From The Encyclopedia of Sexual Knowledge 1934

Is this the world's first recorded successful 'sex-change'?

Firstly it must be said by us at transgender zone that this still remains a rather difficult area.

The main problem is to define what a 'sex-change' actually is? And Next what constitutes a 'procedure'?

The term 'sex change' is seen by many transpeople as incorrect, believing sex is set in the brain at birth, so this can be more accurately described as 'genital reassignment'. But for those on the net looking for answers the term used in the title is easier to understand for lay people.

It is clear that Eunuchs have have existed for thousands of years, what percentage of them were voluntary is unknown - but many probably were volunteers.

The Roman Emperor Elagabalus (204-222) is well documented as attempting sex-change surgery - it remains unclear if this was successful.

So we have to ask this question. If castration has existed for thousands of years then what is modern medicine demanding a monopoly in?

We suggest in this context we use sterile medical procedures coupled with pharmaceuticals that bring about hormonal changes. This however should not deny recognition of the transgender culture and its ancient roots!!!

Modern medicine does not 'own' this process - rather the individual and modern pharmaceuticals does.

This is taken from the Encyclopeadia of Sexual Knowledge by Norman Haire (1934)

The Foot notes at the end discuss more surgery.

Images are not from the book they have been added here by the editor for illustrative purposes.

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The way in which transvestism is brought about raises the same problem as that of the origin of homosexuality. Some insist on its acquired character in the majority of cases, and believe that a too close attachment to the person of the mother often has something to do with the evolution of this tendency. On the other hand, Magnus Hirschfeld and his followers maintain that transvestism is not an acquired tendency, but that it is innate and simply becomes stronger as the subject advances in age. At all events, an apparently chance occurrence may suddenly cause it to attain complete development.

It was during his sixth year that the conduct of the boy first became strange: he tried to ligature his penis with a piece of string. He said he considered his sexual organ superfluous, and wanted to get rid of it in this way. He was discovered in time to prevent more serious consequences, such as suppuration or necrosis.

'However, in the course of the following years, it became still more evident that the boy was adopting girlish ways. He would secretly dress himself in the clothes of his sisters, and nothing gave him more pleasure than to walk about in this attire. Outwardly, he was not in any way different from his comrades of the same social class.

He finished schooling with success, after acquiring a good general knowledge. Having begun work at the age of fourteen years, he was skilled, well thought of, and in public his conduct was perfectly correct. His sexual development was normal, but it soon became evident that his tendencies were of a homosexual nature. His mania for dressing like a woman became intensified in the course of time. On account of this, he left his home district and established himself in a large town, where he could give full freedom to his tendencies. There he managed to live the life, of a woman, beginning at the age of about 26-27 years. As...

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...is often the case with transvestists, this external resemblance to the female sex gradually became insufficient for him, and his one desire was to transform his body in the same way. In this he was aided by his primary constitution, which was of the androgynous type, that is to say, in him the chest, the lower abdomen and the buttocks as well as the arms and the legs were definitely feminine in form. This development of the body took place during and after puberty. 

He took the first step towards changing his sex in 1921, when he had himself castrated, As a result his sexual instinct was enfeebled, but the homosexual tendency, as well as his own feelings, remained the same. This step, however, was not sufficient for him, and he tried to obtain a still greater degree of femininity in his sexual parts. Finally, in 1930, the operation which he himself had attempted at the age of six was performed upon him, viz., the removal of his penis, and six months afterwards the transformation was completed by the grafting of an artificial vagina.


'We see, then, in this case a tendency first evincing itself at the age of six, and persisting throughout life, in such a way that nothing can obstruct its development or its intensity. On the contrary, it becomes stronger and stronger, and the consequences are more and more profound. In no other case is the goal pursued with such intensity of effort and so indefatigably, until definite success is attained. 'Usually, the wearing of a garment belonging to the opposite sex does not imply any serious inconvenience, either for the patient or for his neighbours. 

It happens sometimes, however, that serious embarrassment may be brought about, as in the case of the transvestist sailor mentioned by Magnus Hirschfeld. This individual, having been mobilized during the war, took advantage of his periods of leave on land to dress up as a woman. His suspicious manners attracted the attention of the authorities, who took him for a spy. He would have been shot immediately if his case had not been known to Magnus Hirschfeld, who intervened just in time. Other transvestist, arrested on both sides, were executed without mercy.

