SEX CHANGE CITY: - SFU Wiki

A History of medical services
for transsexual people in british columbia, 1970 - 2007
Rodney Hunt
Keywords:
British Columbia, British Columbia Health Insurance Services, British Columbia Medical
Plan, British Columbia Medical Services Plan, MSP, Canadian Penitentiary Service,
Centre for Sexuality Reproductive Health and Gender Issues, Christine Jorgenson,
Committee on Human Sexuality, Erickson Educational Foundation, EEF, Gender
Reassignment Surgery, Gender Clinic, Genital Reassignment Surgery, Genital
Reconstrucive Surgery, GRS, Institute for Sexual Science, Magnus Hirschfeld, Medical
System, Paul McHugh, Psychiatry, Psychoterapy, Sexualwissenschaft, Sex Reassignment
Surgery, SRS, Transgender Health Program, Transsexual,
Abstract:
An overview of the history of sexual reassignment surgery, particularly as it relates to
transsexuals in British Columbia.
Time Period:
1970-2006

Body:
A History of medical services
for transsexual people in british columbia, 1970 - 2007
Introduction
In this essay, I explore the history of medical services for transsexual people in British
Columbia from 1970 to 2007. Drawing primarily on newspaper articles from the
Vancouver Sun and The Province, I provide an historical overview of the local
organization and development of medical services, with specific attention to provincial
gatekeepers who were charged with the psychiatric evaluation of people wishing to
change their sex and the provision (or non-provision) of provincial health funding for sex
reassignment surgeries.
The history of the organization of medical services in British Columbia is intimately tied
to global changes in ideas about sex, gender, and sexuality that were, in part, shaped by a
growing transgender movement of “ordinary and extraordinary human beings who
searched for workable solutions to pressing personal problems” (Meyerowitz 2002:13). I
begin this essay with a brief historical overview that situates the development of medical
services in the context of early sexological work in Europe. However, my primary aim is
to explore how local stories reported in the Vancouver Sun and The Province newspapers
are tied to developments in North America that led to an increasing awareness of the need
to provide transsexual people with access to medical care that met their needs.
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HISTORICAL CONTEXT
Researchers have documented many stories of people throughout history whose gender
was transgressive to established norms. Among these people, it is probable that some
desired to change their sex (Devor 1999). The concept of transsexuality as we know it
today – that is, as a medical category partly defined by the desire to change one’s sex – is
relatively recent, however, making its first appearance in the medical literature in the
middle of the twentieth century (Meyerowitz 2002:15). That said, the idea that one could
change their sex existed for many years before the term “transsexual” was first used to
label and categorized a distinct identity.
Magnus Hirschfeld is widely considered to be a pioneer in the field of transsexualism and
sex-change surgeries. In 1919, Hirschfeld founded the Institut füer Sexualwissenschaft
(Institute for Sexual Science) in Berlin, which was the first clinic to regularly provide
health services for transgender people (Meyerowitz 2002). Meyerowitz writes that “in
the 1920s and into the early 1930s much of the sex-change experimentation centered in
Berlin at Magnus Hirschfeld’s well-known “Institute for Sexual Science” (2002:18).
Throughout the 1930s, the institute officially publicized its sex-change experiments.
Early surgeries to change a person’s sex were typically incomplete, usually entailing the
removal of a person’s breasts and/or parts of their genitals, such as testicles or uteri.
According to Meyerowitz, “the first complete genital transformation arranged through
Hirschfeld’s institute was a male-to-female reassignment for Dorchen Richter who was
castrated in 1922 and in 1932 had her penis removed and a vagina surgically constructed”
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(Meyerowitz 2002:19). One of the first female-to-male sex reassignment surgeries took
place sometime in the middle of the 1930s, when the Czechoslovakian Olympic runner,
Zdenka Koubkova underwent surgery to become a man. Because she was an Olympic
athlete, Koubkova’s story was widely publicized among accusations of men who
masqueraded as women to gain advantages in Olympic competition (Cavanagh & Sykes
2006).
