Being able to transition took a quantum leap in the early 1970s. Medical transition was not really available before then. In the 1950s and 1960s a small hand full of people had medical help. Less than 200 people in the entire world had had this procedure up until then and the results were crude. Christine Jorgensen returned from Denmark in 1953 as a female, but the surgery was not much more than a penectomy. The vaunted Johns Hopkins gender program of a decade later saw no significant improvements in surgical techniques where only 22 MTF surgeries ever took place.
When I started taking estrogen in the later 1960s it was a dead-end. There was no next step except to go to Casablanca where a surgeon was performing “sex changes” for a princely sum. My OB-GYN told me her boyfriend, going FTM nurse, died on the operating room table at that particular clinic.
Only after Stonewall did things change and the first confirmation surgeries (aka SRS) where true vaginal depth was the standard started to be performed in the USA in Colorado by Biber and in New York City by Granato, the latter who performed the surgery on Renee Richards. I had consults with both and did Richards ever nail Granato’s bedside manner in her book Second Serve.
After 1970, people had an option to change the whole smash, not just to cross-live for the rest of their lives. The programs of the 1950s and early 1960s favored tertiary patients who at least had to claim their lives were totally messed up. Anyone getting SRS had to have made two documented serious suicide attempts. Talk about stacking the deck for McHugh’s claim “they are all suicidal” and with the poor surgery results (penectomies) maybe that’s why some would be profoundly unhappy afterwards.
The programs starting in the 1970s required a strong social adjustment and proof of an ability of being able to have a likelihood other than hooking — which is one of the myths: that everyone was a sex worker in the early. Yes, true, there were sex workers in that kindred, but there were also college graduates, lawyers, accountants, doctors! (beyond just Richards) who were changing their bodies to fit their minds. My roomie at Biber’s was both a college student and a dancer at a drag club. She had entered (stealth of course) and won national known beauty pageants competing against cis women because her goal was to kiss a famous male celebrity and leading man.
Yet, less than a 1000 people had the surgery, MTF, in the western world by 1980. I would put it at ~700 to 800. The criteria was that these people had to want to live the lives of women and not as “professional transsexuals” as was the parlance of the day. Most of the people, though not all, simply slipped into the mainstream never to be noticed again. Some found peace and happiness as “ordinary” housewives living in places like Westchester. If you could not pass and if you failed the doctor’s interview, a different sort of “beauty contest” — where the doctors decided whether you looked pretty enough to take out on a date — you were not allowed to proceed. And if you were not a heterosexual woman, you were not allowed to proceed. If you were married, you had to get divorced.
By the late 1990s that had all changed and as many at 20 times the number of MTF surgeries in the western world had been performed. A study based on interviews with all known surgeons in 1998 put the number at between 15,500 and 18,300 people (some surgeons gave a high/low ranges). Hardly enough for a “revolution.”
Around the turn of this century, being trans was largely de-medicalized and surgery was less important in getting identity papers changed and we entered the modern era. And the rest is history.
Brave New World.