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Sex Reassignment, Hormones, and Health (1991)

Sex Reassignment, Hormones, and Health (1991)

©1991 by Dallas Denny

Source: Denny, Dallas. (1991, Spring). Sex reassignment surgery, hormones, and health. Chrysalis Quarterly, 1(1), pp. 7-10.






Chrysalis Pages (PDF)


Sex Reassignment Surgery, Hormones, and Health 

By Dallas Denny


Disability and Transition

Many disorders can impact on gender dysphoria. We have not tried to exhaustively examine all such, but have focused and will focus in future issues on some of the more common: heart disease, diabetes, cancer, substance abuse, HIV-dis­ease, mental infirmity, and sensory impairment. Although advanced age is not necessarily a disabling condi­tion, the elderly are at special risk for a wide range of impairments; we have therefore taken a look at the impact of aging on transition. We have looked at real people with real disabilities, protecting their identi­ties, when requested. We have looked at dreams unfulfilled, and at obstacles overcome.

Disability and Handicap

A disability is not always a handi­cap. Only when access is denied or limited—when obstacles appear—when the quality of life is impaired—does the person become disadvantaged. Many times, access is needlessly restricted: a book is not available in Braille; a public building does not have a wheelchair ramp; a lifesaving drug is priced beyond the means of ordinary people.

Transsexualism is usually consid­ered to be a disabling condition. As a disorder, it is legitized by its inclusion in The Diagnostic and Statistical Manual of the American Psychiatric Association (the infamous DSM III-R. While crossdressing has historically been lumped with the paraphilias (sexual disorders), trans­sexualism is a gender disorder, with a course of medical treatment that is clearly prescribed in the Standards of Care of the Harry Benjamin International Gender Dysphoria Association, Inc. And yet, for trans­sexual persons, access is more limit­ed than perhaps for any other minority.

The primary cause of lack of access is, purely and simply, igno­rance. The garden-variety American knows little about transsexualism, and that is unfortunate. But the real indictment of things-as-they-stand is the deficiency of knowledge of most physicians, psychologists, social workers, preachers, teachers, journalists, judges, attorneys, and politicians. Sadly, most of them arc not even aware of what they don’t know. And the word for not know­ing what you don’t know is igno­rance.

Ignorance is an unparalleled access-limiter. Not knowing what to do when petitioned for help, most service providers do nothing. “I’m sorry. Doctor doesn’t do that sort of work. No, we don’t have a name to give you.” A few are critical—sometimes cruelly so. Some attempt the impossible—to make the individual happy and secure in the gender of birth. Some, unaware, perhaps, of their own ignorance, give bad advice. “Just ignore it, and it will go away. “Why don’t you just admit that you’re homosexual?” “I want you to try this medication.” Most have good hearts, but don’t know where to refer. “Why don’t you write Geraldo?” The client is not helped, and may even be damaged by the interaction. She goes away ignorant, and more misinformed than when she came.

In seeking services, the person with additional disability is is at even more of a disadvantage. If competent treatment is very hard to find for the “average” person with gender dysphoria, it can be nearly impossible for the diabetic, the elderly, or those who are HIV-positive. With perseverance and ingenuity, services can perhaps be found, but it is even more of an uphill battle.

To those of you who have shared their lives on these pages, we offer our thanks. To those of you who are reading this and have disabilities, we wish you best of luck.

It’s surprising the hurdles that some people overcome in order to have SRS. One such person is Bobbie Montgomery, who was featured in an article by Sylvia Slaughter in The Nashville Tennessean on 22 July, 1990.


Life was never easy for Robert Bennett. He was born with osteogenesis imperfecta, or “chalk bone” disease, a condition that causes brittle bones that break at something so slight as turning over in bed.


During birth, his collar bone broke. When he was 6 weeks old, his mother found him in his crib crying, with both legs swollen and broken.


“Momma grabbed Robert up and rushed him to Charity Hospital in New Orleans,” Montgomery says. “She remembers carrying him in on a pillow, and it was there that the disease was diagnosed.”


For the first eight years of his life, Robert mostly lived at the hospital, a 45-minute bus ride his mother made daily from her home in Slidell. At Charity, he was in a body cast to prevent further bone breakage.


When he was 8 years old, he was transferred to the Shriner’s Hospital for Crippled Children in Shreveport, LA, where he lived until he was 16 years old. “Robert became the bionic boy,” Montgomery says of the steel rods in her arms and her legs, implanted during dozens of surgeries to strengthen her limbs.


Robert was 12 before he even sat up in bed. Montgomery remembers Robert getting his first wheelchair, something he knew he would have to use for the rest of his life. “He was almost happy then. I remember him thinking, ‘Oh, boy, freedom.'” Sort of makes you wonder about the strength of your own resolve, doesn’t it?

