[Received from Dallas Denny ]

It's sad that more than 20 years after the fact, the fraudulent 1979 Meyer & Reter journal article (The infamous "Johns Hopkins study") continues to be cited as if it meant something (Letter to the Editor by Kelli McAllister, GAIN, 9/3/00).

The study in question, which was authored by Hopkins Gender Clinic director Jon Meyer and his secretary, Donna Reter, was published in The Archives of General Psychiatry, and purported to show "no objective improvement" in MTF transsexuals after sex reassignment surgery. The study, which has findings inconsistent with dozens of other outcome studies, was immediately and widely attacked as methodologically unsound and was eventually revealed to be fraudulent. It now appears that the authors' intent was political rather than scientific and the data were cooked (i.e., either made up or prefentially selected while ignoring data that did not support the authors' political agenda). Meyer publicized the findings widely and succeeded in his goal of getting the Hopkins clinic closed; however, this was absolutely a political closing and not a scientific one, as Ms. McAllister has implied.

Follow-up studies indicate high rates of satisfaction with SRS. Dissatisfaction, when it occurs, is generally because of poor surgical results and complications; there seem to be few regrets that the genitals have been transformed.

Thank you.

Dallas Denny

Hi Dallas Denny -

Sorry I made you sad ("It's sad that more than 20 years after the fact, the fraudulent 1979 Meyer & Reter journal article continues to be cited as if it meant something").

I'm not trying to be a wiseass when I say I'd really like to know where I can find information on the Meyer & Reter article to which you refer, and its link to Johns Hopkins. I've searched everywhere, including an exhaustive search on the Hopkins site itself, to no avail. Nothing. All I know is, they supposedly performed SRS in the past. Now they don't. Seems like if the report was really found to be bogus, SRS operations should have resumed.

Also, where can I find empirical documentation on alternative SRS results, NOT from a biased source but from an objective and reputable third-party scientific methodology? I've never met anyone without an agenda ... no one really wants to discover the truth. But belive it or not, I'm the exception: I'm eager to research anything that can lead me to solid scientific answers regarding post-op results. I just don't wanna waste my time with any results earlier than five years after surgery (the "honeymoon"), nor from a subjective source.

I keep coming back to this question: Why hasn't a single large hospital or established medical institution (County USC, e.g) embraced this surgery? Have you known the medical profession traditionally to turn down an opportunity to make an extra buck or two?

For that matter, why does virtually no insurance company cover SRS costs, considering how it's supposed to be a vital treatment for transsexuals?

I think these are legitimate questions. It disappoints me that earnest dialogue is disallowed in the Temple of the T Demigods. Oh well ...

Since Penni chose to print a couple of responses to my letter, neither of which documented any source for their conclusions (sorry, my friend, you never mentioned a single specific study in your response ...), I'm thrust in the unfortunate position of whipping girl without an opportunity to defend my position.

I was considering the ramifications of this earlier today; anyone can run anything about anybody with complete impunity, and largely without fear of reprisal. Penni has said in the recent GAIN that she's not inclined to continue the debate, so whatever you and Michelle said is the last word. Period.

In case you're highly motivated, I thought you might like to read my private response to Michelle. And I promise, this will be MY last word on the subject, too. :)

-- Kelli McAllister

{Email response from Dallas Denny}

Emotion rules in the treatment of transsexualism much more than does logic. The report was a ploy by psychiatrist Paul McHugh and clinic director Jon Meyer to close the clinic-- which was closed not because of the data but because of the publicity campaign McHugh and Meyer waged in close the clinic. Because the Hopkins clinic was the prototype upon which the other 40 plus U.S. clinics were based, they all went out of business within a year or so. Most just shut down; a couple privatized.

Here's the reference to the Meyer & Reter paper. It's not difficult to find. It's widely referenced:

Meyer, J.K., & Reter, D. (1979). Sex reassignment: Follow- up. Archives of General Psychiatry, 36(9), 1010-1015.

