Similar press reports seemed to suggest a growing familiarity with, if not actual acceptance of, public cross-dressing. Another newspaper article from 1912 described a married heterosexual couple who cross-dressed together in public. The husband, a retired official, donned a wig, a dress, jewelry, and makeup, while his wife—who worked as a tailor—wore trousers and a false moustache. The two would patronize restaurants in drag and parade through the streets of their respectable Schöneberg neighborhood. Although neighbors recognized when the two exchanged clothing, “they were never certain if the couple engaged in deliberate mischief or if they both manifested the pathology of transvestitism.”40
Although Hirschfeld’s understanding of “sexual intermediary” ex-panded and grew more complicated, his belief in the biological basis of sexual and gender variation remained unshaken. His view was reinforced by the contemporary experiments and discoveries of the Austrian physiologist Eugen Steinach (1861–1944), a pioneer in the field of endocrinology. As a director at the Institute for Experimental Biology in Vienna, Steinach used “distortive experimentation” to explore physiological development. This included transplantation experiments. Specifically, Steinach implanted male rats and guinea pigs with the ovaries of their female counterparts; conversely, female rats and guinea pigs received testicular implants. The results observed by Steinach were startling: the male animals appeared to develop female behaviors and physical characteristics, while the female creatures were “masculinized,” sometimes mounting other females as if to copulate. Steinach argued that the hormones of these sex glands, what he called “glandular juices”—only later were they named testosterone and estrogen—were responsible for shaping sexual physiology as well as gender identity. He also theorized that an imbalance of the “glandular juices” might account for nonnormative sexual and gender behaviors in humans. This meant, for example, that a homosexual man might be treated with the testicular tissue of a heterosexual.41 For Hirschfeld, this was solid evidence of the biological basis for sexual behavior, and he cited Steinach’s discoveries as irrefutable proof of his own third-sex theory.42
Although Steinach reported his formal research in science journals, he also popularized his discoveries in both print and film media.43 Most successful was Der Steinachfilm (The Steinach film)—yet another example of the so-called Weimar “enlightenment film”—which premiered in Berlin in 1923 at the Ufa-Palast Cinema at the Zoo Station. For weeks the seventy-minute documentary sold out multiple daily showings in the 2,100-seat movie theater. It was screened as well in venues throughout Germany and Austria. The film provided background on basic endocrinology, and explained how the “glandular juices” produced in the testes and ovaries were distributed throughout the body. These substances not only formed distinctive masculine and feminine physical characteristics but also entered the brain, shaping typically feminine or masculine sensibilities. Any imbalance of these sex hormones might result in some nonnormative gender or sexual variation. The film also demonstrated how castrated male and female rats implanted with ovaries or testicles would begin to exhibit the sexual behavior and physical form of the opposite sex. The film then profiled an intersex individual with both a penis and breasts, and hypothesized that “hermaphroditism” results from some hormonal anomaly.
