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Changing Sex
Transsexualism, Technology, and the Idea of Gender
By Bernice L. Hausman Duke University Press
Copyright © 1995 Duke University Press
All rights reserved.
ISBN: 978-0-8223-9627-7
CHAPTER 1
GLANDS, HORMONES, AND PERSONALITY
In 1946, William Heinemann Medical Books released Self: A Study in Ethics and Endocrinology, by Michael Dillon. Self included the first sustained argument for technologically mediated sex change in the twentieth century, based on recent developments in endocrinology and the study of sex hormones. Dillon claimed that cross-sex behaviors could, in certain cases, be indicative of an abnormal endocrine physiology. In these cases, he argued, the adult subject should be free to decide his or her course of action: "If ... there is an incompatability between the mind and the body, either the body must be made to fit the mind ... or the mind be made to fit the body; and that is for the patient himself to judge if he be of age.' Dillon used the terms homosexuality and hermaphroditism to define the condition we would now call transsexualism; of the themes he brought up in Self became central to theories of both intersexual and transsexual personality diat emerged in the mid- to late-1950s Most significant to the arguments of this chapter are Dillon's pleas for the recognition of the "natural mistake" that relegated many to the wrong sex category and for the use of available medical technologies to repair "nature's error."
Written in a detached tone, yet compassionate in the focus of its ethical argument Self was an attempt to address the philosophical and moral issues that emerged with the development of endocrinology as a medical specialty and technical practice Dillon urged his readers to take a more symnathetic attitude toward those whose (endocrine-imbalanced) bodies caused them both suffering and ridicule. He presented himself as an ordinary male citizen who took it upon himself to consider the role of heredity and environment in human behavior and to educate me public about recent advances in medicine, as well as the social and phiosophical implications of those advances. For these reasons alone Self constitutes a significant example of the impact of endocrinology in Britain during the first half of the twentieth century. Yet the book has added attributes in the context of my analysis—written by a person in the process of passing from the categorical status of a woman to that of a man, the book's arguments exemplify how popularizations of endocrine theory (as well as the science on which they are based) came to enable the emergence of transsexualism in this century.
Dillon began Self while employed as a garage attendant during World War II and during the period of his transformation from Laura Maud Dillon to Lawrence Michael Dillon. He obtained testosterone tablets from a doctor, and later, at the suggestion of a plastic surgeon, voluntarily underwent a bilateral mastectomy. He reregistered his birth sex as male. Apparently, the physicians at the hospitals he attended believed he was a genetic male with a developmental abnormality. Sir Harold Gillies, the surgeon who eventually took on the task of constructing an artificial penis and scrotum for Dillon, agreed to "put [him] down as an acute hypospadias," meaning that he would present Dillon's case as one of mistaken sex assignment at birth, not sex change. Self was published prior to Dillon's reconstructive surgeries but while he received testosterone treatments, he began attending Trinity College, Dublin, as a male medical student.
The general reader would know nothing of Dillon's sex status; the author argued insistently but abstractly in favor of sympathetic public judgment for homosexuals and hermaphrodites. In many ways, Self resembles the spate of other texts published between 1920 and 1950 that address the general reader and try to educate him or her about the "new science" of endocrinology. A few relevant titles include The Tides of Life :Endocrine Glands in Bodily Adjustment, The Glands Regulating Personality, Our Mysterious Life Glands; And How They Affect Us, How We Become Personalities: The Glands so Health, Virility, and Success, and What We Are and Why: A Study with Illustrations, of the Relation of the Endocrine Glands to Human Conduct and Dispositional Traits, with Special Reference to the Influence of Gland Derangements on Behavior. Some of these books (and the others like them) were written by doctors, some by medical journalists. Dillon's Self, like the other texts, sets out to educate the public about endocrinology and its significance in the everyday life of modern men and women: "Here then is an attempt to put simply to the average reader the nature of certain parts of his body, the seven endocrine organs, parts which are somehow closely connected with his character, temperament and personality, so closely connected, in fact, that injuries to, or diseases of these glands may transform a man from a respectable citizen into a degenerate or criminal." Comparing Dillon's introductory remarks with those of the other texts just mentioned reveals a striking commonality of purpose:
The object of this book is to present the latest knowledge of the glands and dieir secretions in a popular but strictly scientific manner, free from exaggeration, fanciful guesses, unsupported hypotheses, reckless sensationalism or biased commercialism.... We need a simple honest book dealing with our glands.
It is the present assumption that study of the variation in glandular activities and reactions will bring us to a better understanding of the causes which underlie human behavior and of the variations in personality.... The ultimate and defensible postulate is that in them [endocrine glands] are to be found the roots of human behavior—that their control extends to the emotional as well as the physical centers.
