forced gender reassignment wikipedia

David Reimer and John Money Gender Reassignment Controversy: The John/Joan Case

In the mid-1960s, psychologist John Money encouraged the gender reassignment of David Reimer, who was born a biological male but suffered irreparable damage to his penis as an infant. Born in 1965 as Bruce Reimer, his penis was irreparably damaged during infancy due to a failed circumcision. After encouragement from Money, Reimer’s parents decided to raise Reimer as a girl. Reimer underwent surgery as an infant to construct rudimentary female genitals, and was given female hormones during puberty. During childhood, Reimer was never told he was biologically male and regularly visited Money, who tracked the progress of his gender reassignment. Reimer unknowingly acted as an experimental subject in Money’s controversial investigation, which he called the John/Joan case. The case provided results that were used to justify thousands of sex reassignment surgeries for cases of children with reproductive abnormalities. Despite his upbringing, Reimer rejected the female identity as a young teenager and began living as a male. He suffered severe depression throughout his life, which culminated in his suicide at thirty-eight years old. Reimer, and his public statements about the trauma of his transition, brought attention to gender identity and called into question the sex reassignment of infants and children.

Bruce Peter Reimer was born on 22 August 1965 in Winnipeg, Ontario, to Janet and Ron Reimer. At six months of age, both Reimer and his identical twin, Brian, were diagnosed with phimosis, a condition in which the foreskin of the penis cannot retract, inhibiting regular urination. On 27 April 1966, Reimer underwent circumcision, a common procedure in which a physician surgically removes the foreskin of the penis. Usually, physicians performing circumcisions use a scalpel or other sharp instrument to remove foreskin. However, Reimer’s physician used the unconventional technique of cauterization, or burning to cause tissue death. Reimer’s circumcision failed. Reimer’s brother did not undergo circumcision and his phimosis healed naturally. While the true extent of Reimer’s penile damage was unclear, the overwhelming majority of biographers and journalists maintained that it was either totally severed or otherwise damaged beyond the possibility of function.

In 1967, Reimer’s parents sought the help of John Money, a psychologist and sexologist who worked at the Johns Hopkins Hospital in Baltimore, Maryland. In the mid twentieth century, Money helped establish the views on the psychology of gender identities and roles. In his academic work, Money argued in favor of the increasingly mainstream idea that gender was a societal construct, malleable from an early age. He stated that being raised as a female was in Reimer’s interest, and recommended sexual reassignment surgery. At the time, infants born with abnormal or intersex genitalia commonly received such interventions.

Following their consultation with Money, Reimer’s parents decided to raise Reimer as a girl. Physicians at the Johns Hopkins Hospital removed Reimer’s testes and damaged penis, and constructed a vestigial vulvae and a vaginal canal in their place. The physicians also opened a small hole in Reimer’s lower abdomen for urination. Following his gender reassignment surgery, Reimer was given the first name Brenda, and his parents raised him as a girl. He received estrogen during adolescence to promote the development of breasts. Throughout his childhood, Reimer was not informed about his male biology.

Throughout his childhood, Reimer received annual checkups from Money. His twin brother was also part of Money’s research on sexual development and gender in children. As identical twins growing up in the same family, the Reimer brothers were what Money considered ideal case subjects for a psychology study on gender. Reimer was the first documented case of sex reassignment of a child born developmentally normal, while Reimer’s brother was a control subject who shared Reimer’s genetic makeup, intrauterine space, and household.

During the twin’s psychiatric visits with Money, and as part of his research, Reimer and his twin brother were directed to inspect one another’s genitals and engage in behavior resembling sexual intercourse. Reimer claimed that much of Money’s treatment involved the forced reenactment of sexual positions and motions with his brother. In some exercises, the brothers rehearsed missionary positions with thrusting motions, which Money justified as the rehearsal of healthy childhood sexual exploration. In his Rolling Stone interview, Reimer recalled that at least once, Money photographed those exercises. Money also made the brothers inspect one another’s pubic areas. Reimer stated that Money observed those exercises both alone and with as many as six colleagues. Reimer recounted anger and verbal abuse from Money if he or his brother resisted orders, in contrast to the calm and scientific demeanor Money presented to their parents. Reimer and his brother underwent Money’s treatments at preschool and grade school age. Money described Reimer’s transition as successful, and claimed that Reimer’s girlish behavior stood in stark contrast to his brother’s boyishness. Money reported on Reimer’s case as the John/Joan case, leaving out Reimer’s real name. For over a decade, Reimer and his brother unknowingly provided data that, according to biographers and the Intersex Society of North America, was used to reinforce Money’s theories on gender fluidity and provided justification for thousands of sex reassignment surgeries for children with abnormal genitals.

Contrary to Money’s notes, Reimer reports that as a child he experienced severe gender dysphoria, a condition in which someone experiences distress as a result of their assigned gender. Reimer reported that he did not identify as a girl and resented Money’s visits for treatment. At the age of thirteen, Reimer threatened to commit suicide if his parents took him to Money on the next annual visit. Bullied by peers in school for his masculine traits, Reimer claimed that despite receiving female hormones, wearing dresses, and having his interests directed toward typically female norms, he always felt that he was a boy. In 1980, at the age of fifteen, Reimer’s father told him the truth about his birth and the subsequent procedures. Following that revelation, Reimer assumed a male identity, taking the first name David. By age twenty-one, Reimer had received testosterone therapy and surgeries to remove his breasts and reconstruct a penis. He married Jane Fontaine, a single mother of three, on 22 September 1990.

In adulthood, Reimer reported that he suffered psychological trauma due to Money’s experiments, which Money had used to justify sexual reassignment surgery for children with intersex or damaged genitals since the 1970s. In the mid-1990s, Reimer met Milton Diamond, a psychologist at the University of Hawaii, in Honolulu, Hawaii, and academic rival of Money. Reimer participated in a follow-up study conducted by Diamond, in which Diamond cataloged the failures of Reimer’s transition.