The case of transvestists who go so far as to demand a new...

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...civil status, or ask the doctor to change their sex, would require a special study which we cannot undertake here. [...]

This is the editor's footnotes from the Encyclopeadia not of this article

Editors Note.- Transvestism is much commoner than is generally realized. Quite a large number of persons seize every opportunity of going to a fancy dress ball in the clothes, of the opposite sex. Many at these themselves are not fully conscious that there is a sexual element in the pleasure they get from 'dressing up.' Cases frequently come before the courts of men arrested for various offences, who were found to be dressed as women, and less frequently of women dressed as men. In England the Judicial and legal authorities usually seem to be Ignorant of, or at least make no reference to, the fact that there is a sexual element in these cases. Considerable public interest was aroused by the cases of a man named Augustus Hull and a woman known as "Captain Barker" in this country within the last few years.

Lili was almost certainly intersexed. But it is unclear exactly of what type. She certainly had feminine body and facial features that allowed her to pass as a young woman better than she passed as a man. When presenting in public as a man she was often taken for a young woman masquerading as a man in trousers. Doctors consulted in her early adulthood declared her to be a normal male in spite of the feminine figure.. Hormonal assays taken just before her first surgery indicated more female than male hormones present. It is likely that she had XXY sex chromosome karyotype (Klinefelter’s Syndrome) a condition not medically recognized until 1942.

Lili was under the care of Dr. Warnekros of the Dresden Women’s Clinic. Warnekros was a pioneering gynecologist. All of Lili’s surgeries were of a very experimental nature. Her first surgery removed her male genitals. This first surgery was performed in Berlin after Lili was examined by the famous pioneering sexologist Magnus Hirschfeld. Her second surgery, performed by Warnekros, was to transplant healthy ovaries into her abdomen. A third operation, purpose unspecified, was performed a short time later. An emergency surgery was performed some weeks later, in response to severe abdominal pain, that probably was the removal of the rejected ovaries. Earlier reviews of Lili’s case in transsexual research literature left one with the impression that she died as a result of complications from the failed ovarian transplant... However, her reported death was not until over a year and a half later - this was three months after her fifth operation intended to allow her to “be a mother”...

Additionally, he only owned a single male suit, while having a fairly large female wardrobe. The physical evolution corresponds to the first case, except that surgery was done in shorter intervals. Within two years, E. suffered through castration, amputation and vaginoplasty. 2) 

In how far this surgery, especially the surgical forming of a vagina, has had an effect on the overall health cannot be evaluated at present because not enough time has passed since the end of surgery. The leftovers of the scrotum are to be placed lower and used as labia later, but this surgery has not yet been performed. The described surgery was performed by Dr. Gohrbandt, Director of the Surgical Clinic of the Urban Hospital in Berlin. Both patients have had castration and amputation in previous surgery, so that only the forming of an artificial vagina was necessary.

