Lou Sullivan: Gay Transgender Pioneer

Day 18 of the Pride 30 Project for Pride Month, 2018.

Louis Graydon Sullivan, or Lou, as he liked to be called, is an often overlooked activist because his life did not conform to the narrative traditionally ascribed to gay men. Sullivan was born on June 16th of 1951 in Milwaukee, Wisconsin. From a young age he questioned his gender and sexual orientation, having a sense of himself as not only male, but as a gay man. He began identifying as a “female transvestite,” meaning that though he was identified as female at birth, he identified and wanted to present himself socially as a man. By 1975, he identified as a “female-to-male-transsexual”* who was attracted to other men.

The term “transsexual” was coined by psychiatrist David O. Cauldwell in an article entitled “Psychopathia Transexualis” for the popular magazine Sexology in 1949. Cauldwell defined “transsexuals” as individuals who desired to permanently change sex because their sex assigned at birth did not match their gender identity. While he acknowledged the existence of transsexual persons and that anatomy and gender identity were distinct, Cauldwell, as a psychiatrist, inevitably saw trenssexuality as a mental illness and the concept of medical “sex change” as a crime. The title of his article, in fact, was a play on the nineteenth-century German sexologist Richard von Krafft-Ebing’s landmark work Psychopathia Sexualis, which created a taxonomy of “deviant” sexual types.

Transsexuality and the concept of “sex change” was popularized in the mid-twentieth century by Christine Jorgensen. A former GI who had grown up in the Bronx, New York and served in the military during World War II, Jorgensen created a media frenzy when, in 1952, she underwent a highly-publicized “sex change” in Denmark. “Ex-GI Becomes Blonde Beauty: Operations Transform Bronx Youth,” proclaimed the headline of the New York Daily News on Monday, December 1st of 1952. Jorgensen, who worked to raise awareness about the existence of transsexual people for the rest of her life, was the first transsexual celebrity and the first internationally known “sex-change” recipient. She was also profiled in endocrinologist Harry Benjamin’s 1966 book The Transsexual Phenomenon, which further legitimized the existence of transsexual people. Benjamin advocated for the use of hormone replacement therapy to address issues faced by transsexuals and outlined an affirmative treatment path then referred to as the Harry Benjamin Standards of Care (now called the World Professional Association for Transgender Health, or, WPATH Standards of Care).

Though The Transsexual Phenomenon included a few life histories of transsexual men, Lou Sullivan believed trans men deserved greater cultural visibility and a sense of community. In 1975, realizing Milwaukee was not the best place for a person like him, he moved, like many gay men at the time, to San Francisco. In San Francisco, Sullivan was able to live as a gay man, but was denied access to medical transition due to his sexual orientation. At the time, those seeking “sex reassignment” were expected to conform to stereotypical gender roles, and homosexuality was a disqualifying characteristic for those seeking to medically transition. Transsexuality and heterosexuality were linked, and gender transition was expected to produce a heterosexual outcome. “Real men” were assumed to be sexually and romantically attracted to women, and “real women” were expected to be attracted to men. While the term “homosexual” was coined by sexologists in the late-nineteenth century, the corollary term “heterosexual” was not in popular use until the early-to-mid twentieth century, as the words “man” and “woman” were deemed sufficient to indicate a person’s sexual orientation. In 1979, Sullivan was able to find doctors who allowed him to transition despite his sexual orientation, and he began taking testosterone followed by chest reconstruction in 1980.

Sullivan began to engage in activism on behalf of transsexual men, creating a grassroots FTM movement. He wrote the first guidebook for FTM persons seeking to transition and a biography of the early transsexual man Jack Bee Garland, whose story surely spoke to him. Garland, who was born in the late-nineteenth century, lived in San Francisco’s Tenderloin district, having romantic and sexual relationships with other men. Garland provided confirmation of what Sullivan already knew to be true: that gender and sexuality were not linked, and one could be both transsexual and gay.

Sullivan also founded FTM International, one of the first organizations for trans men and, from 1979 to 1980, edited the San Francisco-based Gateway Newsletter, expanding its focus to include issues pertaining to FTM transsexuals. He brought newfound visibility to transsexual men and, in turn, the FTM community saw a rapid expansion throughout the 1980s. Today, we understand that the historical focus on transsexual women to the neglect of transsexual men was, in part, due to what writer and activist Julia Serano refers to as trans-misogyny. Serano argues that trans women and trans feminine-spectrum people (those whose gender expression is feminine of center) are questioned and ridiculed to a greater extent than trans men and trans masculine-spectrum people (those whose gender expression is masculine of center) due to the inferior position of femininity in Western patriarchal culture. Thus, the confluence of transphobia — the belief transgender people are invalid — and misogyny — the fear and hatred of women and/or femininity — place undue attention and scrutiny on trans women in comparison to trans men.

Sullivan was perhaps the first trans man to publicly identify as gay and, as such, one of the first persons to articulate the difference between gender identity and sexual orientation. He understood one’s sexual anatomy did not automatically determine the gender one felt oneself to be, nor did one’s anatomy or gender identity dictate whom they would be romantically or sexually attracted to. Sexual orientation, while related to gender identity for purposes of categorization, was independent. When Sullivan underwent genital reconstruction surgery in 1986, his doctors discovered he was HIV positive. His advocacy then turned to HIV and AIDS issues within the FTM transsexual community.

Transsexual men’s experiences with HIV/AIDS were obviously different from their non-trans counterparts and are often underrepresented or outright excluded within histories of the epidemic. The HIV virus, identified by French and American scientists in 1983, led to conditions primarily associated with the elderly in a young population. Sullivan was painfully aware that complications due to suppressed immunity could impact an individual’s ability to transition or to present themselves in a manner that aligned with their internal sense of self. He was particularly concerned with wasting, which led to the deterioration of muscle tissue, as he administered his testosterone injections in his thighs. During the phase of the epidemic where there was not yet effective treatment (1981 to the mid-1990s), little attention was paid to how HIV/AIDS impacted the physical and mental health of transsexuals.

During the 1980s, Sullivan also lobbied the American Psychiatric Association (APA) and the Harry Benjamin International Gender Dysphoria Association (HBIGDA), now known as the World Professional Association for Transgender Health (WPATH), to remove sexual orientation from the criteria of “gender identity disorder” so that gay trans people could more easily access medical transition. Today, largely due to Sullivan’s efforts, sexual orientation is not a barrier to accessing transition-related care.

Sullivan died of AIDS-related complications on March 2nd of 1991 and is generally considered the first trans man to die from AIDS. His legacy lives on through the work of contemporary activists such as Buck Angel, Aydian Dowling, and Amos Mac, who have brought newfound visibility to trans men and their experiences. Till the very end of his life, Sullivan remained vigilant of the fundamental differences between gender identity and sexual orientation. Following his AIDS diagnosis, he said the following of a gender clinic that had denied him treatment:

“Even though their program told me I could not live as a Gay man, it looks like I’m going to die like one.”

*A note on terminology: throughout, I have used the terminology Lou Sullivan, and others like him, would have used during the time in which they lived. At times, I have simply used the prefix “trans” in reference to Sullivan to indicate the historical continuity between transsexual and transgender identities. Today, based on our contemporary understanding of the primacy of gender identity over sexual anatomy, we typically use the terminology “assigned female at birth” (AFAB), “transgender man,” or simply “trans man” to refer to individuals formerly referred to as FTM transsexuals, though the term transsexual remains in use. The term “gender-confirmation surgery” has also replaced older terminology such as “sex change” or “sexual reassignment surgery” as a way to indicate these forms of care affirm the gender one already knows oneself to be, not create it via medical intervention.