Your Physical Health and SRS

Most surgeons who do reassignment surgery require that their patients be in good physical condition and in reasonably good mental health. For example, Dr. S., a surgeon in a major European city, requires a negative test for the HIV virus, a letter from a psychologist or psychiatrist, a letter from an endocrinologist or family physician, a statement of good health from the individual, and, for those over 40 years old, an EKG.

Dr. S. isn’t being paranoid; he’s doing major surgery, and he would be foolish to leave himself open to liability for not taking reasonable precautions to ensure the patient will survive such an invasive procedure as genital sex reassignment. But there’s more than that; Dr. S. cares about his patients, and knows a vagina will not do someone any good if they’re dead.

Oops!  There it is– the big D word. Dead. Yes, SRS can make you dead. It’s unlikely to, if your surgeon takes the same sorts of precautions as Dr. S., but you would be deluding yourself to think that it would be impossible to die on the table. You could have a fatal allergic reaction to the anesthetic, aspirate on vomitus, go into cardiac arrest, have a stroke, or expire for any number of other reasons, even if the surgeon and his or her team perform faultlessly.

Obviously, the better your health, the better your chances for being accepted for SRS, and the fewer chances of complications following surgery. There are ways to improve your body to minimize risks—laying off of alcohol and other drugs (including nicotine), for instance, or exercising, or losing weight, but there may be factors which are beyond your power to control.

If so, what do you do? Well, the best you can. I have an acquaintance who is diabetic. She is a mechanic, and she carries around with her reminders of little accidents she had months before—skinned knuckles and little scabs which would have long been healed, if she were anyone else. She heals slowly, and so has to take special precautions, even with electrolysis. She hopes to have SRS, but realizes that it may require her going permanently on insulin. I know two other transsexual people with diabetes. Both plan to have surgery, and one is scheduled with Dr. S., and will be post-op by the time this issue goes to press. Some surgeons would not accept them; in scanning the literature, I discovered that diabetes is often listed as an absolute contraindication to SRS. With luck, all three will persevere, but the struggle will be a little harder for them because of their diabetes.  They know that, but they’re not defeated by it.

Your Health and Hormones

Diethylstilbestrol, Estinyl, Estrace, Ogen, Premarin (estrogens), Amen, Provera (progestins), yes, and Androil, Android, Metandrid (androgens): Hormones are not benign substances, and there are contraindications (meaning reasons to not even begin taking them), and side effects (meaning that you should stop taking them). Counterindications for estrogens include pregnancy (highly unlikely in a MTF transsexual person), breast cancer, thrombophlebitis or thromboembolic disorders, undiagnosed abnormal genital bleeding, known or suspected estrogen-dependent neoplasia (whatever that is), and high blood pressure. Major risks of estrogens and progestins include cancer, gall bladder disease, anomalous blood clotting, and abnormal liver functioning. There are a host of less dangerous side effects. Androgens are even more dangerous, especially when taken orally. Find a PDR (Physician’s Desk Reference); it makes interesting reading.

I know two people who have been taken off of estrogens for health reasons. One wrote me, “It’s so frustrating. It makes me want to eat nails.” She’s currently struggling hard to get her blood pressure and weight under control so that she can resume hormones. I know another person, older, whose history of alcohol abuse has caused cirrhosis of the liver, making ingestion of oral estrogens especially health-threatening. Intra-muscular injections or trans-dermal estrogens will minimize her risk.

An Unplanned Digression or Two Upon Mental Health

When it comes to transsexualism, the issue of mental health is especially cloudy. As gender dysphoria is listed as a mental illness in the DSM III-R (The Diagnostic and Statistical Manual of the American Psychiatric Association), transsexual people are, as was noted by Jan Redbear in a recent issue of Gender Expressions, crazy by decree. Many service providers (and most of the general public) agree wholeheartedly with this. My own opinion is that one’s gender can be a lifestyle choice, and craziness need not factor into it—but many transsexual people have told me they “had no choice.” I believe they did (else how did some of them make it so long?)—that they may not have control of their feelings, but they did and do have control of their actions and their bodies, and can do with them what they will. But that’s an issue for another day. The fact is, there are crazy transsexual people. Lots of them. I’ve had a front-row seat; I’ve seen it. Many t-people are polymorphously perverse:  suicidal, sociopathic, self-destructive, you name it. Unfortunately, these types play a disproportionate role in the literature, for they are oh, so much more interesting than those who are otherwise sane (if you want to see a lot of name-calling, read the literature. See how catty psychiatrists and psychologists can be. See how flawed and conniving and disgusting transsexual people are).

There’s a reason for the above—sort of. In the early years, SRS was considered to be highly experimental and controversial (some still think it to be), and so was done only to those who were psychological basket cases—street queens and hustlers, those who had repeatedly attempted suicide, and those who walked into the doctor’s office, testicles and razor blade in hand (I counted no fewer than twelve journal articles about self-castration between 1954 and 1979). Someone who was reasonably normal stood less than no chance of getting hormones— much less surgery— from the university-affiliated gender clinics.