In contrast to a few isolated cases of early sex change surgeries in the United States –
most of which were reported to have been conducted on intersexed patients – sex
reassignment surgeries were a more widely acknowledged phenomenon in Europe than in
North America. Although some North American doctors had the same surgical skills as
doctors performing sex-change surgeries in Europe, few would provide their consent for
transsexual people to change their sex. For the most part, medical intervention was not
available in the United States until the formalization of a program to perform sex
reassignment surgeries for transsexual patients was established at Johns Hopkins Hospital
in Baltimore in 1966 (Meyerowitz 2002).
Rapid advances made in the areas of plastic surgery and endocrinology throughout World
War II made the possibly sex reassignment surgeries more widely known. In the years
following the war, scattered media reports of transsexuality started to appear, and
according to Meyerowitz, “a few popular magazines stated more clearly that doctors
could change any person’s sex. With the dawn of the atomic age, magazines routinely
expressed admiration for the power of science and the wizardry of technology”
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(2002:41). Throughout the late 1940s and early 1950s, transsexualism began to appear
more and more on the pages of American newspapers. One of the culminating events in
the history of medical services for transsexual people in North America occurred on
December 1, 1952, when the New York Daily News reported the story of Christine
Jorgensen’s return to the United States. Jorgenson was an American GI and male-tofemale
transsexual who underwent sex-reassignment surgery in Denmark during that
same year. Media reports of Jorgenson’s transformation caused a sensation around the
world with the headline, “Ex-GI Becomes Blonde Beauty!”
EARLY NEWSPAPER STORIES ABOUT SRS IN VANCOUVER
The day following the New York Daily News report of Christine Jorgenson’s sex change
surgery, both the Vancouver Sun and The Province newspapers published the story of
Jorgenson’s transformation from an unhappy man to a “very natural and lovely woman”
(Vancouver Sun, December 2, 1952). Though the stories were not front page news in
Vancouver, the report was noticed and prompted at least one reporter from The Province
newspaper to follow-up the next day with an exclusive report declaring, “Sex Switch
Operation Once Performed Here” (December 3, 1952:29). Media coverage of Christine
Jorgenson’s transformation brought the possibility of sex-change into the public’s
imagination and the story motivated local newspaper reporters across North America to
enquire about the possibility of local incidences of transsexualism and sex reassignment
surgeries. For the December 3, 1952 edition of The Province, reporter Herc Monro
interviewed a Vancouver doctor who claimed to have performed two early ‘sex switch”
surgeries – one in Eastern Canada sometime during the early 1930s, and the second in
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Vancouver in 1940. Typical of early accounts of sex reassignment surgeries, the story
reports the doctor as saying that these cases were to correct hermaphrodism. However,
though not entirely clear in The Province article, the report states that “when changing
sex, it is easier for the doctor to work towards the dominant characteristic” (29). Monro
then goes on to write that the doctor found the Vancouver case to be “exceptionally
difficult” because the patient, who was a male hermaphrodite with pronounced masculine
characteristics, insisted on becoming a woman.
By the end of the 1960s, the few North American doctors who were working in the field
of transsexualism began to organize themselves into professional networks and
associations. At the same time, small local support groups of transsexual people started
emerging across Canada and the United States, advocating for their rights and pressing
medical professionals for access to appropriate medical care (Meyerowitz 2002). The
Gender Clinic at John Hopkins Hospital was opened in 1966, with partial funding from
the Erickson Educational Foundation (EEF), an organization founded in 1964 by the
philanthropist and transsexual man, Reed Erickson. The mandate of EEF was “to provide
assistance and support in areas where human potential was limited by adverse physical,
mental or social conditions, or where the scope of research was too new, controversial or
imaginative to receive traditionally oriented support” (Devor 2005). According to Devor,
in some way, the EEF supported almost every aspect of the educational and research
support work that was done in the field of transsexualism in the United States during the
1960s and 1970s (Devor 1999). With the opening of the Gender Clinic, Johns Hopkins
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ecame the first hospital to officially sanction support for sex reassignment surgery for
transsexual people (Meyerowitz 2002).