In 1997, Reimer began speaking publicly about his experiences, beginning with his participation in Diamond’s study. Reimer’s first interview appeared in the December 1997 issue of Rolling Stone magazine. In interviews, and a later book about his experience, Reimer described his interactions with Money as torturous and abusive. Accordingly, Reimer claimed he developed a lifelong distrust of hospitals and medical professionals.

With those reports, Reimer caused a multifaceted controversy over Money’s methods, honesty in data reporting, and the general ethics of sex reassignment surgeries on infants and children. Reimer’s description of his childhood conflicted with the scientific consensus about sex reassignment at the time. According to NOVA, Money led scientists to believe that the John/Joan case demonstrated an unreservedly successful sex transition. Reimer’s parents later blamed Money’s methods and alleged surreptitiousness for the psychological illnesses of their sons, although the notes of a former graduate student in Money’s lab indicated that Reimer’s parents dishonestly represented the transition’s success to Money and his coworkers. Reimer was further alleged by supporters of Money to have incorrectly recalled the details of his treatment. On Reimer’s case, Money publicly dismissed his criticism as antifeminist and anti-trans bias, but, according to his colleagues, was personally ashamed of the failure.

In his early twenties, Reimer attempted to commit suicide twice. According to Reimer, his adult family life was strained by marital problems and employment difficulty. Reimer’s brother, who suffered from depression and schizophrenia, died from an antidepressant drug overdose in July of 2002. On 2 May 2004, Reimer’s wife told him that she wanted a divorce. Two days later, at the age of thirty-eight, Reimer committed suicide by firearm.

Reimer, Money, and the case became subjects of numerous books and documentaries following the exposé. Reimer also became somewhat iconic in popular culture, being directly referenced or alluded to in the television shows Chicago Hope , Law & Order , and Mental . The BBC series Horizon covered his story in two episodes, “The Boy Who Was Turned into a Girl” (2000) and “Dr. Money and the Boy with No Penis” (2004). Canadian rock group The Weakerthans wrote “Hymn of the Medical Oddity” about Reimer, and the New York-based Ensemble Studio Theatre production Boy was based on Reimer’s life.

• Carey, Benedict. “John William Money, 84, Sexual Identity Researcher, Dies.” New York Times , 11 July 2016.
• Colapinto, John. "The True Story of John/Joan." Rolling Stone 11 (1997): 54–73.
• Colapinto, John. As Nature Made Him: The Boy who was Raised as a Girl . New York: HarperCollins Publishers, 2000.
• Colapinto, John. "Gender Gap—What were the Real Reasons behind David Reimer’s Suicide." Slate (2004).
• Dr. Money and the Boy with No Penis , documentary, written by Sanjida O’Connell (BBC, 2004), Film.
• The Boy Who Was Turned Into a Girl , documentary, directed by Andrew Cohen (BBC, 2000.), Film.
• “Who was David Reimer (also, sadly, known as John/Joan)?” Intersex Society of North America . http://www.isna.org/faq/reimer (Accessed October 31, 2017).

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Hopkins Hospital: a history of sex reassignment

By RACHEL WITKIN | May 1, 2014

Editor’s note: this article makes several misleading claims. It does not properly contextualize psychologist John Money ’ s forced sexual reassignment surgery of David Reimer. It also implies that sexual reassignment surgery was introduced in the 1960s, though procedures took place earlier in the 1900s.

The News-Letter regrets these errors.

In 1965, the Hopkins Hospital became the first academic institution in the United States to perform sex reassignment surgeries. Now also known by names like genital reconstruction surgery and sex realignment surgery, the procedures were perceived as radical and attracted attention from The New York Times and tabloids alike. But they were conducted for experimental, not political, reasons. Regardless, as the first place in the country where doctors and researchers could go to learn about sex reassignment surgery, Hopkins became the model for other institutions. But in 1979, Hopkins stopped performing the surgeries and never resumed.

In the 1960s, the idea to attempt the procedures came primarily from psychologist John Money and surgeon Claude Migeon, who were already treating intersex children, who, often due to chromosome variations, possess genitalia that is neither typically male nor typically female. Money and Migeon were searching for a way to assign a gender to these children, and concluded that it would be easiest if they could do reconstructive surgery on the patients to make them appear female from the outside. At the time, the children usually didn’t undergo genetic testing, and the doctors wanted to see if they could be brought up female.

“[Money] raised the legitimate question: ‘Can gender identity be created essentially socially?’ ... Nurture trumping nature,” said Chester Schmidt, who performed psychiatric exams on the surgery candidates in the 60s and 70s.

This theory ended up backfiring on Money, most famously in the case of David Reimer, who was raised as a girl under the supervision of Money after a botched circumcision and later committed suicide after years of depression.

However, at the time, this research led Money to develop an interest in how gender identities were formed. He thought that performing surgery to match one’s sex to one’s gender identity could produce better results than just providing these patients with therapy.

“Money, in understanding that gender was — at least partially — socially constructed, was open to the fact that [transgender] women’s minds had been molded to become female, and if the mind could be manipulated, then so could the rest of the body,” Dana Beyer, Executive Director of Gender Rights Maryland, who came to Hopkins to consider the surgery in the 70s, wrote in an email to The News-Letter .

Surgeon Milton Edgerton, who was the head of the University’s plastic surgery unit, also took an interest in sex reassignment surgery after he encountered patients requesting genital surgery. In 2007, he told Baltimore Style : “I was puzzled by the problem and yet touched by the sincerity of the request.”

