Andy Warhol Was a Hoarder (18 page)

In Denmark, George met with Dr. Christian Hamburger, an eminent endocrinologist who agreed to take him on as an experimental patient, free of charge. As Hamburger would later recount in an article published in the
Journal of the American Medical Association
, George presented as a man fully determined to become a woman: He “felt a pronounced distaste toward his own genitals and toward his male physical features” and “felt it impossible to continue life as a man.” Hamburger was exceedingly interested in the role of hormones, so he had a scientific interest in George's case. He was also compelled by the level of
anguish George revealed, which included thoughts of suicide. Hamburger concluded that it was his responsibility, along with his colleagues, to help. “We clearly pointed out to him that any irrevocable step should be taken only after careful consideration. But on the other hand we did not think we were in the position—despite all difficulties—to decline an attempt at giving the patient medical aid.”

Initially, Hamburger suggested that George consider taking testosterone to make him feel more masculine, but George refused. Instead, he began a steady course of estrogen, which added weight to his hips, stimulated breast development, and softened his face. He had electrolysis to prevent beard growth and grew out the hair on his head. Throughout his care, George underwent a series of psychiatric evaluations to be sure that he was not harboring any deep-seated emotional turmoil that might be clouding his judgment. Ultimately, his doctors were confident that their patient was mentally stable and that his conviction to be a woman was deep and sincere; they approved his request for castration. In two operations, George's genitalia were removed—the last vestiges of his male body.

In May 1952, just before Jorgensen's 26th birthday, the newly transformed American donned a beret and went to visit the U.S. ambassador to Denmark to request a change of name on his, now
her
, passport. The application was approved. George Jorgensen was now Christine, a name chosen in honor of Dr. Christian Hamburger. Before returning to the United States, Jorgensen sent the most important letter of her life, explaining to her family what she had really been doing in Europe and revealing her gender transformation for the first time. “I have changed, changed very much, as my photos will show, but I want you to know that I am an extremely happy person and that the real me, not the physical
me, has not changed,” she wrote. “Nature made a mistake, which I have corrected, and I am now your daughter.”

A
RE SOME PEOPLE DESTINED
to be transgender? Is it steeped into their hormones? Imprinted on their brains? Or are they suffering, instead, from a deeply rooted psychological problem or mental illness that can be diagnosed and treated? Jorgensen's transformation from George to Christine catapulted these questions into the American consciousness. As news accounts focused on the minute details of Jorgensen's appearance—her gestures, her figure, her pearl earrings, her “smooth, low-pitched voice”—people who had never before questioned the essence of gender began to wonder: What constitutes man and woman? Does anatomy define identity? What is gender, anyway?

Jorgensen had become public fodder on December 1, 1952, when the
New York Daily News
published a story about her case while she was still recovering from surgery in Copenhagen. Who tipped the reporter off is unclear—it might have been a lab tech in the Danish hospital or a family friend—but it touched off a media frenzy. Reporters lit up the hospital switchboard, clamoring for interviews; publishers offered thousands of dollars for exclusives. Even today, transgender revelations elicit huge interest; in 2015, 17 million viewers tuned in to the ABC News show
20/20
to watch the gold-medal Olympian then known as Bruce Jenner reveal that “my brain is much more female than it is male.” Several weeks later, Jenner announced her new identity as Caitlyn on the cover of
Vanity Fair
and then thanked her supporters on Twitter after amassing one million followers in a record speed of just four hours.

In Jorgensen's day, the news was far more shocking, because so few people had ever heard of anyone changing his or her sex. Wary of the media's salacious curiosity, Jorgensen accepted a $20,000 contract with
American Weekly
magazine to tell the story on her terms in a five-part series. The first installment was timed to appear just as Jorgensen deplaned in New York on February 12, 1953.

After her case became public, Jorgensen and her doctors received hundreds of letters from other people desperately seeking care for their own gender identity issues. The outpouring prompted Jorgensen's physicians to take a stand. In the account they published in the
Journal of the American Medical Association
in May 1953, Hamburger and his colleagues laid out their patient's medical history and made a plea for supporting, rather than thwarting, patients. Psychotherapy, they argued, had failed to “fix” people; it was time for doctors to better understand the condition, so that they could help their patients achieve productive lives. “It has been an exceedingly depressing experience to learn the degree to which these persons feel they have been let down by the medical profession and by their fellow men,” Hamburger and his colleagues wrote. “In loneliness and misery they have had to fight their own tragic fate.”

Jorgensen's personal transformation was a lightning rod, triggering heated debates that would ultimately require the medical and mental health community to define—and then refine—what gender and biological sex really are. There were loud voices arguing against surgery. In response to Hamburger's report, one doctor wrote a letter to the editor, no doubt emblematic of others' views, which suggested that Jorgensen showed “masochistic traits” and may have been schizophrenic. The patient's “sexual perversion” might have benefited from a more intensive psychotherapy, the doctor advised. “With all due respect for the surgical skill of
Dr. Hamburger and his associates,” he wrote, “one can hardly maintain that the psychiatric indication for this procedure was sound.”

By the 1960s, however, specialists had begun to disentangle the concept of gender identity from sexual orientation and cross-dressing. The endocrinologist Harry Benjamin, who became an advocate for transgender patients and treated many in the United States, pronounced in his 1966 book,
The Transsexual Phenomenon
, that attempting a cure through psychotherapy was a “useless undertaking.” Around the same time, the first American medical center to officially offer sex-reassignment surgery opened its doors at the renowned Johns Hopkins Hospital in Baltimore, staffed by psychiatrists, surgeons, and other specialists. Even then, most mainstream medical practitioners did not support hormone treatment and surgery for patients they deemed to be psychotic or delusional. But at a 1966 press conference announcing their first two successful male-to-female surgeries, the chairman of Hopkins' Gender Identity Clinic said: “If the mind cannot be changed to fit the body, then perhaps we should consider changing the body to fit the mind.”

