|Stanford Report, May 3, 2000|
Two transsexuals reflect on university's pioneering gender dysphoria program
BY DAWN LEVY
Sandy Stone vividly recalls one day in the '80s when she was leaving the stereo-repair shop where she worked. A preoperative transsexual, she had moved to the beachfront town of Santa Cruz, Calif., because it seemed a "fairly safe" place to be during her two-year transition to feminine looks and behavior. But that day her transitional look attracted the attention of a transient. "What are you?!" he demanded to know. "Find out," she replied. The man clutched his matted hair and screamed, "You really make my head hurt, man! I can't figure you out. Could you please just go away?" Stone retreated.
"What I did literally hurt him because he lacked the mechanism to provide closure around some plausible gender image," said Stone, a performance artist and associate professor in new media at the University of Texas, Austin. Stone's comments were part of an April 13 forum called "Sex Change at Stanford: Historical and Personal Perspectives on Stanford's Pioneering Gender Dysphoria Program, 1968-Present." Coordinated by graduate student Ebony Chatman of the Department of Modern Thought and Literature, the forum was sponsored by the History Department, the Humanities Center and the Program in Feminist Studies.
In the '60s and '70s, programs at Stanford and other research universities were part of a brief but important effort to better understand human sexuality. Stone and others spoke about their experiences with the first sex-change clinic on the West Coast, which Stanford opened in 1968 under the direction of plastic surgeon Donald Laub. Psychiatrist Norman Fisk, now retired, also guided the program. Since 1980, the clinic has existed as a nonprofit foundation in Palo Alto, Calif., and is not affiliated with the university.
Laub, 65 and semi-retired, still runs the Palo Alto program and continues to treat both female-to-male (FTM) and male-to-female (MTF) transsexuality, or "gender identity disorder." Another synonym, "gender dysphoria," emphasizes the anguish that results when a person's psychological sex, or gender, does not match his or her physiological sex, or body. Roughly one in 30,000 adult males and one in 100,000 adult females seek sex reassignment surgery, according to the Diagnostic and Statistical Manual of Mental Disorders.
Writer Jamison Green was born in a female body. "Although I was always male-gendered, I never really felt like I was born into the wrong body, exactly," he told the Stanford audience. "Rather than saying there was something 'wrong' with me, I'm saying there was something unbalanced about me." Green is former president of FTM International, the nation's largest advocacy and support group for female-to-male transsexuals. "There is just a huge amount of variety and diversity among human beings," he said. "I am privileged to be able to change my sex to make my gender and body line up."
There always have been people who felt or acted as if they were the other sex, said Indiana University history Professor Joanne Meyerowitz, who earned her doctorate at Stanford and who is writing a history of transsexuality in the United States for Harvard University Press. But only in modern times have transgendered people been able to ask the scientific community to use hormones and surgery to realign sex and gender.
These transformations first took place at the hands of European doctors. On Dec. 1, 1952, the New York Daily News published a first account of a transsexual American, Christine Jorgensen. The front-page story -- "Ex-GI Becomes Blonde Beauty" -- told of Jorgensen's journey to Denmark for a rare and complicated treatment.
The 1960s was an era of big funding for medical research, Meyerowitz said. In this context some doctors began to organize research programs and treatment clinics for transsexuality. The programs were highly controversial, she said: "The American Medical Association didn't back them and government agencies didn't fund them."
The initial money came from a wealthy female-to-male transsexual, Reid Erickson, who founded the Erickson Educational Foundation in 1964. Erickson had been a patient of German-born endocrinologist Harry Benjamin, who emerged as an advocate for American transsexuals in the early 1950s. Today the Harry Benjamin International Gender Dysphoria Association Inc., an organization of medical and mental health professionals, publishes internationally accepted guidelines for the treatment of gender identity disorders.
Erickson had a hysterectomy at Johns Hopkins University, after which he funded both Benjamin's research and the Johns Hopkins program, the first university-based transsexual surgery clinic in the United States. It opened in 1966, followed closely by programs at the University of Minnesota, Northwestern University and Stanford.
University-based programs provided professional legitimization and created new knowledge through research. But doctors had to set up a gatekeeping system to allow them "to control access to treatment and to protect their professional reputations in a controversial field," said forum moderator Susan Stryker, a Social Science Research Council Postdoctoral Fellow in Sexuality Studies at the University of California, Berkeley.
The gatekeeping system created a close but contentious relationship between the service providers and people who demanded hormones and surgery to create the sense of self they needed. "But it was driven by consumer demand," Stryker said. "No one was out there saying, 'Oh, I think it'd be interesting to do these things to people.' If people weren't asking for it, the services would not have been provided."
In the '80s, most gender dysphoria programs left the domain of universities for reasons that remain unclear. Historian Meyerowitz said controversy killed many university-based programs, but Judy Van Maasdam, coordinator of Laub's Gender Dysphoria Program, said in a phone interview that most folded when their founders -- often chiefs of plastic surgery -- left for private practice. Today, the only university-based program still in existence is at the University of Minnesota, and it does not include surgery.
