Tracing Trans Surgery Through the Archives
in Portland, Oregon

(Numbers in brackets [XX] link to endnotes; browser BACK button returns to text.)

By Shir Bach, 2020

A quick note on language: For this paper, I have used ‘trans’ as a general term to refer to what we now consider to be a coherent group of people who do not identify with their assigned gender at birth. In discussing the history of trans care, I have used the terminology specific to that moment in history, including terms that are now outdated. In quoting from direct sources, I have opted not to alter any language used, including pronouns. For much of the period covered, convention was to refer to trans people as the name and pronouns associated with their birth sex until their transition. Today, we use a person’s current name and pronouns even when referring to the time before they transitioned.

I. Introduction:

When computer scientist and transgender activist Lynn Conway started building her personal website in 2000, she decided to collect stories of successful post-operative trans women. Conway wanted to counterbalance the narratives of trans people told by outsiders and replace it with role models to inspire hope and encouragement[1]. One of the nearly 200 women whose stories are housed at this site is Debra, who writes with aching honesty about her sex-reassignment surgeries at a small hospital in Southeast Portland. From the first moments awaking from surgery to regaining her “she-legs” [2], Debra doesn’t censor or hold herself back, and the difference between her story and that of the Jerry Springer-typetabloid specials is precisely what makes Conway’s archive so compelling. When thinking historically about trans surgery, we should keep Debra in mind. This paper traces the history of transgender surgery in Portland, looking for stories like Debra’s wherever they are found, from institutional archives to decades-old websites.

As local historians turn their gaze to the long and rich history of trans community in Portland, having a clear view of local medical history will be essential, but not exhaustive. The medicalization of trans identity is important and worthy of study, but in focusing our attention to surgery specifically, we risk re-inscribing the false image of trans people as white, well-off professional-class adults. So why study surgery?

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Limiting my research to the medical field allows me to focus deeply on the dis/advantages of medicalization, which will be essential to understand as we move simultaneously towards a social model of trans identity and away from a gatekeeping approach towards medical transition. Additionally, limiting my research to surgery allows me to more carefully consider the diffusion of specific approaches to gender transition. Surgery is unique in medical practice in the prestige it gives to individuals. Surgeons specialize in specific surgeries, often performing the same few operations for the entirety of their career. For highly specialized operations, there may be only a handful of surgeons capable of performing the procedure in the United States at a given time. Because of these factors, the history of surgeries is almost universally framed by focusing on individual surgeons. Little agency is given to the recipients of surgery, who are merely passive objects to be acted upon. Surgeries related to gender transition challenge this framing, because it is the patients themselves who advocate for the procedure. Any history of transgender surgery must move beyond the “great men of history” model that prioritizes surgeons at the expense of patients. It must fully consider the autonomy of transgender individuals, as well as the broader social trends that transcend any individual actor.

The need to investigate both individual autonomy and institutional mechanisms leads directly to my specific research methodology, which moved from institutional archives to personal narratives. I began my research at the Oregon Health & Science University (OHSU) Historical Collections and Archives, where I found only traces of evidence of trans care, and began to understand that these stories were left out of the historical record on purpose. In recent years the OHSU archive has compiled subject files on transsexuality, but it is far from comprehensive. GLAPN’s archive benefits from being established and curated specifically by and for LGBT individuals, but sources from before the late 1980s were nonexistent. After I had the opportunity to speak with someone who underwent sex-reassignment surgery in Portland in the early 1970s, I realized how important personal testimonies would be to this research, both ideologically and practically. In personal testimonies like conversations, interviews, memoirs, and essays, the trans individuals themselves have the power of storytelling, rather than doctors or institutions. Besides this advantage, there simply wasn’t enough institutional memory to not rely on personal accounts. For these reasons, the history I present here is divergent and many-voiced.

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This paper covers just over a century of events, from 1917 to 2019. Its major focus, however, is on the years between roughly 1965 and 2003. 1965 marks the first concerted effort to treat trans patients in Portland, by psychiatrist Dr. Ira B. Pauly. The first major section of this paper covers Dr. Pauly’s arrival in Portland, and the network of surgeons who became involved in trans surgery through association with him. The second half of this paper covers from 1989 to 2003, corresponding with the arrival and departure of Dr. Toby Meltzer to Portland. The decision to end my project here comes from the desire to keep a historical gaze, as well as an acknowledgement of the relative abundance of information on trans life in Portland in the 21st century. Finally, a short epilogue details my own surgery in the summer of 2019, and offers some reflections on the future of trans medical history.

II. Prologue: 1917

Among all types of oppressed people, stories of historical figures who share one’s position in society are highly revered. Leslie Feinberg’s Transgender Warriors makes this point explicitly: hir goal in seeking out trans stories across time and space was “to fashion history, politics, and theory into a steely weapon with which to defend a very oppressed segment of the population”. This is a noble goal, but it comes with its own risks. Perhaps no figure in Oregonian LGBT+ history has been weaponized to the degree of the physician Alan L. Hart. Depending on who you talk to, Hart can be read as a transgender pioneer, bravely asserting himself and living his truth before his time. Alternatively, Hart may be a symbol for strong women, and lesbians specifically, who adopted a male persona to do the things women were forbidden to do: become doctors and marry women. Based on Hart’s writings, it is unlikely that he lived as a man purely for those reasons. But in canonizing Hart as a ‘Transgender Warrior’, we risk essentializing a historical figure based on modern classifications, and we forfeit the opportunity to consider the fullness and complexity of Hart’s story—a life that was mutually constituted by the individual and the world they inhabited. For these reasons, I’ve been hesitant to include Hart in this work. Ultimately, however, it would be negligent to write about trans surgery in Portland without writing about Alan Hart, one of the first individuals to ever undergo surgery for the express purpose of gender transition.

