Trans seems to be everywhere in American culture. Yet there is little understanding of how this came about. Are people aware that there were earlier times of gender flexibility and contestability in American history? How well known is it, say, that a previous period of trans visibility in the 1960s and early 1970s faced a vehement backlash right at the time that trans, in the form of what was then termed ‘transvestism’ and ‘transsexuality’, seemed to be so ascendant? Was there transness before transsexuality was named in the 1950s and transgender emerged in the 1990s?

This book explores this history: from a time before trans in the nineteenth century to the transsexual moment of the 1960s and 1970s, the transgender turn of the 1990s, and the so-called tipping point of current culture. It is a rich and varied history, where same-sex desires and identities, cross-dressing, and transsexual and transgender identities jostled for recognition. It is a history that is not at all flattering to US psychiatric and surgical practices.

There are competing narratives in trans history. Some have maintained that convictions of gender dislocation have always existed; this was claimed in True Selves (1996), the popular guide to transsexuality recommended by Jennifer Finney Boylan when she declared her transition to her academic colleagues: ‘one indisputable fact remains: transsexualism exists and has always existed’.¹ The authors of True Selves were in good company. ‘The historical records make it very clear that transsexualism has been a human problem since the most ancient times’, wrote the wealthy, female-to-male transsexual Reed Erickson in his foreword to the classic Transsexualism and Sex Reassignment (1969).² For Max Wolf Valerio, a former radical feminist, ‘People like me have always existed, in every era, on every continent.’³ Yet this is not the case. As this book will explore, transgender does not float free of historical or cultural context.⁴

For others, far from ‘always’ existing, transsexuality was a late-twentieth-century phenomenon. As Catherine Millot once put it, there is a sense in which there was no transsexuality before experts like Harry Benjamin and Robert Stoller ‘invented it’.⁵ Although Joanne Meyerowitz’s influential book on the subject has charted individual and sporadic instances of surgery and experimental sex modifications in Europe and (more rarely) in the USA from the early twentieth century, she effectively began her story with the intense publicity surrounding the sex-reassignment surgery of Christine Jorgensen in the 1950s: ‘Ex-GI Becomes Blonde Beauty’.⁶ Transsexuality, a category that had once not existed, quickly became a widely recognized term after it had been named and described in Benjamin’s The Transsexual Phenomenon (1966), Richard Green and John Money’s edited collection Transsexualism and Sex Reassignment (1969), and Stoller’s The Transsexual Experiment (1975).⁷ Before that, those who experienced gender disjunction would invariably have explained those feelings in terms of homosexual or heterosexual transvestism – such was the rapid movement of sexual classification.⁸ Over the next ten years, the US national picture changed from one of no significant institutional support for transsexual endocrinology, therapy, and surgery to a situation where, by 1975, major medical centres were offering treatment and many transsexuals had been provided with surgery.⁹

One of the notable aspects of trans history is the rapid shift in sexual and gender configurations.¹⁰ The transgender community emerged in the 1980s and 1990s, more sexually and gender diverse than the older transsexual community (which it incorporated) and less wedded to medical intervention.¹¹ When Anne Bolin published her study on male-to-female transsexuals in 1988, stressing surgery (‘There are no halfway measures. If one is a transsexual, then pursuit of surgery accompanies one’s transition’), it was in that period of movement from transsex to transgender – and already seemed dated.¹² By 2008, on the other hand, Walter Bockting was explaining that there was ‘no one way of being transgender’: ‘Feminizing and masculinizing hormones and genitalreconstructive surgery are no longer two steps of one linear process of sex reassignment … Clients no longer necessarily need surgery to live and be recognized in the desired gender role.’¹³ Trans surgery too – for wealthy trans women at least – has shifted from an emphasis on ‘the genitals as the site of a body’s maleness or femaleness’ to an increased focus on the face as a site of true sex: moving from genital reconstruction surgery to facial feminization surgery.¹⁴

The category transgender includes people who want to create and/ or retain characteristics of both genders and who see themselves as neither or both male and female; significantly, other pieces by Bolin in the 1990s argued for far more gender flexibility.¹⁵ The most recent large-scale survey of transgender people has discovered a vast range of different self-identity descriptions among those in the survey who classified themselves as ‘other’ or ‘transgender’, the more common self-descriptions including genderqueer, androgyne, and bi-gender.¹⁶ Trans/Portraits (2015), which contains short testimonies of the experiences of a spectrum of American trans individuals, includes an array of trans masculinities and femininities, as well as those who identify as nonbinary, agender, and gender queer.¹⁷ Dakota, who was agender, said that they were ‘a sort of subset of genderqueer, in that I feel like I don’t really have a gender at all. I don’t feel male or female. I have elements of both sexes, or maybe neither.’¹⁸ In short, there is a new awareness of the ‘diversity of transgender experience’.¹⁹