The terminology around transgender has changed over time and even now it continues to evolve. In Jorgensen's day, individuals who sought out surgery were known as “transsexuals,” a term used to distinguish them from “transvestites”—men who dressed in women's clothing but didn't necessarily want to change their bodies. Today, “transgender” is used broadly to describe people whose gender identity is different from their biological sex. The language around a clinical diagnosis has changed, too, from “gender identity disorder” to its most recent incarnation: “gender dysphoria.” A diagnosis of gender dysphoria requires that a person's feeling of incongruence with his or her assigned gender at birth persists for at least six months. Above all, the diagnosis requires
that the condition causes “clinically significant distress or impairment,” according to the
DSM
.

This latest name change has powerful significance. Prior use of the word “disorder” struck many as judgmental, as if something were mentally wrong with people who felt their bodies were out of sync with their gender. Some transgender advocates argued to eliminate the condition from the
DSM
altogether, echoing the heated history of homosexuality, which was designated a “sociopathic personality disturbance” in 1952 and then removed in 1973, when the medical establishment resolved that it was not a pathological disorder. But sexual orientation and gender dysphoria differ in at least one critical way: You don't need hormones or surgery to be gay. You do if you want to transform your body. In the end, the diagnosis was kept so that patients could seek clinical care, but the name was altered to reduce stigma. “Dysphoria,” which the dictionary defines as a state of feeling unwell or unhappy, was chosen to refer specifically to the distress that might be associated with the condition. But as the American Psychiatric Association puts it, “gender nonconformity is not in itself a mental disorder.”

Nobody knows why certain people feel so strongly at odds with their sex. There are a number of theories about physical causes. One leading contender: If a fetus is exposed to atypical levels of sex hormones in the womb—perhaps because the mother was prescribed hormones for medical reasons—a boy's brain may end up “feminized” and a female's brain may be “masculinized.” Genetic glitches may also contribute. In one study, scientists found that transgender adults who had transitioned from male to female were more likely to have a variation in a gene that mediates testosterone levels, which may result in less testosterone reaching the developing brain. Identical twins are more likely to both be transgender than are fraternal twins or siblings, suggesting a possible hereditary
link. And intriguing studies have found that a region of the brain's hypothalamus, which is involved in regulating sex hormones, is smaller in male-to-female transgender patients than it is in typical males, and much closer in size to typical females. The research so far, however, is preliminary at best. “At the moment, there are a lot of theories with very little evidence,” says Dr. Peggy Cohen-Kettenis, a pioneering transgender researcher and a psychologist at VU University Medical Center in Amsterdam.

What is evident, however, is that many transgender people feel a strong conviction from a very early age. Jan Morris, the widely read Anglo-Welsh travel writer who transitioned from James to Jan when she was 46 years old in 1972, remembers identifying as a girl while sitting underneath a piano in her family home at the age of three or four. “It became fashionable later to talk of my condition as ‘gender confusion,' ” Morris writes in her memoir. “But I think it is a philistine misnomer. I have had no doubt about my gender since that moment of self-realization.” Her feelings were so powerful, she continued, that if she had to do it again, “I would search the earth for surgeons, I would bribe barbers or abortionists, I would take a knife and do it myself, without fear, without qualms, without a second thought.”

Chaz Bono, who began transitioning from female to male in 2008, has been outspoken about how firmly he believes his condition is physical, not psychological. Bono, who was born a girl named Chastity in 1969 to the famed pop music duo Sonny and Cher, told a reporter that he has felt male for as long as he can remember. Bono said he fared pretty well in early childhood, when it is almost always easier for girls to be tomboys than for boys to like dresses and dolls. But when he hit puberty, he felt as if his body was betraying him. “There's a gender in your brain and a gender in your body. For 99 percent of people, those things are
in alignment,” Bono said. “For transgender people, they're mismatched. That's all it is. It's not complicated, it's not a neurosis. It's a mix-up. It's a birth defect, like a cleft palate.”

There is no one-size-fits-all treatment today for gender dysphoria. Some transgender individuals choose not to physically change their bodies. Others seek hormone therapy to alter their sexual characteristics: testosterone to promote hair growth and a deeper voice for a female-to-male transition; estrogen to increase breast development and decrease muscle for a male-to-female transition. Still others will opt for surgery, which might include breast augmentation and vaginal construction for male-to-female patients (Jorgensen underwent plastic surgery to create a vaginal canal and female genitalia after she returned to the United States) and breast reduction and creation of a penis or “phalloplasty” for female-to-male patients. Reliable data is hard to come by, but male to female sex-reassignment surgery is more common than female to male—in part because women who receive hormone treatments may feel satisfied with their transition without undergoing the pain and expense of a difficult operation.

The most controversial debate by far is how young is too young to begin treatment. Jorgensen was in her 20s when she set out to seek a medical solution in Europe. Bono and Morris transitioned in their 40s; so did Renée Richards, the professional tennis player who was born Richard Raskind in 1934. Caitlyn Jenner went public at 65. But today, children as young as five are pleading with their parents to let them become boys or girls. Many of them are being taken to pediatricians, psychologists, and, in some cases, hormone specialists to assess their strong desires.