Review of Sex Changes


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A Review of SEX CHANGES: The Politics of Transgenderism, by Pat Califia.

San Francisco, Cleis Press, 1997. 307 pp including notes, resources, bibliography, and index, $16.95.

Review by William A. Henkin, Ph.D.

Copyright © 1997 by William A. Henkin

Originally published in Spectator

Now I am ready to tell how bodies are changed
Into different bodies.

- Ovid, Metamorphoses, translated by Ted Hughes

I first became aware of my desire to be a girl about the same time Christine Jorgensen was having her first surgery, though I hadn't heard of her and she certainly didn't know about me. Deep in her soul and also, as I read her autobiography, deep in her biology, she had recognized that in some important and incontrovertible way she was female, and had searched against all 1940s and '50s probability to find the almost-only route available at the time that would allow her, insofar as it was possible, to recast her male-born body and live her life in the form that felt right and made sense to her.

My tribulations weren't nearly as difficult as Jorgensen's because her desire to be a woman - or her recognition that in crucial ways she was one - was complete, while the part of me that was or wanted to be female was, however significant in my life, just that: a part, and necessarily much more moderate. In one way a comparison hardly conveys how close I later felt, or, in another, the tremendous distance I recognized I stood from the awesome, awful dimensions of the choices Jorgensen and other people in her position have sometimes been compelled to consider, so in the impossible either/or time and place I first knowingly deliberated the nature of my gender I could explain little more than that I wanted both: to bake cookies and play baseball.

For me, as for most people with conflicting desires in the neo-Freud '50s, the nominal solution was simple and clear: see a psychiatrist until the neurosis was cured. But simple is as simple does: some so-called neuroses are not curable; some conflicting desires persist. That's how God gives us anxiety, as Woody Allen shows repeatedly, and it speaks to the reality poets have written of throughout recorded history, about the presence among human beings and the gods of more than the two most common genders.

My tribulations also weren't as keen as Pat Califia's, apparently, who in her young adulthood went considerably farther than I had gone in my very early adolescence toward examining the real-life possibility that she might be transsexual, though eventually she too decided to retain her birth form. In part it is precisely Califia's experience questioning her own gender identity that led her to write this book and that gives her the authority to do so, as in part it is my experience exploring the whole question of gender identity with myself and with other people that leads me to find Sex Changes not just a remarkable book, but one that is simultaneously unexpected and long overdue. It is also a book that no one but Pat Califia could really have undertaken.

Califia makes her vantage known at the outset, in her Introduction:

Most of the literature about transsexuals has been written by self-proclaimed experts, from a position that claims to be academic or scientific, and therefore objective.... I am uncomfortable with the stance of the objective outsider who, because of a sheaf of credentials, purports to have a point of view that is more important or powerful than that of transgendered people themselves. In medical and feminist discourses, transsexuals are stereotyped as patients undergoing sex reassignment, the troubled clients of psychotherapists, or faux, man-made "women" created by the patriarchy to act as moles in the war between the sexes. This gives the experts a privileged voice and disenfranchises differently-gendered people. In autobiographical or fictional accounts, they may set down what they perceive to be true about themselves and the world around them, but it is the medical doctor, therapist, academic, and feminist theoretician who interpret "them" for the rest of "us"' and thus claim to be the voice of reality.

Sex Changes is neither a book written by a self-proclaimed expert nor an autobiography or work of fiction. It is, instead, the one sort of book that has been missing till now from the growing library of books on the subject of transgender identity: an evaluation and a reconsideration of the field to date. The spirit of the book is evoked in its subtitle - the politics of transgenderism - and its portent is reflected in the fluidity of its title, where sex may be a noun or an adjective and changes may be a verb or a noun. To fulfill the promise of these signals Califia has adopted an approach that is mostly straightforward and chronological to explicate her view that through fifty years of history, the academic, scientific, and feminist experts she alluded to have addressed the lives and concerns of transgendered people without, for the most part, seeing them, or recognizing them as human beings equal to the experts themselves.

