Edgerton & Meyer, 1973
The Johns Hopkins University School of Medicine, Baltimore, MD, USA

This publication appeared in the handbook for "Plastic and Reconstructive Surgery of the Genital Area" and is not conceived as a follow-up study. Its main focus is on the representation of psychiatric and especially surgical treatment of transsexualism. The surgical techniques that were usual at that time are, with many pictures, presented individually. We mention this publication anyway because follow-up study results of the authors are mentioned in it and the primary author was part of the initial surgical team of the Johns Hopkins University School of Medicine and achieved international renown in his later work at the Eastern Virginia Medical School in Norfolk, VA, in the field of sex reassignment surgery and was president of the Harry Benjamin International Gender Dysphoria Association and finally, because the secondary author participated widely in many publications on the discussion of surgical gender reassignment - especially in his publication published together with Reter (comp. Meyer & Reter, 1979) that was noted worldwide.
The figures in the publication are inconsistent. On the one side, it reports that 70 sex conversion surgeries have been performed by the members of the surgical team of The Johns Hopkins Medical School; especially it reports about 31 persons applying for surgery whom the primary author had seen recently. More than half of them were diagnosed as not being transsexual (homosexual, transvestite, compulsive neurotic, psychopathic, borderline, adolescent conflict etc.). Fourteen patients were already operated at the time of the report (ten females, four males). In another part it talks about another 25 operations; again in another part about 26 operated females and six operated males. Again, it is reported that the first eight operated females had cosmetically and/or functionally poor results with many complications because of unsatisfactory surgical techniques; the last seven, to the contrary, had excellent results. Finally, citing a congress speech (Blumer et al., 1970) it reports about a follow-up study under psycho-social aspects of the first 13 females operated at Johns Hopkins. In view of the inconsistency of the reference data, we do not reflect any single data - especially because -- with high probability -- one can suppose that the partial sample of the 13 followed up is contained in the follow-up study of Money & Ehrhardt(1970); Money (1971) and Jones (1972).
Despite this, two aspects of the publication should be highlighted: Even though the authors criticize more than once that gender reassignment surgeries were and are made abroad without a clear indication, it is obvious that their own patients were given hormones after the first provisional diagnosis and then were released into the so-called "Real-Life-Test", that is, to a life in the new gender role. For patients who do not pass this phase or who decide during this time to live like before, the authors think that they will not have any irreversible damages. In MFTs the hormonally induced breasts can be removed surgically and in FMTs hormonally induced facial hair can be removed electrolytically and the ability to reproduce comes back after discontinuing the hormones. They write "if the patient, the psychiatrist, or the surgeon feels the slightest ambivalence at the end of this period, it may be wise to limit the initial surgery to an augmentation mammoplasty" (p. 127). The genital surgery should happen six months later.
The authors seemed not to have awaited how the opposite gender identity expresses itself in the behavior of patients without medical intervention. They even seemed to believe that they could create a gender identity with their treatment.
The final remarks of the authors should also be mentioned: "there is almost no limit to the possible sophistication of future sex conversion surgery. Some methods to make the constructed phallus erectile are being tested. Even uterine and ovarian transplants may follow. But at present, the focus must be on the psychodynamics of transsexualism and on producing simple, reliable, inexpensive methods of surgery for a very carefully selected group of patients." (pp. 159-160). No word is lost in the publication about the psychodynamics of transsexualism. This is not surprising on one side, where the authors seem to be nearer to the fulfilling of wishes (ovarian and uterine transplants) than the psychodynamic analysis of conflicts and suffered traumas. On the other side, with the background of these statements, it is more understandable why the secondary author thought that in his following psychoanalytical career had to distance himself from the surgical practice (comp. Meyer & Reter, 1979) because his own involvement in the here documented uncritical attitude towards the indication for hormonal and surgical treatment by his analytical colleagues (personal note of John Money to F.P.), without his mentioning this background in the common publication with Reter.