” The New York Times, January 29, 1992, C12.
12. L. Gooren, “The Endocrinology of Transsexualism: a Review
and Commentary,” Psychoendocrinology 15 (1990): 3-14.
13. Alice Echols, “The New Feminism of Yin and Yang,” in Ann
Snitow, et al. (eds.), Desire: the Politics of Sexuality (London: Vir­ago, 1984), p. 66.
14. Annie Woodhouse, Fantastic Women: Sex , Gender andTransvestism (New Brunswick: Rutgers University Press, 1989), p.
81.
15. Somer Brodribb, “ReproTech: Script for a New Generation,”
Broadside 10, no. 5 (1989): 11.
16. Sandy Stone, “The Empire Strikes Back: A Posttranssexual
Manifesto,” in Julia Epstein and Kristina Straub, Body Guards: theCultural Politics of Gender Ambiguity (New York: Routledge, 1991),
p. 296.
17. Somer Brodribb, Nothing Matters: A Feminist Critique of Post­
modernism (North Melbourne, Victoria, Australia: Spinifex Press,
1992; also published by New York University Press, 1993), pp. xvi,
xviii.
18. Stone, p. 299.
19. Stone, pp. 283, 300.
20. Judith Shapiro, “Transsexualism: Reflections on the Persist­ence of Gender and the Mutability of Sex,” in Epstein and Straub,
Body Guards, p. 253.
21. Shapiro, p. 262.
22. Shapiro, p. 262.
23. Shapiro, p. 255.
24. Shapiro, p. 259.
25. Steve Greenberg, “The Next Wave,” The Advocate 633, July
13, 1993, pp. 51-52.
26. Greenberg, p. 52.
27. Greenberg, p. 52.
28. Greenberg, p. 52.
29. While I realize that much of the traditional literature distin­
guishes among drag queens, cross dressers, and transvestism, andthat there are some significant differences among these groups,
what they all have in common is that they wear women’s clothes.

189

Notes

Further, they wear the kind of hyperfeminine women’s clothes thatmany women would never wear. Thus, I use these term s inter­changeably for purposes of this Introduction.
30. David A. Keeps, “How RuPaul Ups the Ante for Drag, ” The
New York Times, July 11, 1993, p. H23.
31. Keeps, p. H23.
32. Kathy Miriam, “From Rage to All the Rage: LesbianFeminism, Sadomasochism and the Politics of Memory,” in Irene
Reti, ed., Unleashing Feminism: a Collection of Radical Feminist
Writings (Santa Cruz, CA: Herbooks, 1993), pp. 51-52,n116.
33. Leslie Feinberg, Stone Butch Blues (Ithaca, New York: Fire­brand Books, 1993), pp. 158-59. See text for further page refer­ences.
34. Leslie Bennetts, “k. d. lang Cuts It Close,” Vanity Fair, Au­
gust, 1993, p. 98.
35. Bennetts, p. 97.
36. Bennetts, p. 144.
37. Bennetts, pp. 94-95.
38. Bennetts, p. 99.
39. Bennetts, p. 144.
40. Miriam, pp. 66-67.

INTRODUCTION, PAGES 1-18
1. Harry Benjamin, The Transsexual Phenomenon (New York:
Julian Press, 1966), p. 26.
2. D. H. Russell, “The Sex-Conversion Controversy,” The New
England Journal of Medicine, 279 (September 1968): 535.
3. Milton T. Edgerton, Norman J. Knorr, and James R. Callison,“The Surgical Treatment of Transsexual Patients,” Plastic and Re­
constructive Surgery, 45 (January 1970): 38.
4. Ibid., p. 42.
5. The various definitions of sex can be found in John Money,“ Sex Reassignment as Related to Hermaphroditism and Trans­
sexualism,” in Richard Green and John Money, eds., Transsexualism
and Sex Reassignment (Baltimore: Johns Hopkins University Press,
1969), pp. 91-93.
6. Robert Stoller, Sex and Gender (New York: Science House,1968), pp. viii, ix.
7. Ira Pauly, “ Adult Manifestations of Female Transsexualism,”in Green and Money, Transsexualism, p. 44.
8. John Money and Anke A. Ehrhardt, Man & Woman, Boy &Girl (Baltimore: Johns Hopkins University Press, 1972), p. 4.
9. Quoted in Time, January 21, 1974, p. 64.
10. Jon K. Meyer and John E. Hoopes, “The Gender Dysphoria

190

The Transsexual Empire

Syndromes,” Plastic and Reconstructive Surgery, 54 (October1974): 447.
11. Idem.
12. See Daniel Callahan, Abortion: Law , Choice & Morality (NewYork: Macmillan, 1970).
13. See R. A. Stebbins, “The Unstructured Research Interview as
Incipient Interpersonal Relationship,” Social and Sociological Re­
search, 56 (January 1972): 164-79.
The goal of such unstructured techniques as explained by R. A.
Stebbins is to provide some sort of conscious data for research pur­poses. Dean and Whyte have listed the kinds of subjective data thatare elicited in such interviews as: (a) current emotional states; (b)opinions on a subject; (c) attitudes toward some object; (d) values
or the underlying principles that organize opinions, attitudes, andsubsequent behavior; (e) hypothetical reactions to certain circum­
stances; (f) actual reactions in specified situations. In interviewing
both pre- and postoperative transsexuals, I was most interested in
obtaining information with respect to (d) values or the underlying
principles that organize opinions, attitudes, and subsequent be­havior, especially as it influenced the transsexual’s background of
sex-role conditioning and his/her subsequent desire to be transsexed.
The various questions I asked transsexuals should help to makethe preceding categories more specific. Aside from the commonly
asked questions about family, class, educational, religious, andgeographical background, I asked each transsexual the following
questions: (a) Were they satisfied with the surgery? Did they everlook back and wish they had done differently? Is their genderdissatisfaction relieved? (b) What is their opinion about feminism?
What do they think about homosexuality? (c) What clothes do they
like to wear? What jobs interest them? (d) Why did they want tobecome women (or men)? What do they expect from life? What
did they feel lacking before surgery? Would they like to see what
are called masculine and feminine qualities and characteristics dis­appear? How do they relate to women and men? (e) I asked trans­
sexuals to react to the hypothetical situation o f a role free society
in which people were able to be themselves. Would they then feel
it necessary to change sex? I also asked the transsexuals I inter­viewed how they would react to a hypothetical meeting with afeminist who told them that they were reinforcing sex-role stereo­
types by changing sex. (f) In some cases, where I felt I could ex­press my own opinion, I admitted I was the feminist who felt much
ambiguity about the rightness of transsexualism because it rein­
forced sex-role stereotypes.
14. Mary Daly, Beyond God the Father (Boston: Beacon Press,
1973), especially pp. 179-98.

191

Notes
I: “ EVERYTHING YOU ALWAYS WANTED TO KNOWABOUT TRANSSEXUALISM,” PAGES 19-42

1. D. O. Cauldwell, “ Psychopathia Transsexualis,” Sexology , XVI(1949): 274-80.
2. Christine Jorgensen, A Personal Autobiography (New York:
Bantam Books, 1968). Jorgensen’s autobiography was subsequently
made into a movie.
3. Neils Hoyer, Man Into Woman: An Authentic Record of a
Change of Sex (New York: Dutton, 1933). Harry Benjamin in his
introduction to Money and Green’s Transsexualism and Sex Re­
assignment cites this as being the first popularized account of trans­
sexualism.
4. F. Z. Abraham, “Genitalumwandlung an zwei maennlichen
Transvestiten,” Sexualwiss, 18 (1931): 223-26.
5. Harry Benjamin first became interested in sex conversion(which he later named transsexualism) when sex researcher Alfred
Kinsey referred him to a case that he, Kinsey, could not understand.
Kinsey was preparing a second volume on sexual behavior and dis­covered in the taking of his case histories a young boy whose great
ambition was to become a girl. Benjamin subsequently began seeing
other cases of a similar nature, began referring candidates abroad
for surgery before the operation could be performed legally in the
United States, and published the first systematic and professional
account of transsexualism in a volume entitled The Transsexual
Phenomenon (New York: Julian Press, 1966).
6. Author’s interview with Zelda Suplee, New York City, May
1974. The Erickson Foundation, which was in operation until 1977
and is now defunct, was probably the group most familiar with theworld and national situation on transsexualism. The Janus Infor­
mation Center in Galveston, Texas, is attempting to continue thereferral and public-information services supplied previously by the
Erickson Foundation. In the planning stages at this point, however,is the Harry Benjamin International Academy for Gender Dysphoria,
which, if established, will attem pt to set standards of referral andsurgery, and collect vital statistics on transsexualism worldwide.
7. Paul Walker and John Money in their review of Donald R. Lauband and Patrick Gaudy, eds., Proceedings of the 2nd Interdisci­
plinary Symposium on Gender Dysphoria Syndrome, that appearedin Archives o f Sexual Behavior, 4 (1975): 311.
8. Cited in the Erickson Educational Foundation Newsletter, 8(Spring 1975): 1.
9. Ira B. Pauly, “ Male Psychosexual Inversion: Transsexualism,”
Archives General Psychiatry, XIII (August 1965): 172.
10. A uthor’s interviews with John Money, Baltimore, Maryland,
February 1974, and Canon Clinton Jones, Hartford, Connecticut,
March 1975.

