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Sex reassignment surgery had an earlier life, in an unexpected time and place: 1920s Germany. Several doctors there performed such surgeries using analog technology and organic hormones. They worked under a new paradigm: What if they could make someone’s body fit their mind instead of forcing their mind to fit their body?
Hirschfeld saw himself as an activist, constantly referring to a motto of “justice through science.”—which also made him a target of Germany’s rising far right. In 1921, he was jumped after a lecture and left for dead on the street.
He persisted, though, and became an intermediary between the German government and the trans community. One story tells of a trans woman who was arrested on counts of female impersonation. The judge contacted Hirschfeld, who consulted with the woman. She requested and received reassignment surgery, and later worked in Hirschfeld’s Institute for Sexual Science.
Two of Hirschfeld’s colleagues performed numerous reassignments and began to realize that their patients tended to be wealthy Germans. They publicized their surgeries in newspapers, hoping poorer trans people could learn about the procedures and get in touch.
By the early 1930s, people came from around the world to undergo reassignment surgery in Berlin.
Upon the rise of Adolf Hitler and the National Socialist German Workers Party (the Nazi Party) in Germany, gay men and, to a lesser extent, lesbians, were two of the numerous groups targeted by the Nazis and were ultimately among Holocaust victims. Beginning in 1933, gay organizations were banned, scholarly books about homosexuality, and sexuality in general, (such as those from the Institut für Sexualwissenschaft, run by Jewish gay rights campaigner Magnus Hirschfeld) were burned, and homosexuals within the Nazi Party itself were murdered. The Gestapo compiled lists of homosexuals, who were compelled to sexually conform to the "German norm."
Between 1933 and 1945, an estimated 100,000 men were arrested as homosexuals, of whom some 50,000 were officially sentenced. Most of these men served time in regular prisons, and an estimated 5,000 to 15,000 of those sentenced were incarcerated in Nazi concentration camps.
Hitler also publicly raged against the “vice” of homosexuality and the “degenerate” lives of transsexuals. They weakened the Aryan cause.
The setting for the first transgender surgeries (mostly male-to-female) was in university-based clinics, starting in the 1950s and progressing through the 1960s and the 1970s. When the researchers tallied the results and found no objective proof that it was successful—and, in fact, evidence that it was harmful—the universities stopped offering sex-reassignment surgery.
Since then, private surgeons have stepped in to take their place. Without any scrutiny or accountability for their results, their practices have grown, leaving shame, regret, and suicide in their wake.
Surgical regret is actually very uncommon. Virtually every modern study puts it below 4 percent, and most estimate it to be between 1 and 2 percent (Cohen-Kettenis & Pfafflin 2003, Kuiper & Cohen-Kettenis 1998, Pfafflin & Junge 1998, Smith 2005, Dhejne 2014). In some other recent longitudinal studies, none of the subjects expressed regret over medically transitioning (Krege et al. 2001, De Cuypere et al. 2006).