It is to be recommended, insofar as the necessary procedures have not yet been done, not to perform this surgery at one time with the vaginoplasty, but to proceed at two times. Needless to say, the most scrupulous hygiene is a prerequisite:  The surgical area is cleaned well, the hair removed, and the surgical area covered.  Then a catheter is inserted into the penis stump to avoid damages. After this a cut is made in a vertical direction into the muscles of the perineal area and the vagina is worked deep until the peritoneum is reached. As a rule, a depth of 11 to 12 cm. will be achieved, which is the final depth of the vagina. Next two-piece speculum pliers are inserted and the new vagina dilated.  Meanwhile, a rubber sponge measuring 11 to 12 cm. is prepared (see photos). It will be lined with Thiersch's grafts taken from the upper leg and in such a fashion that the skin surface is on the side of the sponge and that the corium touches the vaginal walls. By this, one achieves that the skin grafts grow on the vaginal wall and that closing and sealing of the vaginal walls is made impossible.  The sponge is introduced in such a fashion that the porcelain speculum is inserted into the vagina and then, through this speculum, the sponge is introduced. Then the speculum is carefully removed and the sponge that remains in the vagina is fixed (best by stitches). The sponge remains two to three weeks and serves during this time to absorb possible secretions.  Before introducing the sponge, it is useful to introduce a wooden rod into its middle, which is removed before the sponge itself, by which a folding of the sponge is achieved and, by this, the extraction of same is facilitated. If after three weeks the adhesion of the grafts to the flesh is not completed, one can introduce a new sponge, but naturally this time without skin grafts. After this, surgery is performed and post-treatments with rinsing, ointments, and so on, and later, dilation of the vaginal walls with a dilator. We describe the surgical procedure also by the photos included. The surgery described here is classified by its cosmetic result and its realization as very easy. Most assuredly, it is to be preferred to a procedure in which part of the intestines is later used as a vagina. The procedure itself takes only a short time, but needs, as previously mentioned, the greatest care and hygienic working conditions and can be classified as easy for the patient.  As said, the result, particularly in its effects on the patient, must be awaited. I just wanted to give a description of the procedure itself, because I believe an infinite number of patients with these same inclinations exist, who desire similar procedures, but do not know of any means and ways to achieve same. One could raise an objection to this type of surgery, that it is some kind of luxury surgery with a frivolous character, because the patient possibly will return to the doctor after some time with new and greater demands. This cannot be excluded. It was not easy for us to decide on the described procedures, but the patients were not to be dismissed, but also were in a mental state that made it probable that self-mutilation, with life-endangering complications, could be possible. From other cases we have learned that transvestites indeed cause themselves very severe harm if the doctor does not fulfill their wishes. To perform this surgery was in these cases (and probably it will be the same in many other cases) a kind of emergency surgery necessary to save patients from worse self-inflicted procedure.

Castration and penis amputation were done at the Institute of Sexual Science in Berlin by Dr. Levy-Lenz HISTORY OF SEXOLOGY - Pioneers of Sexology - Ludwig Levy-Lenz.

* 1930 Editors Note, -There is as yet, no general agreements to the causation of homosexuality. At one extreme there are those who consider that It is due to the psychological effect of a wrong environment, but if one accepts this view it is difficult to understand why some persons subjected to a particular set of environmental influences become homosexual, and others subjected to the same set of influences do not. One is forced to the conclusion that there must be a predisposition in some persons and not in others. Such a predisposition could presumably, in the last analysis be reduced to physical factors, possibly connected the ductless glands. At the other extreme there are those who consider that the psychological and environmental factor is negligible, and that homosexuality is inborn. This school frequently points to physical characteristics such as wide hips knock-knees in male homosexuals, or narrow hips and other male characteristics in female homosexuals. At first sight this argument would an conclusive. but we are faced with the difficulty of explaining the large numbers of men with feminine physical characteristics and women with male physical characteristics, who are nevertheless not at all homosexual, as well as large numbers at profoundly homosexual men and women who present no physical characteristics suggestive of the opposite sex. -N. H.

Magnus Hirschfeld

Magnus Hirschfeld was a German sexologist in the early 20th Century, the first man to systematically describe and work with what we now call transsexuals and transgenderists. He considered TS/TG persons to be a form of intersex. Working with surgeons in Berlin through his “Institute for Sexual Science” (Institut füer Sexualwissenschaft) one might say that he established and operated the world’s first, modern medical, gender clinic. One of Hirschfeld’s clients was Lili Elbe. The Institute was founded in 1919 and closed down by the Nazis in 1933.

Hirschfeld was an openly gay man who visited the gay and transgender bars and nighclubs of Berlin. His nickname in the gay community was “Aunt Magnesia.” The rise of the Nazis forced him, as an openly gay jew, to leave Germany in 1930, never to return. He died in Paris in 1935.

Hirschfeld coined the term transsexualism in 1923, 40 years before Benjamin popularized the term and 25 years before Cauldwell used the term. Hirschfeld and Harry Benjamin met in 1907, when Benjamin was still a medical student. Magnus Hirschfeld The Father of modern Transsexualism?

Citation: Hirschfield, M. (1934). In: Haire, N. (eds) Encyclopaedia of Sexual Knowledge, Encyclopaedic Press, London.