Please note: I am attempting to make this page as accurate as I can... However, I cannot (yet) claim 100% accuracy of the details stated here. If you note any mistakes, or have any helpful additions, please let me know.
Transsexuality has apparently been around long before it was diagnosed in the 19th century. However, modern diagnosis started back in the 1880s in Germany, where the fledgling field of sexology was being created. In 1886, a German doctor by the name of Richard von Krafft-Ebing began studying the prevalence of gender divergence among the homosexual population. He coined a term, "gynandry" to describe the phenomenon. Later, in 1902, he described something he called, "metamorphosis sexualis paranoia", wherein a homosexual truly believed him or herself to be one of the opposite sex. However, Krafft-Ebing believed this, in addition to homosexuality, was purely a delusion, and a mental illness.
Though Krafft-Ebing's work was the first to touch upon transgendered topics, the first true pioneer in the field was Dr. Magnus Hirschfeld. As a gay physician, he devoted his studies to the fields of sex and gender. Hirschfeld was the first to coin two of the most popular terms to describe transgenderism: transvestism and transsexualism.
In 1910, he wrote a two volume monograph entitled, Die Transvestiten: Eine Untersuchung ueber den erotischen Verkleidungstrieb mit umfangreichem casuistischem und historischem Material. In it, he detailed the biographies of several gender variant individuals, who would likely be classified as transsexuals today.
In 1923, Hirschfeld first labeled the phenomenon as what he called "psychic transsexuality" in Die intersexuelle Konstitution. Jahrbuch für sexuelle zwischenstufen, 23: 3-27.
In 1919, Hirshfeld founded the Institut füer Sexualwissenschaft (The Institute for Sexual Science) in Berlin, the world's first sexological institute. Nine years later, in Copenhagen, he and Norman Haire founded The World League of Sex Research.
In 1930, addressing the Association for the Advancement of Psychotherapy, Hirschfeld delivered the first scientific lecture on transsexualism.
In the 1910s, Hirschfeld began to explore the idea of a surgical solution to some of these cases.
Hirschfeld began working with a Vienna physician, Eugen Steinach (who later penned the 1940 book, Sex and Life. Forty years of biological and medical experiments). Steinach had experimented with gonadal transplantation in attempts to cure a variety of sexual disorders (ranging from homosexuality to transvestism). His early papers (Arbitrary Transformation of Male Animals into Animals with Pronounced Female Sex Characteristics and Feminine Psyche, and Feminization of Males and Masculinization of Females) detailed his experiments with transplantation on guinea pigs. He was the first to theorize that the sex glands contained secretions that made men act like men, and women act like women. Later, in the 20s and 30s, the blooming field of endocrinology would discover androgens and estrogens.
In 1918, Hirschfeld reported in Sexuelle Zwischenstufen: Sexualpathologie that the first incomplete sex-reassignment surgeries in female-to-male patients were performed in Berlin in 1912. In 1916, Max Marcuse published an article on Geschlechtsumwandlungstrieb, the desire of some to have their sex changed. In 1926, R. Muehsam reported (in Chirurgische Eingriffe bei Anomalien des Sexuallebens: Therapie der Gegenwart 67: 451-455) that in 1920, Hirschfeld referred the first male-to-female patient to a surgeon, Dr. Felix Abraham.
In 1921, the first private surgeon, Gohrbandt, began to practice early forms of sexual reassignment in Berlin.
These initial attempts at SRS were incomplete, usually entailing simply the removal of the sexual organs of the patient. Further enhancements to the procedure were developed in the following years. Most notable were the first attempts at vaginoplasty. Initially vaginoplasty was performed using skin grafts from the legs and/or lower abdomens. Further enhancements would not come along for over twenty years.
The first complete male-to-female SRS was reported in 1931, and it was performed based on Hirschfeld´s recommendation by two of his co-workers in his institute, Dr. Levy-Lenz, and Dr. Felix Abraham. The patient, Rudolph Richter, later living with the female first name Dorchen, lived and worked in Hirschfeld´s institute for more than 10 years as a housemaid (R. Herrn (1995) Vom Geschlechtsumwandlungswahn zur Geschlechtsumwandlung. pro famila magazin 23(2): 14-18). In 1922, Richter underwent castration, followed in 1931 with a penectomy and the construction of an artificial vagina.
Also that year, Dr. Abraham reported the details of two men undergoing sex reassignment surgery in his 1931 article Genitalumwandlung an zwei maenlichen transvestiten. (Zeitschrift fur Sexualwissenschaft 18:223-226) A translation of his article can be read at http://www.symposion.com/ijt/ijtc0302.htm.