It is the purpose of this volume to present the essential facts about these endocrine glands.... [E]ven a limited knowledge enables one to turn to practical account the essential things for directing the mental and physical development that begins at birth and persists to the closing years of life. Now, for the first time in human history, we know the underlying causes of the quality called "personality," and possess the practical means of shaping and directing it.
In this chapter, I look at the ways in which endocrinology, as a field of scientific knowledge and as a practice of clinical medicine, contributed to the emergence of transsexualism. The books quoted above represent and reiterate the theories of endocrinology found in texts published exclusively for medical audiences, crossing the discursive boundary that often separates medicine from the public sphere. The endocrine theories promoted in them make up what I call the "glandular thesis"—the underlying strata of claims concerning the regulating power of the endocrine glands in human life. This mirroring of discourses across the medical/public boundary is crucial to the emergence of transsexualism, since the publication of numerous popularizations of the glandular thesis guaranteed that individuals had access to the discursive apparatus of medical endocrinology.
Public knowledge about medical advances and technological capabilities produces a situation in which individuals can name themselves as the appropriate subjects of particular medical interventions, and thereby participate in the construction of themselves as patients. This process is especially true with regard to elective surgical procedures, such as cosmetic surgery, where the demand for medical attention is made possible by public knowledge of its existence and probable success. Knowledge about glandular or hormonal influence on personality became central to the self-understanding of the first subjects who asked physicians for medically mediated sex change. Two of the most important physicians advocating sex change for those subjects requesting it were endocrinologists (Harry Benjamin and Christian Hamburger). They were educated in the initial period of endocrinology's popular efflorescence— the first half of the twentieth century—and their backgrounds in glandular medicine clearly influenced the eventual theorization of transsexualism in the 1950S.
I will not argue that the similarity of public and medical discourses concerning endocrinology demonstrates the extent to which endocrinology as a science is bounded by ideological bias; rather, I want to demonstrate how powerful endocrinology became as a cultural discourse in the first half of this century. This distinction is not insignificant. In my view, all sciences are bounded by ideological bias, since to bring one's observations into meaningful discourse with others one must articulate those observations in language, which necessarily means making them subject to ideology. Nevertheless, science, and in that term I include the medical sciences, has a commitment to describing the world as it seems to be given. Scientists tsy to bring into discourse thd very things that seem to escape discursivity, what poststructuralists have come to call "the real." Therefore, the codes created by scientific endeavor have a different relation to "the real" than other kinds of codes. After Roland Barthes, I call the descriptive code of medical science a "terminological" system or code.
Medical science uses terminological codes to describe the human body. These descriptive discourses underlie and support the material practices physicians engage to heal the body. Medicine, like other scientific disciplines, has a certain investment in denying the ideological character of the codes it both produces and uses in everyday practice. Yet demonstrating the ideological commitments of medicine and other sciences—not a particularly difficult thing to do—does not directly address the sociocultural effects of medical progress and knowledge production. In this chapter, while I discuss the ways in which endocrine discourses reiterate the ideological commitments of traditional perceptions of sexual difference, I focus the argument on the ways in which the production of the glandular thesis in the first half of the twentieth century facilitated the emergence of transsexualism at mid-century. That is, I emphasize the cultural effects of the glandular thesis over the cultural bias inherent within it.
In an essay concerning the relationship between social institutions and the organization of scientific research, Nelly Oudshoorn writes:
In analyzing the relationship between gender and science, most scholars in women's studies tend to conceptualize gender bias as something that comes from "outside." This conceptualization is based on the assumption that in science there exists an "inside" and an "outside"—a social/cultural context, and, apart from this, science itself. From this point of view, gender bias is located in the social context, or "society," and then must be transferred into the "realms of science."
Oudshoorn goes on to claim that "gender bias is an integral part of the whole fabric of science," especially in relation to the organization of research materials in the study of sex hormones.
Oudshoorn's argument concerns the development of research on sex hormones in relation to three institutional sites of research—clinical gynecology, laboratory science, and pharmaceutical firms. She persuasively demonstrates that the early and continuing interest in female sex hormones had to do with women's greater involvement in medical institutions as patients: "The differences in the institutionalization of research on male and female reproduction not only led to bias in the access of research materials derived from the male and the female body: the existence of gynaecological clinics also provided an available and established clientele for the products of research on female sex hormones." The development of hormone research in her analysis was intimately connected to the medical institution's greater interest in women as reproductive subjects: "Knowledge claims linking men with reproduction could not be stabilized simply because there did not exist an institutional context for the study of the process of reproduction in men." Thus, the materials that scientists use to produce the terminological codes that make up scientific discourses affect scientific results or outcomes at the level of data collection and assessment: science depends upon, indeed is constituted by, an intimate relation to social institutions and beliefs.