Meyerowitz points out however that the promise of the new clinic at Johns Hopkins
Hospital was never fully realized in terms of the provision of sex reassignment surgeries.
The numbers of transsexual people who were actually admitted to the hospital’s Gender
Identity Clinic remained small; many of those seeking surgery were turned away
(Meyerowitz 2002). In a foreshadowing of what was to become of the clinic at Johns
Hopkins, a local story from the January 22, 1970 edition of the Vancouver Sun hinted at
its failure to meet the needs of transsexual people. The story entitled, “B.C. Man Shifting
Sex Hospital Won’t Say,” speculated that a 21-year old man from Surrey B.C. was one
of 2000 people on a waiting list for sex reassignment surgery at Johns Hopkins (January
22, 1970:66). According to the story, a spokesperson from the hospital would neither
confirm nor deny the speculation, but added that the clinic had recently curtailed its
program of sex-change surgeries in order to complete follow-up assessments of past
patients that would inform a decision as to whether the program should continue. The
story reported that the hospital had performed only 15 sex reassignment surgeries in the
four years since the clinic opened in 1966.
In 1975, Dr. Paul McHugh became the psychiatrist-in-chief at the Johns Hopkins
Hospital. McHugh held strong beliefs that transsexualism was part of a large complex of
personality disorders and he felt that those seeking to change their sex should be treated
by psychiatrists rather surgeons. He later became notorious for insisting that sex
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eassignment surgeries were an unnecessary mutilation of the body, writing that the “zeal
for this sex-change surgery – perhaps, with the exception of frontal lobotomy, the most
radical therapy ever encouraged by twentieth century psychiatrists – did not derive from
critical reasoning or thoughtful assessments (McHugh 1992). Shortly after his
appointment as psychiatrist-in-chief, McHugh put in motion the steps that would
eventually lead to the closure of the Johns Hopkins Gender Identity Clinic in 1979
(Transsexual Roadmap).
FIRST MOVES TOWARD MEDICAL SERVICES, 1970 - 1979
Although few transsexual people had sex reassignment surgery at Johns Hopkins
Hospital, the clinic did lead the way for the establishment of other gender programs
across North America. According to Thomas MacKinnon, who wrote an article for the
November 1972 edition of the B.C. Medical Journal entitled, “Sex Reassignment for the
Transsexual in British Columbia” (1972:295), in the province during the early 1970s,
programs for evaluating transsexual people for sex reassignment surgeries were
underway at the forensic clinic at Vancouver General Hospital and the Health Sciences
Psychiatric Unit at the University of British Columbia. However, because no sex
reassignment surgeries were taking place in British Columbia at that time, a person
granted approval for surgery would have to travel out-of-province for treatment. In the
early 1970s, the closest gender identity clinics were the Seattle Counseling Center for
Sexual Minorities at the University of Washington (which received referrals from British
Columbia doctors) and at the Clarke Institute of Psychiatry in Toronto.
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The 1970s were at time of great change for transsexual people. As transsexual activists
began to publicly articulate their needs, and legal challenges for recognition started to be
addressed in the courts, professional attention and organization around transsexualism
became increasingly formalized. Across North America, newly established gender
identity clinics and university research units started to contribute new knowledge to the
field of transsexualism. By 1972, the American Medical Association Committee on
Human Sexuality had officially recognized sex reassignment surgeries as the preferable
course of action for adult transsexuals, superseding the prevailing medical focus on
psychotherapeutic treatment (Lothstein). Though the official recognition probably helped
advance demands for the availability of appropriate medical care, which may have
facilitated an increase in numbers of sex reassignment surgeries, the prevailing belief by
medical professionals at the time remained that those who desired to change their sex
lived with a psychopathology that would best be treated with psychiatric interventions.