Alan L. Hart was born Alberta Lucille Hart in 1890. Hart was born in Kansas but relocated to Oregon at a young age, and graduated from the University of Oregon Medical School (now OHSU) in 1917. Later that year, Hart began seeing Dr. Joshua Allen Gilbert, a psychiatrist and one of Hart’s professors. Information about Hart’s care by Gilbert come from a case report published in 1920 by Gilbert, entitled “Homosexuality and Its Treatment”. (It is important to note that at this time, same-sex attraction and different-sex identification were conflated under the theory of inversion, which explains Gilbert’s choice of language in referring to Hart as a homosexual.[3] )

Although Hart initially consulted Dr. Gilbert for an unnamed phobia, the topic of sexual identity quickly surfaced. Hart confessed to Gilbert a history of romantic and sexual relationships with women, as well as a life-long association with masculinity. After six months of psychotherapy and limited hypnosis “aimed at the pathological condition”, Hart requested that the doctor “help her prepare definitely and permanently for the role of the male in conformity with her real nature all these years”.[4]

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For Hart, medical transition meant a hysterectomy. Sex hormones such as testosterone and estrogen would not be isolated for another decade[5], and genital reconstruction wasn’t even on the radar for surgeons of the time. Hart justified a hysterectomy for the purposes of ceasing menstruation and sterilization—Gilbert writes that Hart “realized and urged the advisability of sterilization of herself as well as of any individual, afflicted as she was”. Hart used the eugenicist medical framework of the time, with its fixation on controlling reproduction to breed out unwanted populations, to convince doctors to aid in his transition. Gilbert agreed with Hart, and in 1918, Hart received a hysterectomy and began to live as a male. By the time Gilbert published the case study in 1920, Hart had already been forced out of his first job by a former classmate who recognized him from before his transition. This would prove a common theme in Hart’s career—he moved across the Pacific Northwest frequently over the course of his life. Even so, Hart managed to become an acclaimed radiologist, and pioneered the use of x-ray machines to detect tuberculosis. He also published several novels which dealt explicitly with prejudice and greed in the medical profession. Hart died in 1962, leaving behind his wife of 37 years, Edna Ruddick Hart.

Until relatively recently in the historical record, Hart was not considered in the history of transgender identity. In fact, initial scholarship by historian Jonathan Katz in 1967 identified Hart as a lesbian. This association endured, and in 1981, the Portland-based Right to Privacy PAC began using Hart’s birth name in association with their annual fundraising event. This created a controversy between Portland’s gay and lesbian activists and the burgeoning trans movement. After this fight was brought to the public in a 1996 edition of The Oregonian, the “The Lucille Hart Memorial Dinner” became the “Right to Pride Dinner.”[6] Since then, Hart has become a figure of trans history, referred to reverently as a “trans pioneer”. Because Hart’s transition in 1917 was an exceptional case, I have placed it as a prelude to the larger history of transgender surgery in Portland, which begins in earnest nearly 50 years later, in 1965.

III. 1965-1989

In 1972, the Oregon Journal published a profile of Stephani, a transsexual woman who planned to petition the State Welfare Department to cover the cost of her genital reconstruction surgeries. The article takes a sympathetic view towards Stephani, describing her as a "smart-dressing blonde who looks, walks, and talks like a woman". Though some contemporary sources claim that dozens of patients received sex-reassignment surgery in Portland during the 1970s, Stephani is the only person who chose to tell her story publicly and literally put a face on this issue: a portrait of her smiling face and stylish outfit accompany the 1972 article.

In the same article, The Journal also interviewed psychiatrist Dr. Ira Pauly and gynecological surgeon Dr. Raphael Durfee, who are credited as key members of a Portland based team of medical professionals working with transsexual patients. This team left precious few traces in the historical record, making it difficult to ascertain even basic facts such as who was involved and for how long. According to the 1972 article, transsexual operations were "officially banned" at the University of Oregon Medical School (UOMS), so operations took place in private hospitals. Though Drs. Pauly and Durfee were both employed by UOMS, their work with transsexual patients almost certainly occurred in a private capacity. In the 1972 article, Dr. Pauly asserts that 12-15 people have undergone "gender identity operations" under the care of this team. Presumably, the team evaluated far more people than that number, as the gatekeeping model of the time treated surgery as a last resort. In the absence of any way to diagnose gender dysphoria beyond the word of the patient, psychiatrists judged patients based on predicted post-operative success. In his 1965 meta-study of transsexual surgery outcomes, Dr. Pauly cautions against relying on a patient's happiness with the procedure to judge the success of surgery, advocating instead to focus on post-operative adjustment into mainstream society.[7] A transsexual woman's marriage to a man would indicate success, whereas her career as a "female entertainer" indicated failure—regardless of her own feelings on the matter. It is within this environment that Stephani was recommended for surgery.

