When initially published, the book was met with a mixed reception but would be later known as the "transsexuals' Bible", a standard for trans care in the medical community.[1] Benjamin and his work (and specifically this text) are credited with the popularization of the term transsexual in medicine.[2] However, some trans scholars argue that the book created many harmful stereotypes still perpetuated by the medical community today, such as the idea that trans people are "born in the wrong body". Scholars criticize Benjamin's reliance on the idea of "passing" and other cisnormativestereotypes.[3] Overall, Benjamin's work was hugely influential in terms of trans visibility in the medical field and set the stage for transgender studies in the modern day. As a note, throughout his work, Benjamin defines a transsexual person as someone who identifies in opposition to their assigned gender at birth (designated by Benjamin as biological sex). In contemporary vernacular, this term can be encompassed under the transgender identity.
Background information
In the 1920s and 30s, Harry Benjamin treated his first patient with cross-gender hormone therapy: a German crossdresser, Otto Spangler, with conjugated estriol (marketed as progynon), as well as x-ray radiation to sterilize the patient.[4] While he saw various transgender people in his clinical practice, it was his work with Alfred Kinsey which would bring Benjamin into more consistent contact with transgender patients. The Transsexual Phenomenon, released in 1966, was the culmination of Benjamin's published work with the trans community.[5] For example, "7 Kinds of Sex" from the popular sex education magazine Sexology was turned into the opening chapter "Symphony of the Sexes".[1] "Transsexualism and Transvestism as Psycho-somatic and Somato-Psychic Syndromes", published in the American Journal of Psychotherapy in 1954, also provided a framework for The Transsexual Phenomenon.[3]
Summary
Benjamin begins his work by differentiating sex into 7 categories: chromosomal sex, morphological sex (developed secondary sex characteristics), genital sex (which, according to Benjamin, determines man or womanhood), germinal sex, hormonal sex, psychological sex, and social sex. He defines that the transsexual is someone whose psychological sex is in opposition to the other sexes. Thus, in treatment, the goal should be "a symphony of the sexes".[6]
Benjamin differentiates transvestism, transsexualism, and homosexuality. He defines transvestism as dressing or presenting as the opposite sex, with no discomfort with genital or morphological sex. In contrast, the transsexual experiences intense discomfort around their body and seeks medical interventions in order to live as the opposite sex. The transsexual feels as though they were "born in the wrong body". From this differentiation, Benjamin created a 7-point scale, called the Sex Orientation Scale, which was based on Alfred Kinsey's scale of sexuality. A "Type 0" would be a person with no disagreement within their gender, or in modern terms, a cisgender person. The remaining Types 1-6 are a scale between transvestism and transsexualism, with the two identities acting as the poles.
Group 1
Type 1
Pseudo-transvestite
Type 2
Fetishistic transvestite
Type 3
True transvestite
Group 2
Type 4
Transsexual, non-surgical
Group 3
Type 5
True transsexual, moderate intensity
Type 6
True transsexual, high intensity
Table 1: Harry Benjamin's Sex Orientation Scale (sometimes abbreviated to S.O.S).[7]
Benjamin also notes how homosexuality is fundamentally different from both transvestism and transsexualism. In the closing of the section, he essentializes the difference to this: "The transvestite has a social problem. The transsexual has a gender problem. The homosexual has a sex[uality] problem."[8]
After introducing the S.O.S scale, Benjamin goes into greater detail about each of these "types". The "pseudo-transvestite", a Type 1 on the S.O.S, does not dress as the opposite sex, but derives great enjoyment from transvestitic fantasy. In contrast, the true transvestite's central "deviation" is cross-dressing, with a strong emotional and sexual urge to do so. The transvestite can be fetishistic (Type 2) or "latent and basically transsexual", (Type 3)[9] where the transvestitism evolves into transsexualism.
