The Meyer study, cowritten with Donna Reter, noted the generally positive (good or satisfactory) outcomes reported by other researchers but reached a different conclusion. “Sex reassignment surgery confers no objective advantage in terms of social rehabilitation, although it remains subjectively satisfying to those who have rigorously pursued a trial period and who have undergone it.” Meyer and Reter based this conclusion on a comparison of fifteen patients who underwent surgery at Hopkins compared with thirty-five who had not completed the Hopkins program but who, in some cases, continued to pursue sex reassignment and later underwent surgery elsewhere. “While not a rigorous control group, they provided the only available approximation to it,” Meyer and Reter note of the latter group.
“Social rehabilitation” of the two groups was compared using a number of socioeconomic indicators, including job and educational levels, psychiatric and arrest history, frequency of change of residence, and cohabitation with “gender-appropriate” or “gender-inappropriate” partners. A numerical value was assigned to each of these categories in the Adjustment Scoring System. “Most of the scoring is self-evident,” Meyer and Reter note, though “if the patient is male requesting reassignment as female, a gender appropriate cohabitation or marriage means that he lives with or marries a man as a female; a non-gender appropriate situation would be one in which the patient, while requesting sex reassignment, nonetheless cohabitated or married as a man.” Male-to-female transsexuals who had female roommates, girlfriends, or wives were thus assigned negative scores, while marriage to a “gender-appropriate” partner was scored +2, a marker of successful adjustment on a par with a rise in socioeconomic status.
Critics have noted that “the most serious problem with this scale is its arbitrary character… it assigns the same score (—1) to someone who is arrested as someone who cohabits with a non-gender appropriate person. From this same set of cryptic values comes the assertion that being arrested and jailed (—2) is not as bad as being admitted to a psychiatric hospital (—3) or that having a job as a plumber (Hollings-head level 4) is as good (+2) as being married to a member of the gender-appropriate sex (+2). On what basis are these values assigned?” The same authors note that “there is confusion on the variable of cohabitation, particularly since Meyer never specifies whether this implies seuxal intimacy, interpersonal sharing or both. One can infer from the scoring assignment that a transsexual would be better living with no one (o) than with a person of the non-gender appropriate sex (—1) … Does Meyer mean to say that living in isolation is more adaptive than living with someone whatever his/her sex?”
Similarly, continued interaction with therapists and psychiatrists after surgery is viewed as a negative (psychiatric contact = —1, outpatient treatment = —2, and hospitalization = —3), as is failing to improve one’s socioeconomic status (as measured by the Hollingshead job scale). Meyer and Reter’s “objective” values of adjustment seem exceedingly value-laden in retrospect. Moreover, their failure to include any measure of personal satisfaction or happiness in the Adjustment Scale has been almost universally criticized, especially since “none of the operated patients voiced regrets at reassignment, the operative loss of reproductive organs, or substitution of opposite sex facsimiles (except one, previously noted),” as Meyer and Reter acknowledge. In other words, despite their unchanged socioeconomic status, continued tendency to change jobs and residences, and generally insecure and unsettled lives, those who underwent sex-reassignment surgery at the Johns Hopkins clinic appeared nearly universally happy with the results.
Ben Barres, the Stanford neurobiologist who transitioned in his early forties after a lifetime of gender dysphoria, confirms the importance of including affective data in any study attempting to assess the success of sex-reassignment surgery. “I’ve never met a transsexual who wasn’t enormously psychically better [after the surgery],” Barres says. “And the studies I’ve read say that something like 95 percent are very happy that they did it. And in medicine, you don’t usually find that kind of success rate. That’s unheard of, to find a treatment that has a 95 percent success rate. So it seems to me that the actual facts are totally opposite to what this guy [Meyer] said.”
The feelings of happiness and contentment expressed by postoperative transsexuals are irrelevant in the view of Paul McHugh, who closed the Johns Hopkins clinic after the Meyer study. “Maybe it matters to them, but it doesn’t matter to us as psychiatrists. We’re not happy doctors. We’re not out there saying, ‘What do you think would make you happy? Would you like a third arm?’ That’s not what we are,” he says. “The best will in the world would be to say, ‘These people have psychological problems that are dependent on the fact that they are fixed in the wrong body, and their psychological problems will melt away if we treat this. If we do this, it will make them better.’ But we found that they were no better! So we thought, ‘Maybe we’re just masquerading here. We’d like to think that they are better and they aren’t.’” McHugh dismisses sex-change surgery and the misery that drives it as “a craze” that started in the sixties and has been gathering steam ever since. “Crazes are crazes,” he says. “They build up, and they build up in a particular kind of way. We’ve been sold a bill of goods, and vulnerable people are picking this up and running with it. And it will continue to be a craze for a while as they support one another and as our communication systems, for example the Internet, promote it.”
McHugh’s perspective is anathema to most transgendered people, and yet one can find support for certain elements of his critique in the literature of the community itself. In her memoir, The Man-Made Doll, for example, author Patricia Morgan tells a harrowing tale of prostitution, rape, and abuse—both before and after her surgery with Elmer Belt in the seventies—and of the way that sex-reassignment surgery became popular among the crowd of gay and transgendered prostitutes with whom she worked the streets. Morgan says that despite her struggles she was able to make the transition to “straight” life because she had a realistic view of what to expect. Others were not so fortunate, she claims. “There are far too many fags and TVs [transves-tites] around today who think that sex-change surgery is the answer to all their problems,” Morgan writes.For most of them, it merely means trading one set of problems for another. They’ve lived so long in the underworld of fags and TVs, of pimps and prostitutes, that they’re not equipped to cope with the everyday world. They have no idea of what “straight” society is like. To them, it’s a fantasy land, like a child’s conception of the grown-up world. Many of those who go through sex-change surgery think they’ll wind up as sex symbols, love goddesses, movie stars. They think they’ll be transformed overnight into dazzling creatures who’ll sweep men off their feet and have millionaires clamoring to set them up in penthouses. It’s quite a comedown for someone who has such illusions to find out she’s just another broad—and not necessarily a very good-looking one—and that she still has to hustle to make a living.