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Duke University Medical Center
VOLUME 24, NUMBER 25
JUNE 24,1977
DURHAM, NORTH CAROLINA
Lengthy Preparations Precede Operation
Most Sex Change Applicants Turned Away
By David Williamson
Sex change operations are not for
everyone.
Indeed, the sometimes
controversial surgery that sparked
debate across the country in the early
1950s and then again last summer,
isn't even for everyone who wants it.
Not, at least, at Duke.
Members of the Division of
Urologic Surgery at Duke have been
performing the sexual conversion
surgery on adults since 1972 and on
children born with improperly
formed genitals since the early 1930s.
They estimate that more than nine
out of every 10 adults who apply to
Duke to have their sex changed are
turned away as poor risks. Those
who the medical staff feels might be
helped by the operation must
undergo a lengthy series of
interviews, psychological screening
and preparations before they are
accepted.
Extremely Reluctant
"We are extremely reluctant to
perform the surgery because the
hazards of any major operation are
sizeable," said Dr. James F. Glenn,
chief of urology at Duke. "Any time
you put a patient under anesthesia
for three or four hours, you're taking
a risk."
Why then perform the operation at
all?
The surgeon said that most
physicians v^o have kept abreast of
gender identity quertions now
believe that sexual reassignment is a
very positive and perhaps Bte only
form of treatment for true
transsexualism.
"This operation is being done by
competent surgeons at a number of
recognized gender identity clinics
across the United States," he said.
"But there are others who require no
screening, no «valuation and have a
high complication rate. The only
criteria some use is that the patients
present themselves requesting
surgery and also have the money.''
Suigkal Procedures
Operations converting males to
females involve removing the penis
and testicles, turning skin from the
penis inside out to line a
surgically-created vagina and
changing the position of the urethra
which carries uriiie away from the
bladder, he explained.
0]j>erations converting feniales to
mal^ are less common and more
complex, he said. TTiey involve
removal of breasts, uterus and
ovaries.
Sometimes surgeons construct a
penis from tissue taken from the
thigh or the abdomen, and
sometimes they rely on hormone
Male OB Nurse Finds Acceptance at Duke
By John Becton
(From a report by Wilma Yellock,
Reporter, Carter Suite.)
Dan Tscharmen is a pioneer.
Certainly it stretches no one's
imagination to refer to male nurses
as a minority group, but when you
talk about males in obstetrics
nursing, you're down to something
smaller than a group.
Tschannen, a staff nvirse on Carter
Suite, is Duke's first male nurse in
obstetrics. There are probably a few
others somewhere, he says, but he
hasn't heard of them. ("There is one
guy in Georgia who works in
postpartum.")
And he is where he is quite by
design.
"I was interested in the health
field, and chose nursing because 1
wanted a lot of patient contact," he
said. "We're the ones who nwke the
philosophy of health care come alive.
We put the doctor's diagnosis into
practice."
Interest in Preventive Care
He worked for a while in an
intensive care unit in a small
hospital. Many of the patients he
saw there were "10-15-20 years into
the disease process."
This led Tschannen to think more
about prevention.
"1 decided I wanted to work with
young, primarily healthy people,
who are at a decision point in their
lives," he said. "Becoming a parent
makes many people think seriousily
about their sexuality — what it
means to be man, woman, mother,
father."
Tschannen welcomes the
opportunity to help them deal with
treatments to promote growth of the
clitoris.
Infections, tissue rejection and
irreparable damage to the body's
waste disposal canals are just a few
of the potential dangers of the
operation, according to Glenn.
No Serious Complications Here
He said there have been no serious
surgical complications among
transsexual patients at Duke. Nor
have there ^en any psychological
complications such as a patient
changing his or her mind after the
procedure "because we have been
extremely careful in weeding out
those people who are not true
transsexuals," he added.
Drs. John M. Rhoads, a
psychiatrist, and Elaine Crovitz, a
medical psychologist, both faculty
members in the Department of
Psychiatry, help a team of urologists,
plastic surgeons and g)mecologists
decide who will undergo the
transformation.
Rhoads said experts disagree on
the cause or causes of
transsexualism. Some believe it
stems from an unnatural relationship
between a child and its parents
during the first years of life. Others
contend that chromosomal or
hormonal abnormalities in the
unborn fetus are responsible, while
still others maintain that a
combination of these facton bring
on th^ condition, he said. .
Trapp^ in Wrong Body
'But whatever the cause,
transsexuals share the belief that
nature has cruelly trapped them in
the wrong body. Invaribly, they are
unhappy.
Each candidate who has passed a
preliminary screening is interviewed
separately by Crovitz and Rhoads.
Crovitz said she employs a battery
of psychological tests after a
(Continued on page 2)
these issues, as well as concerns
about raising children, nutrition, etc.
And he sees this as a key
contribution nurses make to the
treatment process.
"About 50 per cent of nursing is
psychological,'^ he estimates, adding
that it helps people feel good if they
feel good about themselves.
Accepted at Duke
Of course, being dedicated to
professional goals doesn't
automatically get a man into a
delivery room. Tschannen said that
some of his fellow male RNs had
experienced more problems than he
has.
"Some of my friends simply were
not allowed on obstetrics floors at
other hospitals," he said.
At Duke, Tschannen says, "I found
(Continued on page 3)