192

The Transsexual Empire

11. Anke Ehrhardt, Commentary on Norman Block and Arthur
Tessler, “Transsexualism and Surgical Procedures,” Surgery, Gyne­
cology, and Obstetrics, 132 (March 1971): 527.
12. Quoted in Benjamin, The Transsexual Phenomenon , p. 148.
13. Ira B. Pauly, “ Adult Manifestations of Female Transsexual­ism,” in Richard Green and John Money eds, Transsexualism andSex Reassignment (Baltimore: Johns Hopkins Press, 1969), p. 60.
The Kinsey hypothesis that Pauly refers to can be found in A. C.
Kinsey, et al., Sexual Behavior in the Human Female (Philadelphia:
W. B. Saunders, 1953).
14. Judith Long Laws, “The Psychology of Tokenism: An Analy­
sis,” Sex Roles, I (1975), 51.
15. Idem.
16. Mary Daly, Gyn/Ecology: The Metaethics of Radical Femi­nism (Boston: Beacon Press, 1978), p. 57.
17. The case of Rosalyn Franklin is a primary example of awoman who made an initial and major contribution to the discoveryof the structure of DNA, yet was not part of the group that received
the Nobel Prize for this discovery. See Anne Sayre, Rosalyn Franklin
and the DNA (New York: W. W. Norton, 1975). An even more fa­
mous example of the male scientific erasure of a woman’s discovery
is the case of Helen Taussig who discovered the method for saving
the lives of “blue babies.” Alfred Blalock took the credit for this
discovery, and it has since been named the Blalock method.
18. Karen Horney, Feminine Psychology (New York: W. W. Nor­
ton, 1967).
19. Ralph Greenson, quoted in Charles J. McFadden, Medical
Ethics (Philadelphia: F. A. Davis, 1967), p. 282.
20. Barbara Seaman, Free and Female (New York: Fawcett-Crest,1972).
21. Barbara Ehrenreich and Deirdre English, Witches, Midwives,
and Nurses: A History of Women Healers (New York: Feminist
Press, 1972); and Complaints and Disorders: The Sexual Politics
o f Sickness (New York: Feminist Press, 1973).
22. Christian Hamburger, “Endocrine Treatment of Male andFemale Transsexualism,” in Green and Money, Transsexualism ,p. 291. Hamburger, the surgeon who transsexed Christine Jorgensen,
is credited with being the first to develop surgical specialties for the
medical treatm ent of transsexualism.
23. Harry Benjamin and Charles L. Ihlenfeld, “Transsexualism,”
American Journal of Nursing, 73 (March 1973): 460.
24. Hamburger, “ Endocrine Treatment, ” p. 297.
25. C. Hamburger, G. K. Sturrup, and E. Dahl-Iversen, “Trans­
vestism,” Journal of the American Medical Association , 152 (1953):
391.

193

Notes

26. Norman L. Block and Arthur N. Tessler, “Transsexualism andSurgical Procedures,” Surgery, Gynecology and Obstetrics, 132(March 1971): 523.
27. Benjamin and Ihlenfeld, “Transsexualism,” p. 461.
28. W. S. C. Symmers, “Carcinoma of the Breast in Transsexual
Individuals After Surgical and Hormonal Interference with thePrimary and Secondary Sex Characteristics,” British Medical Jour­nal, 2 (1968): 83.
29. Leo Wollman, “ Office Management of the Postoperative Male
Transsexual,” in Green and Money, Transsexualism, p. 332. Ob­
viously, Wollman’s medical jargon of “running risks” obscures thefact that it is the medical empire that initiates and promotes suchrisks.
30. See Harry Ziel and William Finkle, “Increased Risk of Endo­metrial Carcinoma Among Users of Conjugated Estrogens,” andDonald Smith et al., “ Association of Exogenous Estrogen and Endo­metrial Carcinoma,” New England Journal of Medicine, 293 (Decem­ber 4 , 1975): 1167-70; 1164-66. Both of these articles confirm theconnection between estrogenic therapy and cancer of the endome­
trium and the breast, a connection that has been suspected for many
years and previously demonstrated by many health feminists. Thisevidence written up in the New England Journal of Medicine con­firms that “conservative” doses of estrogen therapy given to the“normal female” may be cancer-inducing. In fact, Smith et al.
found: “ Our data also indicate that the exogenous estrogen-related
risk is highest for women classified as normal—i.e., those with noneof the ‘classic’ predisposing signs” (p. 1166).
31. Benjamin and Ihlenfeld, “Transsexualism,” p. 461.
32. Creighton G. Bellinger and Dicran Goulian, “ Secondary Sur­gery in Transsexuals,” Plastic and Reconstructive Surgery, 51 (June1973): 630.
33. Milton T. Edgerton, Norman J. Knorr, and James R. Callison,“The Surgical Treatment of Transsexual Patients: Limitations andIndications,” Plastic and Reconstructive Surgery, 45 (January1970): 43-44.
34. Quoted in Bellinger and Goulian, “ Secondary Surgery inTranssexuals,” p. 628.
35. J. Hoenig et al., “ Surgical Treatment for Transsexuals,” Acta
Psychiatra Scandinavia, 47 (1971): 106-36.
36. John E. Hoopes, “ Operative Treatment of the Female Trans­
sexual,” in Green and Money, Transsexualism, p. 337.
37. Ibid., p. 341. Hoopes also lists the various attempts at phallus
construction (p. 343). Each attem pt has aimed at constructing afunctionally sexual phallus. Rigidity has been achieved in various
ways. Autogenous rib cartilage grafts have proven most satisfactory

194

The Transsexual Empire(Bogoras, 1936; Franklin, 1944; Bergman, Howard, and Barnes,
1948; Gelb, Malament, and Lo Verme, 1959). This method isis certainly an interesting variation on the theme of “Adam’s rib, ”
this time Eve’s rib providing the necessary material for Adam’s
phallus. However, given the fact that Adam is genetically still Eve,such surgery is actually a pseudoversion of the androgynous person.
Acrylic implants have been utilized by several investigators(Goodwin and Scott, 1952; Morales, O’Connor, and Hotchkiss,
1956; Loeffler and Sayegh, 1960) and have been found to be un­satisfactory. Morales et al. used implanted steel mesh. Munawar
implanted a periosteal tibial bone graft. Farina and Freire (1954)
observed that rigid implants are unnecessary due to the fact that
ibrosis with the abdominal tube pedicle flap provided sufficientrigidity. Millard (1966) described a patient who enjoyed satisfactory
sexual intercourse with the aid of a “stiffener” inserted into the“skin urethra[sic] . ” Finally, there is the most recent method, ex­plained in the text, of a stiffener inserted into an envelope of theskin of the constructed phallus, which presses against the embedded
clitoris during intercourse, thus enabling orgasm.
38. Benjamin, The Transsexual Phenomenon, p. 150.
39. Hoopes, “ Operative Treatment, ” p. 341.
40. All the preceding information concerning legal statutes was
summarized in Robert Veit Sherwin, “ Legal Aspects of Male Trans­
sexualism,” in Green and Money, Transsexualism, pp. 417-20.
41. Ibid., p. 420.
42. Idem.
43. John Money and Florence Schwartz, “Public Opinion andSocial Issues in Transsexualism: A Case Study in Medical Sociol­ogy,” in Green and Money, Transsexualism , p. 260.
44. Sherwin, “ Legal Aspects,” pp. 420-21.
45. Cited in Money and Schwartz, “Public Opinion,” pp. 258-59.
46. Ibid., p. 257.
47. Donald W. Hastings, “ Inauguration of a Research Project on
Transsexualism in a University Medical Center,” in Green andMoney, Transsexualism, p. 251.
48. Money and Schwartz, “Public Opinion,” p. 258.
49. Robert Sherwin, “ The Legal Problem in Transvestism,” Amer­ican Journal of Psychotherapy, III (April 1954): 243-44.
II. ARE TRANSSEXUALS BORN OR M A D EOR BOTH?, PAGES 43-68
1. Q uoted in Richard Green, “ Mythological, Historical, and Cross-

Cultural Aspects of Transsexualism,” in Richard Green and John
Money, eds., Transsexualism and Sex Reassignment (Baltimore:
Johns Hopkins University Press, 1969), p. 14.

195

Notes

2. Organicism signifies “ integration” here.
3. Among other writings at this point, see John Money, “Develop­
mental Differentiation of Femininity and Masculinity Compared,”in The Potential of Women, eds. Seymour M. Farber and Roger
H. L. Wilson (New York: McGraw-Hill, 1963), p. 51.
4. John Money and Anke Ehrhardt, Man & Woman, Boy & Girl
(Baltimore: Johns Hopkins University Press, 1972), p. 1.
5. Ibid., pp. 3-4.
6. Idem.
7. Idem.
8. Ibid., p. 9.
9. Ibid., p. 2.
10. Ibid., p. 21.
11. Ibid., p. 60.
12. Ibid., pp. 63-64.
13. Ibid., p. 71.
14. Ibid., p. 103.
15. Ibid., p. 10.
16. John Money and John G. Brennan, “ Sexual Dimorphism in
the Psychology of Female Transsexuals,” in Green and Money,
Transsexualism, pp. 149-50.
17. Money and Ehrhardt, Man & Woman, p. 161.
18. Money and Brennan, “ Sexual Dimorphism,” p. 150.
19. Ann Oakley, Sex, Gender, & Society (New York: Harper
Colophon Books, 1972), p. 113.
20. Ibid., p. 77.
21. Elizabeth Adkins, “Genes, Hormones, and Gender” (paper
presented at the 144th National Meeting of the American Associa­
tion for the Advancement of Science, Washington, D.C., February
1 4 , 1978), p. 21.
22. Ibid., p. 19.
23. Idem.
24. Oakley, Sex, Gender, & Society, p. 127.
25. Adkins, “ Genes, Hormones, and Gender,” p. 13.
26. See J. W. Mason, “ Psychologic Stress and Endocrine Func­tion, ” in E. J. Sacher, ed., Topics in Psychoendocrinology (NewYork: Grune & Stratton, 1975).
27. Martin Duberman, “The Case of the Gay Sergeant,” the New
York Times Magazine, November 9 , 1975, p. 67.
28. Thomas Aquinas, Summa Theologiae, I, 9 2 , 1, ad. I.
29. Estelle Ramey, “ Sex Hormones and Executive Ability,”
Annals of the New York Academy of Sciences, 208 (March 15,1973): 238.
30. Warren Gadpaille, “ Research into the Physiology of Malenessand Femaleness,” Archives of General Psychiatry, 26 (March 1972):
195.

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The Transsexual Empire

31. Author’s conversation with Eileen van Tassell, Amherst,
Mass., July 1978.
32. Robert Stoller, “The ‘Bedrock’ of Masculinity and Femi­
ninity, ” Archives of General Psychiatry, 26 (March 1972): 209.
33. John Money and Patricia Tucker, Sexual Signatures: On Being
a Man ora Woman (Boston: Little, Brown, 1975), pp. 15-16.
34. In speaking about “ appropriate” versus “ inappropriate” u t­
terances, Julia Stanley has written: “ An appropriate utterance is
one that is fully m eaningful. . . and open to question. ” In order foran utterance to be open to question, the words must have referential
value with respect to the context. (See Julia Stanley, “The Stylistics
of Belief,” in Daniel J. Dieterich, ed., Teaching About Doublespeak[Urbana, 111.: National Council of Teachers of English, 1976],
p. 177. ) The words on page 59 quoted from Sexual Signatures
are totally separated from Money’s “overriding effects of androgen”
statements in Man & Woman, Boy & Girl. The reader is left won­dering how, if androgen is the activating hormone, there can be aneffectual content to the “ Eve base view.”
35. Money and Ehrhardt, Man & Woman, p. 103.
36. Money and Tucker, Sexual Signatures, pp. 88-89.
37. Ibid., p. 89.
38. Money and Ehrhardt, Man & Woman, p. 13.
39. Money and Tucker, Sexual Signatures, pp. 86-87.
40. Ibid., p. 119.
41. Ibid., p. 230.
42. Peter Berger and Thomas Luckmann, The Social Constructionof Reality (New York: Doubleday, 1966), p. 156.
43. Ibid., p. 157.
44. “ Biological Imperatives,” Time, January 8 , 1973, p. 34.
45. Money and Tucker, Sexual Signatures, p. 230.
46. Ibid., p. 231.
47. Ibid., p. 193.
48. Ibid., p. 231.
49. Ibid., p. 233.
50. Money and Ehrhardt, Man & Woman, p. 186.
III.