We are now past the moment when the inaugural 2014 issue of the new academic journal TSQ: Transgender Studies Quarterly, itself indicative of the shift, could refer to the ‘postposttranssexual’.²⁰ It is the era of trans*.²¹ Transgender is considered too limiting, still connoting a gender binary. The asterisk in trans* indicates more openness, ‘greater inclusivity of new gender identities [though even the notion of identity may be too restrictive as we will see later in this book] and expressions … such as gender queer, neutrios, intersex, agender, two-spirit, cross-dresser, and genderfluid’.²² Aren Z. Aizura opts for ‘gender nonconforming’.²³ More crucially, these terms do not necessarily reflect those used by trans people to describe themselves. They have often seen no ambiguity: that is an outsider perspective. Or they have embraced their blurring of conventional gender boundaries – for example, those who use the pronoun ‘they’ instead of ‘she’ or ‘he’. Nonbinary has become a new category.²⁴ CN Lester prefers to be referred to as ‘they’; and considers themself as ‘outside of the gender binary’, neither a man nor a woman.²⁵ Aperture magazine’s 2017 visual homage to ‘Future Gender’ stresses gender as ‘a playground’.²⁶ The androgynous, genderfluid bodies of Ethan James Green’s photographic portfolio Young New York (2019) capture the current moment perfectly.²⁷

‘Today trans is everywhere’, wrote Jacqueline Rose in 2016.²⁸ There are trans-themed television series: Netflix’s Orange Is the New Black (2013–19), Amazon Studios’ Transparent (2014–17), and Pose (2018– ), the last with significant trans participation in acting, directing, and the whole creative process.²⁹ There is an interest in transgender children that ranges from the ‘superficially positive’ to the downright hostile.³⁰ There is a developing trans fiction, aimed at young adults, clearly intended to educate non-trans readers and to support a trans audience.³¹ There are trans celebrities: the very white Caitlyn Jenner of I Am Cait (2015–16) and Vanity Fair (2015) fame, and the black trans woman Janet Mock, with her best-selling memoirs and progressive advice about trans sex work and men who are attracted to trans women.³² Trans women counsel non-trans women on their makeovers, reality television style.³³ YouTube has cleverly crafted – if highly idealized – visual records of trans self-fashioning, charting the respective effects of testosterone and oestrogen on trans man masculinity and trans woman femininity.³⁴ And the website has its own trans celebrities: Giselle Gigi Lazzarato, for example, with her 2.7 million YouTube subscribers.³⁵

There is a comprehensive, trans, self-help guide, Trans Bodies, Trans Selves (New York, 2014), the trans equivalent to the iconic feminist text Our Bodies Ourselves.³⁶ There is a lavishly illustrated, colour-pictured guide to gender affirmation surgery, which does not spare the reader the lows as well as the highs of vaginoplasty and phalloplasty, and may not prove to be the best publicity for such procedures.³⁷ There are medical guides to assist health-care professionals in their treatment of trans patients, which, in contrast to earlier doctor–patient interactions (as we will learn), stress ‘a therapeutic physician–patient alliance’.³⁸ Such humane principles have been comprehensively enshrined in the ‘Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7’ (2011), with its proclamation that being trans ‘is a matter of diversity, not pathology’, and in the World Professional Association for Transgender Health declaration (2018) that ‘opposes all medical requirements that act as barriers to those wishing to change legal sex or gender markers on documents’.³⁹