Edgerton’s curiosity and his plastic surgery experience, along with Money’s interest in psychology and Migeon’s knowledge of plastic surgery, allowed the three to form a surgery unit that incorporated other Hopkins surgeons at different times. With the University’s approval, they started performing sex reassignment surgeries and created the Gender Identity Clinic to investigate whether the surgeries were beneficial.

“This program, including the surgery, is investigational," plastic surgeon John Hoopes, who was the head of the Gender Identity Clinic, told The New York Times in 1966. “The most important result of our efforts will be to determine precisely what constitutes a transsexual and what makes him remain that way.”

To determine if a person was an acceptable candidate for surgery, patients underwent a psychiatric evaluation, took gender hormones and lived and dressed as their preferred gender. The surgery and hospital care cost around $1500 at the time, according to The New York Times .

Beyer found the screening process to be invasive when she came to Hopkins to consider the surgery. She first heard that Hopkins was performing sex reassignment surgeries when she was 14 and read about them in Time and Newsweek .

“That was the time that I finally was able to put a name on who I was and realized that something could be done,” she said. “That was a very important milestone in my consciousness, in understanding who I was.”

When Beyer arrived at Hopkins, the entrance forms she had to fill out were focused on sexuality instead of sexual identity. She says she felt as if they only wanted to consider hyper-feminine candidates for the surgery, so she decided not to stay. She had her surgery decades later in 2003 in Trinidad, Colo.

“It was so highly sexualized, which was not at all my experience, certainly not the reason I was going to Hopkins to consider transition, that I just got up and left, I didn’t want anything to do with it,” she said. “No one said this explicitly, but they certainly implied it, that the whole purpose of this was to get a vagina so you could be penetrated by a penis.”

Beyer thinks that it was very important that the transgender community had access to this program at the time. However, she thinks that the experimental nature of the program was detrimental to its longevity.

“It had negative consequences because when it was done it was clearly experimental,” she said. “Our opponents were able to use the experimental nature of the surgery in the 60s and the 70s against us.”

By the mid-70s, fewer patients were being operated on, and many changes were made to the surgery and psychiatry departments, according to Schmidt, who was also a founder of the Sexual Behaviors Consultation Unit (SBCU) at the time. The new department members were not as supportive of the surgeries.

In 1979, SBCU Chair Jon Meyer conducted a study comparing 29 patients who had the surgery and 21 who didn’t, and concluded that those who had the surgery were not more adjusted to society than those who did not have the surgery. Meyer told The New York Times in 1979: “My personal feeling is that surgery is not proper treatment for a psychiatric disorder, and it’s clear to me that these patients have severe psychological problems that don’t go away following surgery.”

After Meyer’s study was published, Paul McHugh, the Psychiatrist-in-Chief at Hopkins Hospital who never supported the University offering the surgeries according to Schmidt, shut the program down.

Meyer’s study came after a study conducted by Money, which concluded that all but one out of 24 patients were sure that they had made the right decision, 12 had improved their occupational status and 10 had married for the first time. Beyer believes that officials at Hopkins just wanted an excuse to end the program, so they cited Meyer’s study.

“The people at Hopkins who are naturally very conservative anyway … decided that they were embarrassed by this program and wanted to shut it down,” she said.

A 1979 New York Times article also states that not everyone was convinced by Meyer’s study and that other doctors claimed that it was “seriously flawed in its methods and statistics and draws unwarranted conclusions.”

However, McHugh says that it shouldn’t be surprising that Hopkins discontinued the surgeries, and that he still supports this decision today. He points to Meyer’s study as well as a 2011 Swedish study that states that the risk of suicide was higher for people who had the surgery versus the general population.

McHugh says that more research has to be conducted before a surgery with such a high risk should be performed, especially because he does not think the surgery is necessary.

“It’s remarkable when a biological male or female requests the ablation of their sexual reproductive organs when they are normal,” he said. “These are perfectly normal tissue. This is not pathology.”

Beyer, however, cites a study from 1992 that shows that 98.5 percent of patients who underwent male-to-female surgery and 99 percent of patients who underwent female-to-male surgery had no regrets.

“It was clear to me at the time that [McHugh] was conflating sexual orientation and the actual physical act with gender identity,” Beyer said.

However, she thinks that shutting down the surgeries at Hopkins actually helped more people gain access to them, because now the surgeries are privatized.

“Paul McHugh did the trans community a very big favor … Privatization [helps] far more people than the alternative of keeping it locked down in an academic institution which forced trans women to jump through many hoops.”

Twenty major medical institutions offered sex reassignment surgery at the time that Hopkins shut its program down, according to a 1979 AP article.

Though the surgeries at Hopkins ended in 1979, the University continued to study sexual and gender behavior. Today, the SBCU provides consultations for members of the transgender community interested in sex reassignment surgery, provides patients with hormones and refers patients to specialists for surgery.

The Hopkins Student Health and Wellness Center is also working toward providing transgender students necessary services as a plan benefit under the University’s insurance plan once the student health insurance plan switches carriers on Aug. 15.

“We are hopefully working towards getting hormones and other surgical options covered by the student health insurance,” Demere Woolway, director of LGBTQ Life at Hopkins, said. “We’ve done a number of trainings for the folks over in the Health Center both on the counseling side and on the medical side. So we’ve done some great work with them and I think they are in a good place to be welcoming and supportive of folks.”

Schmidt does ongoing work to provide the Hopkins population with transgender services, and says he would like for Hopkins to start performing sex reassignment surgeries again. But Chris Kraft, the current co-director of the SBCU, says that this is not feasible today, as no academic institution provides these surgeries since not enough people request them.