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After the 1972 article in the Oregon Journal, Stephani disappears from the historical record. In her place, however, came Parish: a transsexual woman whose story was published in her own words under the same newspaper in 1974. Pictures accompanying the four-part series appear to depict the same woman as from the 1972 article, and details regarding the woman's upbringing in Southeast Portland remain consistent.[8] Whether the names were changed for anonymity (the previously named Drs. Pauly and Durfee are unnamed in the 1974 articles) or the author changed her name in the intervening years is impossible to say. Either way, Parish wrote with the intention to "increase the understanding of the public of those with problems similar" to her own.

Parish’s recollection of her childhood closely follows what was then the standard patient profile of transsexual women: she writes that she has “always felt like a girl”, began crossdressing in secret as a young child, and was evaluated by a child psychiatrist for ‘effeminate’ behaviors. Despite having infrequent sexual encounters with men, she doesn’t consider herself to be homosexual, and makes a clear distinction between herself and gay men. These key features are used almost unfailingly to identify the transsexual women described by medical professionals, journalists, and trans women themselves from the 1950s onwards. Rather than an indication of a highly homogenous population, however, the tendency to stay “on script” when talking about transgender identity reflects the power given to the medical label ‘transsexual’, and the doctors who wielded that label.

Transsexual, as opposed to other terms like ‘transvestite’ and ‘crossdresser’ and, later, ‘transgender’, is a uniquely medicalized term: it describes individuals who seek to transition completely (i.e., socially, legally, and medically) to a gender other than the one assigned at birth. Dr. Ira Pauly’s mentor Harry Benjamin is largely responsible for the proliferation of the term transsexual through his work with Christine Jorgensen, a transsexual woman whose sex-reassignment surgery was the focus of intense public attention in the 1950s. It is not surprising that Parish’s story sounds so similar to the typical ‘true transsexual’ described by Benjamin—after all, it is this presentation of her narrative that afforded her access to surgery. In Portland, Ira Pauly stood as the ultimate psychiatric gatekeeper, holding veto power over the medical transition of prospective patients. Surgeons feared opening oneself or one’s institution to liability in performing sex-reassignment surgery—they often cited mayhem statutes that criminalize the removal of healthy flesh or organs, though no surgeon in the United States has ever been prosecuted for performing sex-reassignment surgery.[9] For this reason, a key function of early gender identity clinics was to filter out the vast majority of individuals seeking surgery, referring only the candidates with the smallest probability of adverse outcomes. And because the criteria by which prospective patients were judged was available through published material in academic journals, they were quickly disseminated among people who sought surgery. These individuals learned what psychiatrists wanted to hear and presented their histories according to this script. In turn, doctors took note of the ‘unreliability’ of trans patients to tell their own stories, and mistrust begat more mistrust.[10]

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The ultimate goal for these patients, the thing that psychiatrists had begun to gatekeep, was sex-reassignment surgery. The fourth and final article written by Parish in 1974 recounts her experience undergoing a two-stage vaginoplasty at an unnamed Portland hospital.[11] Parish paid $1,024 out of pocket for the procedure, the result of years of working and saving money with her boyfriend John. Parish writes that the staff at the hospital had been well-briefed about her surgery, and she was treated as a woman and referred to as ‘she’ throughout the process. At the same time Parish had surgery, another trans woman was also undergoing the same procedure, and the two women bonded during their weeklong stay at the hospital. Parish writes that the nurses were ‘really agog at what was happening’, making every excuse to come into the room and ask questions, which Parish answered to sate their curiosity. Sex-reassignment surgery clearly was not an everyday occurrence at the hospital, and its likely that the two women were scheduled at the same time out of convenience for the surgeon, not coincidentally.

Parish describes herself post-operatively as having “attained my goal of having a body to match my sex” and devotes the rest of the article to theorizing about the possible biological, social, and spiritual causes of her transsexuality. I have been unable to find Parish’s full name or anyone else who knew her, so her own words and the photographs included are all that remains of her transition. This is common for those who transitioned medically in the 1970s, as they were often encouraged to move to a new location and start a new, private life once they had transitioned.

In my research for this paper, I’ve only had the opportunity to speak with one individual who was a former patient of Dr. Pauly’s, a Portland resident named Lois.[12] This speaks to the treatment model at the time, where the ideal outcome of sex-reassignment surgery would be the patient’s complete assimilation into mainstream life, where they would not be recognized as transsexuals. Based on the case reports of Ira Pauly, this is the course many of his patients took.