According to Benjamin, there is no one "so constantly unhappy (before sex change) as the transsexual."[10] He documents that transsexual patients perform self-mutilation in order to more closely align their "genital sex" to their psychological one. In this discussion of genital sex, Benjamin also looks at the sexual activity of the transsexual. Sex can offer an outlet to express their femininity within a fetish, or simply to pass as a woman (in the case of prostitution). Benjamin emphasizes that sex change operations are essential to transsexual people (Types 5 and 6), but they are widely inaccessible and denied by healthcare providers. The inaccessibility of hormonal treatments, as well as societal stigma, make up "the handicaps of the transsexual".[11]
Benjamin attempts to find the etiology of transsexualism. He concludes there are no genetic factors that influence the "condition" while finding a link to increased levels of hormones associated with the hormonal sex of the preferred gender. Of the psychological causes, Benjamin looks to both childhood conditioning and imprinting as possible etiologies. Childhood conditioning, from a Freudian perspective, appeared to be a very possible explanation, but Benjamin argues that there are too many situations in which an absent father does not lead to homosexuality, transvestism, or transsexualism.[12]
He considers both psychotherapy and hormone therapy for trans women. Benjamin states that since the mind of the transsexual cannot be adjusted to the body, it is logical and justifiable to attempt the opposite: to adjust the body to the mind.[13] He then continues on to detail estrogen therapy, noting the intended results, side effects, including breast growth, and ingestion methods, including oral and parenteral.
Benjamin next depicts methods of surgical intervention for transsexuals: namely, castration, penis amputation, and vaginoplasty, arguing for their use if a doctor deems it is the only way to help a patient to "a happier future".[14] He notes several different methods of castration, describing that some surgeons prefer to leave the testicles in their undescended state for fear of legal retribution. Here, he also creates a set of guidelines for which transsexuals would make "convincing" women, and thus, should qualify for surgery, in his eyes, stating that "a heavy masculine build, a height of six feet or more, and a strong, dark beard were causes for worry and doubt."[15] In a passage of particular importance to the rest of his work, he also notes four basic motives for a sex conversion operation: the sexual motive (as he describes it, the want for the possibility of heterosexual relations with a functioning vagina], the gender motive (or, the urgent need to relieve gendered unhappiness), the legal motive (the constant fear of discovery and arrest), and the social motive (the teasing the results from the perception of trans women as a feminine man).[16]
Next, Benjamin considers 52 "male transsexuals" (trans women) and the results of their respective operations, noting that 33.3% reported a "good" result, 52.9% reported a "satisfactory" result, 9.8% reported a "doubtful" result, 1.9% reported an "unsatisfactory" result, and 1.9% reported an "unknown" result.[17] The results of these findings pushed Benjamin to conclude, after additional consideration of possible sexual handicaps and a review of the "meager" array of medical literature at the time, that no matter how disturbed a transsexual may still be, they "are better off afterward [an operation] than they were before…"[18]
Benjamin also considers the legal aspects of transvestism and transsexuality. Here, he presents an argument against the criminalization of transsexualism and transvestitism, comparing it to homosexuality, addiction, prostitution, and alcoholism as a social issue, not a criminal one.[19] Here, he presents a legal remedy against the arrest of transvestites, based on a model used by the Hamburg Police Department:
Based on a physician’s certificate, the Hamburg police department issues a card to the transvestites, not giving them permission to “dress,” but merely stating that this person is known to the department as a transvestite. That is all, but it is enough to absolve the particular person from any suspicion of “criminal intent” in “dressing” and therefore from arrest.[20]
Finally, Benjamin presents a single chapter considering "female transsexuals", trans men, of which he reports a 1:6 ratio with "male transsexuals". He connects this disparity to an observed lesser frequency of female homosexual behavior as well, but concedes that the symptomatology between male and female transsexuals is nearly identical, though he describes that female transsexuals wish for "typically masculine occupations… but often they have to be practical and settle for office work."[21] He describes androgen injection as a useful medication to suppress menstrual periods, as well as total hysterectomy, and double mastectomy when desired.