“MOTHER’S FEMINIZED PHALLUS” OR FATHER’SCASTRATED FEMME?, PAGES 69-98

1. Robert Stoller, The Transsexual Experiment (London: Hogarth
Press, 1975), pp. 38-55.
2. Robert Stoller, “Parental Influences in Male Transsexualism,”in Richard Green and John Money, eds., Transsexualism and Sex Re­
assignment (Baltimore: Johns Hopkins University Press, 1969),
p. 166.

197

Notes

3. Stoller, The Transsexual Experiment, pp. 223-244.
4. Harry Benjamin and Charles L. Ihlenfeld, “Transsexualism,”
American Journal of Nursing, 73 (March 1973): 458.
5. John Money and Patricia Tucker, Sexual Signatures: On Being
a Man or a Woman (Boston: Little, Brown, 1975), p. 91.
6. Richard Green, Sexual Identity Conflict in Children and Adults(New York: Basic Books, 1974), p. 303.
7. Ibid., p. 302.
8. Idem.
9. Another issue that could be raised in this context is the insig­
nificance of biological fatherhood. If, as the psychologists assert,
fathers have only a passive influence on transsexual development,
then is this an unintended commentary on the inconsequentialityof paternal ability to affect. “Blaming the mother, ” although it isa negative influence, is still an influence. Furthermore, mothers
have been “ credited” with such negative ability to affect in many
areas of child development. As Mary Daly has asked, does it thenbecome the self-appointed task of the medical and therapeutic
fathers to take over a faded and ineffectual biological fatherhood?
Is their construction of a transsexual empire an unwitting admissionthat the biological father is impotent and must be stabilized bytechnological paternity?
10. N. Lukianovicz, “ Survey of Various Aspects of Transvestismin the Light of Our Present Knowledge,” Journal of Nervous andMental Disorders, 128 (1959): 36.
11. Lionel Ovesey and Ethel Person, “Gender Identity and Sexual
Psychopathology in Men: A Psychodynamic Analysis of Homo­sexuality, Transsexualism, and Transvestism,” Journal of the Ameri­
can Academy of Psychoanalysis, 1 (1973): 54.
12. Ibid., p. 65.
13. Henry Guze, “Psychosocial Adjustment of Transsexuals: An
Evaluation and Theoretical Formulation,” in Green and Money,
Transsexualism, p. 179.
14. Idem.
15. Interview with Allen Raysdon, Daily Local News, West Ches­
ter, Pa., Oct. 7 , 1974, p. 2.
16. Judy Klemesrud, “A Transsexual and Her Family: An At­
tem pt at Life as Usual,” New York Times, Oct. 2 3 , 1973.
17. William Cockerham, “ Prisoner Requests Sex-Change Sur­gery,” Hartford Courant, May 5 , 1974.
18. Tommi Avicolli, “Crossing Sexual Borders,” Gay Community
News, May 3 , 1975, p. 12. For the correlation between transsex­
ualism and prostitution, see also: Thomas Kando, Sex Change: The

Achievement of Gender Identity among Feminized Transsexuals(Springfield, Ill.: Charles C. Thomas, 1973), pp. 46-59; J. Hoenig,

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The Transsexual Empire

J. C. Kenna, and A. Yond, “Surgical Treatment for Transsexuals,”
Acta Psychiatra Scandinavia, 47 (May 1974): 106-36. Hoenig et al.
give statistics of transsexuals who turn to prostitution. They also
relate an example of a prosperous businessman who, after changing
sex, couldn’t find work as a woman; Harry Benjamin, The Transsexual Phenomenon (New York: Julian Press, 1966). He reportsthat prostitution is fairly common among transsexuals.
19. Kando, Sex Change, p. 8. Since a large section of the text
is devoted to Kando’s study, the remaining page references quoted
will be placed in parentheses in the text.
20. John Money and John G. Brennan, “Sexual Dimorphismin the Psychology of Male Transsexuals,” in Green and Money,
Transsexualism, p. 139.
21. Peter Berger, The Sacred Canopy (New York: Doubleday,1967), p. 85.
22. Idem.
23. George Gilder, in Sexual Suicide, expressed this same rea­soning, but from quite a different perspective. In attacking thewomen’s movement for its impatience with man’s constant needto prove his masculinity, Gilder accuses feminists of misunderstand­ing a basic point about masculinity: “ Unlike femininity, relaxedmasculinity is at bottom empty, a limp nullity. While the female
body is full of internal possibility, the male is internally barren(from the Old French bar, meaning man). Manhood at the mostbasic level can be validated and expressed only in action. For aman’s body is full only of undefined energies. And all these energies
need the guidance of culture. He is therefore deeply dependent on
the structure of the society to define his role” (p. 18).
24. Money and Tucker, Sexual Signatures, p. 206.
25. Ibid., p. 192. This is a change in Money’s thinking. When I
interviewed him at Johns Hopkins in February 1974, he stated that
he perceived no relation between transsexualism and sex-role stereo­
typing.
26. Diane Dumanoski, “Transsexuals: Anatomy Need Not be
Destiny,” The Boston Phoenix, November 2 5 , 1975.
27. Robin Morgan, “ Lesbianism and Feminism: Synonyms orContradictions? ” The Second Wave, 2, no. 4 (1973): 18.
28. Kando, Sex Change, pp. 113-14.
29. Kando, Sex Change, p. 114. Many transsexuals reject theterms sex conversion surgery and transsexual surgery. They speak in­stead of corrective surgery.
30. Jan Morris, Conundrum (New York: Signet, 1974), pp. 89,
90, 91.
31. New York Times Magazine, March 1 7 , 1974, p. 94.
32. Idem.
33. Morris, Conundrum , p. 177.

199

Notes

34. Susan Brownmiller, Against Our Will: Men, Women, and Rape
(New York: Simon & Schuster, 1975), pp. 257-68.
35. Ernest Becker, The Structure of Evil (New York: George
Braziller, 1968), p. 185.
36. See Avicolli, “ Crossing Sexual Borders.”
37. Norman Knorr, Sanford Wolf, and Eugene Meyer, “Psychia­
tric Evaluation of Male Transsexuals for Surgery,” in Green andMoney, Transsexualism, p. 278.
38. Harry Benjamin, The Transsexual Phenomenon (New York:
Julian Press, 1966), p. 110.
39. Norman Block and Arthur Tessler, “Transsexualism and Sur­gical Procedures,” Surgery, Gynecology, and Obstetrics, 132 (March
1971): 522.
40. Jon K. Meyer and John E. Hoopes, “The Gender Dysphoria
Syndromes: A Position Statement on So-Called ‘Transsexualism,’”
Plastic and Reconstructive Surgery, 54 (October 1974): 447.
41. Quoted in Benjamin, The Transsexual Phenomenon, p. 109.
42. Erickson Educational Foundation, “Counseling the Trans­
sexual: Five Conversations with Professionals in Transsexual Ther­apy,” pp. 9-10.

43. Ibid., p. 14.
44. Idem.
45. Joyce Strait, “The Transsexual Patient After Surgery,” Amer­ican Journal of Nursing, 73 (March 1973): p. 462.
46. George A. Rekers and James W. Vami, “Self-Monitoring and
Self-Reinforcement Processes in a Pre-Transsexual Boy,” Behaviour
Research and Therapy, 15 (1977): 177. Rekers presently heads atreatm ent and research program at U.C.L.A. on childhood “ gender
problems” supported by U.S. Public Health Service Research Grants
and grants from NIMH. Formerly, Richard Green was the directorof this program. See also George A. Rekers, O. Ivar Lovaas, andBenson Low, “The Behavior Treatment of a ‘Transsexual’ Preadoles­
cent Boy,” Journal of Abnormal Child Psychology, 2 (June 1974):
99-116. For an insightful critique of the work of the Child Gender
Program at U.C.L.A., see David M. Rorvik, “The Gender Enforcers,”
Rolling Stone, October 9 , 1975, pp. 53, 67, 86-88. Rorvik cites or­
ganized opposition to the gender program from the “ Coalition
Against the Dehumanization to Children.” This group claimed tohave intercepted a personal memo from Rekers which sought help
in locating more prepubertal males with so-called gender identity
problems for “ diagnostic study. ”
47. Richard Green, Lawrence E. Newman, and Robert J. Stoller,“ Treatment of Boyhood ‘Transsexualism,’” Archives General Psy­
chiatry, 26 (March 1972): 213.
48. Nowhere in this report do the authors define masculinity
or femininity. It is assumed that there is a commonly agreed upon,

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The Transsexual Empire

though invisible, consensus. A major question that could be asked
about this article is how it squares with Money’s contention thatgender identity is fixed by eighteen months. If this is so, then it
seems that no amount of treatment, even of boyhood transsexual
tendencies, would alter core gender identity.
49. Green, Newman, and Stoller, “ Boyhood ‘Transsexualism,’”p. 214.
50. Meyer and Hoopes, p. 445.
51. Ernest Barker, The Political Thought of Plato and Aristotle(New York: Dover Publications, 1959), p. 398.
52. Green, Newman, and Stoller, p. 216.
53. Meyer and Hoopes, p. 445.
54. Julia Stanley, in “The Stylistics of Appropriateness: A Redef­
inition” (paper presented at the Conference on College Composition
and Communication, New Orleans, Louisiana, April 1973), offers an
incisive linguistic commentary on such words: “The adjectives
appropriate and inappropriate belong to the general class of PSY­
CHOLOGICAL PREDICATES. Specifically, these adjectives are
judgment verbals. Such predicates. . . ‘designate psychologicalstates, processes, or attributes. ’ But as with other psychologicalpredicates, like seem and appear, these predicates can imply thatthe underlying presuppositions are not subjective at all, but are
based on some universal consensus regarding behavior. The usageof appropriate and inappropriate covertly suggest that the judg­
ment is attributable to more than just the individual speaker.”
55. Green, Newman, and Stoller, p. 217.
56. Idem. Rorvik, in “The Gender Enforcers,” responds to thiskind of argument. “The Researchers’ stance is thus a ‘liberal’ one. . .
one nods approvingly as the researchers pay liberal lip service tothe idea that society should change in order to accommodate greater
expression of effeminacy among males. But then, they sigh, society
will not do this; so it’s up to them to make the gender male misfit
fit into society, for his own good. . . It all seems terribly logical,
until one reflects: How will society ever change if accommodating
psychotechnologists keep changing us to conform to society? ”(P. 53).
57. Max Stackhouse, Ethics and the Urban Ethos (Boston: Bea­con Press, 1972), p. 28. Stackhouse has stated: “ The personalist
position does not fulfill its own intention; it does not deal with thewhole person or the new shapes of personality.. . . The isolation andabsolutization of the concept of the person extracted from theactual social matrix is a fundamental distortion of what it means to
be a self and what it takes to promote authentic self and small grouprelations.”