This gave T-people an unnecessarily bad rap, but it is my belief that it has conditioned those who do SRS to look primarily for a diagnosis of gender dysphoria and evidence of success in passing—the ubiquitous Real-Life Test, and to ignore manifestations of true mental illness, except when it is so pervasive that it absolutely impairs functioning. In other words, if you’re not too crazy to walk into the doctor’s office and plunk down the money, you’re not too crazy to be operated upon. You are much more likely to be rejected for physical reasons than because of your mental state.

The fact is, the transsexual person is, as always, subject to the service provider’s “subjective conceptions about what constitutes evidence for a DSM III-R classification of transsexualism and a good surgical risk.” (Anne Bolin, In Search of Eve, p. 52). Poor mental or physical health constitutes simply another barrier to the already overwhelming desire for reassignment.  (Editor’s Note:  In the next issue of CQ, we will be taking a look at the known and suspected risks of reassignment and cosmetic surgeries and of hormones, and also at the psychological toll exacted by gender dysphoria.)


The following are composites of real people the CQ staff has known. In some cases, we have used actual quotes; in others we have paraphrased. The names and locations are disguised.


Babette is 72 years old. Since the death of her wife five years ago, she has lived full-time as a woman. She has had electrolysis to get rid of her facial hair, but has never taken hormones. She does not plan to have sex reassignment surgery.

For the first time in my life I’m happy. I no longer have any male clothes. My neighbors all know about me, but they’ve never said anything.

If I could have done this when I was younger, maybe I would have had the sex change operation. I loved my wife and kids, and it would have ruined my career. I was active in politics, and it just wouldn’t have done. But with the kids grown and gone, and with Annette [her wife—ed.] gone, and with being on retirement, there was no reason not to. I know I look a little funny as a woman. I would like to take hormones, but I had a little stroke a year or so ago, and my doctor says absolutely not. I don’t guess it would help much at this late stage anyway.

I don’t have many friends, but I know a crossdresser who lives nearby. We go shopping together. I heard there’s a Tri-Ess group that meets in Chicago, but I’m afraid I’ll see the young, pretty ones and get to thinking about what I missed.


Adrienne is seventeen years old. She has been taking hormones for more than a year. She passes perfectly, and in fact looks nothing like a boy, but continues to live at home with her parents, who absolutely forbid her to wear cosmetics or jewelry or womens’ clothing.

I’m just waiting until I get out of high school. Then I’ll be out of here. I have some friends in Charlotte who tell me I can go to work doing shows. I think I’d like that. I know I’d like it.

I’m going to have my sex change by the time I’m nineteen. I don’t want to wait around half my life. If I can’t have it by the time I’m 23, I won’t bother.


Calhoun is a 24-year-old transsexual person. A truck driver, he has been living as a man for the past six years. Four years ago, he started taking hormones.

I tell you, I almost quit as soon as I got started. The first thing that happened was I started finding hair on my pillow. No one wants to be bald. You can see that my hairline has receded, but I think I’ll be all right. I swear, if it gets bad, I’ll go to one of those hair replacement centers, or try Minoxidil or something. I just can’t stand the through of being bald.

The other thing that bothered me was acne. I had it for more than a year. It went away. The hair loss won’t.

Unfortunately, heart disease runs in my family. It killed my father, and my older brother has had a heart attack. I don’t try to kid myself. It could happen to me because of the androgens I’m taking. Still, heart and acne and baldness notwithstanding, I’m lots happier than I used to be. If I dropped dead of a heart attack tomorrow, I wouldn’t consider it a mistake. But that’s not going to happen.


Morganna, a crossdresser, lost her right arm and her right leg in Viet Nam.

Hell yes, I still dress up. I clump around. Sure, people stare, but you know what? They’re so busy looking at the prostheses that they don’t clock me. Usually don’t, anyway. The leg causes me to wear slacks most of the time, although I prefer shorts, and I wear long sleeves because of my arm. That makes me mad, because I have hardly any hair on my arms and I could have gotten by with short sleeves.

Basically, I just don’t let the arm and the leg slow me down. I go horseback riding. I swim. I work out at the gym, and I get dressed up and go out when I feel like it. It’s not a problem for me. It’s a problem for the people who can’t help staring at it.

I came back to the States with some dependency problems. but the worst thing I’ve had to deal with is survivor guilt. At least part of me got back. Some of my buddies didn’t. I used to lie awake at night and wonder, “Why me? How come I made it back and they didn’t?”

Gloria and Constance

Gloria, a crossdresser, is blind.

I have to have help putting on my makeup. I can’t find anything to read in Braille. I have trouble getting around.

Constance, who considers herself to be a transgenderist, is nonhearing. She writes, 

I have little to say, because my deafness has not been a problem. I read lips, and can talk a little, although I don’t like to. It’s my job and family connections which keep me from moving forward—not my deafness.