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Lois, who was raised as a girl in rural Oregon in the 1950s, began living as a man after being expelled from university for a relationship with another woman. After some time living as a man[13], Lois sought out Dr. Pauly, who she knew treated transsexual patients. Lois was evaluated by Dr. Pauly and became his patient. In 1969, Dr. Pauly included Lois’ case in an article on what he called female transsexualism for the book Transsexualism and Sex Reassignment,[14] which cast Lois as an ideal candidate for sex-reassignment surgery: she presented no psychosis and placed in the 95th percentile on an IQ test, she was able to pass as a man even before hormone therapy, and she planned on marrying and starting a family in Lake Oswego. After having taken testosterone for a period of time, Lois began experiencing medical issues related to her uterus. At the advice of Dr. Durfee, she had surgery to remove both breasts and uterus at Good Samaritan Hospital in the early 1970s. In Dr. Pauly’s case report he indicated that Lois was seriously considering undergoing phalloplasty to create a male sex organ. The first surgery was traumatic for Lois, however, who recounted in an interview:

"So I went to Good Samaritan Hospital and had the original surgery.  On my own, with nobody at my side, riding my Vespa motorcycle over to Good Sam. And I had both breasts removed and my ovaries and my uterus in one surgery. And when when I woke up, I thought, "Is there anything of me left?" I mean, I just felt like I'd been carved up, which was pretty apt way of thinking about it."

Lois lived in Wallowa as a man for the next two years, until a house fire and the end of a relationship forced her to take stock of her situation, at which point she discontinued medical transition and went back to school to become a physical therapist.  

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Lois’ story serves in stark contrast to Parish’s, who wrote in her articles at the Oregon Journal that her sex-reassignment surgeries had brought her closer to her true self. That Lois and Parish were both judged by psychiatrists and surgeons to be ideal candidates for sex-reassignment surgery underscores the uncomfortable truth that the gate-keeping model of medical transition didn’t lead to ideal outcomes, even by their own standards. Focusing on external indicators like an individual’s ability to ‘pass’ as another gender rather than the patient’s own testimony created a system where individuals like Lois, who made society uncomfortable by refusing to capitulate to stereotypes of their assigned sex, could be led by psychiatrists and doctors down a path that treated society’s discomfort with an individual rather than that individual’s own discomfort. And yet, people like Parish were able to work within the limitations of the time and use the language of medicalization to advocate for their own desires and wrest some measure of self-determination back from a society built by essentializing individuals based on their sex.

Personal narratives must be considered within context, so documents such as academic publications and newspaper reports must also be considered. Parish and Lois’ story both mention Drs. Pauly and Durfee, and hint at other unnamed clinicians involved in aiding medical transition. It is from institutional archives and print journalism that we can get a clearer picture as to the scope of this work in the 1970s. In 1975, Dr. Durfee was interviewed by the Dallas Morning News for his work with transsexual patients. Dr. Durfee, who was in Dallas to address the Association of Operating Room Nurses, presented an unequivocally positive record of Portland’s gender identity clinic. He reported that the clinic had seen 25 patients, 14 of whom had undergone sex-reassignment surgery. The article then elaborates on the distinctions between homosexuals, transvestites, hermaphrodites, and transsexuals— differences that psychiatrists were working hard to try and catalog for the purposes of aiding differential diagnosis. According to Dr. Durfee, once a transsexual is appropriately diagnosed by the clinic, they begin a trial period of one to two years where they present as their preferred gender full time before obtaining surgery. This ‘real life test’ would later be codified by the Harry Benjamin International Gender Dysphoria Association Standards of Care in 1979, which persists to this day in the Oregon Health Plan’s coverage of sex-reassignment surgery.[15] The article ends with Dr. Durfee commenting on the clinic’s perceived excellent results. As evidence towards that claim, he mentions that his patients who are post-operative transsexual men are working in gendered jobs like manufacturing, and that two patients have gone on to start families with a heterosexual partner using artificial insemination.

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In 1976, the Oregon Department of Human Resources appealed an order from the circuit court directing it to issue a new birth certificate for a transsexual man. As part of the appeal, the initial affidavit supplied by the petitioner’s attorney in 1975 was made public record. In the affidavit, attorney John Arenz wrote that his client, known as ‘K’ for the purposes of the case, received sex reassignment surgery at the University of Oregon Health Sciences Center (OHSC) in February of 1974. The surgery was performed by pediatric urologist Dr. Edward S. Tank, who served as Associate Professor of Urological Surgery at OHSC at the time of the surgery. A letter from Dr. Tank was also included in the affidavit, reading:

This letter is to certify that [K] has at this point completed sex reassignment so that he should be considered a male rather than a female. Mr. [K] underwent a complete psychiatric evaluation by Dr. Ira Pauly, internationally known expert on transsexualism, and after that evaluation was considered by the transsexual surgical team at the University of Oregon Medical Center. That team unanimously decided to proceed with the surgical aspect of his sex reassignment. He subsequently had removal of all his internal female organs. Then had genitoplastic surgery to complete the surgical reconstruction. There is no question in the minds in any of the members of the transsexual team or Dr. Pauly that this patient is anything but a male.

This information contradicts the 1972 article, where Dr. Pauly asserts that sex-reassignment surgeries were performed at private hospitals rather than at OHSC/UOMS, and that the Portland-based team operated as private practitioners separate from their affiliation to the university.