201

Notes
IV. SAPPHO BY SURGERY: THE TRANSSEXUALLYCONSTRUCTED LESBIAN-FEMINIST, PAGES 99-119

1. In June/July of 1977, twenty-two feminist musicians, soundtechnicians, radio women, producers, and managers sent an open
letter to Olivia Records via Sister, a West Coast feminist newspaper.
The letter focused on the employment of Sandy Stone, a male-toconstructed-female transsexual, as Olivia’s recording engineer andsound technician. The signers protested Stone’s presence at Olivia
and the fact that Olivia did not inform women that Stone was a
postoperative transsexual. They criticized Stone’s participation
in women-only events and accused him of taking work away fromthe “ few competent women sound technicians in the Bay Area. . .
whose opportunities are extremely limited.” They noted that
Stone’s male privilege gave him access to his skills, and that hehas never had to suffer the oppression that women face every day.
The letter concluded by stating that “it is not our intention to dis­credit or trash Olivia,” and requested that they publish a statement
in response.
In the same issue of Sister, Olivia replied that: 1. Surgery alone
does not make a transsexual a woman. “This too-publicized stepis merely the confirmation of a process that has already gone tonear completion by that time. ” 2. Aside from a few well-publicizedtranssexuals, a person does not gain privilege by becoming a trans­
sexual. Because Stone gave up his male identity and lives as a
“woman” and a “lesbian,” he is faced with the same kinds of op­
pression that “other” women and lesbians face, along with the added
ostracism that results from being a transsexual. 3. A person’s historyis important but most significant is what that person’s actions arenow. 4. Day-to-day interaction with Sandy Stone has convinced
the Olivia women that Sandy is a “woman we can relate to with
comfort and trust. ” 5. Olivia did not indicate Stone’s transsexual
status, because they were afraid he would be “objectified.” “We
see transsexualism as a state of transition, and we feel that to con­tinue to define a person primarily by that condition is to stigmatize
her at the expense of her growth process as a woman.” 6. Stone has
trained women in technical skills and will build Olivia’s recording
studio where many women will apprentice. He is also writing a how­
to book for women explaining the recording process. Thus Stone
does not take employment away from women but provides it andmay be “perhaps even the Goddess-sent engineering wizard we had
so long sought. ”
2. A uthor’s conversation with Pat Hynes, Cambridge, Mass.,
January 1978.

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The Transsexual Empire

3. A uthor’s conversation with Mary Daly, Boston, Mass., Feb­
ruary 1978.
4. Rosemary Anderson, Letter entitled “Transsexual Feminism? ”
Sister, August-September 1977, p. 7.
5. Recently, questions have been raised by transsexuals who claim
to be lesbian-feminists and by some professionals in gender identity
clinics about clinic requirements of “passing” and about the stereo­
typical behavior of transsexuals. “We urge professionals not to as­sume or expect that all transsexuals will be heterosexually oriented
or politically conservative and not to judge (for example) lesbianism
in a male-to-female transsexual as invalid while accepting it in a
genetic woman. Biological women and male-to-female transsexuals
present a similarly vast range of sexual orientation and life-stylechoices; different choices are valid for different people.. . . Posi­
tively, we recommend a setting where the client is not forced to
avow rigid self-definitions, but is permitted and even encouraged
to find her/his own answers to the difficult and complex questionsof sexuality and identity that confront us all.” Deborah Heller
Feinbloom etal. , “ Lesbian/Feminist Orientation Among Male-toFemale Transsexuals,” Journal of Homosexuality, 2 (Fall 1976):
70-71.
There are several criticisms that can be made of such a stance.
First, nonstereotypical behavior is encouraged as one choice among“ different choices [that] are valid for different people.” Thus there
is no commitment to eradicating stereotypical behavior but only to
encouraging alternative behavior (“ different strokes for different
folks”). And thus there is no commitment to ultimately phasing out
gender identity control over various styles of behavior. The authors’conclusions coincide with John Money’s recommendations in Sexual
Signatures for “ flexible” stereotypes.
Second, the unanswered question is why are such transsexuals
and transsexual professionals still advocating surgery. Transsexual
surgery would not be necessary if rigid self-definitions had not pro­
duced the phenomenon of a “female mind in a male body. ” This
self-definition would make no sense in a society that did not accept
that split. Therefore, to support behavior and orientation that is notstereotypical, yet to continue advocating transsexualism is contra­
dictory.
Such recommendations only make the issue of “passing” andstereotypical behavior more invisible. These authors appear to getbeyond the stereotypes, but they are actually supporting “passing”
behavior on a deeper level. In effect, they are now advocating thatmen “pass” as lesbian-feminists, thus making a “role” out of lesbianfeminism that can be taken on by anyone. Ultimately, this brings
lesbian-feminism within the confines of the gender identity clinics,
where it can be observed, studied, and controlled—first in trans­

203

Notes

sexuals, and then perhaps in lesbian-feminists. With the acceptanceof transsexuals as lesbian-feminists by the gender identity clinics,
the “passing” requirements only become modified. The transsexual“ passes” what are the current (seemingly avant-garde) requirementsof the gender identity clinics. In order to become transsexed, how­ever, his “passing” behavior must still be “baptized” as legitimately
female.
It is significant that these recommendations are coming frommale-to-constructed-female transsexuals. Here is a clear admissionthat lesbian-feminism is perceived as important and that more isat stake in transsexual surgery than obtaining the body and the tra­ditional role of a woman. There is a recognition here that female
power/energy/creativity is at the heart of the matter. Why are there
no female-to-constructed-male transsexuals, for example, who areseeking to “pass” as homosexual men?
6. Author’s conversation with Mary Daly, Boston, Mass., Feb­
ruary 1978.
7. Robert Spencer, “The Cultural Aspects of Eunuchism,” CIBA
Symposia, 8 (1946): 407.
8. Ibid., p. 408.
9. Ibid., p. 413.
10. Another parallel is that some royal eunuchs also wore women’s
clothing, and their physical characteristics, especially as represented
on Assyrian monuments, resembled those of women. Eunuch priestsof goddess temples were said to wear women’s garb and performwomen’s tasks. See John L. McKenzie, “Eunuch,” Dictionary of the
Bible (Milwaukee: The Bruce Publishing Company, 1965), 252.
11. Simone de Beauvoir, The Second Sex (New York: Bantam
Books, 1953), p. 174.
12. See Mary Daly, Gyn/Ecology: The Metaethics of Radical
Feminism (Boston: Beacon Press, 1978), pp. 66-67.
13. Philip Slater, The Glory of Hera: Greek Mythology and the
Greek Family (Boston: Beacon Press, 1968), p. 211.
14. Jane Harrison, Mythology (New York: Harcourt, Brace andWorld, 1963), p. 97.
15. See comments in Chapter I about transsexual desire forfemale creativity as represented in female biology.
16. Radicalesbians, “The Woman Identified Woman,” in Anne
Koedt, Ellen Levine, and Anita Rapone, eds., Radical Feminism(New York: Quadrangle/New York Times Book Co., 1973), p. 241.
17. Norman O. Brown, Love's Body (New York: Random House,1966), p. 116.
18. Daly, Gyn/Ecology, pp. 67-68.
19. Elizabeth Rose, Letter to the Editors, Chrysalis, 5 (1978): 6.
20. Idem.
21. Daly, Gyn/Ecology , p. 67.

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The Transsexual Empire

22. Ibid.
23. Judy Antonelli, “Open Letter to Olivia,” Sister, AugustSeptember 1977), p. 6.
24. T. C. Boyle, “The Women’s Restaurant, ” Penthouse , May
1977, p. 112.
25. Ibid., p. 132.
26. Ibid., p. 133.
27. Conversation with Adrienne Rich, Montague, Mass., May
1977.
28. Jill Johnston, Lesbian Nation: The Feminist Solution (NewYork: Simon & Schuster, 1973), p. 180.
29. Angela Douglas, Letter, Sister, August-September 1977, p. 7.
30. Johnston, Lesbian Nation, p. 278.
31. Ibid., p. 279.
32. See, for example, photographer J. Frederick Smith’s “port­
folio of stunning portraits inspired by ancient Greek poems onloving women,” in Playboy, October 1975, pp. 126-35.
33. One photographer who is particularly obsessed with “ cap­turing” women in pseudolesbian poses is David Hamilton. He is
the creator of the following books of photography:
Dreams of a Young Girl, text by Alain Robbe-Grillet (New York:
William Morrow and Co., 1971).
Sisters, text by Alain Robbe-Grillet (New York: William Morrow
and Co., 1973). This book has an outrageous pictorial section en­
titled “Charms of the Harem.”
Hamilton's Movies—Bilitis (Zug, Switzerland: Swan Productions
AG, 1977).
34. Lisa Buck (Unpublished notes on transsexualism, October1977), p. 3.
35. An example of this literature is Robert Wilson’s Feminine
Forever (New York: M. Evans, 1966). This book sold 100,000
copies in its first year, as well as being excerpted in Look and Vogue.
36. See Deborah Lamed, “The Greening of the Womb,” NewTimes, December 1 2 , 1974, pp. 35-39.
V.
THERAPY AS A WAY OF LIFE:
MEDICAL VALUES VERSUS SOCIAL CHANGE, PAGES 120-153

1. Thomas Szasz, Ceremonial Chemistry (New York: Doubleday,
1975), p. 149.
2. Ernest Becker, The Structure of Evil (New York: George
Braziller, 1968), p. 297.
3. See the Oxford English Dictionary listing for the word health ,which traces the word from its Old English spelling originally mean­ing “whole.”
4. Becker, The Structure of Evil, p. 298.