“It is unfortunate that no medical schools in the country have faculty who are trained or able to provide surgeries,” he wrote in an email to The News-Letter . “All the best surgeons work free-standing, away from medical schools. If we had surgeons who could provide the same quality services as the other surgeons in the country, then it would make sense to provide these services. Sadly, few physicians are willing to make gender surgery a priority in their careers because gender patients who go on to surgery are a very small population.”

Beyer, however, does not think that the transgender community needs Hopkins to reinstate its program, and that there are currently enough options available.

“We’re way, way past that,” she said. “It’s no longer the kind of procedure that needs an academic institution to perform research and development.”

Though she finds the way that Hopkins treated its sex reassignment patients in the 60s and 70s questionable, she thinks that the SBCU has been a great resource for the transgender community.

“Today those folks are wonderful people,” Beyer said. “They’re very helpful. They’re the go-to place up in Baltimore. They’ve done a lot of good for a lot of people. They’ve contributed politically as well to passage of gender identity legislation in Maryland and elsewhere.”

The Maryland Coalition for Trans Equality’s Donna Cartwright said that the transgender community does not have enough resources available to them. She said offering surgery at a nearby academic institution could provide more support to the community.

“Generally, the medical community needs to be better educated on trans health care and there should be greater availability [of sex reassignment surgery],” she said. “I think it would be good if there was an institution in the area that did provide health care, including surgery.”

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Interview: Cattle Decapitation Vocalist Travis Ryan Discusses New Album, 'Monolith of Inhumanity'

Vocalist Travis Ryan has been fronting vegetarian grindcore band Cattle Decapitation since 1997, back when the band was a side project for members of The Locust.

With more than nine albums under his belt, including a new one with his side project, Murder Construct, Ryan recently sat down with Guitar World to discuss all things Cattle Decapitation, including a switch in their lineup and their new album, Monolith of Inhumanity , which came out May 8 via Metal Blade Records.

GUITAR WORLD: Was there a difference in the songwriting process between 2009’s The Harvest Floor and Monolith of Inhumanity ?

For one thing, we got a new bass player [Derek Engemann] since The Harvest Floor , and you know that’ll always change things up. We hired him from touring with him, and I was always amazed by how quickly he picked up on things. That always says a lot about somebody. But luckily, you know, we didn’t really know what to expect from him as far as songwriting goes at all. So, it totally worked out. He always told us, “My main thing that I’m trying to do is add structure,” you know, so I think he helped bring a lot more structure to the songs.

We spent like a year writing it, because all of us, we all have day jobs, you know, we’re grown men. It’s not like all these young bands, where I don’t know what the hell they do -- nothing, I guess -- Mom and Dad gave ‘em all MacBooks and they know how to use ‘em. We don’t, we do it the old-fashioned way; practicing an hour or two a night. Not even a night, more like three nights a week. So honestly, it’s a miracle we could even pull off a record.

What we wanted to do was to spend five months writing it, like we usually do, and then another five or six months rehearsing it, playing it live. ‘Cause you know, when you play things live you come up with so much, you come up with so many different things to do to these songs, and it’s usually after the record comes out. And you’re sitting there tooling around on these things going, “Shit, I should’ve totally done that. This song would have been so much better. This part would have been so much better.”

We’ve never really been afforded that opportunity, ‘cause just getting all of us in a room three nights a week turned out to be such a nightmare. But luckily, I think we work well under pressure, you know?

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The album cover art is an interesting play on the imagery from Stanley Kubrik’s 2001: A Space Odyssey . Do the album and the film have any common themes? Does the album have a consistent theme, or does it vary from song to song?

The album’s definitely got a theme all on its own. I mean, the only thing that it really draws from is the theme in 2001 with the dog-man, and it shows the same kinda scenario, except more so how humans have evolved, but it takes place in the future. it’s just filled with metaphors. It’s about how we’re regressing back to apes as a result of the byproduct of our technological advancements and, essentially what the monolith represents is the unwavering self-destruction of man through our technological advancements.

It really does play into the vegetarian section of the band, and that idea or aesthetic. Again, anything we’ve ever really talked about has been either revenge or anti-factory farming and the industrialization of how we live and our food supply. You know, it’s just more of this condemning humanity for damage we’ve done. Pretty much.

How extensively will the band be touring following this release?

We’re gonna try to cut down; we’re known for doing like five US tours for every album we do. So we’re gonna try to cut that out and do more international touring, stuff like that. We haven’t hit any other countries. We need to do South America, we need to do Australia, we need to do South Africa. We just wanna explore all those areas, you know? As opposed to 50 US tours, ‘cause everyone’s sick of us by the time we’re on our 20th anyway.

How much new material will you be incorporating into your live set?

Currently, I think we do three old songs, and that’s it. It’s funny, dude, because the audience reaction to the new stuff has been pretty unprecedented for us. Usually it’s been like, “Oh, new song? Cool, that’s cool.” And now it’s been like, “FUCK YEAHHH!” just when I say the words, “Okay, we’re gonna play a new one.” I almost feel dumb playing the old shit, anything pre- Harvest Floor , there’s so much other better stuff that’s, you know. But you wanna appease people, you've gotta play stuff they know. Maybe we’ll cut it down to only one or two old songs when the record comes out [laughs] because we really just wanna play the new stuff, to be honest.

The band worked with producer Billy Anderson on your previous two releases, The Harvest Floor and Karma.Bloody.Karma . Did he return to work on Monolith of Inhumanity ?

No, we decided to go with this guy Dave Otero. We talked to Billy a bunch, you know, it was almost like we kept our options open, we’ll put it that way. We made sure Billy was going to be available and it was gonna be cool, just in case, but we still just kept our options open. And we went with Dave because we were like, “OK, let’s try something new.” Because we’d already done a couple records with Billy, they’re great, but let’s try something new because that’s what we do.