Across the handful of sources that mention this Portland team of medical professionals, there are more contradictions than continuities. This presents a historical challenge: how do we account for such widely varying reports, and how does that affect the conclusions we might draw? Based on the evidence covered in this paper, I argue that conflicting facts have their basis in the diffuse nature of the network of people involved. Because the “Portland transsexual team” did not have institutional backing, there was no centralization of information or authority. There is no evidence that the clinicians came together to discuss patients as a group. Instead, the experiences of Parish and Lois suggest that doctors saw patients individually and referred them to other clinicians when appropriate, and that there was no communication between patients. As such, no one would be keeping track of how many individuals were seen by the clinicians as a whole, and the numbers would thus vary based on which clinician was consulted. Because Dr. Pauly is the only member who published research pertaining to transsexuality under his own name, we can conclude that Dr. Pauly was at the center of this network, and the other doctors lent their expertise as necessary. After Dr. Pauly left Oregon for Nevada in 1978, there are no further mentions of a gender-identity focused team in Portland.

IV. 1990-2003

Because gender-affirming healthcare for trans individuals was so controversial, it could not be sustained without a prominent clinician whose primary clinical focus was trans individuals. When Dr. Pauly left Oregon, it’s likely that the other clinicians he worked with saw trans individuals less and less because Dr. Pauly was no longer referring new patients to them. Combined with the public closure of the first and most prominent gender identity clinic, at Johns Hopkins University in 1979, it seemed that the world of academic medicine had lost its interest in transsexualism. Across the country, trans healthcare moved out of research institutions and into private practices—a shift well-documented by historian Joanne Meyerowitz in her definitive account of the medicalization of trans identity.[16] But this shift was neither universal nor linear, as the stories of trans Portlanders in the 1990s shows.

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Aaron Raz Link is an educator, creator, and long-time Portland resident, whose 2007 novel What Becomes You offers a multi-generational perspective on his transition. In describing the process he went through to gain access to medical transition, Link critically examines the medical protocols that guided his doctors’ decisions. At the time of Link’s transition, the fifth edition of the Harry Benjamin International Gender Dysphoria Association's (HBIGDA) Standards of Care was used by most medical practitioners as a guideline for treating gender identity disorder (GID). These standards of care still retained most of the features outlined in the first edition, which was published in 1979, when Dr. Ira Pauly was the president of HBIGDA. According to the standards of care, the correct order of operations for treating GID would be: 1) psychiatric evaluation, 2) “real life test”, 3) hormone therapy, 4) secondary psychiatric evaluation, 5) referral to a surgeon for genital surgery. This prescribed order resulted in a process where the patient had neither sufficient information to make informed decisions on their health, nor the authority to make those decisions. Link writes:

The moment at which I decided to take responsibility for my own health and to cooperate fully and truthfully with my physicians in dealing responsibly with my treatment, my diagnosis became mental illness. Diagnosed as mentally ill, I became legally incompetent to decide on treatment options for myself. I went through this process voluntarily, more or less; like all transsexuals, I had to be declared mentally incompetent to make surgical decisions for myself before a competent and experienced surgeon was willing to perform surgery on me. [17]

The defining feature of Link’s transition was the absence of even the most basic information about what transition might entail. In 1996, Loren Cameron published Body Alchemy: Transsexual Portraits. It was the first time Link had seen the bodies of post-op transsexual men—before then, photos of surgical results were only available through the surgeons who performed them. And according to the standards of care, a patient could only speak to those surgeons after a mental health professional had referred them for sex-reassignment surgery—the culmination of years of psychiatric evaluation and real life experience. The same year that Body Alchemy was published, Link underwent surgery with Dr. Toby Meltzer at OHSU. Initially scheduled for just chest surgery, Link was able to obtain the second letter necessary for genital surgery before the scheduled date, so the surgeon performed chest and genital reconstruction on the same day.

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Dr. Meltzer, a Louisiana-born plastic surgeon, is one of the few medical figures in Link’s memoir who come across favorably. In the decade between Dr. Meltzer’s arrival to Oregon as a a clinical professor of plastic surgery in 1990 and his departure in 2002, he rose to prominence as one of a new generation of reconstructive plastic surgeons who specialized in various trans surgeries. This shift was largely brought about by the rise of the internet. Websites and forums solved the problem of information that plagued Link’s transition: they offered a space outside of the medical establishment that trans people could share photos and stories about their transitions. And because it was the trans patients themselves sharing this information, they could speak candidly about the beside manner and technical skills of the surgeons. In this climate, Dr. Meltzer and other surgeons like Dr. Stanley Biber quickly gained a favorable reputation among prospective and former trans patients. Because Meltzer was such a prominent and prolific surgeon, we can use his career to chart the changes in trans surgery from the 1990s to the early 2000s. Recognizing this potential, OHSU recently conducted an oral history interview with Dr. Meltzer. Much of the following information about Meltzer’s early career comes from this interview, which will be made publicly available in the coming months. [18]

Soon after Dr. Meltzer started at the Plastic and Reconstructive Surgery Division at OHSU in 1990, he was approached by Drs. Robert Demuth and Ed Tank. The two surgeons were both getting ready to retire and wanted to train a successor in sex-reassignment surgeries. This training consisted of observing a metoidioplasty under Dr. Tank and a vaginoplasty under Dr. Demuth, after which the older surgeons began to refer patients to Dr. Meltzer. From this anecdote, it would seem that Demuth and Tank represented the vestige of the network of clinicians initially gathered by Dr. Pauly, who continued to see trans patients infrequently over the course of a decade.

