Totally irreversible

Charles Foley

Los Angeles

Doris Richards, a thirty-six-year-old girls' Physical education teacher at Emery High School in California, decided last year to become a man. She took six months sick leave and went to the Gender Dysphoria Clinic at Stanford University, one of forty Medical institutions in this country which try to help transsexuals, through hormone therapy and surgery, achieve the transformation they have sought for most of their lives.

Today, Doris Richards is Steve Dain, a bearded, mascular, post-operative man. His case has divided the small town of meryville and attracted national atten tion, because Dain — unlike the majority of transsexuals — has refused to leave town, give up his teaching career and find a lower Paying job elsewhere. He is fighting to keep lits job at the school, and says he'll pursue the case to the Supreme Court if need be. Dam will probably have to do just that. Although last January a state hearing board overturned his dismissal by school chiefs, theY are appealing that decision.

Steve Dain is one of at least 10,000

People in the US with this puzzling llersonality disorder. The transsexual has !ne physical equipment of one sex, yet feels rnmself trapped, by a fluke of nature, in the b°dY of the other. The operation which completes gender transformation is becoming Increasingly common in America, and the public seems to be growing more tolerant and understanding of those who

undergo it.

DaM — despite much vociferous, Bibleheating protest, and a three-to-one vote by Ihe School Board to fire him — says he has .round a lot of support in Emeryville, an industrial community with a large black PoPulation. He is convinced that the

majority of children, and their mothers, would like to see him back at the school.

At public hearings in the School Board offices, many spoke up for him, including Ms Juanita Forester, a teacher who heads the Emeryville Teachers' Association. 'Steve Dain has the right to a tenured post,' she says. 'He's a very fine teacher, he's in excellent mental and physical health and 1 for one wish that both adults and students would stop fussing and look on this as one more educational opportunity.' Dain himself says he's never felt better, psychologically as well as physically. A short (5ft 4ins) man, with blue eyes, sandy hair, and a well-muscled 140lb body, he says that he has always possessed male emotional drives. He also had some male physical characteristics. As Doris Richards he had the same muscular build; he was very hirsute, had to shave and use astringent creams to drive away a beard. The Stanford University clinic decided that his gender difficulties were not purely psychological. The clinic began work in 1968 and since then has performed more than 150 operations, mostly male-to-female in the early years, but today almost equal in ratio. Public acceptance and the medical profession's legitimisation of the operation haVe encouraged more women to come forward.

Patients are of all ages, colours, creeds and stations in life. The Stanford clinic's youngest transsexual is a boy of sixteen, who is receiving preliminary hormone therapy but will not have the operation until he comes of age. Its oldest was a woman of sixty-five years. One was a top-level corporation executive who, on reaching retirement age, divorced his wife, took the Stanford treatment and went to live as a woman in a small Western town where no one knew his past.

A growing number of doctors are now providing this -surgery more or less on demand. But at Stanford the patient must pass through a long screening process, beginning with a series of probing interviews, for which $200 is charged, `to discourage cranks'. People with obvious emotional problems — some transsexuals have attempted suicide, others have alcohol or drug troubles — are referred to a psychiatrist. Those with a physical build which would make it hard for them to appear as a member of the opposite sex are also discouraged. The married are told they must divorce.

It's a costly procedure. Surgery and hospital run to around $5,000, with hundreds more dollars for such iterns as electrolysis to remove hair (more than 100 sessions are needed) and post-operative counselling. Medicaid, the government health service, won't foot the bills, nor will the great majority of insurance companies. This is elective surgery, they say: no illness is involved. Most experts, however, while differing on whether the cause is hormonal imbalance or early childhood conditioning, agree that it is a serious mental and sometimes physical.

Transsexualism is often confused with homosexuality. But in fact the two are at opposite ends of the psychological spectrum: the homosexual is so pleased to be the sex he/she is, that the opposite sex is excluded; the transsexual actively dislikes the sex he/ she is and will go to extreme lengths to change it. 'People don't understand this difference,' says Steve DaM — who has lived for several years with a woman friend, Pat. When Dain was 'Doris Richards' people thought they were a lesbian couple. 'But true homosexuals never want to change their sex: the idea is repellent to them.'

The operation is not the end of the road for a transsexual. For the male, it means removal of male organs, construction of artificial female genitalia; for the female, it means all that, in reverse order, plus a hysterectomy and a double mastectomy. And then, for the rest of their lives, patients must continue hormone treatment. Estrogen for men, softening skin and producing a more womanly body. Androgen for women, deepening their voices, preventing menstruation and increasing hair growth.

'Obviously, an individual who would undergo such an elaborate and costly procedure is not doing so lightly,' says Dr Norman Fisk, co-director of the Stanford programme. 'For many, this is a last hope.' After years of anxiety and mental suffering some patients are suicidal, or deeply depressed and unable to cope with life.

The Stanford clinic claims a remarkable success record: all but three of the 150-plus patients have adapted well to their new sexual identities. The three were all formerly men. They find life as women harsher, less socially rewardibg, and poorly paid. But the operation is irreversible.