Especially with this record, and if anything it’s going to be our best one. I keep seeing that on the comments online; I try not to look at that shit anyway. So we’re pretty confident with this one. It’s really helped bring a lot of stuff to the table, as far as like arranging issues. We’d bring something in and be like, “What about this part? I’m not sure what to do with this.” And Dave would say, “You know, why don’t you try this?” We never really had anyone do that before. It’s weird. It’s always been like, we play our part, and that was cool. Little pitchy, or this or that, but it was cool. Not like, “That’s cool, but what if this?” you know, like a producer does.

I think a lot of that’s our fault, because we’ve always been like, “We want production credits on this too. We wanna be in control of what we sound like.” And maybe that was our downfall. Because we came into the studio and we kinda dropped it in his lap. “Work your magic, make us sound cool” [laughs]. The same with the director of the new video. As long as it sounds like the band, and it matches the band, and you’ve got trust in this person that they’ll make it sound cool or look cool, then you can add all these different dynamics by dropping it in this person’s lap and saying, “work your magic.” And that’s kinda what we did here.

You recently contributed guest vocals to Soulfly’s “World Scum” off their new album, Enslaved . What can you tell me about that experience?

That was crazy, I was putzing around at like 9 in the morning, and I got a call from Gloria [Cavalera] saying, “Max [ Cavalera, ex-Sepultura ] wants you to do something on the new record.” And I was like, “Oh shit, cool! I’ve never been paid to do guest vocals before, so yeah!” We had gone on tour with Soulfly, and Max is actually a huge Cattle fan. It’s pretty amazing how he took to us, but he’s really into us; talks us up in interviews and stuff.

That really freaked our drummer out because he’s a huge Max Cavalera fan; he’s from Chile, and South America really reveres Sepultura and everything Max Cavalera. His whole calf is a Max Cavalera tattoo. He actually called me and was like, “Dude, dude. Gloria’s gonna call you” [laughs]. “She just texted me, Max wants you on the album.” And I was like, “Oh shit.” And he’s sitting there like “Goddamn it, why wasn’t I a singer?” It was actually pretty funny.

So you know, I got a call from their producer a couple days later and he’s like, “Here’s how it works. Max is gonna have you basically write your own lyrics for the part. Did he tell you that?” and I was like “Ahhh, shit. No.” And he was like, “You get a certain percentage of songwriting credits, but yeah, you gotta write your own lyrics.” And I’m like, “Ah fuck.” So here I am sitting in the middle of writing the Cattle record, and the Murder Construct record, writing both records at once as far as lyrics go. And I’d never done anything like that, and it was really freaking me out because I didn’t want either to suffer. Especially Cattle, because I put a lot of personal stock into Cattle, you know, emotional and mental stock. Hell, physical stock; I’m always on the road with those guys and then with Murder Construct too, you know.

So, it was a monumental pain in the ass. I was constantly writing lyrics, and I’m not used to that. I’m used to getting a new song from Cattle, letting it sit for a couple days, and then coming up with something. This was just constant lyric writing. But I looked at his lyrics, and I was like, “Oh, this is a piece of cake.” It was a lot of Cattle’s themes rolled into one song. It was the easiest thing I think I’ve ever done because it was right up my alley. And I remember emailing Gloria and being like, “Oh dude, I got this. I’m glad he picked me for this because it’s right up my alley.” I think I wrote the lyrics in 15 minutes or less [laughs] and went and recorded right in San Marcos, California, close to where I grew up. And it went great; it worked out amazingly.

What are your plans for future Cattle Decapitation recordings? How do you take it further once you’ve released an album with tracks like “Gristle Licker," “Forced Gender Reassignment” and “Projectile Ovulation”?

That’s the thing, man. That’s a good question. Harvest Floor was really well-received. I feel like we used it as a yardstick of what we needed to achieve on Monolith , and I’ve never been stumped on lyrics. But knowing that everything has to be trumped, it just makes everything way harder. Just knowing that everything has to be really good.

We write music for ourselves; what we wanna hear. But at the end of the day, you can’t alienate your fans, you have to not piss ‘em off, basically. They’re why you’re able to do this. It was a challenge, man. But what I do, is I’ve got a folder on various computers and phones that’s a work in progress from over the last three years. And when we finish an album, when we finished Harvest Floor , I just kept this file going and going. Keep adding to it, subtracting from it. I think I have like 65 or 70 stockpiled song titles.

I come up with song titles first, before our lyrics. I’ve always done that. I still already have another probably three albums’ worth sitting right there. Are they good? I don’t know [laughs], but I got a lot of stuff to choose from. There’s already a ton of song titles in there I’m bummed I didn’t get to use but that’s good, because that means I have plenty to work with for the next record. And the funny thing is I already have, or at least I believe I have the next album cover; I’m not sure if it’s ready to go yet. But I definitely have a title for the next one ready to go. I just have to work in the concept.

With this one, I didn’t even come up with Monolith of Inhumanity until I’d say, like, summer of last year. It’s been almost a year. Maybe nine months. And that freaked me out, because usually I have the album title and theme before the last record. Like how I have it now. We just finished the last record, I already have the album title for the next one. And it’s usually that way. Or I’ll skip, like Harvest Floor skipped Karma.Bloody.Karma , which was actually supposed to be called something else entirely. Things have to happen for a reason, they have to fall into place. That’s how you make a near-perfect, or, I don’t wanna use the word "perfect" because nothing’s perfect. So at least an album that the fans find to be near perfection. That requires serious thought. And things have to fall into place.

The band’s lyrical direction has swayed from pro-vegetarian/vegan themes to, in recent times, more misanthropic, anti-human views. Obviously, the underlying theme to Cattle Decapitation will always remain a commentary on the state of factory farming and mass-produced meat. Since you joined the band in 1999, do you feel there’s been any improvement in public awareness of this issue?