Given her own history with gender identity, and her position as one of the pre-eminent independent scholars of contemporary North American sexuality, it comes as small surprise to find that a goodly portion of Sex Changes consists of her examination and deconstruction of nearly every self-proclaimed expert and sacred cow in the field, from Harry Benjamin, Richard Green, and John Money to Janice Raymond, Robert Stoller, and Walter Williams. Even gender community activists, models, and spokespersons such as Virginia Prince, Rene Richards, and Kate Bornstein get a certain amount of cummupence. The reason nearly no one gets out of Sex Changes alive is not simply that Califia is a happy iconoclast, but also that - perhaps because she is an independent scholar and a gadfly gladly beholden to no one - she has taken the time to read the literature of the field with a critical, personally educated eye; thought about it from the vantage of one who might have been a consumer of services; identified the unfortunate holes, awkward inconsistencies, and unsupported assumptions she found therein that no one else has seriously addressed so thoroughly; and used her relentless intelligence to call attention to questions the "self-proclaimed experts" themselves have sometimes overlooked, ignored, or glossed over. In her apparently boundless capacity to identify with the outcast in all matters pertaining to sex and gender, she has once again demonstrated herself to be the supreme, and supremely articulate, champion of the erotically disenfranchised.

It could have been expected that if Califia, with her passion for inclusive justice, was going to write a book about transgenderism she would have to do in Janice Raymond, and she does. Raymond's 1979 polemic, The Transsexual Empire, reissued in 1994 virtually unchanged, is probably the single best-known attack on the integrity of transsexual women and men ever published, and springs from the very heart of feminist fundamentalism. It claims, in brief, that someone born with male genitalia and socialized as a male can never be a woman in any sense; that transsexual women are pawns in a patriarchal conspiracy of (male) doctors and psychotherapists to infiltrate and usurp the feminist movement with the ultimate objective of doing away with women altogether; and that, incidentally, transsexual men are dupes of the system and traitors to their morphological sisters.

While Raymond says that people born with male bodies cannot "become" women because they are both socially programmed and biologically predetermined to be men, she is also adamant that people born with female bodies can resist social learning, which is how they become feminists. As Califia shows, however, Raymond's logic is even faultier than it first appears, because her arguments against biological determinism are so sweeping they can only lead to the conclusion that anyone can learn to be a woman - which is exactly not what Raymond states or wishes to espouse. Raymond's theory is so casuistic, her reasoning so tendentious, and her real-life behavior regarding other women who disagree with her so, well, so bad, that she has left the door wide open for an attack on her own ethics, which Califia mounts with a sort of ecstatic, anguished fervor all too rare in scholarly treatises. Her exasperation is not only with Raymond, however: as a very well known feminist herself, Califia's distress is with the entire brood Raymond represents, because "nothing upsets the underpinnings of feminist fundamentalism more than the existence of transsexuals."

In my more cynical moments, I believe that another underpinning of feminist fundamentalism is the fact that it is much easier to harangue and shame women about their sexuality and attack things like prostitution, pornography, and sexual deviation, which the state already sees as dangerous, than it is to dismantle male domination. I wonder for how many more centuries women will involve themselves in campaigns for moral purity, which certainly have an impact on the world we live in, but don't fundamentally alter the concept of woman or propel us into a new battleground. We are supposed to be indignant about immorality and vice, dammit. We are supposed to split off from one another along... sexual lines as well as lines of race and class. We are supposed to view one another with suspicion and mistrust. Feminist fundamentalism, with its "big sister is watching you" attitude, intensifies the divisions and splits between us. An attempt to divide us into the good girls who deserve freedom and the bad girls who do not smacks more of high school than it does of revolution.

Less expected than her destruction of Raymond's work is Califia's dissection of John Money's. After all, however dangerous Raymond may seek to be to the human and feminist freedoms Califia holds dear, her positions are very palpably wed to the lunatic fringe; but in humanist and sexological circles John Money is very nearly an icon. Author or co-author of a shelf full of books and professional articles too numerous for anyone but a dedicated compulsive to count, he has been president of most important professional and academic organizations devoted to the study of human sexuality and has been honored by the rest. In the world of gender studies the reputation of his pioneering work on intersexuality helped establish the gender identity clinic at Johns Hopkins University where he is emeritus professor of medical psychology and where, due to his efforts, much of the early sex reassignment surgery in this country was performed.

But lately Money's reputation has come under attack from people such as Cheryl Chase, founder of the Intersex Society of North America, who has charged that he had no basis in scientific research or fact to encourage the surgeries on intersexed children he urged, that he damaged people's lives in the course of treating them, and that a good deal of the motivation underlying his work was an unacknowledged bias in favor of heterosexual coitus as the only healthy form of human sexual expression. Califia, in turn, finds it "odd that someone as sophisticated as Money would allow his gender categories to collapse to two very small boxes, which could be labeled `boy = has a penis' and `girl = has a vagina.'" After skewering his research and his writings on gender, as well as his best-known work on other forms of sexuality, she interprets her own understandings:

Money. . . is an enormously influential intellectual and researcher who clearly sees himself as a humanitarian who advocates better treatment for those he views as being less sexually fortunate than normal people. But he does not seem to understand how precarious the scientific basis is for his high-handed division of the world into "normal sexuality" and "paraphilias." Money is essentially a moralist masquerading as a scientist, and he gets away with it because of his medical credentials and his prolific output of technical-sounding publications about sexuality. In fact, it is the sort of attitudes toward sex, gender, and pleasure that he promotes which are the underpinnings of such things as sodomy laws and psychiatric incarceration of "differently-gendered" people. . . . [He advocates] intervention in the lives of sexually different children without conclusive proof that such interventions have any impact on adult sexual orientation, gender identity, or pleasure-seeking behavior.

It is their willingness to intervene in people's lives - or refuse to intervene when asked to - on the basis of opinion without conclusive proof and without reference to the experiences of the people they were treating to which Califia keeps returning in her discussions of the early physicians and psychologists who were concerned with transgender identity issues. Among the early gender scientists only Harry Benjamin comes off with a balance of high marks for dealing humanely with the misery he saw in the lives of the transsexuals he knew, perhaps because, unlike Raymond and Money, he was not a moralist; Califia regards "his approach to transsexualism [as] deeply practical," commends his "straightforward compassion," and finds his description of Christine Jorgensen's family's acceptance of her unique station "touching."

Benjamin, who was Jorgensen's physician, was the endocrinologist who first observed that hormones and surgery might satisfactorily make some peoples' bodies congruent with their gender identities when psychiatry, the law, religion, and other social interventions had utterly failed to make their gender identities congruent with their bodies. He clarified different ways people could understand sex - anatomical, chromosomal, genetic, germinal, gonadal, hormonal, legal, psychological, and social. He distinguished homosexuality from transsexuality, male from masculine, and female from feminine. He devised the first set of standards by which a doctor might identify someone as transsexual so she could receive proper care, and he worked hard to make a liberal, scientific view of the complexities of gender identity and human sexuality acceptable in the conservative world of North American medicine.

At the same time, he argued that transsexuals (whom at first he assumed to be male-bodied at birth by a ratio of 8:1, though he later revised his estimates to a more even proportion) hated their genitals, and would mutilate or kill themselves if they could not have hormones and sex reassignment surgery, which is sometimes but not nearly usually true. His ideal transsexual was, like Money's, a happily married homemaker housewife in a middle-class utopia, who has made up a past she never lived and whose husband does not even know about her history. And here is where he runs afoul of Califia, for, as she notes, the "selective amnesia" Benjamin recommended "would hardly be considered healthy for anyone other than a transsexual. He seems completely unaware of any damage it might do to a reassigned transsexual woman to hide her past from her intimate partners." Like those of the other men she calls Father Figures to the modern transgendered family, Benjamin's notions of a successful male-to-female genital reconstruction were also very specifically limited: "Since Masters and Johnson's pioneering work on female sexual response, which established the primacy of the clitoris as the locus of women's pleasure, was published the same year this book [Benjamin's The Transsexual Phenomenon] appeared, in 1966, it rankles to see women's sexuality reduced to the creation of a hole that is adequate for male use during intercourse."

Califia does note that Benjamin, Money, Richard Green, Robert Stoller, and others involved in early work with transsexualism were basically well-intentioned men who sought to help others as best they could according to their own lights at a time when all understandings of gender identity lay in profound darkness. But she also shows that they were all men almost universally unaware of their own considerable prejudices, as well as of the ways their own positions and power blindered them and made it impossible for them to appreciate the unspeakably valuable knowledge, insights, understandings, and wisdom their patients had earned through the most rigorous sort of real-life test imaginable, and also, sometimes, blindered them to the agony inherent in the plights of their patients' simple humanity. Not the least of their ignorance concerned the realities of human sexuality rather than unsubstantiated beliefs, and because of their limits, and especially because they did not - could not - acknowledge those limits, much of the good they did was balanced out, for many of the people they served, by considerable if inadvertent ill. "What dignity and validation the medical profession gives the transsexual with one hand, it takes away with the other," Califia observes ruefully in one place; and in another, "`help' from doctors is truly a double-edged sword for sexual minorities."

It doesn't matter if sex [including gender] deviation is caused by social learning or biology; or at least it doesn't matter to the "deviate." If it weren't for loneliness, discrimination, and stigma, most sexual-minority members would never consider giving up or altering their fantasies and pleasures. But it does matter to the doctors and scientists and researchers .... We need to question the so-called experts who are too quick to pathologize behavior or self-concepts that are not inherently self-destructive and that don't necessarily interfere with people's ability to love or pleasure one another. We can only do that if we jettison our own guilt and apply the same intellectual standards to sex research that we would apply to a piece of research in the field of astronomy or physics.