Clearly Steinach had assimilated Hirschfeld’s theory of sexual intermediaries: the film displayed human subjects to demonstrate the hip, waist, and shoulder proportions of a “normal” man, and those of a “feminized” intermediary. Caused by hormonal imbalance, sexual intermediacy also helped to explain why some men preferred feminine jobs or pastimes (child care and embroidery, for example), while certain women entered masculine domains. The film’s most arresting scene showed Steinach performing a surgical procedure; after removing the undescended testicle of a “normal” man, Steinach bisected it and implanted one of the halves into the groin of a homosexual patient. The film’s intertitle explained how the secretions from this implant would alter the homosexual’s erotic orientation, and essentially make him “straight.”44
The surgical procedure that Steinach demonstrated in his film was one that had already been used on human subjects in Berlin. Hirschfeld, for one, participated in such procedures—testicular implants—in the institute’s surgery in the first years of the Weimar Republic. It seems odd in retrospect that an activist for the rights of homosexuals would have attempted to “fix” their orientation or make them “normal.” Hirschfeld was not pursuing a “cure,” however, but hoping rather to prove that sexual orientation was determined by sex hormones, which would demonstrate in turn the biological underpinnings of sexual and gender variation. The experimentation failed miserably and was quickly halted. The fate of the test subjects and likewise the source of the implanted testicles remain unknown, moreover, since Hirschfeld never published a detailed account and made only passing mention of these dubious procedures. Although Hirschfeld’s cavalier experimentation was not exceptional, the application of Steinach’s theories to human subjects illustrates the relatively extreme measures taken by both doctors and their patients.45
What Hirschfeld and many others quickly grasped was that if hormone therapy might be used to change sexual orientation or “cure” homosexuals, it might also aid those who hoped to change their biological sex. The 1923 Steinachfilm had certainly broadcast the therapeutic potential of sex hormones. But even before this, in 1920, Steinach had published a popular sixty-eight-page pamphlet explaining his research and its applications.46 The pamphlet was mentioned by one young man who wrote Hirschfeld in 1920—a rare surviving letter preserved at the Kinsey Institute—explaining that he was “more woman than man.” This correspondent also described that he had just had the chance to read “the book about artificial rejuvenation and sex change,” a clear reference to Steinach. The promise of hormone therapy inspired him to write Hirschfeld: “[W]ould it not perhaps be possible to remove my testicles and in their place insert an ovary, and then in this fashion I could become a complete woman…. I trust you completely Herr Dr., and perhaps I could serve science as an important experiment.”47 Included with this missive was a small photograph of the man in drag. As the Berlin PhD student Werner Holz, who worked at the institute, commented in his 1924 dissertation, “a majority of transvestites express the wish to be castrated.”48 For many cross-dressers, apparently, identification with the opposite sex entailed the desire for a complete physical metamorphosis. Simply affecting femininity or masculinity with dress and manners no longer satisfied.
This was indeed a therapeutic frontier. Medical ethics was in its infancy, and decisions about specific surgical procedures were made by individual doctors in response to their patients’ wishes. In 1916 the Berlin doctor and psychotherapist Max Marcuse published the case study of a thirty-six-year-old man, “Herr A.,” who approached Marcuse for hormone treatment and the removal of his male genitalia. As Marcuse reported, Herr A. had always wanted to be a girl, and as a young man fantasized that his penis and testicles might be “violently removed.” Marcuse’s patient had learned of Steinach’s experiments in the popular press, and hoped that the discovery of sex hormones might offer a practical treatment. In his study, Marcuse explained that the “presence of his penis and testicles caused him [Herr A.] great despair,” leading to thoughts of suicide. Although Marcuse availed himself of Hirschfeld’s neologism and described Herr A. as a case of Transvestitismus, the parallels between Herr A. and most of Hirschfeld’s case studies were superficial at best. Marcuse considered Herr A. pathological or mentally ill—a diagnosis Hirschfeld would have likely rejected—and denied the request for surgery. Marcuse was willing to provide a kind of primitive hormone therapy, however, and treated Herr A. with an unspecified “ovarian preparation,” which reportedly quieted and comforted the man.49
One of the first (primitive) male-to-female sex-reassignment surgeries was undertaken in stages, beginning at the institute in Berlin and then completed in Dresden in 1920–21. The patient was a twenty-three-y
ear-old officer who had attended a military academy and then fought in the First World War. Since childhood, the young man claimed to have felt himself trapped in the wrong body; he pursued a military career in the desperate attempt to demonstrate his masculinity. Not even military service, however, was able to mitigate his feminine feelings, and after the war he fell into a suicidal depression. Hirschfeld’s colleague Dr. Arthur Kronfeld began the initial treatment. Refusing to amputate the penis, Kronfeld finally agreed to remove the man’s testicles (though not his scrotal sack); Kronfeld justified his decision as a measure to prevent the man from committing suicide. The effect was quite positive, in Kronfeld’s report. Castration led to a certain “psychic relaxation and a permanent feeling of harmony and balance.” The patient lost secondary sex characteristics, including facial hair, and was able to live and pass more easily as a woman.