In his interview for the OHSU oral history project, Dr. Meltzer remarks that “doing [sex-reassignment surgeries] sporadically, you’ll never be good at them, and you’ll never get consistent results, so I don’t think it’s a practice to dabble in.” With this in mind, Dr. Meltzer traveled to Trinidad to train under someone who dedicated his entire practice to working with trans patients: Dr. Stanley Biber. At the time, Dr. Biber was the most prominent American surgeon in the field. Meltzer noticed that Biber performed a perineal prostatectomy to remove the prostate gland during a vaginoplasty. This approach was considered outdated by urological surgeons, who preferred retropubic approaches when performing prostatectomies to remove tumors. When he returned, Dr. Meltzer consulted pediatric urological surgeon Dr. Steven Skoog to train him in this unfamiliar approach. Meltzer and Skoog collaborated on the first 50 or so surgeries that Meltzer performed, with Dr. Skoog providing expertise on the urological aspects of the surgery.

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When Drs. Demuth and Tank set out to train Dr. Meltzer, they most likely were envisioning that sex-reassignment surgeries would be one of many surgeries that Meltzer would perform through his practice at OHSU, just as they had been for Demuth and Tank themselves. But in 1993, Dr. Meltzer suddenly gained a high profile when he pioneered a new technique in vaginoplasty to create a sensate clitoris from the glans of the penis. The surgery went well, and the patient shared her experience online for other trans women to read. Suddenly, Dr. Meltzer was receiving calls from people across the country who were looking to have the same surgery. In 1994, for example, the website “The Transgender Support Site” published Dr. Meltzer’s response to an inquiry about sex-reassignment surgery. In this letter, Meltzer identifies himself, Dr. Skoog, and gynecologist Dr. Paul Kirk as the members of OHSU’s “gender dysphoria team” and provides information on the surgeries performed on male-to-female patients.[19] The rise of the internet, combined with the fact that transition-related healthcare was specifically excluded from insurance coverage, created an environment where those seeking surgery were incentivized to “shop around” for surgeons outside of their geographic area. In this environment, Dr. Meltzer’s reputation rose dramatically. By 1996, half of his practice was devoted to sex-reassignment surgeries.

In his interview with OHSU, Dr. Meltzer characterizes the institution as misunderstanding of his practice, suggesting that they saw the relatively long hospital stay required from some sex-reassignment surgeries as a drain on resources. Link’s experience suggests that some at OHSU might have been initially co-operative with Meltzer, only to later grow actively hostile to his practice. In his memoir, Link recalls his experience with Dr. Kirk, who Meltzer had referred Link to in preparation for surgery. After a terse consultation in which Kirk was unwilling to discuss the anatomical details of the procedure, he dropped out of the surgical team. Kirk later served on a medical advisory committee that in 1999 argued against the coverage of sex-reassignment surgery by public insurance. The committee found that “medical evidence on sex reassignment surgery was plagued by a number of important failings”, including the reliance on self-reporting to gauge post-operative success.[20] Over the course of five years, Kirk had gone from being one of three members of OHSUs “gender dysphoria team”, to publicly arguing against the efficacy of sex-reassignment surgery. This change marks an important shift in the treatment of trans patients: as medical transition moved from research clinics to private practice, medical practitioners lost the complete monopoly they previously held on information and judgement making on behalf of their trans patients. Dr. Kirk’s patronizing attitude towards Link during his consultation reflects a paternalistic mindset that contrasts heavily with how trans patients described Meltzer himself. Meltzer’s willingness to discuss matters openly with patients and treat them as competent individuals put him at odds with other doctors at OHSU, and in high demand from trans patients.

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In 1996, Meltzer obtained operating privileges at Eastmoreland Hospital in Southeast Portland, at the time the smallest hospital in the state. Moving to Eastmoreland would have allowed Meltzer to guarantee overnight beds for patients, and give him more control over his surgical team. When Link had surgery in 1996, he was originally scheduled at Eastmoreland Hospital, but was rescheduled to OHSU. Though it was intended to be an out-patient surgery, Link had complications that necessitated an overnight stay, and experienced hostility from nurses there who withheld painkillers. Experiences like this highlighted that Meltzer and his patients were not welcome at OHSU, and probably contributed to Meltzer’s decision that year to leave OHSU and operate exclusively from Eastmoreland. For the next six years, Meltzer steadily grew his practice, seeing more patients and offering more surgeries.

Though he made a point of declining media interviews, Meltzer nonetheless advertised his practice among the newly forming trans community through appearances at the Esprit Gala. First held in 1990, the Esprit Gala, a week-long convention in Port Angeles, Washington, has been a staple of the trans community in the Pacific Northwest since its founding. Esprit catered to a larger demographic than just those pursuing medical transition—it was largely attended by part-time crossdressers, who lived professionally as men but found joy in presenting as women, and especially in forming friendships with other crossdressers. The attempts of psychologists like Ira Pauly to describe and differentiate between different forms of transsexuality had failed, and support and social groups increasingly turned towards the usage of transgender as an umbrella term to cover a wide spectrum of cross-gender identity and presentation. Meltzer was a staple at Esprit while his practice was active in Portland; in a 1997 article of the Northwest Gender Alliance’s monthly newsletter, contributor Elaine Lerner mentions Meltzer’s appearance at that year’s Esprit Gala. She writes that Meltzer and most of his surgical team had driven up to Port Angeles to give a presentation on the different surgeries that Meltzer offered, and that “several of Dr. Meltzers girls – pre- and post-op – were in attendance”.[21] This outreach to the trans community was still relatively rare for medical practitioners, and marked a significant departure from the previous generation of surgeons.

