he says. “The surgeons were saying to me, ‘Imagine what it’s like to get up in the morning and come in and hack away at perfectly normal organs because you psychiatrists don’t know what to do with these people.’” Though he denies that he was recruited by Johns Hopkins for the express purpose of shutting down the unit, it is clear that he has no regrets about that decision. “When I came here and saw the incoherence of the unit, it became clear to me that it wasn’t serving a good purpose,” he says. “I felt that we’d try to find good evidence for it or against it. The evidence that I found was against it. People weren’t being made better, all of it was anecdotal, there were real problems as to what the nature of this condition was, and even the surgeons were weary of doing it.” McHugh formally based his decision to close the clinic on an outcome study produced by Dr. Jon Meyer, the head of the Gender Identity Clinic at the time. The Meyer study, which was immediately attacked for its poor methodology and which has been refuted by subsequent outcome studies, “was adequate for what it was intended to do,” McHugh says, “which was to show, to find out, whether these people were over their psychological problems. And it turned out that they were no more psychologically stable—stable in their employment or relationships—than they were [before surgery].”
The Meyer study, cowritten with Donna Reter, noted the generally positive (good or satisfactory) outcomes reported by other researchers but reached a different conclusion. “Sex reassignment surgery confers no objective advantage in terms of social rehabilitation, although it remains subjectively satisfying to those who have rigorously pursued a trial period and who have undergone it.” Meyer and Reter based this conclusion on a comparison of fifteen patients who underwent surgery at Hopkins compared with thirty-five who had not completed the Hopkins program but who, in some cases, continued to pursue sex reassignment and later underwent surgery elsewhere. “While not a rigorous control group, they provided the only available approximation to it,” Meyer and Reter note of the latter group.
“Social rehabilitation” of the two groups was compared using a number of socioeconomic indicators, including job and educational levels, psychiatric and arrest history, frequency of change of residence, and cohabitation with “gender-appropriate” or “gender-inappropriate” partners. A numerical value was assigned to each of these categories in the Adjustment Scoring System. “Most of the scoring is self-evident,” Meyer and Reter note, though “if the patient is male requesting reassignment as female, a gender appropriate cohabitation or marriage means that he lives with or marries a man as a female; a non-gender appropriate situation would be one in which the patient, while requesting sex reassignment, nonetheless cohabitated or married as a man.” Male-to-female transsexuals who had female roommates, girlfriends, or wives were thus assigned negative scores, while marriage to a “gender-appropriate” partner was scored +2, a marker of successful adjustment on a par with a rise in socioeconomic status.
Critics have noted that “the most serious problem with this scale is its arbitrary character… it assigns the same score (—1) to someone who is arrested as someone who cohabits with a non-gender appropriate person. From this same set of cryptic values comes the assertion that being arrested and jailed (—2) is not as bad as being admitted to a psychiatric hospital (—3) or that having a job as a plumber (Hollings-head level 4) is as good (+2) as being married to a member of the gender-appropriate sex (+2). On what basis are these values assigned?” The same authors note that “there is confusion on the variable of cohabitation, particularly since Meyer never specifies whether this implies seuxal intimacy, interpersonal sharing or both. One can infer from the scoring assignment that a transsexual would be better living with no one (o) than with a person of the non-gender appropriate sex (—1) … Does Meyer mean to say that living in isolation is more adaptive than living with someone whatever his/her sex?”
Similarly, continued interaction with therapists and psychiatrists after surgery is viewed as a negative (psychiatric contact = —1, outpatient treatment = —2, and hospitalization = —3), as is failing to improve one’s socioeconomic status (as measured by the Hollingshead job scale). Meyer and Reter’s “objective” values of adjustment seem exceedingly value-laden in retrospect. Moreover, their failure to include any measure of personal satisfaction or happiness in the Adjustment Scale has been almost universally criticized, especially since “none of the operated patients voiced regrets at reassignment, the operative loss of reproductive organs, or substitution of opposite sex facsimiles (except one, previously noted),” as Meyer and Reter acknowledge. In other words, despite their unchanged socioeconomic status, continued tendency to change jobs and residences, and generally insecure and unsettled lives, those who underwent sex-reassignment surgery at the Johns Hopkins clinic appeared nearly universally happy with the results.
Ben Barres, the Stanford neurobiologist who transitioned in his early forties after a lifetime of gender dysphoria, confirms the importance of including affective data in any study attempting to assess the success of sex-reassignment surgery. “I’ve never met a transsexual who wasn’t enormously psychically better [after the surgery],” Barres says. “And the studies I’ve read say that something like 95 percent are very happy that they did it. And in medicine, you don’t usually find that kind of success rate. That’s unheard of, to find a treatment that has a 95 percent success rate. So it seems to me that the actual facts are totally opposite to what this guy [Meyer] said.”
The feelings of happiness and contentment expressed by postoperative transsexuals are irrelevant in the view of Paul McHugh, who closed the Johns Hopkins clinic after the Meyer study. “Maybe it matters to them, but it doesn’t matter to us as psychiatrists. We’re not happy doctors. We’re not out there saying, ‘What do you think would make you happy? Would you like a third arm?’ That’s not what we are,” he says. “The best will in the world would be to say, ‘These people have psychological problems that are dependent on the fact that they are fixed in the wrong body, and their psychological problems will melt away if we treat this. If we do this, it will make them better.’ But we found that they were no better! So we thought, ‘Maybe we’re just masquerading here. We’d like to think that they are better and they aren’t.’” McHugh dismisses sex-change surgery and the misery that drives it as “a craze” that started in the sixties and has been gathering steam ever since. “Crazes are crazes,” he says. “They build up, and they build up in a particular kind of way. We’ve been sold a bill of goods, and vulnerable people are picking this up and running with it. And it will continue to be a craze for a while as they support one another and as our communication systems, for example the Internet, promote it.”
McHugh’s perspective is anathema to most transgendered people, and yet one can find support for certain elements of his critique in the literature of the community itself. In her memoir,
Morgan also has sharp words for the underground surgeons who were beginning to offer sex-change surgery on demand. “A dozen years ago, when I had my operation, it was a rare thing. Now sex-change surgery has become as common as blue jeans, and many people are getting it who shouldn’t,” she charges. “For this I blame the doctors. Once I thought highly of doctors who did sex-change surgery. I regarded them as saviors of souls. Now I realize that they’re rip-off artists just like everyone else. … Very few of them send their patients to psychiatric counseling to find out if they’ll be able to function as women.” Bluntly, she lists the challenges that confronted transwomen after reassignment in that era. “The girl who had sex-change surgery gets rejected by her family. She isn’t able to hold a job. Most don’t have experience or education. Some have legal problems, because their papers still list them as men. Others get fired when their bosses find out. She can’t live the life of a normal woman. A man might fall for her, but when he finds out what she is, he says goodbye.”
Patricia Morgan’s assessment is couched in the tough talk of the streets, not the formal language of academia, but she reaches a conclusion similar to that of Jon Meyer’s infamous study. Far from solving their problems, sex reassignment created a whole new set of problems for some troubled individuals, challenges that