The following year, in March 1921, the Dresden gynecologist Dr. Richard Mühsam performed a second surgery on the same patient, implanting an ovary. A month after this, Mühsam refashioned the patient’s penis and scrotal sack into a “vagina-like structure” by cutting from the scrotum to the perineum and then “hiding” the penis in the open wound and using the scrotal skin to form something like a labia over it. Mühsam was pleased with his handiwork—the first known attempt to construct a vagina for a man—but the patient, ultimately, was not. By August the former officer returned and reported experiencing erections in his now “hidden” penis. Moreover, he had met and fallen in love with a young woman, given up his cross-dressing, adopted a masculine demeanor, and insisted that Mühsam now undo the surgery. The doctor complied and was able to “restore” the penis and close the “vagina-like structure.” The fate of the implanted ovary was never reported, nor its source, though the man lived a productive life, reportedly, completing a medical degree and pursuing a career as a pathologist.50
Mühsam also participated in an early female-to-male sex-reassignment procedure. The patient, a painter, had always considered herself a “man in disguise,” and underwent a double mastectomy and a hysterectomy in 1912 at the age of thirty-five. In 1921 Mühsam agreed to remove the patient’s ovaries as well. Although the painter died in 1924 of tuberculosis, Mühsam claimed that the surgeries, overall, had a salutary effect on the patient’s sense of well-being and “spiritual condition.”51 Mühsam published this research in 1926, claiming at this point that he had conducted four testicle implants on three homosexuals and one bisexual. The “Steinach procedure,” as Mühsam understood it, required the insertion of half a testicle of a heterosexual man into the patient’s stomach muscle (oblique), where the “testicular hormone” (and the testicle itself) would be absorbed. The operation initially induced heterosexual tendencies, Mühsam reported, but had a lasting effect only for the bisexual. These results were ultimately so disappointing that Mühsam, like Hirschfeld and others, abandoned the procedure.52
Although there are relatively few detailed case studies, the institute attracted a large number of cross-dressers, many of whom were certainly “total transvestites,” as Hirschfeld would label them. In 1926, the gynecologist Ludwig Levy-Lenz joined the institute as a staff member and quickly became the primary surgeon for most sex-reassignment procedures. As Levy-Lenz described, “This task [sex reassignment] fell to me, as surgeon of the Institute, and I was able to find a quite satisfactory solution to the problem of creating an artificial vagina and artificial lips of the vulva…. I almost became a ‘specialist’ in plastic genital operations—a strange calling indeed!” Levy-Lenz also introduced surgical procedures to feminize or masculinize facial features by altering noses, chins, lips, and cheekbones.53 From other sources it is clear that Levy-Lenz and other institute-affiliated surgeons performed hysterectomies, oophorectomies (removal of the ovaries), and breast-reduction surgeries. The institute developed “ovarian” and “testicular preparations” to be injected as a primitive form of hormone therapy. The institute’s X-ray facility was used for depilation or hair removal, though the dangerous and unpleasant side effects included nausea and skin burns. Medical doctors had experimented with paraffin injections to reconstruct breasts for women disfigured in accidents, but this procedure was considered too dangerous to continue and had been halted before the war.54 Although experimental and, ultimately, dangerous, these sex-reassignment procedures were developed largely in response to the ardent requests of patients. In one case, Levy-Lenz refused to remove the breasts of a sixteen-year-old because of her age. After she mutilated herself with a razor, “in order to necessitate amputation,” Levy-Lenz acquiesced and performed the double mastectomy. As Levy-Lenz claimed in his memoirs, “[N]ever have I operated upon more grateful patients.”55
What Levy-Lenz, Hirschfeld, and others at the institute effectively pioneered was a primitive diagnosis with corresponding treatments for what is now described as gender dysphoria. As historian Rainer Herrn has noted, Hirschfeld used the term Transsexualismus but ultimately recurred to his model of “transvestitism.”56 In 1926 Hirschfeld introduced the term “total transvestitism”: “We find the strongest form of total transvestitism among those who want to transform not only their sartorial but also their biological appearance…. These strive for a complete transformation of their genitalia…. This means the elimination of menstruation by removing the ovaries for female transvestites, and for men castration. The number of cases is much greater than one had anticipated before.”57