I actually joined in early ’97, but we didn’t have a chance to put anything out until ’99 because those dudes were in The Locust, and they were constantly touring and constantly doing stuff. There was almost a point where they broke up the band because we didn’t have a bass player and they were just thinking, “Eh, we don’t need to find a bass player, we’re just not even going to do this anymore.”

And I was like, “Well, fuck dude, I’ll do it!” and I got us a bass player within like, two days. And he stayed with us for 12 or so years. So what was the question? I just woke up [laughs]. Oh, people are definitely more aware considering what we’ve been doing. But you know, we’re only a half-vegetarian band, just Josh [ Elmore, guitar ] and I.

We hired two dudes who weren’t vegetarian, which was totally cool with us, because we’re not going to put off the band just because we’re searching for top-notch musicians who just so happen to be vegetarian [laughs]. That’s never been a prerequisite to join anyway. A lot of people get it, a lot of people don’t.

But mostly, people don’t subscribe, and those are the idiots at the shows yelling, “Eat a steak!” and other extremely unoriginal shit. I mean, we’re up there playing pretty original music and the only offense that should be taken is by everyone else in the room because it just cheapens the whole experience.

Like what the fuck does that have to do with anything? I don’t give a shit what you eat. We don’t preach to anybody. What we say is more observational; we’re not trying to twist anybody’s arm, because people are gonna do what they want to, you know? So like, fuck ‘em. That’s pretty much what it’s all about. And, of course, the media is obliged to grab onto something flashy, and that’s what it was. The name of the band, the extremity of the whole situation. You know, I understand, it’s just a little off-base I think. There’s so much else going on in our lyrics and what we talk about.

Is there anything else you’d like to add I didn’t already ask you? Any statement to the fans?

The typical bullshit: Check out our album, watch our video, see you on tour!

Cattle Decapitation's latest album, Monolith of Inhumanity , is available now on Metal Blade Records. To learn more about Cattle Decapitation, check out www.cattledecapitation.com and their Facebook page.

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“Everyone treated me like a saint”—In Iran, there’s only one way to survive as a transgender person

In Iran, homosexuality is a crime, punishable with death for men and lashings for women. But Iran is also the only Muslim country in the Persian Gulf region that gives trans citizens the right to have their gender identity recognized by the law. In fact, the Islamic Republic of Iran not only allows sex reassignment, but also subsidizes it.

Before the 1979 Islamic revolution in Iran there was no official government policy on transgender people. After the revolution, under the new religious government, transsexuals were placed in the same category as homosexuals,  condemned by Islamic leaders and considered illegal.

Things changed largely due to the efforts of Maryam Khatoon Molkara. Molkara was fired from her job, forcibly injected with male hormones and put in a psychiatric institution during the 1979 revolution. But thanks to her high-level contacts among Iran’s influential clerics, she was able to get released. Afterwards, she worked with several religious leaders to advocate for trans rights and eventually managed to wrangle a meeting with Ayatollah Khomeini, the “supreme leader” of Iran at the time. Molkara and her group were able to eventually convince Khamenei to pass a fatwa in 1986 declaring gender-confirmation surgery and hormone-replacement therapy religiously acceptable medical procedures.

Essentially, Molkara, the Iranian religious leaders she worked with, and the Iranian government had reframed the question of trans people. Trans people were no longer discussed as or thought of as deviants, but as having a medical illness (gender identity disorder) with a cure (sex reassignment surgery).

“The Iranian government doesn’t recognize being trans as a category per se, rather they see trans individuals as people with psychosexual problems, and so provide them with a medical solution,” says Kevin Schumacher, a Middle East and North Africa expert with OutRight Action International, a global LGBTIQ-rights organization. The policy is based on Islamic notions that gender is binary and that social responsibilities should be split between men and women. “If you’re born a man and your body is a female then in order to protect you and the wellbeing of society,” says Schumacher says, “the government is responsible for fixing the issue.”

An uncomfortable truth

For Sarah, life in Iran was divided into two very distinct parts: before and after she had gender confirmation surgery.

As a young child growing up in the late 1980s in Tehran, Sarah (who, because she is not openly trans, did not want to publish her full name) was uncomfortable wearing the clothes and playing the games traditionally associated with being a boy, and felt she did not belong at the all-boy’s school to which her parents sent her. “You are alone against all the social norms that dictate what you should do, what you should wear, how you should live,” she says.

She was a good student, but in high school, when puberty hit and gender roles grew starker, Sarah began to have difficulty coping with schoolwork and dropped out. “I had to deal with sexual harassment from my classmates and from other people in society on a daily basis, from everyone that thought that [I] was a girlish boy, a sissy boy,” she says. “My life as a teenager was total hell.”

Despite the official policy about trans individuals, trans issues are not openly discussed in Iran. And because the government heavily censors material available on the internet ( a 2013 analysis found that nearly half of the 500 most popular sites on the internet are blacklisted in Iran) Sarah couldn’t research what it means to be transgender or connect with others in the community.

Meanwhile, she felt guilty about her inability to fit in. “Everybody expected me to behave like a man and be like a man and I hated to be like that,” she says. “I wondered why I couldn’t be like other people. Why I couldn’t meet the social expectations.”

At 16, she decided to make a change. “If I’m not a woman, if I’m not a man, I thought at least I should be a productive person and live a…happy life,” she says. So she enrolled in university in Tehran, and began to study languages and translation skills. Even though she continued to live as a man, she grew more confident in her gender identity thanks to the more tolerant atmosphere at the university, and from her academic successes—though she was still years away from realizing she was trans.