The Transsexual Phenomenon concludes with four appendices. The first of which, written by Benjamin, presents a set of concluding remarks. He maintains that the etiology of transsexualism remains obscure, but points to neurology and psychology as disciplines that may provide answers. He predicts that sex reassignment surgery will be accepted as legitimate, operative techniques will be perfected, and legal reforms will follow, but concedes that the respective transsexual patient in the United States has to be born "lucky" to receive suitable treatment.[22] Appendix B, written by Gobind Behari Lal, argues for the complementarity of the human sexes, and for a view of human beings with dual sexes, instead of opposite, of varying proportions. Written by Benjamin's colleague Richard Green, the penultimate appendix considers the history and mythology of transsexualism in Classical and indigenous society. The last appendix in Benjamin's work, compiled by R.E.L. Masters, consists of four autobiographies as well as three biographical profiles of transsexual patients. The book concludes with photographs of several of Benjamin's patients' genitals before and after operation.[23]
Publication history
The Transsexual Phenomenon was first published in 1966 by The Julian Press, and again in 1977 by Warner Press.[24] It was also distributed in 1966 by Ace Publishing Company,[25] and published electronically by Symposium Publishing, based in Düsseldorf, in 1999.[26] On first publication, it was read and reviewed heavily in Germany, as well as the United States.[27]
Critical reception
Upon publication, the book had a mixed reception. The Winter 1966-67 issue of Psychoanalytic Review considered it "worthy of respect as a thoughtful digest of much work and a compassionate view of a phenomenon," but disappointing to psychologists and psychoanalysts. Real Life Guide, however, described it as readable, and to a very high standard of bookmaking. And though Homophile Studies reported frustration with the book for its unclear audience, and apparent promotion of conversion surgery, The American Journal of Psychotherapy described it as a "literary event", writing that "it is satisfying to see that Benjamin's long plea for the right of transsexuals begin to be successful."[27]
Cultural influence
The Transsexual Phenomenon has grown to be known as a "transsexuals' Bible" in scholarship.[1] It is regarded as the first textbook on the subject of transsexualism,[3] and it brought new legitimacy to transsexuality within medicine, helping to open gender identity clinics at Johns Hopkins University, University of Minnesota, Stanford University, and University of California, Los Angeles.[28] Because of the publication of Benjamin's work, "the national picture changed from one of no significant institutional support for transsexual therapy and surgery in 1965 to a situation in 1975 where about twenty major medical centers were offering treatment and some thousand transsexuals had been provided with surgery."[29] Indeed, historian Vern Bullough cites The Transsexual Phenomenon as so influential it singlehandedly popularized the term transsexual in American discourse.[2] In fact, Sandy Stone documents that one can trace the influences of early sexologist David Oliver Cauldwell and Harry Benjamin based on the spelling of transsexual—Cauldwell sometimes only used one "s", while Benjamin always used two.[3]
The Transsexual Phenomenon was the first medical text to seriously consider that it was possible for trans people to "successfully" live as the sex and gender they identify with.[30] Thus, some have even argued that its legacy positions Harry Benjamin as the "founding father of contemporary Western transsexualism."[1] in that "all subsequent published works by practitioners perpetuated the stereotype[s]" Benjamin helped to create.[31] The influence of The Transsexual Phenomenon extends individually as well as systemically: for example, historian Susan Stryker also notes that San Francisco police officer Elliott Blackstone, an influential figure in the Compton Cafeteria Riots, became an outspoken advocate against police harassment of transsexuals after reading a copy of The Transsexual Phenomenon.[32]
Benjamin's work has also been especially important for the discipline of trans theory, though its reception and influence here is mixed. In the seminal "The Empire Strikes Back: a Posttransexual Manifesto", Sandy Stone documents:
When the first clinics were constituted, Benjamin’s book was the standard reference. And when the first transsexuals were evaluated for their suitability for surgery, their behavior matched up gratifyingly with Benjamin’s criteria. The researchers produced papers which reported on this, and which were used as bases for funding. It took a surprisingly long time--several years--for the researchers to realize that the reason the candidates’ behavioral profiles matched Benjamin’s so well was that the candidates, too, had read Benjamin’s book, which was passed from hand to hand within the transsexual community, and they were only too happy to provide the behavior that led to acceptance for surgery.[3]
In this manner, trans historians have argued that transsexuals at early gender clinics expressed Benjamin's criteria of "being in the wrong body" because they, too, had all read The Transsexual Phenomenon—and knew embodying Benjamin's descriptions was the path to the surgical affirmation of their gender identity.