In a culture where scientific discourses hold a significant amount of rhetorical power, however, any new developments that seem to promise a breakthrough understanding of "human nature" or a sure path to healthy living will themselves have discursive effects on the social. Thus, while Oudshoorn's work demonstrates the complicity of scientific endeavors with the structure of social institutions, it does not address how new forms of scientific knowledge reconfigure the social formation. If "the social" is always already "inside" science, then isn't science also "inside" the social? What are the social effects of discursive transformations in science; how do new concepts affect established ideas about humanity, the being of people and their social organizations?
It is my contention that advances in medical technologies and the discourses that surround and support the use of those technologies make possible new forms of being human. To take transsexualism as a form of being human that emerges in the twentieth century is to suggest that something happened historically to facilitate its emergence and codify its existence. Endocrinology, as the scientific study of the glands of internal secretion, was an essential discipline for the incipient development of what might be called "transsexual subjectivity"—understood as involving the demand for sex change through hormonal treatment and plastic genital surgery. In order to understand the impact of endocrinology on the emergence of transsexualism, we must examine both medical theories of the endocrine regulation of personality and those discourses produced for "public" consumption. Distinguishing between these discourses will not be as important for this analysis as demonstrating their points of convergence, since it is the public dissemination of scientific knowledge of the human endocrine system that will help us understand how certain human subjects in the twentieth century came to understand themselves as members of the "other" sex.
The development of germ theory in the late nineteenth century and the discovery of sulfa drugs and later antibiotics in the mid-twentieth century perhaps overshadow the development of endocrinology as a medical specialty. The realization that many diseases are spread through germs—bacteria and viruses—and the subsequent development of antiseptic procedures, vaccines, and sulfa and antibiotic drugs was instrumental in the transformation of medicine into a scientific service profession able to identify and treat contagious diseases. Endocrinology, on the other hand, concerned itself with diseases occurring within the human organism that were not caused by the invasion of germs or by carcinogens. Like vitamin deficiency diseases, some endocrine disorders are the effects of a lack—but unlike vitamins, endocrine secretions are produced in the body itself. Other endocrine diseases are caused by glandular overproduction.
Many people consider endocrinological diseases "mistakes of nature," since they have no specific social cause (such as contagion). In this sense, hormonal disorders represent errors in what people think of as "nature's grand design." Thus, endocrinologists' ability to rectify diseases of the internal secretory system can be perceived as victories against a randomly cruel natural force, victories for the ideal of humanity, victories for normality. With the tools that endocrinological technology makes available, doctors can offer those who suffer from disfiguring or discomfiting endocrine disorders a place in the world of the physiologically and physically normal.
Charles-Edouard Brown-Séquard (1817-1894) is credited with the discovery that extracts made of glandular material can have therapeutic effects. Often considered the "seminal" figure in modern endocrinology (a term that is, as we shall see, more appropriate man not), Brown-Séquard was also the originator of organotherapy, a precursor science that quickly became a fad in late nineteenth-century America. An elderly man in 1889, he subcutaneously self-injected extracts of canine testicular tissue and observed a rejuvenating effect. While the results of his experiment were contested, the principle was of immense importance to the development of endocrinology, as it suggested that endocrine glands affect the physiology of the body by secreting potent substances directly into the bloodstream, and not through the mediation of the nervous system. In addition, Brown-Séquard's work stimulated others to experiment with rejuvenating technologies. In the twentieth century, French physician Serge Voronoff experimented with transplants of monkey testes, and German researcher Eugen Steinach with a variation of vasectomy, both in order to restore youthfulness to elderly men.
The first medical applications of endocrinology were made with gland extracts—from the thyroid, the pituitary, the testicles, and the ovaries, to name a few. Even after 1905, when British scientist Ernest Henry Starling introduced the term "hormone" as a name for the chemical secretion, glandular medicine was largely confined to the use of gland extracts to replace lost or defective glands in the body. Sometimes gland transplants would be attempted, but transplant technology was not well developed and human bodies tended to reject transplanted tissues. One chief complaint of Voronoff's monkey gland grafts was that the effects were temporary: often, the body would simply absorb the transplanted tissue. In addition, transplants or grafts necessitated surgery which although greatly improved dirough advances in anesthesiology and antisepsis, was still a risky procedure in the first quarter of the twentieth century.
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Excerpted from Changing Sex by Bernice L. Hausman. Copyright © 1995 Duke University Press. Excerpted by permission of Duke University Press.
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