In the Spring of 1930, Lili Elbe (formerly the Dutch painter, Einar Wegener), referred by Hirschfeld, had SRS under Dr. Gohrbandt in Dresden. She died the following year of complications from the surgery, but not before being heralded as the world's first transsexual. Dutch newspapers began reporting the news at the end of 1930, and her posthumous autobiography, Man into Woman (under the pseudonym of Niels Hoyer), was published two years after her death.
Some early female-to-male transexuals include Claire Schreckengost and Henri Acces (formerly Alice Henriette Acces). In 1935, a Czechoslovakian runner by the name of Zdenka Koubkova became Zdenek Koubkov. British athlete Mary Edith Louise Weston became Mark Weston in the mid-1930s. In 1937, Belgian cycling champion Elvira de Brujin became Willy de Brujin.
On May 6th, 1933, Magnus Hirschfeld's Institute for Sexual Science was raided and destroyed by Nazis. Hirschfeld, in exile, died two years later. Writings on sexology were burnt, and sexologists were persecuted. Soon, even Hirschfeld's World League of Sex Research was disbanded.
Due to the political events in Europe, SRS was placed on a back burner. Only a handful of sex reassignment operations would be performed until the next decade. Clinics in Denmark and Norway resume some of the work halted by Germany, performing theraputic penectomies and castration.
However, the early years of WWII were also a time of medical advancement which would help future transexuals. It was at this time that the first estrogens became available, with the introduction of Di-Ethyl Stilbesterol in 1938 (originally for use in chicken feed!), and Premarin in 1941.
In 1944-5, a British surgeon, Harold Gillies, performed some initial operations on Michael Dillon (formerly Laura). He used the wartime technique of flap surgery, which proved to be a crucial advancement for FTM surgery.
Occassional articles appeared throughout the 1930s detailing various transsexual operations, but none truly caught the public limelight. In 1941, several stories appeared about Edward Richards, who went to court to legally become Barbara Ann Richards. Later, Richards travelled overseas to have sex change surgery.
However, it wasn't until the late 40s and early 50s that transsexualism moved into the public spotlight. That happened when the first American, Christine Jorgensen, had sex-reassignment surgery in 1952. She traveled to Copenhagen, where surgeons Paul Fough-Anderson and Erling Dahl-Iversen performed her initial SRS.
On December 1 of that year, the New York Daily News broke the story with the headline: Ex-GI Becomes Blonde Beauty!
Aside from the news articles, transsexuals began telling their own stories, following the trend started by Lili Elbe in 1933. Michael Dillon (a female-to-male transsexual) described his case in Self: A Study of Ethics and Endocrinology in 1946. Christine Jorgensen wrote her autobiography in 1967. Striptease artists, Hedy Jo Star, wrote one of the earliest, I Changed My Sex. Roberta Cowell, a prominent transsexual in the UK, also wrote an autobiography.
The one movie which attempted to capitalize on transsexualism at this time, Glen or Glenda, was a resounding flop, and is widely considered to be one of the worst movies of all time.
Still, even though transsexuality was more prevalent, it remained a mystery to the general public. Its occasional excursions into the public eye were still marred by sensationalism and incredulity.
However, among the scientific community, word continued to spread. In 1949, David O. Cauldwell wrote an article, Psychopathia Transsexualis, In the journal, (Sexology 16: 274-280), and is often incorrectly credited with creating the term "transsexual". Cauldwell did create "psychopathia transexualis" as an alternate sexological category, separate from issues involving intersexuality. However, Cauldwell was a fervent opponent of a surgical remedy, except in intersex cases.
In 1953, Dr. Harry Benjamin authored the article, Transvestism and Transsexualism, in the International Journal of Sexology (7: 12-14). Dr. Benjamin had begun to treat transexuals with hormone therapy in 1949.
As a direct result of the Jorgensen publicity, the number of sex reassignment surgeries, a mere handful in the first half of the century, grew dramatically. Surgeons outside of Europe begand to offer SRS. Notable clinics opened in Tijuana, and Casablanca.
The latter was where a surgeon by the name of Dr. Georges Burou began to practice SRS in 1953. He pioneered the penile inversion form of vaginoplasty, which is used up to this day.
Despite its growing prevalence in Europe, surgeons in the United States were hesitant to perform the operation, primarily for fear of prosecution, both civil and criminal. Without an officially recognized diagnosis making SRS a valid medical cause, it could be seen as being the crime of "medical mayhem" (the permanent maiming or mutilating of an individual, rendering that individual partly or wholly defenseless).
In 1958, a group of UCLA doctors, Robert Stoller, Harold Garfinkel and Alexander Rosen, performed feminization surgery on an intersexual woman named Agnes.
