Prisoners of Sex

Rachelle McAdam is no ordinary girl next door. A former Salt Lake City high school teacher, she stands a stately 5 ft. 11 in. tall and displays a well-turned 36-26-35 figure. Eight weeks ago, before her operation in San Francisco, her name was Richard, and she was a man, twice married and twice divorced.

McAdam is one of about 1,500 transexuals in the U.S. who have changed their sex by surgery. Because most sex change operations are done confidentially, the exact number is hard to determine. But the trend is clear: about 700 such operations were performed last year, double the rate of the year before.

Transexuals, of whom there are perhaps 10,000 in the U.S., are not to be confused with homosexuals and transvestites. Classic transexuals are born with the anatomy of one sex but suffer from a total, lifelong identification with the other, perhaps influenced by prenatal hormone disturbances. Transexuals generally disdain association with professed homosexuals. Unlike transvestites, they do not dress in clothes of the opposite gender for erotic stimulation, but simply because they feel more comfortable that way.

Careful Screening. Though the first modern medically supervised sex-change operation took place in Europe in 1930, transexual surgery did not attract wide notice until the transformation of a former G.I. named George Jorgensen to Christine* in 1952. In 1966 Johns Hopkins Hospital in Baltimore opened its Gender Identity Clinic, having the year before performed its first complete transexual operation. University hospitals at Minnesota, Stanford, Northwestern, Arkansas, Michigan, Kentucky, Virginia and a few others soon followed suit.

In Stanford's Gender Dysphoria Program, headed by Psychiatrist Norman Fisk and Plastic Surgeon Donald Laub, applicants for surgery are carefully screened. For those who doctors feel could benefit from an operation, at least a full year of hormonal therapy is prescribed: estrogens and progestins to enlarge the breasts and soften the skin on men, and androgens to deepen the voices and stimulate beards on women.

During their hormone therapy, patients are asked to adopt the characteristics of their new gender. Transexual men don dresses, wear makeup, live and work as women. Transexual women wear men's clothes and live as men. After a year, if doctors judge the adjustment to new life-styles a success, surgery is performed.

Procedures and costs differ from hospital to hospital. The male-to-female operation, which costs from $3,000 to $5,000, is by far the easier and more satisfactory. After amputation of the penis and testicles, an artificial vagina is created, using scrotal or penile tissue or skin grafts from the thigh or hip. Because the penile tissue is still sensitive, male-to-female transexuals may experience orgasm, though of course pregnancy is impossible.

Less than half as many operations are requested by women as by men. According to Johns Hopkins Medical Psychologist John Money, the preponderance of men transexuals reflects the fact that men are far more vulnerable to psychosexual disorders than women. Moreover, female-to-male operations are more difficult, more lengthy and more costly (up to $12,000). Breasts are removed, a hysterectomy performed, and in some cases a miniature penis is created by freeing the clitoris from its connective tissue. In others, skin grafts and silicone forms are used to create a penis which may bring a sexual partner to orgasm but has no sensation in itself.

Their own sexual satisfaction, however, is often less important to transexuals than the desire to match their bodies to the gender with which they identify. The major psychological problem after surgery, according to Dr. Fisk, is that in spite of careful counseling, "expectations are often way out of line with reality." For those who want to keep their operation a secret, there is also the chronic tension that goes along with the fear of discovery and exposure.

Keeping a job or getting a new one is also difficult. When Rachelle McAdam appeared before school authorities in a dress, she was given two options: "Resign or be fired." She resigned. Many transexuals marry and adopt children, but there are often legal difficulties, especially in states that forbid sex changes on birth certificates.

Even so, more Americans want transexual surgery than are accepted by U.S. hospitals; many of them have gone abroad for operations. In Casablanca, more than 700 sex-change operations on patients from 17 to 70 have been performed over the past 15 years by Dr. Georges Burou, who specializes in the male-to-female type. Most of his patients have usually lived as women long before they go to Casablanca to take what he calls "the last, irrevocable step." But, insists Dr. Burou, a plain-speaking Frenchman: "I don't change men into women. I transform male genitals into genitals that have a female aspect. All the rest is in the patient's mind."

*Jorgensen, 47, now lives near Los Angeles and lectures on transexuality at colleges across the U.S.

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