With few exceptions in the 1970s, medical and surgical interventions became the method of choice in the treatment of transsexual individuals. While Haynal was convinced that transsexual individuals could be successfully treated with psychotherapy (Haynal 1974: 114), the vast majority of West German sexologists argued that sex reassignment surgery was the only viable method for treating individuals with »an irreversibly transposed gender identity« (Eicher/Herms 1978: 45). Eicher and Herms noted that in their clinical experience any other known treatment in fact had detrimental effects on transsexual persons: »Psy-chiatric or psychotherapeutic treatments or a hormone treatment according to the physical image can be found in the case history. They were unsuccessful in all cases and agonising for the patients. They may even lead to attempted suicide as we observed in two cases.« (Eicher/Herms 1978: 44)
While there was widespread agreement on surgery as the best available treatment (Eicher 1976: 44; Spengler 1980: 103; Schorsch 1974: 197; Richter 1977: 913), proponents of the surgical route were in part ambiguous about this solution. Sigusch, Meyenburg and Reiche expressed their unease by associat-ing sex reassignment surgery with »emergency therapy« (Sigusch/Meyenburg/
Reiche 1979: 289).9 In a similar vein, Eicher and Herms suggested that while surgery offered a solution, it nevertheless remained »a compromise« (Eicher/
Herms 1978: 45).
8 | A brief outline of the therapeutic route and the medical management of transsexuality is published in German in de Silva 2013, 85-87.
9 | In a medical commentary on the Transsexual Act, Sigusch expanded on this notion:
»Irreversible physical interventions should not be the be-all and end-all of medicine.
Transsexualism is a psychological disease and therefore needs to be treated with psychological means. That this has so far rarely been successful is certainly also up to the therapists who, urged by patients and without effective psychotherapeutical means, have got more and more used to a type of emergency therapy that was from the beginning an act of desperation for both, the therapist and the patient.« (Sigusch 1980: 2745) He repealed his statement in an interview in 1992, arguing that he »nowadays no longer had the totalitarian illusion that psychiatric examinations or psychological treatment could
›capture‹, understand or even comprehend a patient’s life« (Sigusch 1992: 656).
Sexologists who endorsed the surgical route generally agreed on adminis-tering counter-sexed hormones and surgery in adult female-bodied men and male-bodied women, provided there were no serious contraindications.10 The extent of the medical, surgical and otherwise therapeutic interventions deemed necessary or advisable varied, depending on the programme in the respective hospital.
Medical measures in male-to-female transsexual individuals (mtf) involved treating the individual with estrogenes. Eicher and Richter suggested adminis-tering estrogenes in order to induce the development of the breast glands, the redistribution of fat according to a female pattern and the softening of the skin (Eicher 1976: 43; Richter 1977: 914). However, Sigusch, Meyenburg and Re-iche proposed possibly supplementing the estrogene regimen with gestagenes, since they believed the latter to have an additional positive effect on breast de-velopment and the reduction of body hair (Sigusch/Meyenburg/Reiche 1979:
295).
The endocrinological treatment of ftm transsexual individuals varied, too.
In general, all sexologists proposed treating ftm transsexual individuals with testosterone. However, while Eicher and Richter considered this hormone treat-ment permanent (Eicher 1976: 43; Richter 1977: 914), Sigusch, Meyenburg and Reiche suggested initially administering testosterone until the desired effects such as the lowering of the voice, increased facial hair and clitoral enlargement materialise. They furthermore proposed to use progestins in order to suppress menstruation (Sigusch/Meyenburg/Reiche 1979: 295).11
10 | The contraindications were (and in part continue to be) subdivided into internal, psy-chiatric, neurological, social, personal and legal aspects. Physical contraindications are those that threaten the physical well-being or even the life of a transsexual person, such as e. g. an estrogene therapy in individuals who suffer from liver diseases or damages or who experienced thromboses, embolism or hypotonia (Richter 1978: 56). Psychiatric contraindications are e. g. psychoses and borderline pathologies »other« than transsexu-ality (Sigusch/Meyenburg/Reiche 1979: 289). Temporal lobe diseases are a neurological contraindication in the case of transsexuality. Lack of intelligence and reason and the inability or unwillingness to collaborate are personal contraindications. Social contrain-dications are according to Richter e. g. a marriage and the lack of a partner’s consent to get divorced, adolescent age and the risk of triggering a socio-economic and cultural crisis. Legal aspects are a criminal record that is not related to transsexualism and the refusal to sign a declaration stating that the physician is not responsible for the effects of the intervention, if it has been conducted properly (Richter 1977: 914; 1978: 58 f.).