The official view

Officially, an Iranian can be diagnosed as having gender identity disorder only after a complex series of medical tests and legal procedures including obtaining a court order, multiple visits to a psychiatrist, and physical and psychological examinations at the state’s Legal Medicine Organization. Even if you somehow figure out how to navigate this process—and Sarah did not—it can take over a year, according to a report compiled by OutRight Action International, a global LGBTIQ-rights organization.

When people do approach doctors in Iran about being transgender, the experience is not always pleasant or helpful. Amir, a 26-year-old trans man from Shiraz, Iran, told OutRight that when he approached a medical professional about his condition, the doctor tried to intimidate him:

It all started when I was eight or nine years old. My parents took me to see a doctor because I kept saying I was a boy. The doctors never talked to me. They just told horrible and terrifying stories to shut me up. They said things like “you will die if you undergo [sex reassignment surgery],” or “many girls who wanted to become boys died during the surgery”

All of them treated me like I was delusional…. They would tell me: “It’s not possible, you were born like this.” But I knew I had to do this operation and change my sex. I was convinced there was a way and I was just looking for some kind of confirmation, from someone, who would tell me “yes, it’s possible!” Instead, one of the doctors gave me pills, and another other one injections…. [Another] told me to “get out and close the door behind [me],” as if I was a dirty and untouchable person.

If an Iranian is officially diagnosed with gender identity disorder, the government issues the authorization for them to legally start the sex reassignment process, and at the end of that process the court issues a new identity card, with a new gender listed. In other words, while Iran does not mandate that all trans individuals have the surgery, it is not possible to change your gender marker on official documents without undergoing the surgery.

Over the last decade, with high-profile clerics and academic centers advocating for trans rights, social awareness on the issue has grown, says Schumacher. In 2007, Molkara established the Iranian Society to Support Individuals with Gender Identity Disorder, the first legally registered trans advocacy group. In 2008, the BBC reported that Iran was second only to Thailand in the number of sex-change operations performed, and the country’s surgery industry still attracts patients from all over the Middle East and Eastern Europe. Between 2006 and 2014, nearly 1,400 people applied for permission for the process according to government figures published in Iranian media.

There are even Iranian movies about accepting trans identities: 2012’s Facing Mirrors was something of a social turning point, giving local journalists a chance to address the issue publicly.  The film’s release was even covered by state-run television and radio channels.

Nevertheless, stigmas remain, reinforced by the notion perpetuated by the government that being trans is a medical problem. Outright’s report found that trans individuals are often subjected to bullying, domestic violence, and social discrimination. In some cases, family members disown trans relatives. Openly trans people often can’t get jobs, and when employers find out an employee is trans they are often fired. Trans individuals can’t rent houses or apartments easily and find it hard to get married because families don’t welcome the idea of having a trans son- or daughter-in-law.

All of which is why when Sarah finally realized that she was trans, when she was in her early 20s and already graduated from college, she did not feel comfortable coming out in public. “Only my family members and few of my close friends knew about it,” she says. “I had to hide everything.”

Making the decision to go through with gender-confirmation surgery was fraught with uncertainty. “On one hand I really wanted to do that and be free and liberated from all the problems of my past,” says Sarah. “On the other hand I was so scared of the ramifications of what I was going to do, because I thought I [would] lose everyone and everything that I had fought for. My university degree, my job, everything. I saw myself having to stand against the entire world.”

Practically, she did not have the means to go through with the surgery and live independently. According to OutRight’s report , the cost of the gender-confirmation surgery in Iran is $13,000 and hormone-replacement therapy costs $20-$40 a month—and the average Iranian’s monthly income is about $400.

The government does offer some limited financial support for gender-confirmation surgery, hormone-replacement therapy, and psychosocial counseling. But funds are limited and government officials decide on a case-by-case basis which individuals qualify. In 2012, the government announced that health insurance companies must cover the full cost of sex-change operations, according to a BBC report . But OutRight has found that insurance companies still often decline to cover some forms of transition-related care, on the basis that they are cosmetic and not medical.

“The government pays a lot of lip service but the actual services that they provide are extremely limited,” says Schumacher. “You talk to many people and they tell you that they have been waiting for many years, hoping to receive some government assistance for these medical bills, but they are still waiting.”

The challenges of being trans in Iran

For those who don’t get the surgery, life in Iran is exceedingly difficult.

Sharia-based laws mandate segregation of men and women in schools and public transport, and Iranian law requires men and women to wear “gender-appropriate” clothing in public spaces. Women are expected by law to wear a hijab , which means they must dress modestly and cover their head, arms, and legs. Traditionally, this is interpreted as a long jacket, called a manteau, accompanied by a headscarf. Failure to conform to this is a crime and could result in arrest or assault at the hands of vigilantes.

“If their appearance is not completely male or female, they are even stopped in the streets by the moral police in Iran,” says Saghi Ghahreman, president of the Iranian Queer Organization based in Canada. These are the undercover agents deployed by the police to patrol public spaces looking for men and women dressed or behaving in a manner deemed un-Islamic, The Guardian reported in 2016. The moral police crack down on loose-fitting headscarves, tight overcoats, shortened trousers for women and necklaces and shorts for men.The laws are often extended to cover new fashions. For instance in 2010 Iran banned ponytails, mullets, and long, gelled hair for men; in 2015 the country cracked down on “homosexual” and “devil worshiping” hairstyles along with tattoos, sunbed treatments, and plucked eyebrows for men.

Hasti, a 30-year-old Iranian trans woman from Khansar, told OutRight that she was frequently harassed by Iranian police for her feminine appearance and makeup. “The [police] would lift up my dress, look at my ID card and ask me if I was a man or a woman,” she said. “In the end they would force me to sign a pledge letter [to promise that I would no longer dress as a woman] and then release me.”

Because women are expected to get married at a young age and produce children, trans people who have not gone through the surgery are sometimes forced into marriage.