Benjamin has also been heavily criticized for his endorsements of heteronormativity and cisnormativity throughout the text, his reliance on notions of "passing", his construction of gender success, and his criteria for "male transsexuals" who would make "suitable" women.[1][3] Other contemporary critiques of Benjamin also include Jillian St. Jacques, who writes that the legacy of "The Transsexual Phenomenon" shrouds those who no longer identify as transsexual but resist "a return to an a priori sexual designation" in discourses of regret.[33] Nearly 40 years later, Richard Ekins and Dave King published The Transgender Phenomenon, which presents both update and homage to Benjamin's work through chapters "Towards a Sociology of Transgendering", "Migrating Stories", "Oscillating Stories", "Negating Stories", and "Transcending Stories".[34] In arguing that Benjamin's frameworks of transsexualism no longer fit the transgender communities he applied them to, Ekins and King consider a "gender outlaw... beyond the binary" view of transness through the framework of "transgendering", or the act of living between and "beyond" gender(s).[35]
Gender-affirming surgery is a surgical procedure, or series of procedures, that alters a person's physical appearance and sexual characteristics to resemble those associated with their identified gender. The phrase is most often associated with transgender health care and intersex medical interventions, although many such treatments are also pursued by cisgender and non-intersex individuals. It is also known as sex reassignment surgery, gender confirmation surgery, and several other names.
Transvestism is the practice of dressing in a manner traditionally or stereotypically associated with a different gender.
Harry Benjamin was a German-American endocrinologist and sexologist, widely known for his clinical work with transgender people.
The World Professional Association for Transgender Health (WPATH), formerly the Harry Benjamin International Gender Dysphoria Association (HBIGDA), is a professional organization devoted to the understanding and treatment of gender identity and gender dysphoria, and creating standardized treatment for transgender and gender variant people. WPATH was founded in 1979 and named HBIGDA in honor of Harry Benjamin during a period where there was no clinical consensus on how and when to provide gender-affirming care. WPATH is mostly known for the Standards of Care for the Health of Transgender and Gender Diverse People (SOC).
The Standards of Care for the Health of Transgender and Gender Diverse People (SOC) is an international clinical protocol by the World Professional Association for Transgender Health (WPATH) outlining the recommended assessment and treatment for transgender and gender-diverse individuals across the lifespan including social, hormonal, or surgical transition. It often influences clinicians' decisions regarding patients' treatment. While other standards, protocols, and guidelines exist – especially outside the United States – the WPATH SOC is the most widespread protocol used by professionals working with transgender or gender-variant people.
The following outline is provided as an overview of and topical guide to transgender topics.
The American-Canadian sexologist Ray Blanchard proposed a psychological typology of gender dysphoria, transsexualism, and fetishistic transvestism in a series of academic papers through the 1980s and 1990s. Building on the work of earlier researchers, including his colleague Kurt Freund, Blanchard categorized trans women into two groups: homosexual transsexuals who are attracted exclusively to men and are feminine in both behavior and appearance; and autogynephilic transsexuals who experience sexual arousal at the idea of having a female body. Blanchard and his supporters argue that the typology explains differences between the two groups in childhood gender nonconformity, sexual orientation, history of sexual fetishism, and age of transition.
The Compton's Cafeteria riot occurred in August 1966 in the Tenderloin district of San Francisco. The riot was a response to the violent and constant police harassment of trans people, particularly trans women, and drag queens. The incident was one of the first LGBTQ-related riots in United States history, preceding the more famous 1969 Stonewall riots in New York City. It marked the beginning of transgender activism in San Francisco.
Sexuality in transgender individuals encompasses all the issues of sexuality of other groups, including establishing a sexual identity, learning to deal with one's sexual needs, and finding a partner, but may be complicated by issues of gender dysphoria, side effects of surgery, physiological and emotional effects of hormone replacement therapy, psychological aspects of expressing sexuality after medical transition, or social aspects of expressing their gender.
The Sex Orientation Scale (SOS) was Harry Benjamin's attempt to classify and understand various forms and subtypes of transvestism and transsexualism in biological males, published in 1966. It was a seven-point scale ; it was analogous to the Kinsey Scale as it relates to sexual orientation, which also had seven categories.
The classification of transgender people into distinct groups has been attempted since the mid-1960s. The most common modern classifications in use are the DSM-5 and ICD, which are mainly used for insurance and administration of gender-affirming care.
David Oliver Cauldwell was a prolific and pioneering sexologist, who coined the term transsexual as used in its current definition. Many of his monographs on sex, psychology, or health were published by Emanuel Haldeman-Julius in such forms as Big Blue Books. He was the editor of Sexology magazine's question and answer department. Cauldwell and Harry Benjamin were "two early and important American voices on transsexuality".