205

Notes

5. Philip Rieff, The Triumph of the Therapeutic (New York:
Harper and Row, 1966), p. 13.
6. Ibid., p. 15.
7. Idem.
8. Thomas Szasz, Ideology and Insanity (New York: Doubleday,1970), p. 3.
9. Ibid., p. 11.
10. Quoted in Time, January 2 1 , 1974, p. 64.
11. Jan Morris, Conundrum (New York: New American Library,1974), p. 177.
12. John Money and Patricia Tucker, Sexual Signatures: On Being
a Man ora Woman (Boston: Little, Brown, 1975), pp. 230-31.
13. Becker, The Structure of Evil, p. 282.
14. Ibid., p. 182.
15. Percentages vary slightly but most authors doing postopera­
tive follow-up report that “the majority” or “most of” the trans­
sexuals they surveyed are satisfied, both with the results of the sur­gery and their own state of being after the operation. Harry Benjamin
reported on thirty-one male transsexuals and concluded that theresults of such operations were “excellent” in sixteen cases, “ satis­
factory” in eleven cases, “ doubtful” in four. See Harry Benjamin,“Nature and Management of Transsexualism with a Report on 31
Operated Cases,” Western Journal of Surgery, Obstetrics and Gyne­
cology, 72 (1964): 105-11.
Benjamin in 1966 published findings on a larger number of post­
operative transsexuals (fifty-one). “ Assessment of postoperative
adjustment was made and was considered ‘good’ if the total life
situation was successful, and with good integration into the worldof women and acceptance by society and by the patient’s fam ilyseventeen cases (thirty-three percent). If the result lacked one ofthese features, including the ability to experience orgasm, the re­sult was considered “satisfactory”—twenty-seven cases (fifty-three
percent). Where appearance and sexual function were unsatisfactory,
despite relief from unhappiness in the male role, the result of theoperation was designated ‘doubtful—five cases (ten percent). Only
one patient was regarded as having an unsatisfactory result (a patient
Dr. Benjamin did not endorse).” See Benjamin, The Transsexual
Phenomenon (New York: Julian Press, 1966).
These apparently satisfactory results of transsexual surgery are
not, however, endorsed by all reporters. See, for example, P. Clark­
son and D. Stafford-Clark, “ Role of the Plastic Surgeon and Psy­
chiatrist in the Surgery of Appearance,” British Medical Journal(December 17, 1960), 1768. See also M. Ostow, Letter to the Edi­tor, Journal of the American Medical Association, 152 (1953):
1552-53. However, these reports are the results of a much earlier
period of transsexual surgery.

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The Transsexual Empire

John Randell in “Preoperative and Postoperative Status of Maleand Female Transsexuals,” in Richard Green and John Money, eds.,
Transsexualism and Sex Reassignment (Baltimore: Johns Hopkins
University Press, 1969), pp. 1, 32, concluded the following afterworking with thirty-five postoperative transsexuals. The postopera­
tive results in the case of six female transsexuals “were almost uni­versally satisfactory” (p. 378). The evaluation of twenty-nine maleto-constructed-female transsexuals was:Excellent
7
Poor
1
Good
14
Very Poor 4
Fair
3“The postoperative results reported above indicate that the majorityof males and females undergoing operation for sex reassignment are
subjectively improved both in their adjustment to their environment
and in their own feelings of well-being and satisfaction in their gen­
der role” (379).
However, as Henry Guze notes, “While a frequent response is ela­tion at being closer to one’s imaged self, there are noteworthy excep­
tions. ” See Henry Guze, “Psychosocial Adjustment of Transsexuals:
An Evaluation and Theoretical Formulation, ” in Green and Money,
Transsexualism, pp. 171-200. “ . . . both subtle and gross expressionsof psychological disorder have been observed in some nine patients. ”
These included dreams of death, inexplicable phobias, concern about
physical appearance, dreams of previous masculine selves, guilt, re­morse, and depression. Two patients felt angry and hopeless thatthey could not return to their previous masculine state. In Randell’s
study, there were four cases in which the postoperative adjustment
was worse than before the operation (p. 373). “There the result
can be designated ‘very poor. ’” The behavior included suicide,suicidal impulse, moral depravity, and a wish to reverse the effects
of operation. Two of these men succeeded in committing suicide.
16. Szasz, Ideology , p. 18.
17. Kate Millett, Sexual Politics (New York: Doubleday, 1970),
p. 23.
18. Ibid., p. 25.
19. See G. J. Barker-Benfield, The Horrors of the Half-Known
Life (New York: Harper and Row, 1976). It is estimated that clitoridectomies are still being performed on over 9 million women today,
particularly in Northern Africa. See past issues of the Women's
International Network News, especially vol. 2 (Summer 1976), ed.
by Fran P. Hosken (187 Grant St., Lexington, MA 02173). See also
for present evidence of clitoridectomies: Diane E. H. Russell andNicole Van de Ven, eds., The Proceedings of the International Tri­bunal on Crimes against Women (Millbrae, CA: Les Femmes, 1976).
20. For the most extensive documentation about current psycho-

207

Notes

surgery theories, practices, and groups of people on whom such
surgery is being performed, see Peter Breggin, “The Return of Lo­
botomy and Psychosurgery,” Congressional Record. Proceedings
and Debates of the 92nd Congress, Second Session, Feb. 2 4 , 1972.
See also Peter Breggin, “ New Information in the Debate over Psy­
chosurgery,” Congressional Record. Proceedings and Debates of
the 92nd Congress, Second Session, March 3 0 , 1972.
21. See B. F. Skinner, Beyond Freedom and Dignity (New York:
Alfred A. Knopf, 1971).
22. Willard Gaylin, “ On the Borders of Persuasion: A Psycho­
analytic Look at Coercion,” Psychiatry, 37 (February 1974): 7.
23. Ibid., p. 8.
24. Quoted in Al Huebner and Terry Kupers, “ Violence Center:
Psychotechnology for Repression,” Science for the People, VI(May 1974): 17.
25. See Breggin, Congressional Record. He cites the fact that in1970, William Sweet, Frank Ervin, and Vernon Mark were awarded
a $500, 000 grant from NIMH (National Institute of Mental Health).
In 1971, Sweet et al. also received $188,000 from LEAA (Law En­
forcement Assistance Administration) which was used to study
the supposed biological basis of criminal behavior.
26. See George Gilder, Sexual Suicide (New York: Quadrangle/
New York Times Book Co., 1973).
27. Vernon Mark, William Sweet, and Frank Ervin, “ Role ofBrain Disease in Riots and Urban Violence,” Journal of the Ameri­can Medical Association, 201 (1967): 895.
If slum conditions alone determined and initiated riots, why are
the vast majority of slum dwellers able to resist the temptationsof unrestrained violence? Is there something peculiar about
the slum dweller that differentiates him from his peaceful neigh­bor?. . . It would be of more than passing interest to find whatpercentage of the attem pted and completed murders committed
during the recent wave of riots were done without a motive. . .
We need intensive research and clinical studies of the individuals
committing the violence. The goal of such studies would be to
pinpoint, diagnose and treat these people with low violence
thresholds before they contribute to further tragedies.
28. Jos£ Delgado, The Physical Control of the Mind: Toward a
Psychocivilized Society (New York: Harper and Row, 1960), p. 145.
29. Randell in Green and Money, Transsexualism, pp. 374-75.
30. William Irwin Thompson, Evil and World Order (New York:
Harper and Row, 1976), p. 27.
31. Ibid., p. 39.
32. See Kenneth L. Lehrman, “Pulmonary Embolism in a Trans­
sexual Man Taking Diethylstilbesterol,” Journal of the American
Medical Association, 235 (February 2 , 1976): 532-33. The con-

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The Transsexual Empire

elusion of this study was that: “With increased acceptance of sex
reassignment operations. . . and attem pts to alter secondary sex
characteristics, we believe that the possible association of throm bo­
embolism and estrogen therapy should be considered as strongly
in the young man as in the young woman” (p. 533). This conclusion
was based on a study of a twenty-nine-year-old male-to-constructedfemale transsexual with no prior history of varicosities, injuries,
or prolonged inactivity.
J. Hoenig et a/., in their article, “The Surgical Treatment forTranssexuals” (Acta Psychiatra Scandinavia, 47 [May 1974]: 10636), state that surgical treatm ent to increase breasts in male trans­
sexuals should not be undertaken, especially if such treatm ent isfollowed up with estrogen therapy, since there is a risk of malig­
nancy. They cited the study of W. Symmers, “Carcinoma of theBreast in Transsexual Individuals after Surgical and Hormonal In­
terference with the Primary and Secondary Sex Characteristics,”
British Medical Journal, 2 (1968): 83. Symmers reported two cases
who came to autopsy with carcinoma of the breast. He suggeststhat the malignance was entirely due to the hormonal imbalancecreated by castration plus the massive doses of estrogen received.
Jan Stiefel has noted the significant factor that serious and accepted
research was being done on transsexuals with breast cancer resulting
from exogenous estrogen therapy, long before a comparable serious
and accepted study was done on native-born women.
Other studies that have investigated the correlation between maleto-constructed-female transsexualism and cancer are:
The Veteran’s Administration Cooperative Urological ResearchGroup, “Treatment and Survival of Patients with Carcinoma of theProstate, ” Surgery , Gynecology , and Obstetrics, 124 (1967): 1011.
K. A. Hanash, etal. y “ Relationships of Estrogen Therapy for
Carcinoma of the Prostate to Atherosclerotic Cardiovascular
Disease: A Clinicopathologic Study, ” Journal of Urology, 103(1970): 467.
J. D. Bailar and D. P. Byar, “The Veteran’s Administration Co­
operative Urological Research Group: Estrogen Treatment for Can­cer of the Prostate: Early Results with Three Doses of Diethylstilbesterol and Placebo,” Cancer, 26 (1970): 257.
33.
See Guze, “Male and Female Transsexuals,” in Green andMoney, Transsexualism, pp. 171-200. Meyer and Hoopes note thatwhile most of their patients are emotionally and socially satisfied
and stable post-operatively, “ Another group of patients have done
extraordinarily poorly^w ith inappropriate and self-destructive rela­tionships, multiple and serious suicide attem pts, drug abuse, serious
physical complications, etc. ”
Charles L. Ihlenfeld, the endocrinologist, whose work on trans­
sexualism has been quoted in this book and who was a prominent