An example from Vancouver can be seen in a decision made by Vancouver Hospital in
the early 1970s. According to MacKinnon (1972), sometime prior to 1972, the Medical
Board at Vancouver Hospital considered a report of a committee that had been appointed
to look into the possibility of opening a Gender Identity Clinic. After meeting to discuss
the issue, however, the Board decided not to proceed with such a program because of the
possibility of “unfavourable publicity” against the hospital. According to MacKinnon,
the decision of the Medical Board was at least partly based on their belief that providing
an opportunity for a person to change their sex might do more psychological harm than
good, risking the creation of more “problems in the mind of the patient” (1972: 296).
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During the early 1970s, the British Columbia Health Insurance Services (known as the
B.C. Medical Plan), was also opposed to the idea of providing sex reassignment surgeries
in the province (MacKinnon 1972). The B.C. Medical Plan apparently rejected the idea
based on administrative reasoning, stating that the decision was made as part of a
provincial-wide effort to cut down on the incidence of surgery generally. That said, in
1972, some funding did exist for specific out-of-province sex reassignment surgeries,
which may have benefited at least a few adult transsexual patients. In a Vancouver Sun
article from May 4, 1972, Ann Barling reported that B.C. Medical Plan funding “for
conversion surgery outside B.C. is granted only when information clearly indicates the
proposed surgery is medically required in order to correct a biological or congenital
anomaly” (Barling 1972).
In the same Vancouver Sun article (1972), Barling reported that in the two years since
1970, the Health Sciences Psychiatric Unit at the University of British Columbia had
evaluated up to 30 people for sex reassignment surgeries. In addition, from an interview
with a therapist at the UBC Health Sciences Psychiatric Unit, Barling notes that there
were an estimated 150 and 200 transsexual people seeking medical services in Vancouver
in the early 1970s. By 1972, the Seattle Counseling Center for Sexual Minorities had
apparently received dozens of inquiries about sex reassignment surgeries from people in
almost every province in Canada (Barling 1972). By the same year, two transsexual
people from British Columbia had completed their surgeries in Seattle, and
approximately ten applicants from the province had been interviewed by clinicians at the
Seattle Centre and were awaiting treatment (MacKinnon 1972).
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Lack of funding by the provincial government, however, made it difficult for most
transsexual people who had been approved for sex reassignment surgeries to receive the
treatment they sought. In the early 1970s, in order for an application to be considered by
the Seattle Center, for example, an applicant for surgery had to agree to a number of
requirements including participation in a long-term follow study, which necessitated a
security deposit of $1500 as insurance against non-compliance (MacKinnon 1972).
Though the Seattle Centre was a research center that operated with funds from research
grants, and did not charge patients for surgeries, applicants for sex reassignment surgery
were also required to prove they had at least $1500 in the bank to cover the cost of any
post-operative complications that might occur (Barling 1972). Moreover, MacKinnon
notes that even if provincial funding was available for out-of-province surgeries, in the
early 1970s, the Seattle Center had no authority to accept B.C. Medical Plan payment for
costs incurred.