Accounts written by patients of Dr. Meltzer’s about their surgeries can still be found on the internet today, though many are linked to abandoned domains. Christine Beatty’s website glamazon.net is somewhat of a time-capsule, offering a view into the internet before social media, where people collected information and personal writings on their own websites. Pages upon pages of Beatty’s ‘transition diary’ offer reflections and photos from every step along the way in her social and medical transition, and a ‘links’ page directs readers to similar websites curated by other trans women. Much of the content on her website was reformatted into a memoir that Beatty self-published in 2011, entitled Not Your Average American Girl. In it, Beatty shares intimate details of her sex-reassignment surgery at Eastmoreland Hospital in 2002.

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Beatty writes that she initially became aware of Meltzer’s practice after reading online about surgeons who accepted HIV+ patients for sex-reassignment surgery. Meltzer was an outlier in this regard—surgeons at the time largely refused to operative on HIV+ patients, fearing increased complications or transmission of the disease from the patient to surgical staff.[22] The prevalence of HIV/AIDS among trans people also further stigmatized their bodies and cast them as unreliable narrators of their own histories, adding yet another excuse to deny bodily autonomy. Meltzer’s willingness to operate on HIV+ patients so long as they maintained T-cell counts above 200 is another reason why trans people outside of Portland traveled into the city to receive surgery.

In the years between Link and Beatty’s surgeries, post-operative care for patients had improved by leaps and bounds. Beatty writes about the nurses who cared for her in the weeks following her vaginoplasty as being knowledgeable and attentive, guiding Beatty in the delicate and intimate post-op care of vaginoplasty, such as vaginal dilation. After four days in Eastmoreland Hospital, Beatty was sent to TLC, the Temporary Living Center at Meridian Park Hospital in Tualatin. The TLC offered a place for patients to recover in a hospital-like environment with on-duty nurses, and Meltzer often sent patients there rather than keep them at Eastmoreland or send them home. An account by David Schreier, a trans man who underwent metoidioplasty with Dr. Meltzer in 1996, also mentions the TLC as a positive place where he was treated well by nurses.[23]

Beatty’s vaginoplasty was performed by Meltzer at Eastmoreland hospital in October of 2002. By January of the following year, Dr. Meltzer was seeing patients out of Scottsdale, Arizona. What changed? In March of 2002, Eastmoreland hospital was bought by Symphony Healthcare, a private corporation based in Nashville, Tennessee. Soon after, Meltzer learned from hospital administrators that his operating privileges had been revoked. According to Meltzer, he was told by administrators that they could not attract new physicians as long as Meltzer’s patients took up such a large percentage of the hospital’s business. Knowledgeable about the city’s antidiscrimination clauses, Meltzer attempted to contact then-Mayor Vera Katz, but did not receive a response. An attorney fought for Meltzer to retain his privileges at Eastmoreland until the end of 2002, so that already-scheduled surgeries would not have to be cancelled. During this period, Meltzer says that he contacted nearly every hospital in the state of Oregon, none of which were willing to grant him operating privileges. As a result, Meltzer moved to Arizona and began operating out of The Greenbaum Specialty Surgical Hospital in Scottsdale.

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Eastmoreland Hospital struggled without the revenue provided by Meltzer’s patients—just two years later, the hospital only filled an average of 12-17 of their 100 beds at a time.[24] In 2004, Symphony Healthcare announced the closing of Eastmoreland, along with Woodland Park Hospital, another institution purchased by Symphony in 2002. Symphony’s CEO Ken Perry blamed the closures on the fact that the two major insurance providers in the region excluded the hospitals from their network, though it’s unclear whether Eastmoreland had been included previously. The building itself was sold to Reed College and demolished shortly after. [25]

Meltzer’s departure from Portland in 2003 was not the end of trans surgery in Portland, but it was certainly an inflection point. According to Meltzer, hospitals in Portland at the time were unwilling to associate themselves with a polarizing practice like sex-reassignment surgery, and the lack of institutional support from OHSU made the gender clinic model of the 1970s infeasible. In response, trans people in Portland sought surgery elsewhere—in centers across the country and overseas. When surgeons saw trans patients, it was to address complications from previous surgeries they had traveled to access.

Meltzer’s tenure in Portland represents a distinct moment in local trans medical history: one marked by the markedly unequal flow of information between trans patients and practitioners, as well as the predominance of a few surgeons operating out of private clinics and drawing patients from across the country. In contrast, the system of trans healthcare that exists in Portland today is the result of a confluence of factors in the 2010s: the increased visibility of transgender experiences in media, the transformation of the Oregon Health Plan, and the national rise of a multidisciplinary clinic model of trans health. Because these changes are so recent, and because they are being implemented in institutions that have reason to record them, I have chosen not to cover these more contemporary events in this project.