209

Notes

prot6g6 of Harry Benjamin and co-author of several articles withhim, has left the field after helping one hundred or more trans­
sexuals change sex. He is reported to have given the reason that:“Whatever surgery did, it did not fulfill a basic yearning for some­thing that is difficult to define. This goes along with the idea that
we are trying to treat superficially something that is much deeper.”
Quoted in the National Observer, October 1 6 , 1976, p. 14.
34. John Postgate, “ Bat’s Chance in Hell,” New Scientist, April5, 1973, pp. 14-15.
35. Ibid., p. 15.
36. The literature on human experimentation is voluminous.
Some primary sources for discussion of the issues of informed con­sent and the individual versus societal benefits are the series ofarticles in: Paul A. Freund, ed., Experimentation with Human
Subjects (New York: George Braziller, 1969).
37. Ivan Illich, Medical Nemesis, The Expropriation of Health(London: Calder and Boyars, 1975), p. 9 5 . 1 have used the British
edition, because this quote does not appear in the American editionin the same way.
38. Peter Berger, The Sacred Canopy: Elements of a Sociological
Theory of Religion (New York: Doubleday and Co., 1969), p. 54.
39. Ibid., p. 55.
40. Jon K. Meyer and John H. Hoopes, “The Gender Dysphoria
Syndromes: A Position Statement on So-Called Transsexualism,”
Plastic and Reconstructive Surgery, 54 (October 1977): 448.
41. Becker, The Structure of Evil, p. 182.
42. Ibid., pp. 184-85.
43. Ibid., p. 185.
44. Berger, Sacred Canopy, p. 59.
45. Green, “ Conclusion,” in Green and Money, Transsexualism,
p. 467.
46. Milton T. Edgerton, “Transsexualism—A Surgical Problem? ”
Plastic and Reconstructive Surgery, 54 (October 1974): 448.
47. “Captive populations” generally include prisoners, mental
patients, the poor, or any group in which the element of coercion
conditions the choices of those groups, usually through the institu­
tional context in which they are placed, and often in subtle ways.
48. Otto E. Guttentag, “Ethical Problems in Human Experimen­
tation, ” in E. Fuller Torrey, ed., Ethical Issues in Medicine: The
Role of the Physician in Today's Society (Boston: Little, Brown,1968), p. 204.
49. See William L. Shirer, The Rise and Fall of the Third Reich,
A History of Nazi Germany (New York: Simon and Schuster, 1959),
especially pp. 979-91. Also see Alexander Mitscherlich and Fred
Mielke, Doctors of Infamy: The Story of the Nazi Medical Crimes(New York: Henri Schuman, 1949).

210

The Transsexual Empire

50. Szasz, Ceremonial Chemistry, p. 116.
51. Szasz discusses the notion of pharmacracy in Ceremonial
Chemistry, p. 128, in the following manner: “ Inasmuch as we havewords to describe medicine as a healing art, but have none to de­scribe it as a method of social control or political rule, we must first
give it a name. I propose that we call it pharmacracy , from the Greek
roots pharmakon, for “ medicine” or “ drug” and kratein, for “torule” or “to control.. . . As theocracy is rule by God or priests, anddemocracy is rule by the people or the majority, so pharmacracy
is rule by medicine or physicians.”
52. Alexander Mitscherlich and Fred Mielke, Doctors of Infamy:
The Story o f the Nazi Medical Crimes (New York: Henry Schuman,
1949), p. 152.
53. Brandt conducted freezing and warming experiments, as wellas mass sterilization experiments with no anaesthesia.
54. Quoted in Mitscherlich and Mielke, Doctors o f Infamy,p. 147.
55. Report of a House of Representatives subcommittee on un­
necessary surgery, the Boston Globe, July 1975, p. 1.
56. Idem.
57. Shirer, Rise and Fall, p. 979.
58. Guttentag, “ Ethical Problems,” p. 200.
59. Harry Benjamin, The Transsexual Phenomenon (New York:
Julian Press, 1966), p. 12.
60. Joseph Wechsberg, ed., The Murderers among Us: The Simon
Wiesenthal Memoirs (New York: McGraw-Hill, 1967), p. 155.
VI.

TOWARD THE DEVELOPMENT OF AN ETHIC
OF INTEGRITY, PAGES 154-177

1. Mary Daly, “The Qualitative Leap Beyond Patriarchal Reli­gion,” Quest: A Feminist Quarterly, I (Spring 1975): 30. Daly has
updated her androgyny imagery as “ conveying something likeJohn Travolta and Farrah Fawcett-Majors Scotch-taped together.. . ”
2. The Gospel of Thomas, Logion 114, pi. 99, vs. 18-26.
3. Virginia Woolf, A Room of One's Own (New York: Harcourt,
Brace and World, 1957), p. 102.
4. Betty Roszak, “The Human Continuum,” in Betty Roszak and
Theodore Roszak, Masculine/Feminine (New York: Harper andRow, 1969), p. 304.
5. Carolyn Heilbrun, Toward a Recognition of Androgyny (NewYork: Alfred Knopf, 1973), p. xv.
6. James Nolan, “The Third Sex,” Ramparts, December 1973,
p. 24.
7. Idem.
8. Ibid., p. 25.

211

Notes

9. Refer to notes 15 and 32 for Chapter V.
10. See Ivan Illich, Medical Nemesis (New York: Random House,1976). See especially Chapter 3, “The Killing of Pain,” pp. 133-54.
11. Ibid., p. 275.
12. Mary Daly, Gyn/Ecology: The Metaethics of Radical Femi­nism (Boston: Beacon Press, 1978), pp. 337-43
13. Ibid., p. 340.
14. Paul Tillich, Systematic Theology , vol. I, Reason and Revela­tion, Being and God (Chicago: University of Chicago Press, 1951),
p. 267.
15. Herbert Richardson, “Three Myths of Transcendence,” inHerbert W. Richardson and Donald R. Cutler, eds., Transcendence(Boston: Beacon Press, 1969), pp. 98-113.
16. Jon K. Meyer and John E. Hoopes, “The Gender Dysphoria
Syndromes: A Position Statement on So-Called Transsexualism,”
Plastic and Reconstructive Surgery, 54 (October 1974), p. 450.
17. Richardson, “Three Myths,” p. 112.
18. Because the ontological tradition generated such a static
notion of being, modern ethicists have talked about its impossi­
bility for providing a basis for ethics. They have often pointed to
the need for a postmetaphysical way. Yet the split between being
and becoming is not a necessary one, as Mary Daly has pointed
out, and has always seemed rather artificial and imposed as com­pared to the experience of being and its philosophical intuition
in individual lives. Thus Daly speaks about being as be-ing. Be-ing
is the initial power of everything, not as static structure, but as the
direction of a process.
How then does this notion of be-ing serve as an ethical criterion.
In making be-ing an ethical norm, one must test human actions
against a texture of be-ing, a texture that is not static but moving.
To do this, the texture of be-ing must be more explicitly described
as a moral criterion. Tillich attempted to do just this when he spelled
out love, power, and justice in ontological terms. Love, power, andjustice, however, obviously do not account for the whole textureof be-ing. One could also talk about faith, courage, hope, among
other qualities. I have chosen to focus on integrity because this isessentially what is at stake in the transsexual situation. It is also
dislocated or completely eclipsed by integration—an integration
whose source is not in be-ing but rather in a narrow and immediate
sense of well-being or static being.
The final question thus becomes how does one verify ontologicalethical judgments—specifically how does one measure integrity inthe transsexual situation? At this point, I would join ontology withpragmatism in asserting that the only way of testing whether or nota particular procedure, value, etc., is good, is to test its efficacy inthe life process. This is a verification standard somewhat similar

212

The Transsexual Empire

to William James’s pragmatic yardstick. Thus one would have to
examine transsexual procedures in light of how such ventures con­tribute to human be-ingH;hat is, to the self-actualization of indi­viduals and to the world-building processes of society. Therefore,
the question of verification of ontological judgments, the questionof method, cannot be answered before the method is applied suc­cessfully or unsuccessfully—that is, before its efficacy in human
lives and community is tested.
19. Mary Daly, Beyond God the Father (Boston: Beacon Press,
1973), pp. 189-90.
20. Jacques Maritain, Sept lecons sur Vetre et les premiers principes de la raison speculative (Paris: Pierre Tequi, 1934), p. 54.
21. Ibid., p. 30.
22. Tillich, Systematics, I, p. 186.
23. Herbert Marcuse, “ Repressive Tolerance,” in Robert Paul
Wolff, Barrington Moore, Jr., and Herbert Marcuse, A Critique ofPure Tolerance (Boston: Beacon Press, 1965), pp. 82-83.
24. Ibid., p. 83.
APPENDIX: SUGGESTIONS FOR CHANGE,PAGES 178-185
1. See, for example, the Hart-Devlin debate on law and morality,
which is contained in: Patrick Devlin, The Enforcement of Morals(London: Oxford University Press, 1965); H. L. A. Hart, Law,
Liberty, and Morality (Stanford: Stanford University Press, 1963).
2. Ivan Illich, Medical Nemesis (New York: Random House,1976), pp. 33-34.
3. See, for example, the articles on consciousness-raising in Anne
Koedt, Ellen Levine, and Anita Rapone, eds., Radical Feminism(New York: Quadrangle/New York Times, 1973), pp. 280-85.
4. Charles Ihlenfeld was very active in doing much initial workon transsexualism with Harry Benjamin. Together they co-authored
several key articles on the subject. Thus Ihlenfeld’s statem en tquoted in “A Doctor Tells Why He’ll No Longer Treat Transsex­
uals,” The National Observer, October 1 6 , 1976, p. 14—represents
a significant defection from the transsexual empire.

