Harry Benjamin: a Pioneer in Transgender Care

Early Life and Education

Harry Benjamin was born in Berlin, Germany on January 12, 1885 to a German mother and Jewish father. He was the oldest of three siblings. His father converted to Lutheranism shortly before Dr. Benjamin’s birth. Dr. Benjamin enjoyed opera from a young age, and was enamored with singer Geraldine Farrar, who sang at the Royal Opera. In his frequenting of opera houses, he became acquainted with a house physician, and began to learn his trade from him. He served in the Prussian Guards prior to his medical studies. (Zagria, 2012)

Dr. Benjamin met Magnus Hirschfeld in his early twenties, and subsequently read Die sexuelle Frage. Eine naturwissenschaftliche, psychologische, hygeinische und soziologische Stude fur Gebildete (The sexual question. A scientific, psychological, hygienic and sociological study for educated people) by Auguste Forel, which piqued his interest in human sexuality (Schoen, 2007). He and Dr. Hirschfeld frequented gay bars to observe their drag shows, as their shared interest was in human sexuality, and what Dr. Hirschfeld called “transvestites” a very outdated term that he coined during his study in 1910, used to describe individuals who dress as the opposite sex, usually males dressing as female, for sexual or other kinds of satisfaction. This was the first major study on transgender individuals, and Dr. Hirschfeld founded the “Institute of Sex” (translated from German), which was later destroyed by Hitler at the start of the Holocaust. These outings were Dr. Benjamin’s introduction to the field of sexology.

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Education and Early Career

Dr. Benjamin studied medicine at The University of Tbingen in Baden-Wurttemberg, Germany. (Schilt, 2014) He finished his academic program in 1912, and wrote his final dissertation on tuberculosis. During his post-graduate years, he worked with several different doctors in various field. One of these doctors had finally cured tuberculosis of the joints, which was a huge development in 1913. A wealthy banker paid a large amount of money for Dr. Benjamin to travel to New York to cure his son. The press had reported that the cure worked better than it did, and when Dr. Benjamin was unable to cure his son, the banker refused to pay for his trip back to Germany.

Dr. Benjamin attempted to return home in 1914, but was on a ship that was heading for an area that France had hostile control over, and the ship’s captain opted to turn back, and Dr. Benjamin was left with his “last dollar.” Upon realizing that he was stuck in New York indefinitely, Dr. Benjamin found a job at a New York hospital. In 1925, Dr. Benjamin married his wife Gretchen, and soon after his mother came to live with him after his father died.

Dr. Benjamin also met Sigmund Freud in 1925, who was not fond of him because of a joke that he made: “disharmony of the emotions may… be the dishormony of the endocrines.” Of course Freud’s assumption was that Dr. Benjamin was a “latent homosexual.” (Zagria, 2012)

Sexology and Transsexual (Transgender) Research

In 1930, Dr. Benjamin and his wife brought Dr. Hirschfeld to the United States, and they worked together on private lectures. In 1945, he was introduced to Dr. Alfred Kinsey, the creator of the well-known Kinsey Scale, which is a gradient scale to describe one’s sexuality (table 1).

Three years later, Dr. Kinsey referred a patient whom had a genuine desire to transition, and he had never encountered this before. He referred this patient to Dr. Benjamin, and this was the first patient that Dr. Benjamin recognized to be different than a transvestite this is when he coined the term “transsexual.” This first patient was Christine Jorgenson, who subsequently became a well known actress, and spoke openly and regularly about her gender identity and treatment, which consisted of psychotherapy, hormone therapy, and several very successful surgeries. (Schoen, 2007) In the next twenty or so years, Dr. Benjamin would see hundreds of patients with similar ailments, counsel them, and aid in their transition.

Dr. Benjamin studied not only the physical effects of the transitional process, but also the emotional, mental, and behavioral issues. In 1966, he released “The Transsexual Phenomenon,” which documented his studies on hundreds of patients, about half of which were diagnosed transsexual (as opposed to transvestite). In Dr. Schoen’s memorial video, published in 2007, it is noted that “this book brought many patients their first ray of hope, and taught many professioals their first lesson on the subject of gender identity.” (Schoen, 2007) He came up with the “Benjamin Scale,” which scored patients between transvestite and transsexual, judging them on items such as gender feeling, dressing habits, the infamous Kinsey Scale, conversion operation, hormone medication, and psychotherapy (table 2). In his studies, he found that with physical changes, such as those brought on by hormone injections, his patients started to feel more emotional and mental congruency with their bodies. This gave them comfort, and they were finally able to excel as human beings and citizens. (Benjamin publication, 1966)

In 1966, Dr. Benjamin gave a lecture in Los Angeles about his first contact with transsexuals. He treated a trans woman (he called them transsexual males), who later was in an accident. In the medical documentation, he was disappointed to find that the medical examiner documented this patient as a male degenerate; she was wearing male clothing over female clothing. Because of this bias, the patient was allowed to decline physically and pass away, where they would otherwise be fine, given proper treatment. He went on to talk about the taboo around sex change, stating sarcastically, “surgical manipulation of the genitals are off limits, but we can do anything else, like lobotomies.” This remark was followed by laughter by his listeners. (Benjamin lecture, 1966)

In this same lecture, Dr. Benjamin stated that through his research, he found that something happened during fetal life to cause transsexualism, and something may have happened in their early childhood that further conditioned, but in the end it was a matter of a predisposition that is, they did not have a choice. He later went on to talk about plans to do minor animal testing at Stanford University. Dr. Benjamin called the psychological condition of being transgender “gender dysphoria” a term that is still used today, but will be phased out and replaced with “gender incongruence” in the 2025 revision of the Diagnostic & Statistical Manual.