SRS finally came to America with the help of a FTM, Reid Erickson. Born female, Reid inherited a fortune from his father, and began transitioning to live as a male under the supervision of Dr. Harry Benjamin.
Erickson formed an organization, The Erickson Educational Foundation, to promote the study of transsexualism. A group of doctors at Johns Hopkins University were among the first to benefit from the generosity of the EEF. Doctors John Money, Howard Jones and Milton Edgerton started America's first Gender Identity Clinic. There, in 1965, after receiving permission from a Baltimore court, Phillip Wilson underwent the first SRS in the U.S. to become Phyllis Wilson.
In 1966, the Johns Hopkins Gender Clinic announced its success to the New York Times. In addition, that year Dr. Harry Benjamin wrote his penultimate work, The Transsexual Phenomenon.
Now, the floodgates opened, as over the next couple years several universities opened gender clinic: Stanford (under Psychiatrist Norman Fisk and surgeon Donald Laub), UCLA (headed by Dr. Robert Stoller), Northwestern, and the University of Minnesota (Dr. Hastings?). The Stanford clinic in particular was noted for its pioneering work, involving both the sigmoid colon resection vaginoplasty, and advances in phaloplasty techniques.
In 1969, the first private practicioner began performing SRS in America: Dr. Stanley Biber, working from drawings from the Johns Hopkins Clinic. His practice was seen as an alternative to the gender clinics, where prospective transsexuals were expected to meet sometimes strict criteria before being awarded with SRS.
Other countries soon became more relaxed about SRS. In 1967, a change in British law allowed Charing Cross Hospital to begin performing SRS, under Dr. Phillip, and in 1969, Germany decriminalized the procedure. In 1971, Dr. Léon Pérel performs the first sex reassignment at the Saint-Francois hospital in Paris.
The Erickson Educational Foundation began sponsoring a series of International Symposia on Gender Identity. The first was held in London, in 1969. Future meetings took place in Denmark - 1971, Yugoslavia - 1973, Stanford - 1975, Norfolk - 1977, and finally in San Diego - 1979.
In 1972, the AMA first officially sanctions SRS as the treatment for transsexualism. "Gender Dysphoria Syndrome" was coined a year later by Norman Fisk.
In the late 1970s, however, the climate began to change. The first signs were seen at Johns Hopkins, where the chairman of the Psychiatry department, Dr. Joel Elkes, was replaced by Dr. Paul McHugh. McHugh saw SRS as unnecessary mutilation, and set out to kill the program. He assigned Dr. John Meyer to do a long-term follow-up study of 50 transsexuals who underwent SRS at Johns Hopkins. Meyer's report, issued in 1977, claimed that SRS confers no objective advantage in terms of social rehabilitation for transsexuals. Although the paper was widely criticized as flawed, it led to the October 1979 closing of the Johns Hopkins Gender Identity Clinic.
Transsexuals came under fire at this time from both the lesbian/gay community and feminist groups. A prime example was the 1979 publication of Janice Raymond's book The Transsexual Empire: The Making of the She-Male, wherein she attacked transsexuals from a feminist angle. In short, she criticized TSs for reenforcing gender roles, and complained that men (the TSs) were only transitioning to dominate and further oppress "true" women.
Sensing political pressure, other universities began to taper off their own gender programs. Some were discontinued completely. Others, such as Stanford's, were removed from the university, becoming non-affiliated, nonprofit foundations. In 1977, the Erickson Educational Foundation dissolved, leaving even the ISGE with an uncertain future.
During its 1977 and 1979 meetings, the ISGE began to plan its future. The downfall of the gender clinics, and the loss of support from the EEF indicated a fundamental shift in the way transgender support would be offered.
Under the guidance of Paul Walker, in 1979, the ISGE reformed itself as the Harry Benjamin International Gender Dysphoria Association. To provide its members with a consistent standard for treatment of transgender issues, the HBIGDA adopted a group of guidelines called The Standards of Care. Click here to peruse a copy.
The Standards of Care were revised five times since (in January 1980, March 1981, January 1990, June 1998, and February 2001).
In 1980, the American Psychiatric Association listed transsexualism as an official disorder in the DSM-III. The diagnosis was changed to "gender identity disorder" in the DSM-IV.
Through the 1980s, more private surgeons began taking up the mantle of SRS. Additional innovations were made, such as the ascending colon vaginoplasty, the use of scrotal tissue for additional vaginal grafts, and urethral mucosal flaps for providing lubrication.
A Few References:
An excellent book is now available: Joanne Meyerowitz' How Sex Changed: A History of Transsexuality in the United States
Also, visit these websites for more information:
Transsexual, Transgender, and Intersex History
Transgender History
Reed Erickson and the Erickson Educational Foundation
Transsexual Chronology - in French
...more to come