INDEX

Abraham, F. Z., 21, 52
Adam, 194
the androgynous tradition and,156-57m ythic dimensions of trans­
sexualism, 106
Adkins, Elizabeth, 54-56
Adrenogenital syndrom e, 56
M oney’s study of, 52, 56, 160
Against Our Will: M en, Womenand Rape (Brownmiller), 90
Alienation, 81-82, 121
Anatomical or morphologicalsex, 7, 10
Androgen, 160
adrenogenital syndrom e and,56
in animal experim ents, 53-55
ill-effects of, 36
I. Q. and, 51, 51n“ overriding effects” of, 40, 5053, 57, 59
is a prenatal factor, 48-49, 58
as treatm ent, 35-36
Androgeny, 160
Androgyne, Divine, 156
A ndrogyny, 100, 154-68
Animal experim entation, 48-49,
53-57
Apollo, 108-9
Aquinas, Thomas, 57
A ristotle, 16, 57, 96-97
A thena, 106
Bagby, Eleanor, 15
Barker, Ernest, 96
Barker-Benfield, G. J., xxiii,
xv
Becker, Ernest, 90, 121, 127-28,
144

Behavior control and modifica­
tion
control-through-pleasure, 137139
electronic brain stim ulation(ESB), 137-139
historical (surgical) precedents
for, 131as limiting transcendence, 132public funding for, 136
reinforcem ent of sex-role ste­reotypes a n d , 132-137
as a tool of American law en­forcem ent, 136
voluntarism and, 134-35
Being, 171, 173, 211-12
Be-ing, 17-18, 125, 145, 211-12
integrity and the intuition of
be-ing, 171-75
integrity as the original state of
be-ing, 163
Be-ing, 173-74
political power and, 174
as short-circuited by trans­
sexualism, 174
Benjamin, Harry, 4-5, 19-22,
24, 32, 92, 152, 191, 205-6,
209
Berdyaev, Nikolai, 158
Berger, Peter, 14, 64, 81-82,
1 4 3 , 145“ Blaming the m o ther, ” 42, 7273, 75, 85, 197
Richard Green on, 74-75
John Money on, 73
as psychologists* ploy, 69
R obert Stoller on, 71
Blue Cross/Blue Shield, 24
Boehme, Jacob, 156-57
Boyle, T. C., I l l

213

214

Index

Brandt, Karl, 150, 210
Breast cancer, 33, 172, 193, 208
Breast im plants, 33
Brennan, Jo h n G., 52, 81
Brown, N orm an O., 108
Brownmiller, Susan, 90
Buck, Lisa, 119
Bureau o f Vital Statistics (Bal­tim ore), 39
Burou, Georges, 10, 126
Cabala, 156-57
Callahan, Daniel, 15
Callison, James, 6Carson, Rachel, 165
Carter, Jim m y, 24
Castration, 138, 208
definition of, xxiv
fear of, 71
as irreversible surgery, 104
as surgical procedure, 33
Castration, female. See Female
castration“ Castration, h orm onal. ” See“ H ormonal castration”
Castration anxiety, 75-7 6
Cauldwell, D. O., 20
Childhood transsexualism, 200
as treated in gender identity clin­
ics, 77, 9 4-98, 136, 199-200
Chromosom al sex, 6, 7, 10, 126
indispensability of X chrom o­some, 58
personal history and, 116
Chrysalis, 109
Clitoridectom y, xxv, 207 (seealso Female castration)
as behavior control and m odi­
fication, 131
Com m oner, Barry, 165
Comte, Auguste, 158-59
Conflict and vindication, 169-70
Connors, Denise, 187
Consciousness-raising, 124
as counseling, 180-83
elem ents of, 1 8 1-82
peer support and, 183
Control-through-pleasure, 137-38
Conundrum (Morris), 87-8 8Core gender identity, 2, 44-45,
200 (see also Gender id entity)
as altered by feminism, 64-6 5social change and, 66-68
R obert Stoller on, 71
Cosmetic surgery, 34
Cross-dressing, 38, 4 1-42, 73,
76, 144
gender identity clinics and, 93
Culpepper, Emily, 188
Cultural iatrogenesis, 181
Daly, Mary, 17, 28, 102, 104,
107, 110, 159, 168-69, 173,
197, 211de Beauvoir, Simone, 106
D e-ethicization, 125-27
Delgado, Jose, 137-38
DES, 32
Dionysus, 106-10“ D octors T rial, ” 148
Edgerton, Milton, 6, 35, 146
Ehrenreich, Barbara, 29
Ehrhardt, Anke, 9, 25, 27, 47,
4 9-53, 56-59
Elbe, Lili, 21
Electrolysis, 24, 32
Electronic brain stim ulation(ESB), 138-39, 139n
Emergence (M artino with harriet), xxii
Endocrine or horm onal sex, 7, 10
English, Dierdre, 29
Enspirit, 168
Erickson Educational F ounda­tion, 16, 19, 21, 23, 92, 192
Erigena, John Scotus, 156, 158
Ervin, Frank, 137, 207
Estrogenas cancer-causing, 33-34, 193,
208
in developing em bryo, 58
as nothing, 50, 57
as treatm ent, 32-34
Estrogen replacem ent therapy(ERT), 34, 119
Ethics, 1-2, 67
de-ethicization, 125-27“ h ealth ” values versus ethicalvalues, 121
medical m odel as ethical con­struct, 1 21-25
the ontological tradition and,211-12

Indextranssexualism as an ethical is­sue, 178
Eunuchs, 203
as forerunners o f transsexuallyconstructed lesbian-feminists,105-6
as keepers o f women, 105-6
Eve, 106, 157, 194“ Eve base view, ” 59
Exhibitionism , 83-84, 88n“ Experience deprivation, ” 76
Fall, the, 156, 158, 164
into masculinity and femi­
ninity, 164
Family, 43, 6 0-70, 77
childhood transsexualism and,
95-98
Father, 95
role in developm ent of trans­
sexualism, 69, 71-75, 96,
197“ Fear of discovery, ” 37, 138
Feinbloom , Deborah Heller, 202
Female castration, xxiii-xxv
Female-to-constructed-m aletranssexualism
as assimilation o f potentiallydeviant women, xxiii, xv
horm onal and surgical tre a t­
m ent, 35-38
incidence of, xxi-xxii
Fem ale-to-constructed-m aletranssexuals, 203difficulty in obtaining data on,
2 5 , 189
experience o f role strain, 8182
identification with men, xxv,
84-85
as tokens, xxi, xxiv, 27-28,
140
Feminism, 80, 85, 114-15, 177,
184
alteration o f core gender iden­tity a n d , 64
consciousness-raising and, 181
transsexuals’ claims to be femi­
nist, 89, 9 1 , 99-1 0 0 ntranssexuals’ opinion of, 82
Fem ininity/fem inine
use of these term s, 3215

Fetishdefinitions of, 30
Fetishization (see also Objecti­
fication)as process of control, 31
in surgery, 132
in therapy, 127-29
as typified in transsexualism,
29-31
First Causelegislation, 179-80
of transsexualism, 16, 70, 86,
185
Freud, Sigmund, 54, 63, 71
Gadpaille, Warren, 58
Gender, 8, 9
Gender dysphoria, 9, 11-12
Gender identity, 3, 46-50, 5253, 60-68 (see also Core gen­
der identity)
animal experim ents and, 4 8 4 9 , 53-57
gender role and, 9“ locking tig h t” of, 46, 62-65,
200
native language and, 46, 60-62
Gender identity clinics, 142,
199-200, 202-3
behavior control and modifica­tion and, 132-39
establishment of, 23
as future centers of sex-role
control, 136-37, 167
as perpetuators of sex-role
stereotyping, 13, 77, 91-98,
180
tokenism and, 27
Gender role, 9Genital or gonadal sex, 7, 10
Gennys, 117
Gilder, George, 198
Gnosticism, 156-60
God, 106, 156
Green, Richard, 73-74, 146
Grossman, Paula (Paul), 78, 165
G uttentag, O tto, 147, 151
Guze, Henry, 76, 87, 206
Gynandry, 160
Gyn/Ecology: The Metaethics o f
Radical Feminism (Daly),
107

216

Index

Haire, Norma, 21
Halleck, Seym our, 128 -3 0
Hamburger, Christian, 20-21,
25, 193
Harrison, Jane, 109
Healthetym ology, 122, 205“ H ealth” values, 2
the medical m odel and, 121-25
Heilbrun, Carolyn, 160-61
Herm aphroditism , 62 (see alsoIntersexuality)
androgyny and, 155, 159, 164
in animal experim ents, 53
H eterosexuality, 84, 87, 122,
157, 202
H om osexuality, 4, 95, 184
as an androgynous them e, 157
legislation against, 38-39, 108transsexuals’ an tipathy for, 84,
87, 122
Hoopes, John, 12, 170“ H orm onal castratio n , ” 32
Hormonal treatm ent, 2, 13, 70,
126, 129, 132
androgen as, 35-36
as bio-ecologically destructive,
165, 172
as cancer-causing, 33, 140,
193, 208
estrogen as, 32-34
o f fem ale-to-constructed maletranssexuals, 35-37
of male-to-constructed-fem aletranssexuals, 32
H om ey, Karen, 24
Horrors o f the H alf-Known L ife,
The (Barker-Benfield), xxiii
Hoyer, Neils, 21“ Human Continuum , T he”(Roszak), 161
Hynes, Pat, 102, 113
Hypothalam us, 46, 48, 50-51
H ysterectom y, 143
as tam ing potentially deviant
women, xxv, 36n
as transsexual surgery, 36-37
Iatrogenesis. See Cultural iatro­genesisIhlenfeld, Charles, 184, 209, 212
Illich, Ivan, 142, 181“ Inform ed co n sent, ” 134, 137,
146-47
Integration, 212
as com pletion, 159
definition of, 1 5 4 - 5 5 , 159
hybrid aspect of, 160-61
versus integrity, 159-64
Integrity, 1, 17 -1 8, 104, 15556, 163, 174, 181, 211-12
definition of, 154, 163“ h ealth ” values and, 122
and the intuition of be-ing,
171-75
loss of, 164
social aspects of, 167, 179
versus integration, 159-64
Integrity and transform ation,
169-71
Interactionist theory, 44-53
Intersexuality, 114-15 (See also
H erm aphroditism )Interviews
difficulty in locating female-toconstructed-m ale transsex­
uals, 25, 88n
techniques, 15-16, 190-91
with transsexuals, 77-86, 9091
Janus Inform ation Facility, 23,
192
Jesus, 106, 156
Johns Hopkins, 6, 15, 19, 22,
24, 39, 41, 91-92, 96-97,
136
Johnston, Jill, 1 17-18
Jones, Clinton, 24
Jorgensen, Christine (George),
13, 20-21, 78
Journal o f the Am erican Medical
Association, 20, 137
Kando, Thomas, 79-86
Kinsey, Alfred, 191
K norr, N orm an, 6Lawm orality and, 1 79-80
Laws, Ju d ith Long, 27
Legal aspects o f transsexualism,78“ catchall” statutes, 39, 42