Canadian Penitentiary Services
An interesting story from the January 31, 1976 edition of the Vancouver Sun, with the
title, “B.C. Pen inmate undergoes operation to change his sex” (13), reported that a 24-
year old male-to-female transsexual had recently undergone a “mainly cosmetic
operation” at Royal Columbian Hospital in New Westminster as a follow-up to surgery
received prior to incarceration in Vancouver and San Francisco. According to the story,
the surgery was performed in accordance with Canadian Penitentiary Service guidelines
that specified the provision of medical services be granted to inmates in order attain and
maintain their physical and mental well-being. Though the story might otherwise be
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unexceptional, it is worthy of note because of the provincial context in which gender
identity evaluations and sex reassignment surgeries were taking place at that time. In
addition, throughout the 1960s and into the 1970s federal prisoners in the penitentiary
system could volunteer as test subjects for various experiments. According to an article
published in the Ottawa Citizen newspaper on September 28, 1998, during the 1960s and
early 1970s, Canadian Penitentiary Service inmates “took part in trials of the
hallucinogenic drug LSD, other unproven pharmaceuticals, and food additives, as well as
in sensory deprivation research and pain studies. Drug companies were welcomed into
various prisons to conduct trials, but some of the research was funded or sponsored by
federal agencies, including the Health Department and the Solicitor General. Given that
there was no officially organized team of surgeons performing sex reassignment surgeries
in British Columbia at that time, it is possible that the surgery was conducted as part of an
experiment in plastic surgery.
THE CENTRALIZATION OF MEDICAL SERVICES, 1980 – 2000
In the spring of 1982, the B.C. Medical Services Plan begins to fully or
substantially cover out-of-province SRS in accordance with the Federal Health
Act (up to the rate that would have been paid had SRS been available in BC).
Prior to 1984, clinical evaluations for transsexual people seeking out-of-province
SRS were handled by a handful of clinicians in private practice, as well as through
an unstructured arrangement between Dr. Diane Watson of South Burnaby Mental
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Heath, Dr. Jerrilynn Prior of UBC School of Medicine, and Ms. Pat Diewold,
Clinical Psychologist at VGH.
During this time, the majority of transsexual people travelled to either The Clarke
Institute in Toronto or to London England for SRS.
In 1984 the Centre for Sexuality, Reproductive Health and Gender Issues (The
Gender Clinic) at Vancouver General Hospital was established by Dr. Diane
Watson to focus on the assessment and treatment of transsexual people.
In June 1988, the Social Credit government of Bill Van der Zalm blocks SRS
funding and the B.C. Medical Services Plan de-lists coverage. Funding is no
longer available.
In the fall of 1993, Stephanie Castle travelled to Victoria to meet with a person in
the Ministry of Health who was undertaking an internal review on transsexualism.
At this meeting, Stephanie discovers that, apart from the first year of delisting
SRS from MSP coverage, SRS funding had in fact been available in BC from late
1989. Access to the funding, however, was not made available to anyone except
those inside the Ministry. Even clinicians at the Gender Clinic were not aware
that they could apply for funding on behalf of their patients.
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In 1994, controversy arises when it is reported that the Ministry of Social Services
had fully paid for the cost of SRS for two transsexual people receiving welfare
benefits.
In June 1995, the exclusion of SRS from MSP was officially repealed by the then
NDP government of Mike Harcourt, and “full” funding is reinstated for SRS.
In March 1997, a contract was entered into between the B.C. Ministry of Health
and Dr. Toby Meltzer in Portland Oregon for paid for out-of-province SRS.
THE TRANSGENDER HEALTH PROGRAM, 2000 - 2008
In May of 2002, the Gender Clinic closes as a result of budget constraints
imposed by the BC Liberal government of Gordon Campbell. Vancouver General
Hospital makes cuts throughout the Department of Psychiatry, including several
staff positions at the Gender Clinic. The remaining staff could not continue to
provide adequate services and announced the closure of the program.
In 2002, Vancouver Coastal Health Authority supports a community consultation
and survey of transsexual people in B.C. on transition and cross-dressing services
in British Columbia. The Director of Mental health Services at VCHA
commissions a report outlining recommendations for a Transgender Health
Program to provide support, information, referrals, and advocacy.
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In June 2003, the Transgender Health Program at VCHA is launched from Three
Bridges Community Health Centre.
In 2008, under the auspices of the Transgender Health Program, a new Sex
Reassignment Surgery (SRS) Program is created in Vancouver with the aim of
offering all SRS procedures within British Columbia. Plastic Surgeon, Cameron
Bowman is coordinating the development of an interdisciplinary team of
specialists (very recent changes to be investigated).
