HF01-20: Elmer Belt, Harry Benjamin, and the Urologic Origins of American Transgender Surgery
Friday, May 3, 2024 4:43 PM to 4:50 PM · 7 min. (US/Central)
206
Abstract
History of Urology Forum
Information
Full Abstract and Figures
Author Block
David Diamond, Laena Hines*, Thomas Osinski, Ronald Rabinowitz, Rochester, NY
Introduction
Although Transgenderism has likely existed from time immemorial, Gender Affirming Surgery (GAS) has been a recent development with limited historic documentation. The objective of this study was to explore the urologic origins of GAS.
Methods
A Pubmed search on the topics 'Transgender' and 'GAS' in the English Literature was performed, along with literature searches on Elmer Belt, MD, and Harry Benjamin, MD.
Results
Initial developments in GAS took place in early 20th century Germany at the Institut für Sexualwissenschaft in Berlin under the leadership of Magnus Hirschfeld. America lagged behind Europe in acceptance and treatment of the transgender population. A transformation began in the 1950’s due first to the sensational story of Christine Jorgensen, an American GI, who underwent transgender surgery in Denmark, and secondly to the influence of Harry Benjamin, MD, a German trained endocrinologist and leading authority on transgenderism. Benjamin defined the spectrum of behavior from transvestite to transgender, supporting surgery for the truly transgendered. He required a willing surgical partner for these patients and found one in Elmer Belt, MD, a urologist in Los Angeles and the uncle of Willard Goodwin, MD. In the 1950’s and 60’s, Belt treated transfeminine (Male to Female) patients referred by Benjamin, who was consulted by virtually every transgender patient in the US interested in GAS. Belt performed penectomies, vaginoplasties and testicular “repositioning” into the abdomen to avoid long term risks of orchidectomy. Despite Benjamin reporting ~80% patient satisfaction post operatively, Belt developed great concerns about patient regret and legal recrimination. As a result, he required a psychological evaluation and often a second surgical opinion preoperatively as legal safeguards. Belt and Benjamin’s shared concerns regarding the uncertainty of patients’ mindsets led to the controversial 2 letter requirement by mental health professionals prior to surgery in the World Professional Association of Transgender Health (WPATH) guidelines. Belt discontinued his GAS practice in the 1960's after tiring of unrealistic demands from this patient population and the growing reputation of Georges Burou, a French gynecologist in Casablanca, Morocco, to whom Belt referred his transgender patients.
Conclusions
Elmer Belt, in partnership with Harry Benjamin, pioneered transfeminine GAS in the US. They demonstrated a supportive and responsible approach to this patient population while navigating societal pressures that continue to impact transgender patient care today.
Source Of Funding
N/A
Author Block
David Diamond, Laena Hines*, Thomas Osinski, Ronald Rabinowitz, Rochester, NY
Introduction
Although Transgenderism has likely existed from time immemorial, Gender Affirming Surgery (GAS) has been a recent development with limited historic documentation. The objective of this study was to explore the urologic origins of GAS.
Methods
A Pubmed search on the topics 'Transgender' and 'GAS' in the English Literature was performed, along with literature searches on Elmer Belt, MD, and Harry Benjamin, MD.
Results
Initial developments in GAS took place in early 20th century Germany at the Institut für Sexualwissenschaft in Berlin under the leadership of Magnus Hirschfeld. America lagged behind Europe in acceptance and treatment of the transgender population. A transformation began in the 1950’s due first to the sensational story of Christine Jorgensen, an American GI, who underwent transgender surgery in Denmark, and secondly to the influence of Harry Benjamin, MD, a German trained endocrinologist and leading authority on transgenderism. Benjamin defined the spectrum of behavior from transvestite to transgender, supporting surgery for the truly transgendered. He required a willing surgical partner for these patients and found one in Elmer Belt, MD, a urologist in Los Angeles and the uncle of Willard Goodwin, MD. In the 1950’s and 60’s, Belt treated transfeminine (Male to Female) patients referred by Benjamin, who was consulted by virtually every transgender patient in the US interested in GAS. Belt performed penectomies, vaginoplasties and testicular “repositioning” into the abdomen to avoid long term risks of orchidectomy. Despite Benjamin reporting ~80% patient satisfaction post operatively, Belt developed great concerns about patient regret and legal recrimination. As a result, he required a psychological evaluation and often a second surgical opinion preoperatively as legal safeguards. Belt and Benjamin’s shared concerns regarding the uncertainty of patients’ mindsets led to the controversial 2 letter requirement by mental health professionals prior to surgery in the World Professional Association of Transgender Health (WPATH) guidelines. Belt discontinued his GAS practice in the 1960's after tiring of unrealistic demands from this patient population and the growing reputation of Georges Burou, a French gynecologist in Casablanca, Morocco, to whom Belt referred his transgender patients.
Conclusions
Elmer Belt, in partnership with Harry Benjamin, pioneered transfeminine GAS in the US. They demonstrated a supportive and responsible approach to this patient population while navigating societal pressures that continue to impact transgender patient care today.
Source Of Funding
N/A
Sessions
History of Urology Forum
206