Indexcross-dressing, 38, 41-4 2
disorderly conduct statutes,
3 8 , 42
female im personation, 38, 42
liability in to rt, 40
m ayhem statutes, 40
prostitution, 79n
Legal sex, 7, 10-11
Lesbian-feminism
as boundary-crossing, 108
as n o t man-made, 105-6

self-definition and, 101, 11319
Lobotom y, 131 (See also Psy­
chosurgery )Luckm ann, Thomas, 64
Lukianovicz, N., 75
Lysistrata, (Aristophanes), 158“ Male child” pill, 140-41“ Male m othering, ” 29, 74, 75n,
107, 157
M ammoplasty, 33, 143
Man & Woman, Boy & Girl
(Money and Ehrhardt), 9, 46,
53, 59, 160
Man Into Woman: A n A u th en tic
Record o f a Change o f Sex(Hoyer), 21
Marcuse, H erbert, 176-77
Maritain, Jacques, 171, 174
Mark, V ernon, 137, 207
M artino, Mario (Marie), xxii
Mary, 106
Masculinity /masculine
use of these term s, 3
Masochism. See Sado-masochism
M astectom y, 143
as transsexual surgery, 36-37
Medical experim entation, 13953, 209, 210

217

M illett, Kate, 130
Misogyny, 158, 167-68
Money, John, 1-2, 6, 9, 11, 15,
22-25, 28, 43-53, 56-68, 7374, 81, 83, 126, 160, 198,
200
Moniz, Egas, 131
Morality, 121, 123, 131
the law and, 179-80
reclassified as a technical prob­lem, 2, 125
Morgan, Robin, xxv, 85
Morris, Jan (James), 78, 83, 8690, 126, 143, 166, 184
M other, 95
role in development of trans­
sexualism, 71-76, 96-97
Murderers A m ong Us, The: The
Sim on Wiesenthal Memoirs(Wechsberg), 152
Mystification, 125
Native language
gender identity and, 46, 6062
N ature-nurture debate, 1, 44-49
Nazi medical experim entation,
148-52
New York State Code of Crimi­
nal Procedure, 38, 41
Nolan, James, 162
Nuremberg trials, 148, 150
Nursesas models of femininity fortranssexuals, 94
Oakley, Ann, 49, 53-54
Objectification, 79, 93 (see also
Fetishization)
as typified in transsexualism,
29-30
Oedipus (Sophocles), 158
Olivia Records, 102-3, 201
O ophorectom y (ovariotom y)as surgical procedure in femaleto-constructed-m ale trans­
sexuals, 36
as taming potentially deviant
women, xxiii-xxiv, 36n
O perant conditioning, 133
Ovariotom y. See O ophorectom y
Ovesey, Lionel, 76

218

Index

Pain
medical theodicies and, 142 -4 5pleasure and, 1 4 3 -4 4social situation of, 142
transcendence and, 168, 174“ Passing,” 13, 70, 83, 126, 180SI
as behavior control and m odi­
fication, 133, 135
as fetishization, 128
in gender identity clinics, 9 1 92, 128
in K ando’s study, 83
in transsexually constructedlesbian-feminists, 104, 202-3transsexuals’ accounts of, 77
Peer grouping
lesbian-feminism and, 118
Peer support
in consciousness-raising coun­
seling, 183
Penectom y, 143
as transsexual surgery, 33
Penthouse, 111-12
Person, Ethel, 76
Personal A utobiography, A (Jor­gensen), 191“ Phallic w om an, ” 76
Phallus construction
as transsexual surgery, 36-38,
194
Pharmacracy, 149, 210
Plastic reconstruction
as transsexual surgery, 33
Plato, 1 57-58
P layboy, 118
Polysurgery, 4, 35, 181
Postgate, John, 140-41
Progesterone, 57
as treatm ent, 32
Progestin-induced syndrom e, 52,
56
Prostitution, 79, 79n, 83, 92,
198
Psychological sex, 8-9“ Psychopath ia transsexualis, ” 20
Psychosurgery, 131, 137
Radiation m enopause, 36
Ramey, Estelle, 58
Ramparts, 161
Randell, John, 24, 206

R aym ond, Janice G., 109, 156n
R aysdon, Allen, 78
R einforcem ent, 133
Rekers, George, 199-200
Repressive tolerance
sensitivity and, 175-77“ Repressive Tolerance” (Mar­cuse), 177
Rich, A drienne, 113, 139n
Richards, Renee, 102, 184
Richardson, H erbert, 169
Rieff, Philip, 123-24
Rise and Fall o f the Third R eich,
The (Shirer), 151
Role strain, 81
R o o m o f One's Own, A (Woolf),
160
Rorvik, David M., 200
Rosalyn Franklin and the D NA
(Sayre), 192
Rose, Elizabeth, 109
Roszak, B etty, 161
Russell, Donald, 5
Sado-masochism, 90, 143-45
Saint-Simonians, 158-59“ Sappho Pictorial, ” 118
Sayre, Anne, 192
Seaman, Barbara, 29
Self-definition
female history and, 113-119
Separation and return, 169-70
Separation anxiety, 76
Sex Change: The A chievem ent
o f Gender Id entity among
Fem inized Transsexuals(K ando), 79
Sexes, the six, 6-8
Sexology magazine, 93
Sex-selection technology, 140
Sexual Id en tity C onflict in Chil­dren and A d u lts (Green), 74
Sexual Politics (M illett), 130
Sexual Signatures (Money andTucker), 59, 65-66, 196, 202
Sexual Suicide (Gilder), 198
Sherwin, R obert, 42
Shirer, William, 151
Sister, 201
Skinner, B. F., 133-34, 137
Slater, Philip, 107
Speech therapy, 32IndexStackhouse, Max, 201
Stanley, Julia, 196, 200
Stebbins, R. A., 190
Stereotypes, 3, 46, 67, 77-79
definition of, 66
as the First Cause of trans­
sexualism, 16, 70, 86, 185“ flexible” stereotypes (Money),
4 6 , 6 5-68
interchangeability of roles, 899 1 , 169
in K ando’s study, 79-86
in psychological theories oftranssexualism, 75, 77
as reinforced by gender iden­tity clinics, 91-98
transsexually constructedlesbian-feminists and, 99,102-4transsexuals’ rearrangem ent of,
86-91
Steifel, Jan, 208
Stoller, R obert, 8, 59, 70-73,
75, 121
Stone, Sandy, 101-3, 201-2
Structure o f Evil, The (Becker),
127
Suplee, Zelda, 16, 23, 25, 37,
88n, 192
Surgery, 2, 129
as behavior control and m odi­
fication, 131-39
com plications, 34-35, 37, 140,
143, 165, 208
cost of, 23-24, 150-51
as experim entation, 140, 14753
as false signal of transcendence,
171
in fem ale-to-constructed-m aletranssexuals, 36-37
as fetishization, 132
in male-to-constructed-fem aletranssexuals, 32-35
pain and, 143, 174
public and private financing of,24, 150-51
sex-role oppression and, 13
as taming potentially deviant
wom en, xxiv
Sweet, William, 137
Szasz, Thom as, 125, 130, 149219

Testosterone
in animal experiments, 54
social factors and, 57
as treatm ent, 35-36
Theodicy\
definition of, 2
medical theodicies, 142-48
as sado-masochistic collusion,
143-45
Therapy, 2
as experim entation, 139-40
as fetishization, 127-29
as individualizing, 121-23, 125
as limiting moral options, 123,125
as political, 129-31“ Third Sex, T he” (Nolan), 161
Thom pson, William Irwin, 139
Tillich, Paul, 174, 211“ Toilet traum a, ” 37
Tokenism, xxi, xxiv, 26-28, 140
Tomboyism, 51-53, 56, 59-60
Toward a Recognition o f A n ­drogyny (Heilbrun), 160

Transcendence, 2, 17, 140, 143,
1 6 3 , 1 6 6 , 168-71
gender dissatisfaction and, 132
integrity and, 163

220

Index

Transsexualism (continued)
medical procedures, 31-3 8m ythic dimensions of, 1 06-10
public and private financing of,24, 136, 150-51, 199, 207
as takeover o f female creativity,
29, 107-8, 203
w om en's non-acceptance of,
84-85“ Transsexualism: An Etiologicaland Ethical Analysis” (R ay­
m ond), 156n
Transsexualism and Sex Reassignm en t (Money and Green),
191“ Transsexualism: The U ltim ate
Homage to Sex-Role Pow er”(R aym ond), 109
Transsexually constructed lesbian-feminists, 202-3
as boundary-violators, 1 08-10
deception o f w om en by, 100,
104, 113
divisiveness of, 100n, 102, 104,114
as image-makers o f the lesbianfeminist, 106, 119
as keepers o f women, 99, 105-6
masculinity of, 102-4
as men w ith o u t “ m em bers, ’'104-6
the m yth o f Dionysus and,1 06-10
seduction o f lesbian-feminists
by, 1 1 0-13
as violators o f w om en’s sex­
uality and spirit, 104, 118
Transsexuals (see also Trans­
sexually constructed lesbianfeminists)
evaluation o f surgery, 35, 2056, 209
identification w ith m en, 25,
84-85, 87-88, 88n
interviews w ith, 7 7 -7 9
masochism of, 1 4 3 -4 5
as medically managed indi­viduals, 33, 122-23, 145,
172-73, 180-81
occupations of, 83

as potential social critics, 12324, 129, 132, 172, 176, 18182
Transvestism, 144, 152
com pared with transsexualism,76
the law and, 38-39, 42“ Trial o f the Tw enty-Three, ”
148
Tucker, Patricia, 27, 59, 60-61,
65-66, 126
U.C.L. A. Gender Identity andResearch Program, 40, 95, 97
University of M innesota, 40, 80
Vaginoplasty, 143
as transsexual surgery, 33
Van Tassell, Eileen, 58
V oluntarism , 134-35, 137, 140,
147, 152
Walker, Paul, 11, 15, 23
Well-being, 125, 171-72
West, Rebecca, 87
Wollman, Leo, 33, 193
Woolf, Virginia, 160-61
Zeus, 106-7