Nonetheless, most people who qualify can get sex-change surgeries, Van Maasdam said. Patients still can get surgeries at many university hospitals, including Stanford Medical Center, she said. To qualify, they must have two endorsements -- one from a doctoral-level (Ph.D. or M.D.) professional, one from a master's-level professional.
About 2,000 people have been through the counseling phase of the program that began at Stanford. About 600 have had genital surgery, according to Van Maasdam.
The MTF genital surgery -- vaginoplasty, or vaginal construction -- costs about $12,000 for a type of skin graft called a penile inversion or $28,000 for a "rectosigmoid transfer" procedure, in which surgeons use rectal tissue to construct a vagina, Van Maasdam said. FTM surgeries range from $6,000 for a mastectomy to $80,000 for construction of a penis capable of achieving erection and permitting a person to urinate while standing. Some insurances will cover the cost of surgery, she said. While vaginoplasty is "state of the art," she said, penis construction "still has a ways to go."
Sandy Stone: A male-to-female experience
The path to Stanford was not a straight one for Sandy Stone, who went through the Stanford program in the '70s.
"I went from being a Jewish prince after bar mitzvah to being a neurologist and then a rock-and-roll engineer and then a filmmaker and then a sex change and then a lesbian separatist and ultimately wound up in a heterosexual marriage," she told the Stanford audience. "It's been something of an amusement park ride.
"My awareness that there was something quote 'different' about me started when I was 4 or 5 years old, back before we had clearly formed ideas of what sex and gender really are," Stone said. "I dreamed that I was climbing mountains and swimming rivers and doing all sorts of other activities usually the province of male athletes, except that in my dream I was doing these in the company of women. And when I looked at myself in the dream, I was a little girl."
By puberty she was in crisis as she tried to suppress expression of her gender. "If you're secretive about it and you're a male-to-female potentially, you buy women's clothing," she said. "You'll hide them in little compartments on the roof. You'll hide them in the car. If you're really daring you start wearing women's clothing under your male clothing. Not everyone can be so daring. And then all of a sudden you wake up one morning and say, 'Oh, my God! What am I doing?' You find it all . . . and you throw it away. Or you burn it. You do some act of excision. You get it out of your life. You close that off forever, rebuild that barrier. 'I'm never going back. Everything is OK now. I'm just another guy.' Oh, it feels so good! That lasts usually for about 90 days."
The cycle repeated itself for years until one midlife morning when Stone woke up and thought: "My God! I'm going to die in this body unless I do something about this!"
At this point Stone called a society for transgendered individuals and found out about the Stanford program.
"Stanford is presented to me as a place where one goes if one is very small, very willowy, very blonde, likes to wear high heels and heavy makeup," she said. "'You must blend in the population. We hope you get married.' (I did, but I didn't expect to.) I think, 'Hot diggity dog! I am about as far from this as anyone can possibly be.'"
Stone's first meeting with Stanford surgeon Laub foreshadowed clashes to come. "I looked at Don, and Don looked at me, and we had this mutual moment of regard. I at the time was wearing jeans, engineer's boots and had a long beard. I said in my best macho engineer voice, 'I am interested in a sex change.' He said, 'To what?'"
Stone entered the program, which employs a coordinator, a psychologist, a psychiatrist, a surgeon and other professionals to help patients during their transitions. Counseling, hormones and living in a feminine gender for two years were part of Stone's regimen.
She and Laub butted heads regularly over what passed for femininity. A standard interview, Stone said, went as follows: "I sit down. Don says, 'Why aren't you dressed like a woman?' I look down. I'm wearing jeans and a T-shirt. I say, 'I am dressed like a woman.' Don says, 'No, you're not.' I say, 'Have you looked out the window recently?'"
The program's focus on "passability" expired with the '70s, Van Maasdam said. The current program focuses on adaptation to the gender role while acknowledging that there's no such thing as a "classic" transsexual.
When the time came for her sex-change operation, Stone said Laub asked her if she was "100 percent sure" that she wanted surgery. "I said, 'No, I'm not.' I felt 99 percent sure. I think anybody who's 100 percent sure of anything is probably crazy. I mean, we all have doubts. I said, 'I'm an adult. I can take responsibility for my actions. This is informed consent. If I made a mistake, it's my fault, not yours. Let's go.' Don said, 'I'm sorry. You're not eligible.' So I went home."
Three months later Stone got a call from the program coordinator to rescript the meeting. "This time both of us are prompted," Stone said. "Each of us needs a particular thing. I don't want to be thought of as crazy. Don doesn't want to have to let go of control. So we go in there into a room, and this time things go much better. Don says, quote, 'Are you ready for surgery?' I say, quote, 'Yes.'"