Legacy

Dr. Benjamin retired at age ninety. He had seen hundreds of transgender patients, and changed their lives. He pioneered treatment of transgender individuals, and began the destigmatization of these patients. While Dr. Benjamin was primarily an endocrinologist, he was also a sexologist and spent significant amounts of time researching the behaviors and motivations of what we know today as transgender individuals.

In 1978, Dr. Benjamin founded the Harry Benjamin International Gender Dysphoria Association (HBIBDA), which is still the world’s leading resource on transgender treatment, and known today as World Professional Association for Transgender Health (WPATH). HBIBDA released the first rendition of “The Standards of Care for Transgender Individuals,” and WPATH releases periodic revisions, based on research and societal language changes (Devor). Examples of this are “transsexual” now being “transgender,” the addition of “nonbinary” individuals (those who do not fit into any gender stereotype, thus are between or outside of the gender spectrum), and changing “gender dysphoria” to “gender incongruence.” The latter change is due to the implication that every trans person must suffer from gender dysphoria, which is known to be a horrendous affliction, causing profound depression and often suicidatlity. This has been found to not be a consistent truth I myself have never suffered from gender dysphoria; incongruence resonates much more soundly with me: I only felt content after transitioning.

Dr. Benjamin died at 101 years old, in 1986. He left behind a legacy that has affected and improved the lives of thousands upon thousands of transgender individuals (Pace, 1986). WPATH continues to be the leader in transgender healthcare, and has provided many with resources for therapy, hormone therapy, and surgical intervention. His work as undoubtedly saved an overwhelming amount of lives the rate of suicide attempts of transgender individuals is 41% prior to transitioning. Without his work, we wouldn’t have the amount of knowledge or destigmatization that we have today.

Effects on my Personal Life and Psyche

Dr. Benjamin’s research has had very real effects on my personal life and psyche. I lived the first twenty eight years of my life feeling a profound incongruence with my assigned gender (the gender one is assigned at birth, including intersex individuals who present with characteristics of both genders). This led to a plethora of psychological, familial, social, and occupational obstacles because I was conflicted about how to relate to the people around me. I was a “tom boy” from a very early age, and dressed masculine for my entire life except when forced to do otherwise by my unknowing parents. I finally came out and began my transition with testosterone therapy at age 28, in 2014. Physical and emotional changes came on quickly, and I had two surgeries within eight months of beginning hormone therapy with my court-ordered name and gender change in the mix. I finally began to feel at peace with my perception of myself and haven’t looked back since. I’m calmer and happier than I’d been during any other era of my life, and I have had some seriously dark times. I was not a complete person prior to transitioning.

None of this would have been possible without Dr. Benjamin’s research and advocacy. He opened doors for an extremely disenfranchised group of people to realize who they are and get closer to being able to achieve self-actualization. I mentioned earlier that the documented attempted suicide rate among transgender individuals is 41%. This number is pre-transition individuals; after being able to transition, this number drops close to the same level as cisgender (non-trangender) individuals. Dr. Benjamin also founded the organization now known as WPATH. This organization has historically created the guidelines for the safest and most thorough care plans for transgender individuals. The classic path to transition begins with extensive psychotherapy and living as your intended gender for a period of time prior to beginning medical intervention. Recently, some impatient individuals have pushed practitioners to implement “informed consent,” which is a watered down set of requirements to transition: see a therapist once or twice, address any hypertension or hyperlipidemia that could be dangerous, sign a paper stating you’ve been informed of the risks. This undereducation has led to patients panicking because they don’t understand what’s happening to their body, and a rise in regret to the point of detransitioning (stopping transition and taking steps to transition back).

While the language he used is now very outdated, Dr. Benjamin developed a process in order to keep his patients safe and healthy while they undergo a very taxing, however lifechanging process. He helped fight the stigma during a time where being transgender was not understood even using humor during lectures to get his point across. Transgender therapy and medicine was not understood by any means. Without Dr. Benjamin’s work, there never would have been a transgender program with an emphasis on patient care at Johns Hopkins Medical Center. Not only did he provide direct care to his patient, but he and his colleagues also collected extensive resources to refer their patients to whatever they needed. His patients reported being treated like an equal where they otherwise were face with judgement and dissent. He was an example of dedication and empathy to a group of people that otherwise only awkward people would have been involved (Schoen, 2007). Dr. Benjamin left behind a legacy that has changed many lives, and opened the doors for a greater societal acceptance and normalization of transgender individuals.

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