According to the April 2008 B.C. Medical Association Guide to Fees, “Gender
Reassignment Surgery” is deemed a benefit of MSP, but only following prior
approval. Approvals require that patients are assessed by two psychiatrists.
Individual assessments are then considered by the Gender Reassessment Review
Committee before being recommended for SRS.
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REFERENCES
Barling, A. (1972). Transsexuals drawn to Vancouver. The Vancouver Sun. May 4,
1972.
Blanchfield, M., and Bronskill, J. (1998). An extreme case of questionable ethics:
Debate on the morality of the tests in prisons unfolded in the shadows. The
Ottawa Citizen, September 28, 1998. Retreived online April 23, 2008 from http://
www.aches-mc.org/ethics2.html
Castle, S. (2005). The Zenith Experience: Encounters and Memories in a Transgender
Setting. Vancouver, BC: perceptions Press.
Cavanagh, S.L. & Sykes, H. (2006). Transsexual Bodies at the Olympic: The
International Olympic Committee’s policy on Transsexual Athletes at the 2004
Athens Summer Games. Body & Society, 12(3), 75-102.
Devor, H. (1997). FTM: Female-to-Male Transsexuals in Society. Bloomington, IN:
Indiana University Press.
Devor, A. H. (2005). Reed Erickson and The Erickson Educational Foundation.
Retrieved online April 19, 2008 from http://web.uvic.ca/~erick123
Farrow, M. (1987). B.C. pays sex-change expenses. The Vancouver Sun. Vancouver,
B.C.: August 12, 1987. p. A7.
Goldberg, J. (2004). First Year Report: Transgender Health Program. Report prepared
for Vancouver Coastal Health, July 7, 2004.
Goldberg, J. (2003). Transition and Crossdressing Service Delivery: A Review. Report
prepared for Vancouver Coastal Health Authority, February 21, 2003.
Kopala, L. (2003). Recommendations for a Transgender Health Program. Report
prepared for Vancouver Coastal Health Authority, April 26, 2003.
Lothstein, L.M. (undated). Sex Reassignment Surgery: Historical, Bioethical, and
Theoretical Issues. Retrieved online April 20, 2008 from
http://www.jadephoenix.org/lvtgw/Info_htm/Sergical/reassurg.htm
MacKinnon, T.J. (1972). Sex Reassignment for the Transsexual in British Columbia.
B.C. Medical Journal, 14(11), p.295.
Mason, G. (1987). Dueck balks at sex-change funding. The Vancouver Sun. August 13,
1987.
McHugh, P. (1992). Psychiatric Misadventures. The American Scholar, 61(4), 497-510.
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Meyerowitz, J. (2002). How Sex Changed: A History of Transsexuality in the United
States. Cambridge, MA: Harvard University Press.
Munro, H. (1952). City Doctor Did Work Without Hormones: Sex Switch Operation
Once Performed Here. The Province, December 3, 1952. p.29.
Padmore, T. (1980). Frankie yearns to be a normal woman. The Vancouver Sun. April
22, 1980.
Transsexual Roadmap (undated). Paul McHugh on transsexualism. Retrieved April 23,
2008 from http://www.tsroadmap.com/info/paul-mchugh.html
Vancouver Sun. (1977). Trans-sexuals ‘in limbo’ unless law is changed. February 15,
1977.
Vancouver Sun (1976). B.C. Pen inmate undergoes operation to change his sex. January
31, 1976. p.13.
Vancouver Sun. (1970). B.C. Man Shifting Sex Hospital Won’t Say. January 22, 1970.
p.66.
Vancouver Sun. (1952). Ordeal Turns Man Into Lovely Girl. December 2, 1952. p.7
Watson, P. (1982). Transsexuals a rough crossing. The Vancouver Sun. August 17,
1983.
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