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Benjamin's first 10 cases

The following is an excerpt from a clinical historical note written in 1995 by Leah Cahan Schaefer and Connie Christine Wheeler on Harry Benjamin's first ten cases which he saw between 1938 and 1953. What is interesting to note are not only the ages but the varying degrees of dysphoria that they suffered:

“A collective overview of Benjamin's first 10 gender dysphoria patients reflects a wide range of life circumstances and patterns (Schaefer and Wheeler, 1987b). There were 9 neonatal males and 1 neonatal female. (This ratio of 9:1 was considered representative until the mid 1960s.)

Date of first contact with Harry Benjamin was from 1920-1953. Ages at initial contact ranged from 23-54: 3 in their 20s, 3 in their 30s, 3 in their 40s, and 1 in the 50s. Socio-economic levels were exclusively middle class, with 3 from upper-class backgrounds. Occupations varied: writer, office worker, scientific farmer, interior decorator, housewife, machinist, entertainer, military service, art student, chemist, and photographer. Education levels were not consistently recorded.

Marital status of the 10 patients: 4 never married; 1 married once and separated due to transvestism; 2 married twice in their male roles and then were divorced or widowed; 1 married in her new gender role, but had the marriage annulled; and 2 already married to each other went through simultaneous gender changes and remarried each other in their reversed roles. Offspring: Among the 10 patients, 3 had children, and 1 reported grandchildren.

The physical/phenotype of the patients included 3 feminine, 1 hypo-gonadal androgynous, and 6 masculine (including a male-to-female transsexual with a massively tattooed body). Their voice types included 4 masculine, 1 feminine, 2 equally masculine and feminine-sounding, 1 androgynous-sounding, and 2 unknown.

Sibling Order: 1 First-born and 2 only-children (married to one another). Only-children and first-born represent the same birth-status category. Other sibling orders ranged from the youngest of 2 to the 13th child of 14.

First evidence reported includes both "initial cross-gender identity feelings" and "first contact with crossdressing." Six reported feelings of "being the opposite sex from very early childhood"; 1 reported "having those feelings sporadically"; 1 reported "never having the feeling of wanting to be a girl";the remaining 2 patients' feelings are not recorded. All 10 had a history of cross-dressing from early ages into adult life. Unusual childhood conditioning: 4 were raised as boys while 3 were raised as girls one of whom was discovered at age 13 to have a birth anomaly as evidenced initially by undescended testes; for 3 patients no information is available.

Sexual Orientation. Of the 10 patients, 2 were heterosexual, 5 bisexual, and 3 homosexual (Kinsey et al., 1948, pp. 638, 641; 1953, pp 469-472). Kinsey Scale ratings were identified as a 1, a 2, two 3s, two 4s, no 5s, three 6s, and one "unknown." Descriptors that coincide with category designations of Benjamin's famous Sex (Gender) Orientation Scale (SOS), which was added to his evaluation at a later date (1966b), were recorded allowing for interpretation of the following (Wheeler and Schaefer, 1987):1 genuine transvestite, 6 Category V and VI transsexuals, and 3 Category IV transsexuals. We were amazed to identify 3 of 10 as being transsexual IVs, i.e., the genuine transsexual who does not require genital reassignment surgery. This ratio may be as valid today as it was 30-40 years ago (Schaefer, Wheeler, and Futterweit, 1995).

Known FamiIy Attitudes. Five mates were "sympathetic or permissive," while 2 showed "opposition and lack of sympathy;" (only 1 of 10 divorced because of the negative attitude toward gender dysphoria); for 3, no information is available.

Hormone Medication. Seven patients received both oral doses (i.e., premarin and progesterone) and injections of estrogen (i.e., Enovid) to increase feelings of femininity, 1 receive injections of testosterone for increased feelings of masculinity, 1 used hormones for weight gain to appear more masculine, and 1 received no hormones at all. Additionally, all 10 received psychological support from Benjamin for their condition (Benjamin, 1964b).

Surgery. Six of the 10 were ultimately considered genitally operated. Three had their first stage - castration - done abroad, while the other 3 had both stages, castration and penile amputation then known as conversion therapy (Benjamin, 1954), done in the United States. (Vaginoplasty was not yet performed in conjunction with these two procedures.) Various surgeries for these patients were performed between 1945 and 1960. The female-to-male transsexual's surgery was both the earliest and the latest reported: a mastectomy in 1945, the hysterectomy and plastic testicles in 1960 (Benjamin, 1964a)”

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