The Meyer & Reter study was immediately attacked as methodologically unsound. A good summary of the criticisms can be found in:

Blanchard, R., & Sheridan, P.M. (1990). Gender reorientation and psychosocial adjustment. In R. Blanchard & B.W. Steiner (Eds.), Clinical management of gender identity disorders in children and adults, 159-189. Washington, D.C.: American Psychiatric Press.

Blanchard & Sheridan also critique the study, some 10 years after its publication.

You might also check out:

Ogas, O. (1994, 9 March). Spare parts: New information reignites a controversy surrounding the Hopkins gender identity clinic. City Paper (Baltimore), 18(10), cover, 10-15.

which describes the conspiracy to close the Hopkins clinic (attached). Most likely Meyer (Donna Reter was his secretary and probably had little to do with anything except typing) and McHugh looked about until they found some data which supported their political aspirations to close the clinic; in other words, it appears the study was compiled post-hoc, although purporting not to be. No other explanation can come so close to explaining such a truly methodologically unsound study.

"Also, where can I find empirical documentation on alternative SRS results, NOT from a biased source but from an objective and reputable third-party scientific methodology? I've never met anyone without an agenda ... no one really wants to discover the truth. But belive it or not, I'm the exception: I'm eager to research anything that can lead me to solid scientific answers regarding post-op results. I just don't wanna waste my time with any results earlier than five years after surgery (the "honeymoon"), nor from a subjective source."

The literature is replete with outcome studies. If you can lay a hand on my Garland bibliography, it contains a complete list through 1994. Amazon.com has it, I think, for $30, but most university libraries should have it. It's called _Gender Dysphoria: A Guide to Research_. It lists perhaps several hundred outcome studies, almost all of which indicate the surgery is helpful. Some studies focus on patient satisfaction, others on more objective outcomes. The studies from the Netherlands are perhaps the best, for they tracked large numbers of transsexuals for some years. Blanchard et al.'s study of regrets is interesting, for they found that transsexuals are most likely to be unhappy not about having had the surgery, but about bad surgical results. Here are a few studies:

Blanchard, R., Steiner, B.W., Clemmensen, L.H., & Dickey, R. (1989). Prediction of regrets in postoperative transsexuals. Canadian Journal of Psychiatry, 34(1), 43-45.

Green R., & Fleming, D.T. (1990). Transsexual surgery follow- up: Status in the 1990s. In J. Bancroft, C.M. Davis, & D. Weinstein (Eds.), Annual Review of Sex Research. Society for the Scientific Study of Sex, P.O. Box 208, Mount Vernon, IA.

Kuiper, A., & Cohen-Kettenis, P. (1988). Sex reassignment surgery: A study of 141 Dutch transsexuals. Archives of Sexual Behavior, 17(5), 439-457.

Lindemalm, G., Korlin, D., & Uddenberg, N. (1986). Long-term follow-up of "sex change" in 13 male-to-female transsexuals. Archives of Sexual Behavior, 15(3), 187-210.

Lindemalm, G., Korlin, D., & Uddenberg, N. (1987). Prognostic factors vs. outcome in male-to-female transsexualism: A follow- up study of 13 cases. Acta Psychiatrica Scandinavica, 75(3),

Green, R. (1998). Conclusion to Transsexualism and sex reassignment: Reflections at 25 years. In D. Denny (Ed.), Current concepts in transgender identity, pp. 419-423. New York: Garland Publishing.

Taken as a whole, outcome studies overwhelmingly indicate subjective satisfaction in about 85% of patients; regrets usually happen to those who haven't followed the SOC. Someone (I'm not sure who-- Green & Fleming, listed above?) recently did a metanalysis of outcome studies; it would be worth reading.

There are problems with SRS. Quality of surgery varies, the orgasm rate for MTFs seems to be about 25-30%, and self-promoting surgeons like (100% orgasm Biber) need to be held accountable for their advertising. However, most people who have it are glad they did, and that includes perhaps 400 people I personally know who had it.