As Califia feels that rigorous standards should apply across the boards, she takes to task some members of the contemporary gay academic establishment who have almost religiously adopted transgendered identities of people from other cultures and claimed them as their own. She objects that Jonathan Katz, author of Gay American History and the functional founder of gay historical studies, has amalgamated into gay history those third-gendered Native Americans generally known to us (though not to themselves) as berdache, who had social niches in at least 130 tribes, and whose orientation was not generally seen as same-sex just because the plumbing of two partners matched, when the individual her- or himself was accepted as what we would call cross-gendered. She adds that in The Spirit and the Flesh anthropologist Walter Williams "shows no inclination to update Katz's reading of the berdache as gay role models who have absolutely nothing to do with transgenderism." Williams holds that the whole notion of transsexuality is a modern and Western one because it is, he says, based in a medical paradigm that assumes two opposite sexes. But Califia finds Williams' position uncomfortable, because

if transsexuality is a modern Western category, dependent upon medical diagnosis, is not homosexuality also a modern construct of medicine and psychology? If Williams can recognize that desire could exist between males, for one another, throughout human history, why can't he validate the yearning that some people feel to live in a gender other than the one they were given at birth, even in societies where medically-assisted sex reassignment is not or was not available?

"At its root," she says, "Williams's attitude toward transsexuality is every bit as negative and prejudicial as that of Raymond or Katz."

No one but a hugely prominent, greatly respected, dyed-in-the-wool homosexual person could hope to make Califia's points in this venue. Certainly she does not seek to make internecine enemies of Katz, Williams, Will Roscoe, or others who have sought valiantly to clarify the presence of gay men and lesbians in societies throughout the world. But in defense of her subject she does want to set the record straight, and has some objections to its presentation up till now. After all, as she notes, "It does not further our understanding of human sexuality to press for recognition of homosexuality throughout history at the expense of recognizing other sexual minorities."

Califia has questions for transgendered people too, that only a hugely prominent, greatly respected, dyed-in-the-wool queer person could hope to make. She rakes Virginia Prince, the grande dame of modern male-to-female cross-dressing, for her unabashed homophobia (but not for her recent eccentric diatribes against transsexuals), and she objects that Rene Richards's "self-appointed status as [a critic] of genetic females and [an expert] on femininity" is "one of the least attractive qualities that male-to-female transsexuals sometimes display." She notes with sympathy but disapproval the distance Jan Morris and especially Christine Jorgensen keep from sex in their autobiographies, and seems pained that all three of these prominent transsexual women assert, albeit early in the evolution of the transgendered movement, that transsexuality is a disease that should be governed by the wisdom of the very medical practitioners Califia pillories.

Still, on balance she is far kinder to transgendered people than she is to those who observe transgendered lives professionally. She recognizes the importance of Prince's efforts in the acceptance of any cross-gendered behavior at all, acknowledges Morris for the homosexual experiments "he" made - and enjoyed - as a boy while trying to understand his own sexuality even while he felt "wrongly equipped," and regrets Richards's deeply disturbed childhood as the child of a psychiatrist. Califia is especially gentle with Jorgensen, as befits the demure, ladylike life she sought to live despite being outed by the press and then compelled to earn her living in the public eye. She seems to rather honor the "consistently low-key, normal, and even dull" tone of the autobiography in which Jorgensen "insists on her right to have a life full of the same trivia and minutiae as anyone else's. She consistently downplays any hint of strong emotion, partly because, it seems, she really did want nothing more than to be an ordinary woman."

Although Califia discusses Mario Martino's 1977 autobiography Emergence, Mark Rees's Dear Sir or Madame, published in 1996, and a 1990s interview with a collection of FTM shape-shifters, she unhappily acknowledges the paucity of female-to-male writing so far available. But she observes how that community has recently begun to come into its own, and her book is dedicated to the memory of Lou Sullivan: founder of what has become the largest female-to male group in the world, FTM International, and the subject of the first academic study (1988) that acknowledged the existence of a post-operative transsexual man who was gay.