V. Epilogue: 2019

In 2015, after years of organizing from trans Portlanders and their allies, the Oregon Health Plan extended coverage for transition-related healthcare, including some surgeries. In the following year, the three major healthcare providers in the city: OHSU, Kaiser, and Legacy Health, each established their own clinic/program focused on transgender healthcare. OHP’s extension of coverage (which came after many private insurance providers had already extended coverage, thanks to the tireless work of LGBT community activists) incorporated trans surgery into the mainstream, institutional healthcare world—for better and for worse. One of the effects this had was to draw transgender people from around the country to Oregon in search of medical transition. Neola Young, who works with Legacy Health on transgender healthcare, says they often field questions from people who plan to move to Portland for access to medical care, legal protections, and community. I can personally vouch for this phenomenon—in 2017, I moved from North Carolina to Portland for college, and a significant factor in my decision was the promise of surgery.

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I am a transgender man, and I have been binding every day since the age of 14. By the time I was 17, I knew I wanted top surgery. When I arrived on campus in the fall on 2017, I hit the ground running, aiming to have surgery the following summer. I hit an immediate roadblock: OHSU wouldn’t even schedule a consultation until I had a letter from a therapist. After the three months it took to establish care with a therapist in Portland to write me a letter of referral, I was able to schedule a consultation for June of 2018. After my consultation, I could finally begin the process of scheduling the actual surgery. In a cruel twist of bureaucratic fate, the referral letter I had received in the fall was already out of date, and I had to get an updated version before insurance would agree to cover the procedure. One consequence of adding insurance to the equation, it seems, was that the waiting time to schedule surgery now outpaced the expiration of the letter needed at both ends of the process. At the end of that summer, I finally received my surgery date: June 20th, 2019. It seemed like an eternity away, and I filled the time reading countless accounts of people’s top surgeries in Portland and elsewhere, available through the forums and servers that trans people have used to share information since the early days of the internet.

When I learned about the opportunity to work with GLAPN on a project about LGBT history here in Portland over the summer, my immediate first thought was of Alan Hart, a figure I learned about from the 2018 Pride edition of PDX Monthly.[26] There would be just over 100 years between Hart’s surgery at UOMS in 2017 and my own surgery at that same institution in 2019. It seemed only fitting: I would be physically restricted to Portland for the summer because of my surgery, and I could spend that time investigating surgeries like it in Portland.

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By the date of my operation, I had already been working on this project for about six months. In all of the surprising and interesting information I had been able to turn up, by far the most impactful were the testimonies from other trans people about their surgeries. I read and listened to these stories as primary documents, but also as instruction manuals. It was the first time I had truly connected to trans people across generations, and it helped me feel more grounded and secure in my medical transition.

I walked into this experience expecting as much, and I did indeed find comfort in my research. But I also found stories that pushed and prodded me into discomfort, creating dissonance between my identity as a trans person and the figure of a transsexual that emerged from case reports, court documents, and oral histories. My conversations with Lois forced me to engage with the trauma that trans identity can bring, and its use by medical professionals to rationalize deviation and make non-conformity intelligible. Reading the medical literature, I found that the surgeries performed on transsexual adults were made possible from the experience those surgeons gained by operating on intersex infants and children. Amid all of the connections I felt to the trans people I learned from, there were disruptions that broke the lazy line I had drawn from Alan Hart to myself. As I write this, I think to Sandy Stone’s refutation of the standard transsexual discourse: “"Making" history, whether autobiographic, academic, or clinical, is partly a struggle to ground an account in some natural inevitability.” [27]

This project indeed has engaged with history making through the personal, academic, and medical. But in blending these forms, I risk making the argument that there is some essential, unchanging trans identity, and that the purpose of trans history is to study how that fixed point changes under the variable of chronology. The reality is far more complicated, something I hope has come across in this account. Even the first words of this paper speak to this, through the ‘quick note on language’. The first task of telling trans history is to invent trans history.

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In spite of (or perhaps because of) these difficulties, I believe that the history covered here is useful on two major levels. The first, and most shallow level, is the representational: studying trans history, ideally, lifts up the voices of trans individuals, and helps this generation of trans people recognize themselves in the annals of history. But the second level, more difficult and more rewarding, is the analytical. Understanding the history of medical transition provides us with a deeper understanding of medicine’s role in reifying social categories. As an example: medical transition occupies a contested space in between Ian Hacking’s examples of multiple personality disorder and high functioning autism—he distinguishes the two by his response to the question: did this type of person exist before the diagnosis was created?[28] In this paper, we have seen the ways in which transsexuality as a type of person was consciously co-created by doctors and their patients. And yet, Alan Hart reminds us that medical transition predates the diagnosis of transsexuality by decades. Where along Hacking’s continuum might transsexuality fit? Would transgender identity occupy a different space? I cannot resolve this issue, but it makes clear that grappling with the full history of trans healthcare is worthwhile beyond its representational role. It is my sincerest hope that this work lays a strong foundation for future analytical forays into this area, and wherever else it might be useful.

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