11 | Sigusch, Meyenburg and Reiche only suggested a bilateral oophorectomy in cases of insufficient virilisation (Sigusch/Meyenburg/Reiche 1979: 298). They argued that if the ovaries were retained, the virilisation through initial doses of testosterone alone would
All authors mentioned here agreed on an orchidectomy, a penectomy and the construction of a neovagina as appropriate surgical interventions for mtf transsexual individuals (Eicher 1976: 43; Richter 1977: 914; 1978: 57; Sigusch/
Meyenburg/Reiche 1979: 297). Sigusch, Meyenburg and Reiche rejected re-quests for any other sex reassignment surgery, such as oto-rhinoplasties or the injection of liquid silicon as a means to augment breasts, arguing that they wanted to avoid complications that may result from any of these types of inter-ventions (Sigusch/Meyenburg/Reiche 1979: 298).
Unlike Sigusch, Meyenburg and Reiche, Eicher and Richter proposed addi-tional, albeit optional surgical interventions. These included the construction of labia out of scrotal skin, breast augmentation surgery, if estrogene-induced breast gland growth was considered insufficient, oto-rhinoplasty, the smooth-ing out of male facial wrinkles (Eicher 1976: 43; Richter 1978: 57; 1977: 914) and »whatever else is felt to be disturbing and in need of correction« (Richter 1978: 57).
As with male-to-female transsexual individuals, Sigusch, Meyenburg and Reiche opted for as few surgical interventions as possible in female-to-male individuals. They proposed a bilateral mastectomy. In their opinion a hyster-ectomy and bilateral oophorhyster-ectomy were only indicated, if the ovaries inter-fered with the process of virilisation. They did not propose a phalloplasty due to dissatisfactory results (Sigusch/Meyenburg/Reiche 1979: 298). In contrast to Sigusch, Meyenburg and Reiche, a hysterectomy and adnectomy were part of the standardised programme with Eicher and Richter (Eicher 1976: 43; Richter 1977: 914; 1978: 57). In addition, Richter suggested a colpectomy (Richter 1977:
914). While both authors mentioned the possibility of a phalloplasty,12 they, too, did not consider this means mandatory due to poor surgical results (Eicher 1976: 43; Richter 1977: 914; 1978: 58).13
Otherwise therapeutic measures for male-to-female transsexual individuals potentially consisted of electrolysis and speech therapy. While Sigusch,
Meyen-suffice, and when the hormone therapy with testosterone ends, the body would continue to be supplied with growth hormones.
12 | Surgeons did not offer a standardised procedure in the 1970s, and phalloplasties were considered experimental surgery. The phalloplasty Eicher had in mind had a neoure-thra. The penoid was non-erectable (Eicher 1976: 43). Richter suggested a phalloplasty that may or may not have a urethra and a penis prosthesis. He also proposed the construction of a scrotum, possibly with an implantation of testicles (Richter 1977: 914;
1978: 58).
13 | Frequent complications were strictures and fistulae. Occasionally thromboses and necroses occurred, resulting in a loss of the neo-phallus. These complications continue to occur to the present.
burg and Reiche did not mention any of these options in their programme of treatment, Eicher suggested offering all measures (Eicher 1976: 43).