The rest, as they say, is herstory. But Stone's long, strange trip didn't end with the operation that aligned gender with genitalia. "One of the things I did try to do [before surgery] was duplicate [writer] Jan Morris's experience of going to the mirror and giving her old self a wink for luck because it was the last time they would ever meet," Stone said. "So a week or two later [after the surgery], I went to the mirror and it was still me, and I felt like I'd done something terribly wrong. But it's been me ever since."
Stone said she is continually challenged by real problems in a world where "nothing is clear, the lines are extraordinarily difficult to find and the important thing is not what sex are you, but what kind of a person are you? What kind of a life do you want to craft for yourself? In a world filled with people who attempt to erect walls against the possibility of divergence, of gradations of difference, how can we find ways to live well and to be fully human? My problem, I think, as well as yours."
Jamison Green: A female-to-male experience
"When I showed up at the Stanford clinic, it was 1988," Jamison Green told the audience. "How I came there was through years of fear. And also years of wanting to be legitimate in some way."
Born in 1948, Green knew the term transsexual by the time he was 20 years old. "I was scared to death to think that it might apply to me. But by the time I was 27, I had pretty much accepted that I probably was a transsexual."
At this point, he said, he still did not know it was possible to change from female to male. When he was about 28, he met a female-to-male transsexual in Oregon who, like Green, was living in the lesbian world. Green's friend had chest reconstruction and hormones from the University of Oregon but to this day has not had genital reconstruction. Though Green was raised in the Bay Area, he heard about the Stanford program from his friend: "He wanted genital reconstruction from Dr. Laub here at Stanford. He had done all the research that he could possibly do. He said that Laub was the best, no two ways about it, and at the time he was talking to me as if I was going to do this someday."
Ten years passed, Green said, "before it sunk in real hard, through a number of events in my life, that the only way that I was going to grow up was to become a man, that I was never going to be an adult woman. It simply wasn't going to happen."
So he moved back to the Bay Area and requested an application for the Stanford-born program. "It came in the mail at 16 pages long," Green recalled. "I just flipped out and put it in a desk drawer. It sat there for two years before I had the guts to fill it out. Lest you think that people who have sex change make an instant, overnight decision, this is a long, drawn-out process."
In 1987 Green began meeting with a transsexual support group that ranged in size from four to 18 and that was started by Lou Sullivan, publisher of The FTM Newsletter.
"Lou had identified as gay," Green recalled. "This was unheard of in gender programs, which basically had a model of people that they would allow to have surgery, and that included people who were going to be heterosexual afterward, people who were not going to contact other transsexuals and urge them to do anything that might be considered political. So Lou had been turned down by the Stanford program."
The guest speaker at Green's first support-group meeting was Steve Dain, the first prominent FTM transsexual in the United States. Dain, who had been a girls' physical education teacher in Emeryville, Calif., went through his transition in the mid-1970s and lost his job as a result. In Dain's poise, intelligence and appearance, Green saw a role model.
Dain, who had been through the Stanford program, answered many of Green's questions. "He really, really admired and appreciated Dr. Laub. Dr. Laub was one of two surgeons who independently and simultaneously developed a new technique for creating the male genitalia in female-bodied people that was not very invasive and that created an organ that actually could have sexual function and was naturally erectile and completely orgasmic, whereas most phalloplasty techniques were prohibitively expensive if you wanted any kind of erotic sensation," Green said. "That was a problem for a lot of female-to-male people, which is one reason why a lot of female-to-males don't have genital reconstruction."
Green finally decided to fill out the program application. "I mailed it in and got an appointment and I actually was treated extremely well." He liked the program's emphasis on "just plain day-to-day stability in one's life. In other words, to show that one could actually negotiate the transition. People have often said that clinics tell you that you have to lie about your past and tell no one that you've done this: Get a new job, get all new relatives, destroy all your photographs, change your whole life. And what I was told was that if you have the strength to be present when people know about your past, if you have the strength to know that people are talking about you behind your back, then stay in your job. Do it. Because that's what people are going to do. You're going to be the freak in the room, and if you're strong enough to deal with that, then that's fine. So that's what I did."
Sullivan died in 1991. Before he did, he asked Green to take over publishing a quarterly newsletter that went out to about 230 transgendered people worldwide who were geographically isolated from a peer group. "I began to hear other people's stories," he said. "They would call me up. They would write letters. And I'd hear the shame and fear that people expressed about living their life as someone who's gone through sex reassignment. And what I did with that information was say, I can't live like this. It is wrong for people to live in a state of fear and shame. I have to get over my own transphobia, my own internalized fear of being perceived as being a 'professional transsexual,' which was the big phrase that everyone was supposed to avoid, and I have to live as if it is OK to be someone like me."
He began conducting civil rights work on behalf of transsexuals. "For me it's all about the essence of human dignity. I think the Stanford program started out and actually still at core follows an edict or ethos of human dignity -- basically has tried to improve the lives of the people who have these issues in their life. And I think it's an extremely important service that's being done. It certainly has done wonders for my life. I have an incredible life right now, I've got to tell you." SR