Rachelle McAdam is no ordinary girl next door. A former Salt Lake City high school teacher, she stands a stately 5 ft. 11 in. tall and displays a well-turned 36-26-35 figure. Eight weeks ago, before her operation in San Francisco, her name was Richard, and she was a man, twice married and twice divorced.
McAdam is one of about 1,500 transexuals in the U.S. who have changed their sex by surgery. Because most sex change operations are done confidentially, the exact number is hard to determine. But the trend is clear: about 700 such operations were performed last year, double the rate of the year before.
Transexuals, of whom there are perhaps 10,000 in the U.S., are not to be confused with homosexuals and transvestites. Classic transexuals are born with the anatomy of one sex but suffer from a total, lifelong identification with the other, perhaps influenced by prenatal hormone disturbances. Transexuals generally disdain association with professed homosexuals. Unlike transvestites, they do not dress in clothes of the opposite gender for erotic stimulation, but simply because they feel more comfortable that way.
Careful Screening. Though the first modern medically supervised sex-change operation took place in Europe in 1930, transexual surgery did not attract wide notice until the transformation of a former G.I. named George Jorgensen to Christine* in 1952. In 1966 Johns Hopkins Hospital in Baltimore opened its Gender Identity Clinic, having the year before performed its first complete transexual operation. University hospitals at Minnesota, Stanford, Northwestern, Arkansas, Michigan, Kentucky, Virginia and a few others soon followed suit.
In Stanford's Gender Dysphoria Program, headed by Psychiatrist Norman Fisk and Plastic Surgeon Donald Laub, applicants for surgery are carefully screened. For those who doctors feel could benefit from an operation, at least a full year of hormonal therapy is prescribed: estrogens and progestins to enlarge the breasts and soften the skin on men, and androgens to deepen the voices and stimulate beards on women.
During their hormone therapy, patients are asked to adopt the characteristics of their new gender. Transexual men don dresses, wear makeup, live and work as women. Transexual women wear men's clothes and live as men. After a year, if doctors judge the adjustment to new life-styles a success, surgery is performed.
Procedures and costs differ from hospital to hospital. The male-to-female operation, which costs from $3,000 to $5,000, is by far the easier and more satisfactory. After amputation of the penis and testicles, an artificial vagina is created, using scrotal or penile tissue or skin grafts from the thigh or hip. Because the penile tissue is still sensitive, male-to-female transexuals may experience orgasm, though of course pregnancy is impossible.