There are foundational Transgender Studies Readers, representing both Transgender Studies 1.0 and Transgender Studies 2.0.⁴⁰ There is a new transgender studies textbook, written by a nonbinary trans academic, intended for use by high-school and college students, and with significant input from trans contributors, including a section in each chapter called ‘writings from the community’.⁴¹ There is an anthology of trans poetry and poetics: ‘Strange that you’d let me / give birth to my own body / even though I know I’ve always been / a boy, moving / toward what? Manhood?’⁴² There are trans archives. The Transgender Archives at the University of Victoria, in Canada, is a relatively new archive (2011), formed out of the collection of Rikki Swan and the papers of Reed Erickson.⁴³ Cyberspace provides the scope for ‘transgender history to be provoked, recorded, disseminated, accessed, and preserved in ways untethered from traditional, offline, and analog practices of history’; the curated Digital Transgender Archive is a most impressive demonstration of that very potential.⁴⁴ The Tretter Transgender Oral History Project of the University of Minnesota provides nearly 200 moving-image oral histories online.⁴⁵ There is a growing portfolio of trans photography: most recently, Zackary Drucker and Rhys Ernst’s moving catalogue of a trans/trans relationship, and Mark Seliger’s beautiful images of trans masculinity and femininity, and those in-between – ‘endless possibilities of potential selves’, in Janet Mock’s words.⁴⁶ Vice.Com has set up the online Gender Spectrum Collection, providing free stock photographs of trans and nonbinary models (taken by Drucker) to increase the visual presence and enhance the media representation of those ‘beyond the binary’.⁴⁷ See Illustration 1. Although it has just stopped publication, for ten years trans men had their own, genuinely innovative, magazine, Original Plumbing, edited by Amos Mac and Rocco Kayiatos, which, both visually and in prose, shows the sheer range and vibrancy of trans male culture.⁴⁸ See Illustration 2.

Hence, it has become possible to ask, ‘Is Pop Culture having a Trans Moment?’⁴⁹ Time magazine cover stories can proclaim a ‘Transgender Tipping Point’ (with the black, trans woman Laverne Cox on its cover) and ‘Beyond He or She’.⁵⁰ The National Geographic, no less, has had a special edition on ‘The Shifting Landscape of Gender’.⁵¹

I will be using the literature of psychology, psychiatry, and modern surgery among my source material. But that does not mean that I have been captured by what is usually called the medical model, where trans is viewed through the lenses of the medical and psychiatric experts, the gatekeepers of transition. Some trans advocates, as we will see, are deeply suspicious of such influences; others have opted to work strategically within the system.⁵² The trans community has long been divided on such issues.⁵³ On the one hand, the medical model provides (some) access to health care and (as a legitimizer) to legal advocacy, even if many of those involved do not really believe in the paradigm. On the other hand, it is resisted because it not only pathologizes but also privileges a particular kind of transgender, excluding more flexible forms of transness as well as those (the majority) precluded by poverty.⁵⁴ As Riki Lane expresses it, the ‘tension between seeking approval for treatment and resisting pathologization is a defining characteristic of the relationship between clinicians and TGD [trans and gender-diverse] people, both as individuals and as a social movement’.⁵⁵

Obviously, the medical model has framed discussion and shaped the lives first of transsexuals and then of transgender people; it has determined the rules, the parameters, the gates to treatment, and even self-perception. Austin Johnson’s labels ‘hegemonic’ and ‘normative’ are entirely appropriate.⁵⁶ The sociologist Myra Hird was horrified by the attitudes of psychiatrists, physicians, and psychologists when she attended a gender identity conference in 2000, including ‘highly stereotyped notions of gender’ and the continued framing of transsex (and homosex) as pathology.⁵⁷ Many commentators have pointed to the persistent gender essentialism and heteronormativity of the paradigm still present in the regime of DSM-5.⁵⁸

Yet, despite this dominating role, there has still been room for trans agency, evidence of what Dean Spade has termed ‘a self-conscious strategy of deployment of the transsexual narrative by people who do not believe in the gender fictions produced by such a narrative, and who seek to occupy ambiguous gender positions in resistance to norms of gender rigidity’.⁵⁹ Judith Butler once referred to San Francisco’s ‘dramaturges of transsexuality’, who coached trans men in the gender essentialism which they did not personally hold – yet needed when they approached the psychiatrists and doctors who were the gatekeepers to the sought treatment.⁶⁰ ‘I braced myself for a conversation where not adhering to stereotypes and clichés could undo this whole plan’, the British trans woman Mia Violet recalled of her encounter with her therapist in the 2000s. ‘I recited my history of gender dysphoria on cue.’⁶¹ She carefully avoided complicating the expected narrative.