Arguably this definition comes close to that of “transsexualism,” first used by Dr. Harry Benjamin in the 1950s. Hirschfeld’s own theory of sexual intermediacy blurred distinctions between cross-dressing (“transvestitism”) and transsexuality (“total transvestitism”), preventing a clear analysis of the phenomenon of transgender identity. However, his early work on cross-dressing and enthusiastic embrace of Steinach’s hormonal theory created the essential foundation for the improved terminology and clearer understanding that was to come. In the 1950s Benjamin spearheaded a modern protocol for the medical diagnosis of transsexuality—a condition in which an individual’s biological sex conflicts with his or her psychological gender identity—and worked to develop effective sex-reassignment surgeries and hormone treatments, enabling transgender individuals to “transition” from one biological sex to the other.58
The influence of the Berlin institute is very direct: Benjamin was born in Berlin, studied medicine in Germany, and met Hirschfeld for the first time around 1907. And it was Hirschfeld, moreover, who introduced Benjamin to the city’s homosexual milieu. Although he immigrated to the United States in 1913, Benjamin visited the institute annually throughout the 1920s, and, as a native German speaker, read and closely followed developments in his native capital.59 For example, Benjamin wrote the introduction for the first English-language treatment of Steinach’s theory, which appeared in 1923.60 Based on the discoveries of Steinach, and the still-somewhat illusive promise of hormone therapy, the institute served as a veritable incubator for the science of transsexuality.
In addition to medical procedures for transgender persons, Hirschfeld and his colleagues offered a range of counseling services geared specifically to homosexual men and women. These sessions typically used Hirschfeld’s own special method, “adaptation therapy” (Adaptionsbehand-lung), which he developed before the war. In his monumental study of 1914, Homosexualität, Hirschfeld outlined his approach:
In the first place we reassure the homosexual personality, whether male or female; we explain that they have an innocent, inborn orientation, which is not a misfortune in and of itself but rather experienced as such because of unjust condemnation. Many extremely moral homosexuals, including those who are not abstinent, “suffer far more injustice than they ever inflict.” We also emphasize that the unhappiness of being homosexual is often exaggerated, and many are quite content. Homosexuality itself is a burden to no one, even if at present there are many more difficulties, even for a moral person, to becoming a socially useful member of society.61
Of g
reatest importance was befriending others in similar situations, especially those with more experience. A social network of other lesbians and homosexuals was therefore the best hedge against depression and suicide. Hirschfeld and his colleagues actually recommended specific bars and locales for lesbians, homosexual men, and cross-dressers. The institute also attempted to help with the selection of jobs or careers, and sometimes placed patients with appropriate and sympathetic employers. Several cross-dressers, including some who had undergone surgical procedures, found work directly in the institute.
In his protocol for adaptation therapy, Hirschfeld also recommended that patients—especially male homosexuals—be apprised of the dangers of same-sex eroticism: chief among these, police arrest, blackmail, and disease. But his counsel remained generally “sex positive,” and he did not emphasize abstinence. Sexual asceticism had its own disadvantages, Hirschfeld believed, including isolation, loneliness, and, potentially, neurosis. Ultimately such decisions needed to be left to the individual, just as individual heterosexuals made choices about friendship, intimacy, and ultimately partnership. Where Hirschfeld differentiated between homosexuals and “straights” was on the question of marriage. Both men and women with same-sex attractions should be strongly discouraged from entering traditional marriages. This might seem self-evident to most. But Hirschfeld felt compelled to counter the advice of some conservative therapists and religious figures who argued that heterosexual marriage could alleviate homosexual desire. Here Hirschfeld made a lone exception for heterosexual transvestites, though he insisted that the transvestite inform his or her partner before entering wedlock. Hirschfeld also rejected “degeneration theory” as an explanation for the etiology of homosexuality (and other sexual peculiarities)—a view espoused by all but the most progressive sexologists. Even Krafft-Ebing abandoned degeneration theory only at the very end of his life, in an essay published in 1901 in Hirschfeld’s Jahrbuch.62 Hirschfeld had reframed his position by 1914 when he began to describe homosexuality as a “means to preempt degeneration” by eliminating the chance or opportunity for procreation.63
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