The transgender movement is largely about moving away from binary gender roles, and that includes the right to have or not have surgery regardless of one's gender role. Sometimes people have have recently had SRS, like Dana, get a bit carried away. Sometimes post-ops believe SRS legitimizes them in some way (See Anne Lawrence et al.'s statement about the Michigan Womyn's Music Festival for an example of this). Sometimes people who elect not to have surgery have a lot of emotion tied up in trying to justify their decision by demonstrating that SRS is evil, wrong, misrepresented, or just a mistake. Bottom line, it's here to stay, and some folks will have it and some won't.

"I keep coming back to this question: Why hasn't a single large hospital or established medical institution (County USC, e.g) embraced this surgery? Have you known the medical profession traditionally to turn down an opportunity to make an extra buck or two?"

This is the sex-negative U.S. culture. Hopkins took a huge risk in starting their gender clinic and at the first hint of trouble (even artificially manufactured trouble) it got a huge amount of negative publicity. What large U.S. institution would risk it? Nontheless, there are several university-affiliated gender programs in the U.S., and any number of private practitioners.

I wrote Paul McHugh about five years ago, pointing out that although his success in closing the Hopkins clinic led to more SRS because it created a market economy. That's what we have now; the days of the big university gender program is gone, and good riddance.

Other countries, for instance Germany, the Netherlands, the U.K., Australia, Canada, and several Eastern European nations all have gender programs.

"For that matter, why does virtually no insurance company cover SRS costs, considering how it's supposed to be a vital treatment for transsexuals?"

Insurance companies don't have much of a clue. Janice Raymond waged a campaign of disinformation in the early 80s, managing to convince the HCFA to let her write a paper on the subject. You can imagine what she wrote. Insurance companies are phobic, as is much of the rest of the U.S.; they don't want to take risks on a controversial treatment-- and SRS is still and will probably always be controversial.

Hi Dallas Denny -

Thanks for being ... well, honestly, the first intelligent transsexual with whom I've had the privilege to correspond. Your exhaustive bibliography and obvious knowledge of SRS is a privilege to behold, and your apparent lack of an agenda is refreshing in the traditional cacophony of pugnacious cant.

You may have caught the gist of my response to Michelle Steiner when you intimated your agreement that trannies need not all be cut from the same cloth, and Dana Rivers' overzealous definition of "woman" might not have been your own personal anatomical interpretation.

I read your attached download text; very interesting, but I feel the Meyer-Reter study has been "spun" by post-ops. The main criticism of the study seems to be that it focused on SRS candidates who exhibited various degrees of suicidal tendencies, and that inherently skewed the study. But later in the same article, defenders of SRS state that surgical candidates view the surgery as inevitable and mandatory, and will go to dangerous extremes in its absence (specifically referring to the T who blew her penis off in a Winnebago). Ergo, ALL trannies are potential suicides in the absence of SRS, based on this newspaper article.

I also suspect any study conducted prior to, say, five years post-op. From my own surgeries I know the honeymoon period can be lengthy and powerful. A few years down the road, however, when employers still won't hire you or "normal" men still won't date you, the reality of transsexual existence may ameliorate whatever initial blush of womanhood the patient enjoys.

I obviously know several post-ops. Frankly, DD, they're all crazy, and in SERIOUS denial. As facilitator of our local support group for two years, believe me when I say: there are so many secondary psychological and sexual and emotional issues for nearly every T, the LAST thing most of us need is irrevocable surgery to remove a functioning body part and a necessary physiological hormone. Stabilize, babe, then we can talk ...

The most cogent quote in the article you forwarded came at the end, from Dr. Money: "Transsexuals do not become the opposite sex after surgery-- they remain transexuals." Sadly, I'm ignored when I try to emphasize that point to my friends who believe SOMEONE ... their ex-lover, their disowned family, the entire world ... will love them when they address the "cognitive dissonance" found in a woman with a penis. But it almost never happens.

Anyway, thank you again for trying to shed some light on the SRS political hot potato. It was a pleasure hearing from someone besides the peanut gallery. :)

-- Kelli McAllister

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