What clinicians took for patient duplicity could be interpreted as trans agency – as in the case of the famous Agnes, discussed in a later chapter. L. M. Lothstein, the psychologist at Case Western Reserve Medical School in Cleveland, whom we will also encounter later, held group therapy sessions in the 1970s in which patient power was evident. Some black trans women brought their street alliances (forged in sex work) into the clinic, where it became black patient versus white clinician. One, Ann, ‘argued that the real experts on transsexualism were the patients and that the therapists were learning a lot about them via the group therapy’. She claimed that therapists could be ‘bullied into recommending all patients for surgery’.⁶² When a surgeon was invited in to show slides of gender reassignment, ‘the group focused on the “ugliness” of the constructed vagina’.⁶³ In a later study, Lothstein and his team claimed that such therapy revealed material that had been ‘denied’ and ‘falsified’ in earlier evaluations, again evidence of patient initiative.⁶⁴

Elroi J. Windsor has outlined the strategies (apart from submission) available to trans men when negotiating therapy: what Windsor terms ‘manipulation’ (choosing sympathetic therapists, and/or seizing back the initiative in the patient–therapist interaction), and ‘resistance’ (avoiding therapy, challenging diagnosis, walking away when the therapy does not suit). There are overlaps between categories, but the essential point is that, other than merely just ‘doing what needed to be done’ on the therapist’s terms (which was also a tactic), trans men could operate within the medical model.⁶⁵ Readers should afford me the comparable ability to work the sources analytically, to read against the grain, rather than assume that I am the prisoner of a literature of which I am very critical anyway.

This will apply, too, with the discussion of surgery, which will recur in the pages that follow. We will see that many trans people eschew such accounts because they objectify and pathologize the trans body and pander (again) to the medical model. In his account of his trans journey, Nick Krieger consciously edited out descriptions of the immediate results of his top surgery in an effort to avoid a ‘trans narrative cliché’.⁶⁶ Yet, either in its practice or in its absent presence (its denial), surgery has always been part of trans history.⁶⁷ As Eric Plemons frames it, ‘I am an ethnographer of trans- surgical practice not because surgery defines us as trans- people but because it is so very important to so many of our lives.’⁶⁸

We have to be wary of essentializing categories. Just as we should avoid subsuming transvestism under transsexuality, we should resist transgender as a master category for all aspects of trans history: the danger of the Transgender Studies Readers is that they may do just that. When Megan Davidson interviewed over 100 transgender activists in 2004 and 2005, well into the second decade of the transgender turn, she found conflict as well as shared values.⁶⁹ There were those for whom the medical model of transsexuality, with its binary and surgical certainties, was imbricated in their sense of self. Then there were those for whom fluidity was the key. The former sometimes saw the latter, especially those self-identifying as gender queer, as the province of white, privileged, college students. Davidson encountered an activist who clearly resented what they called the ‘girl in a tie with a crew cut who now feels male and yet is not willing to manifest it other than [with] a tie and a crew cut’.⁷⁰ Raewyn Connell’s deft history of transsexual women for a feminist readership demonstrates both an awareness of the emergence of transgender and her own preference for transsexuality as the more meaningful category, presumably because it best fits the centrality of the body to that history.⁷¹

Something strange is happening in some strands of trans studies: the erasure of much of trans history. Of course, historical frames of reference vary. For Zackary Drucker, one of the current trans generation, the mid-1990s were formative, and she spoke of discovering the words ‘queer’ and ‘transgender’ as a ‘fourteen-year-old queer youth’. Kate Bornstein was her ‘gender pioneer’. But Bornstein, Zackary’s inspiration, had different influences and perspectives, other historical reference points: Christine Jorgensen, Lou Sullivan, Tula’s 1982 book I Am Woman.⁷² Writing in the early 1990s, Gordene Olga MacKenzie identified the influence of the TV talk shows – mainly negative – on trans ‘coming out’.⁷³ For Rhyannon Styles, on the other hand, history is compressed even more. Her inspiration, as a gay club kid, was reality television. Before that, ‘Men could only be women in pantomimes, or when using drag to entertain’!⁷⁴

The most recent trans generation, of course, turns to the Internet, to varied online communities, Gaming, Google, Facebook, Twitter, Tumblr, and YouTube.⁷⁵ Tiq Milan has said that in the early 2000s he thought that he was the only ‘Black trans man in existence’ until he found a Yahoo discussion group.⁷⁶ ‘Computer games were my mirror’, writes Shane McGriever, a trans boy, ‘showing me the truth of myself while giving me the purest escape from truth’.⁷⁷ For Harlow Figa, it was YouTube’s trans male vloggers (‘up to ten hours a day’) who were his big influence: ‘I learned how to speak about my transness through YouTube.’⁷⁸ The queer, gender-nonconforming, and trans youth at the drop-in centre studied by Mary Robertson found their sexual scripts on Google, and in anime and fan fiction.⁷⁹ Not surprisingly, Genny Beemyn and Susan Rankin’s survey of nearly 3,500 transgender people has argued that the Internet was crucial to transgender identity work among the younger transgender participants.⁸⁰