A transgender person is someone whose gender identity differs from that typically associated with the sex they were assigned at birth. Some transgender people who desire medical assistance to transition from one sex to another identify as transsexual. Transgender is also an umbrella term; in addition to including people whose gender identity differs from the gender typically associated with their assigned sex at birth, it may also include people who are non-binary or genderqueer. Other definitions of transgender also include people who belong to a third gender, or else conceptualize transgender people as a third gender. The term may also include cross-dressers or drag kings and drag queens in some contexts. The term transgender does not have a universally accepted definition, including among researchers.
Louis Graydon Sullivan was an American author and activist known for his work on behalf of trans men. He was perhaps the first transgender man to publicly identify as gay, and is largely responsible for the modern understanding of sexual orientation and gender identity as distinct, unrelated concepts.
A transsexual person is someone who experiences a gender identity that is inconsistent with their assigned sex, and desires to permanently transition to the sex or gender with which they identify, usually seeking medical assistance to help them align their body with their identified sex or gender.
Virginia Charles Prince, born Arnold Lowman, was an American transgender woman and transgender activist. She published Transvestia magazine, and started Full Personality Expression, which later became Tri-Ess, for male heterosexual cross-dressers.
"The Empire Strikes Back: A Posttranssexual Manifesto" is a 1987 essay written by Sandy Stone. Stone's essay is considered to be the founding text of transgender studies in academia, with other critical transgender works emerging after it. The essay examines how transgender women have historically been viewed, studied, and treated by the western medical establishment.
Louise Lawrence (1912–1976) was an American transgender activist, artist, writer and lecturer. During the mid-20th century, she organized a network of gender non-conforming people across the US and abroad, and advocated for transgender issues. She was an early founder of the magazine, Transvestia. Academic and historian Susan Stryker wrote, "If there is an unheralded founder of the transgender community in the United States, it’s Louise Lawrence.".
Transvestism and Transsexualism in Modern Society, also known as The First National TV.TS Conference, was a conference held in Leeds, England, from 15 to 17 March 1974. It was the first such event to be organised by members of the community. With an educational remit, the conference sought to further understanding of issues faced by transvestites and trans women.
Carol S. Riddell is a British feminist and socialist sociologist and transgender lesbian who was active in the UK Women's liberation movement in the 1970s. She is known for authoring Divided Sisterhood, the first feminist critique of Janice Raymond's book The Transsexual Empire.
References
1 2 3 4 5 Ekins, Richard (July 1, 2005). "Science, Politics and Clinical Intervention: Harry Benjamin, Transsexualism and the Problem of Heteronormativity". Sexualities. 8 (3): 306–328. doi:10.1177/1363460705049578. S2CID143544267.
↑ Benjamin, Harry (1999). The Transsexual Phenomenon. Düsseldorf: Symposium Publishing.
1 2 Hirschfield, Magnus (ed.). Book Reviews of Harry Benjamin's "The Transsexual Phenomenon". Harry Benjamin Collection, Kinsey Institute for Research in Sex, Gender, and Reproduction in Alexander Street Database.
↑ Hillman, Betty Luther (2011). "'The Most Profoundly Revolutionary Act a Homosexual Can Engage In': Drag and the Politics of Gender Presentation in the San Francisco Gay Liberation Movement, 1964-1972". Journal of the History of Sexuality. 20 (1): 152–181.
↑ Reay, Barry (Summer 2014). "The Transsexual Phenomenon: A Counter History". Journal of Social History. 47 (4): 1042–1070. doi:10.1093/jsh/shu018.
↑ Pehl, Emerson Parker (2020). "(Trans)Gender Fluidity"(PDF). Body Studies Journal. 2 (1). Cabrini University: 1–8. ISSN2642-9772. Retrieved 10 August 2024.
↑ Jason Cromwell (2006). Stryker, Susan; Whittle, Steven (eds.). The Transgender Studies Reader. New York: Routledge. p.511.
↑ Stryker, Susan (2008). Transgender History. Basic Books.
↑ St. Jacques, Jillian (2007). "Retrotranslations of Post-Transsexuality, Notions of Regret". Journal of Visual Culture. 6 (1): 77–90. doi:10.1177/1470412907075070. S2CID146317396.
↑ Ekins, Richard; King, David (November 2006). The Transgender Phenomenon. SAGE Publication. p.ix.
↑ Ekins, Richard; King, David (November 2006). The Transgender Phenomenon. SAGE Publication. pp.xiv.
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