What seems to interest Califia more than anything in Sex Changes is the way individuals have contributed to the growth of an increasingly radicalized political awareness among overlapping communities of people who have learned the hard way the extent to which they must rely on themselves. She clearly wants to support and encourage the work of playwright and actor Kate Bornstein, for instance, whose 1994 book, Gender Outlaw, proposed one of the first deeply important departures from previous transgender models. Although Bornstein is a beautiful, articulate, accomplished, media-savvy SM lesbian and was for awhile the poster-child of American transgenderism, she rejected the whole notion that she was female or male and made an experiential case for the existence of a third gender. Califia has occasional criticisms of Bornstein's logic, and of the fact that some of Bornstein's observations recapitulate statements Califia herself made in the early 1980s, but she is highly encouraging of the way "the transsexual is, in Bornstein's able midwifery, transmuted from an isolated freak whose existence must be examined and explained by experts, into a wise outsider full of wry insights into the freakishness of everyday life and its central organizing principle, polarized, binary gender."

In discussing the growth of radical activism in the transgendered communities, Califia offers glimpses of the few people she sees in a clearly positive light who have lately been proclaiming that they are not what the good doctors have said they should be. Bornstein and Leslie Feinberg spearhead these new breeds. "Bornstein breaks the frame of previous transsexual narrative," and Feinberg breaks a different frame in her novel Stone Butch Blues. As her books and her activism both demonstrate, Feinberg - who was born female-bodied, took hormones when he identified as an FTM, then reconsidered - chose to "straddle the gender line and challenge us to create a new social category that recognizes the dignity and rights of those who blend gender in such a way that they are not easy to label as men or women." She is clearly a spokseperson for individual choice, and individual choice is Califia's calling card.

Perhaps because individual choice is such an important matter for Califia, the people who come off best in this overview are those who best exemplify that trait in themselves and for others: Lou Sullivan; James Green, who took over FTM at Sullivan's death and built on his vision to make the organization large, vibrant, and visible; Margaret Dierdre O'Hartigan, another independent transgender scholar and frequent gadfly in her community, whose exceptional courage even in a world of exceptionally courageous people moves Califia. Somewhat to my surprise, neither Dallas Denny nor Paul Walker is mentioned in the book. As a psychologist Walker's service in behalf of the transgendered communities is legendary, and only begins with his principal authorship of the Harry Benjamin Society's original Standards of Care. Denny, as Executive Director of the American Educational Gender Information Service (AEGIS), took over dissemination of information that had once been distributed through Walker's Janus Information Facility, and through her own prodigious work as a scholar, researcher, businesswoman, writer, editor, and activist, is helping the greater transgendered community to steer a surprisingly stable course through the roiling waters of change.

In her chapter on feminist fundamentalism Califia writes about Catherine Millot's book Horsexe in terms I can only call polite contempt. Along the way she criticizes the English edition of the book because it is "packaged with a cover featuring a large photograph of a nude person who has breasts and a penis.... The titillating nudity of a hermaphrodite is used to sell a book that dehumanizes people in gender transition...." Califia's book does anything but dehumanize people in or out of gender transition, but I wonder who got the bright idea of using as a cover for Sex Changes a photograph featuring a sexually ambiguous nude in a collar and chain? Overriding the observation that because of the double-exposure image the nude could easily be seen as a male with emerging breasts, every person I've shown the book to has commented on the collar in this piece of design with the same assumption that someone at Cleis Press sought to capitalize on Califia's reputation as an expert on consensual sadomasochism. The cover choice is unfortunate, because the generally estimable Cleis has been publishing some particularly good books of late, including Carol Queen's Real Live Nude Girl and Loren Cameron's Body Alchemy. But while the cover may confuse some buyers, it in no way diminishes the quality of Pat Califia's important contribution to the literature of transgender studies.

Sex Changes concludes with a page-and-a-half of questions "that might shed some light on how the movement for gender freedom could have a positive impact for us all." If I had the room in this review I'd reprint all the questions so that you, dear Reader, could think about them for yourself. On the other hand, to have the questions from a writer who has thought as pointedly about these matters as Pat Califia has is really worth the price of admission all by itself. If gender identity is a question for you in any way, Sex Changes is one of the very few contemporary books you can't afford to miss. And yes, there will be a test.


William A. Henkin, Ph.D., is a psychotherapist and sex therapist who wrote his dissertation on female-to-male transsexualism. A member of the Harry Benjamin International Gender Dysphoria Association (HBIGDA), the International Foundation for Gender Education (IFGE), American Educational Gender Information Services (AEGIS), ETVC, and FTM International, as well as the Society for the Scientific Study of Sexuality (SSSS) and other organizations full of letters, he co-teaches a course in Transgender Identity Issues at the California School of Professional Psychology. Along with this sheaf of credentials to review Sex Changes, Dr. Henkin conducts his private practice in San Francisco.


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