But, whatever the favoured medium, narrative, or cited forerunner, the tendency has been to obscure what this book will argue was a contested and troubled – even provisional – past. In Drucker’s representation, the 1960s seem lost in the mists of time: ‘For the 1960s, that was so forward thinking.’⁸¹ For genderqueer, nonbinary Jacob Tobia, the 2000s – inconceivably, given all that you will read in this book – provided no language to describe their genderless feelings, and 2009 is almost ancient history: ‘no one knew who Laverne Cox was yet (can you imagine?)’.⁸² Or take the historical introduction to Vanity Fair’s 2015 special edition, Trans America, that denies any ‘smooth continuum’ from trans rejection to acceptance, yet which demonstrates the precise opposite by moving quickly to what it terms the ‘sustained high’ for transgender in contemporary US culture and to the celebrity trans promoted by that magazine.⁸³ Lest it be argued that these are examples of popular rather than academic culture, consider Jack Halberstam’s recent book Trans* (2018), which, apart from a discussion of 1970s feminism, has almost nothing from the period before the 2000s.⁸⁴ Of course CN Lester must be excluded from my criticism, for they have read widely in the historical literature and are thoughtful about the value of the past for the trans community: ‘What I have learnt about our histories shows me that the gendered bars and limits placed around us need not be permanent.’⁸⁵ Similarly, many of the contributors to the edited collection Trap Door (2017) are committed to recovering a useable trans history.⁸⁶ But they are the exceptions that prove the rule.

When did this neglected history actually begin? Was it in the 1950s as already intimated? Or does this Jorgensen-inspired focus on those years distort a longer story? Julian Gill-Peterson has convincingly argued for ‘displacing the 1950s as a default starting point for trans history’.⁸⁷ If it is possible to think of heterosexuality before heterosexuality, and homosexuality before homosexuality, why not think of transgender before transgender?⁸⁸ What is the history of trans feelings, tendencies – it is difficult to find the right term – before transsexuality and transgender were named in the second half of the last century? How useful is it to claim transsexual subjectivities for the late nineteenth and early twentieth centuries? Chapter 1, ‘Before Trans’, deals with these issues.

Chapters 2 to 4 examine the so-termed transsexual moment. Janice Irvine, one of the most perceptive observers of the twentieth-century historical sociology of sex, has written of transsexuality’s ‘widespread public and professional acceptance’ by the 1970s, ‘an accepted syndrome, buttressed by a vast medical armamentarium of research, publications, and treatment programs’.⁸⁹ But how seamless, really, was the triumph of transsexuality in the 1960s and 1970s? Chapter 2, ‘The Transsexual Moment’, discusses this ostensibly successful establishment of a new medical diagnosis and entity, arguing for the importance of cross-dressing (then known as transvestism) during this period of trans history. There is a case that the rather more fixed definitional qualities of the earlier 1960s and 1970s regime of transsexuality were necessary to establish a new category and to distinguish it from homosexuality and transvestism. However, we will see in Chapter 3, ‘Blurring the Boundaries’, that this sexual certainty masked a world of far more ambiguous alliances and practices. Chapter 4, ‘Backlash’, deliberates a neglected aspect of trans history, a period of intense critique right at the point where transsexuality had seemed to have become established.

Chapter 5, ‘The Transgender Turn’, considers the shift from transsexuality to transgender, and it assesses claims about the speed with which transgender has become established in the American cultural psyche. How, and in what ways, has that shift occurred? Has there been both a 1990s turn and a 2010s tipping point? Is trans culture really experiencing a cultural high?

Categories like transvestite, transsexual, transgender, and trans itself are good to rethink US history, but this book will demonstrate that it is the slippages and overlaps between these types that can be the most informative. As most dictionaries will explain, trans means across, beyond, over, and between; it can also denote change, transformation.⁹⁰ The history that follows will include those with transgender bodies before transgender emerged as a descriptor; those who cannot be categorized as either transvestite or transsexual; cross-dressers who modify their bodies but who are not transsexual; those who wanted to be homosexual rather than heterosexual after their bodily reconstruction; and those who consider themselves beyond classification. This book will locate and contest some of the more significant structural and conceptual weaknesses in trans history: the neglect of an important period of critique in transsexuality’s early years; a claimed recognition of systems of technology and therapy and notions of sexual identity that I will suggest were far more tentative, contested, and fragmentary; and a neglect of other forms of trans expression both before and after the transsexual moment of the 1960s and 1970s. This book will attempt a new history of transsexuality and transgender in modern America.