How one of America’s best medical schools started a secret transgender surgery clinic
Fifty years ago, Johns Hopkins pioneered the science
In 1966, a pioneering group of doctors at Johns Hopkins quietly opened the first sex reassignment surgery clinic in America. The Hopkins Gender Identity Clinic was made up of two plastic surgeons, two psychiatrists, two psychologists, a gynecologist, a urologist, and a pediatrician. These researchers weren’t seeking publicity — not yet, anyway. First they wanted to know if they could successfully perform the procedures, and if surgery would actually improve the lives of their patients. The program was meant to be cautiously and rigorously experimental. And, for the time being, secret.
But just months after the clinic performed its first surgery, the New York Daily News “discovered” its inaugural patient, “a stunning girl who admits she was a male less than one year ago.” The African-American woman “underwent a sex change operation at, of all places, Johns Hopkins Hospital in Baltimore.” The cat was out of the bag, whether Johns Hopkins liked it or not.
In an attempt to stem the tide of sensationalist news stories, the hospital sent a thorough press release to The New York Times, and offered full access to researchers. Johns Hopkins collaborated with a sympathetic reporter, Thomas Buckley, to get the story straight. The result was a front-page article that was, for its time, reasonably sensitive to trans people. The article spent much of its time explaining what being trans meant to an uninitiated public, and attempting to destigmatize the surgery by preempting criticisms:
The men and women who seek sex change surgery are called transsexuals. They are almost always physically normal, but they have a total aversion to their biological sex that dates from early childhood… There appear to be no known cases in which the subject of sex transformation surgery has expressed regrets later. Nor do there seem to be many cases of postoperative complications.
But not every media outlet approached the topic with the same open-mindedness. For its part, Time saw fit to publish readers’ responses to the news story. These included that sex reassignment surgery constituted “irresponsible tampering with the body” and turned people “into freaks.”
By this time, the clinic already had a waiting list of over a hundred people, and the increased media attention sent the numbers through the roof. So, the doctors could be extremely selective — they chose only patients who were already living as the gender they were not assigned at birth, and with no history of mental illness beyond being transgender itself (which was considered a psychological condition). They were even known to prefer patients who presented as more masculine or feminine, respective to their gender identity (for instance, choosing a petite trans woman over a tall, muscular applicant). While these criteria left many at-risk applicants behind, barring many trans people from procuring the clinic’s services, Hopkins rationalized it as a necessary incrementalist approach.
Johns Hopkins was considered a conservative institution, but this was the 1960s, and even patrician East Coast medical establishments were experiencing shake-ups. “The more liberal sexual climate of the 1960s probably made sex reassignment surgery seem less outrageous to the doctors at Hopkins,” writes Joanne J. Mereyowitz in How Sex Changed, “and so did the growing familiarity with other forms of bold operations, such as organ transplants.”
Two of the team’s researchers, Harry Benjamin and John Money, were high-profile figures during the mid-20th century golden age of sexology. Benjamin had been fascinated by gay culture in pre-World War II Germany, and worked with Alfred Kinsey after immigrating to the United States. As early as 1948, he was working to assist — rather than “cure” — transgender children. John Money, for his part, coined the phrases “gender identity” and “sexual orientation,” for the first time recognizing the distinctions between gender, biological sex, and sexual behavior.
But the story of transgender opportunities and acceptance in this country is far from linear — and not everyone at Hopkins agreed with Benjamin and Money. As the revolutionary spirit of the 1960s waned, the Hopkins Gender Identity Clinic came under increased scrutiny from inside the institution itself. In 1969, Jon Meyer, a psychologist who focused on sexual disorders, became the chair of the clinic. Skeptical of the benefits of surgery, he began conducting his own research on the clinic’s patients. Over time, he became convinced (if indeed he needed convincing) that being transgender was a mental illness that required a purely psychological approach.
Over the next decade, the surgeries dwindled under Meyer. In 1979, Meyer published his findings, and divulged to The New York Times:
“To say that this type of surgery cures psychiatric disturbance is incorrect. We now have objective evidence that there is no real difference in the transsexual’s adjustment to life in terms of jobs, educational attainment, marital adjustment and social stability. My personal feeling is that surgery is not a proper treatment for a psychiatric disorder, and it’s clear to me that these patients have severe psychological problems that don’t go away following surgery.”
This result stood in direct contradiction to the findings of other researchers at the clinic. John Money’s research found, for example, that all but one of 24 surgery recipients said their lives had changed for the better. Money protested, insisting that Meyer had intentionally “distorted the findings of the study way out of proportion” in order to stop the clinic from continuing its surgical program. In any case, Meyer’s announcement sounded the death knell for the Hopkins Gender Identity Clinic, which never performed another surgery.
But it was important all the same. Despite its prohibitive barriers to entry — not to mention the long-term damage of Meyer’s assertions — the clinic was a place that took trans people seriously in a time when that was extremely rare. It was also a place for doctors to learn, practice and improve the science of surgical sex reassignment. By 1979, only 30 surgeries had actually been performed at Hopkins itself, but the clinic consulted on more than a thousand surgeries at different hospitals, training doctors along the way. By the time the Hopkins clinic closed, between 15 and 20 medical centers were performing the surgery.
The Hopkins Clinic is long gone and mostly forgotten. After it was shut down, the surgery started to take place increasingly in private clinics, leaving academic medical institutions behind. Nowadays, some researchers at Hopkins regret losing the program. “All the best surgeons work free-standing, away from medical schools,” laments one Hopkins researcher. “If we had surgeons who could provide the same quality services as the other surgeons in the country, then it would make sense to provide these services. Sadly, few physicians are willing to make gender surgery a priority in their careers.”