Worse, a trans person who is not legally recognized can be accused of homosexuality and face the death penalty. In fact, in some cases gay people in Iran decide to undergo the surgery because the alternative is death. “The sex change operation is most of the time forced on trans people by the culture and by the government,” says Ghahreman.

Making the transition

Sarah spent six years preparing mentally and financially to go through with the surgery.  She describes that period as one of the darkest phases of her life. “I was so depressed and anxious about everything,” she says. “At that time almost all the transgender people I saw in Iranian society were involved in prostitution, were isolated, were ostracized by the society and their family. I didn’t see any successful transgender people. I was afraid if I did it myself, my life would turn into a kind of new misery.”

But she stuck with the plan: she worked in a managerial job, living and dressing like a man, while saving for the surgery. When she had enough money, she decided to travel to Thailand for the surgery; despite the high number of gender confirmation surgeries performed in Iran, the quality of the work is poor. “The operations are done by surgeons that are not professionally trained,” says Ghahreman. “Almost all of the trans people who have operations in Iran are suffering from many side effects that disable their body. Every trans person I have met in the past 10 years, they have a lot of pain because of the surgery and they cannot have normal or pleasurable intercourse.”

When she was 28, Sarah had sex reassignment surgery. “I turned into a whole new version of myself which I loved so much,” she says, likening the process to dying and being reborn. I felt more liberated than what I was in the past. Because in the past I was imprisoned within the framework of my body and my former identity. After the surgery, I got liberated from all those things. For me, anything was better, anything. At least after the surgery I got to enjoy some basic rights that I didn’t enjoy before the surgery.”

Afterwards, she was surprised to find that “almost everyone was very welcoming and very supportive.” Sarah had worried government officials would harass her during the legal process after the surgery, but “everyone treated me like a saint,” she says. “They adore me so much and they admire me so much for doing such a courageous thing—they respect me on a whole different level. I didn’t even expect that—to be respected by people for being a transgender. But it all happened after the surgery.” And, all of a sudden, she could wear the clothes she wanted, change her name, and live the lifestyle of her choice.

Not everyone has such a positive experience with Iranian officials. Assal, a trans woman who travelled back from Iran after undergoing the surgery in Thailand told OutRight she was harassed by Iranian border police agents who passed around her medical documents to each other and laughed at her.  “I felt I was a monkey at the zoo,” she told OutRight.

And despite the support, Sarah never came out officially. Instead, she began to live as a woman in Iran. “The people who know me from the past, they know that I am a transgender, but the people who know me after the surgery, they have no idea of who I was,” she says. “They just think that I am a straight woman.”

Sarah stayed in Iran for six years after surgery. Now 36, she lives in Canada and works as a freelance journalist and translator. But she returns to the country of her birth frequently, and helped found an organization for trans rights there with Maryam Khatoon Molkara. “The culture needs to change,” says Sarah. “The society needs to change its mindset towards people who not like the mainstream. It doesn’t matter if they are gay, bisexual, or trans.”

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High court grants leave to appeal to UK gender identity service

NHS trust wins right of appeal over referrals for puberty-blocking drugs for under-16s who want gender reassignment

An NHS trust has been allowed to appeal against a high court decision that barred it from referring under-16s for puberty-blocking treatment.

The court ruled that children considering gender reassignment were unlikely to be able to give informed consent. Now the Tavistock and Portman NHS trust, which runs the UK’s main gender identity development service for children, has been granted permission to appeal, alongside University College Hospitals NHS foundation trust and Leeds Teaching Hospitals NHS trust.

In a statement, a spokesperson for the Tavistock, which leads the national Gender Identity and Development Service (Gids), said it welcomed the court’s decision. “Our priority is to work together with our partners to support our patients and their families while legal proceedings are ongoing,” the spokesperson said.

At the start of December last year the London clinic lost a case brought by Keira Bell , a 23-year-old woman who began taking puberty blockers when she was 16 before detransitioning, and the unnamed mother of a 15-year-old autistic girl who is on the waiting list for treatment.

In their decision , Dame Victoria Sharp, president of the Queen’s bench division, Lord Justice Lewis and Mrs Justice Lieven, ruled that it unlikely that children under the age of 16 who were considering gender reassignment were mature enough to give informed consent to be prescribed puberty-blocking drugs.

In addition the judges ruled that even in cases involving teenagers under 18 doctors may need to consult the courts for authorisation for medical intervention. They added: “It is doubtful that a child aged 14 or 15 could understand and weigh the long-term risks and consequences of the administration of puberty blockers.”

At the time of the ruling an NHS spokesperson said the Tavistock had immediately suspended new referrals for puberty blockers and cross-sex hormones for the under-16s, which would henceforth only be permitted where specifically authorised by a court.

Susie Green, CEO of Mermaids, a charity providing support to transgender or non-gender-conforming children, said the initial ruling forced transgender young people to go to court to get basic healthcare.

“Whatever our beliefs, most of us can agree that it is the young people themselves, together with their parents and their doctor, who best understand their needs,” she said.

“We are pleased to see that this ruling will now be challenged – for the sake of every child who deserves the chance to live a happy life and be true to themselves.”

In September last year the NHS launched an independent review into the future of gender identity services for children and young people to examine the use of puberty blockers and cross-sex hormone drugs as well as looking at how care could be improved.

The NHS service at Tavistock, to which those under the age of 18 with concerns about their gender are referred for treatment, has had a surge in demand from 77 in 2009 to 2,590 in 2018-19.

An inspection of the Tavistock and Portman NHS foundation trust gender identity services for children and young people by The Care Quality Commission due to report on Wednesday is expected to include feedback from people using the service, parents, relatives, carers and staff.

• Transgender
• Young people
• Court of appeal

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