Transness and Transition in Twentieth-Century British Medical Science Before Transsexuality, 1920-1966

人们普遍认为，英国目前的性别确认医疗体系起源于1966年查林十字性别认同诊所（Charing Cross’Gender Identity Clinic）。在那里，精神病学家约翰·兰德尔（John Randell）开始用“变性欲症之父”、美国性学家哈里·本杰明（Harry Benjamin）开出的内分泌和外科“变性手术”处方治疗“变性人”。自本世纪中叶以来，变性医学一直主导着我们对变性生活和医学转变的看法；将“变性”历史化，就是追溯它在20世纪医学科学中不可避免的出现。沿着美国历史学家Gill-Peterson、Aizura和Amin开辟的道路，我着手研究20世纪英国科学和医学的“前变性”历史。我的问题是：在“变性”或“性别”进入诊所之前，英国的跨性别者通过哪些理论、技术和实践来表达自己？本调查可分为三个相互关联的研究问题，分别是智力，技术和社会性质。在智力上，我追踪了从20世纪20年代末到60年代初医学科学思想中“性”概念的波动和争论。借鉴英国成熟的性学、精神病学、心理学和大众科学史学，我研究了专家和病人的话语，以考虑在变性之前占主导地位的“雌雄同体”、“同性恋”和“间性”的“转移诊断矩阵”中，变性生活是如何被不同地理解和表达的。从技术上讲，我对研究、技术和临床实践的变化如何允许被归类为“医学过渡”的身体增强形式感兴趣。我首先考察了自20世纪20年代末以来，生物化学和生物医学研究以及临床内分泌学是如何促进激素治疗的。谈到泌尿生殖外科，我研究了20世纪30年代以来泌尿外科整形手术中可能出现的“男性化”或“女性化”形式。在社会方面，我研究演员如何在诊所内外发展和运用理论和技术。病人和医生之间的互动如何塑造了过渡的形式和可及性？最近，我研究了国家如何在后nhs时期从事医疗转型，以查询什么，如果有的话，前变性患者公民身份存在于公共医学。实践是将这三种考察方式统一起来的客体和启发式。虽然我借鉴了方法论，并参与了英国知识、技术、社会、文化和主观历史的历史编纂，但我的研究倾向主要是实践学。在Mol和Mak之后，我认为医学科学的“实践”是代理人、对象、网络和程序的集合。因此，实践包含、创造了整个世界。这些世界被牵连到历史谱系中，它们的各种元素通过这些谱系实现。实践允许我们通过开放实验室和诊所汇聚的知识、技术、学科和社会历史来追求不同的研究路线。我的研究致力于广泛地思考医学转型和相关的医学科学实践，以充分地将英国的变性和20世纪后期由此发展起来的医学法律体系历史化。在这样做的过程中，我追寻“未走过的路”，就像追寻通往现在的路一样。

The present system of British gender-affirming healthcare is generally thought to originate with Charing Cross' Gender Identity Clinic in 1966, where psychiatrist John Randell began treating 'transsexuals' with the endocrinological and surgical 'sex-reassignment' prescribed by the 'father of transsexualism,' U.S. sexologist Harry Benjamin. Since the mid-century, transsexual medicine has dominated how we think about trans life and medical transition; to historicise 'transsexuality' was to trace its inevitable emergence in twentieth-century medical science. Following the path broken by U.S. historians Gill-Peterson, Aizura, and Amin, I undertake a 'pre-transsexual' history of twentieth-century British science and medicine. I ask: through what theories, technologies, and practices did British transness articulate itself before 'transsexuality' or 'gender' entered the clinic?This investigation is divisible into three interrelated research questions, which are respectively intellectual, technical, and social in nature.Intellectually, I trace fluctuation and contest in the conceptualisation of 'sex' in medical-scientific thought from the late-1920s to the early-1960s. Drawing on the well-established British historiographies of sexology, psychiatry, psychology, and popular science, I examine expert and patient discourses to consider how trans life was differently apprehended and expressed within the 'shifting diagnostic matrix' of 'hermaphroditism,' homosexuality, and 'intersexuality' that dominated before transsexuality. Technically, I am interested in how changes in research, technology, and clinical practice permitted forms of bodily augmentation classifiable as 'medical transition.' I first examine how biochemical and biomedical research and clinical endocrinology facilitated hormonal therapies from the late-1920s. Turning to urogenital surgery, I examine the forms of 'masculinisation' or 'feminisation' possible within reconstructive and urological plastics from the 1930s. Socially, I study how actors developed and engaged theory and technology in the clinic and beyond. How did interactions between patients and practitioners shape the form and accessibility of transition? Latterly, I examine how the state engaged with medical transition in the post-NHS period, to query what, if any, pre-transsexual patient-citizenship existed within public medicine.Practice is the object and heuristic uniting these three modes of investigation. Though I draw on the methodologies and engage the historiographies of British intellectual, technical, social, cultural, and subjective history, the bent of my research is primarily praxiographic. After Mol and Mak, I consider medical-scientific 'practice' as an assemblage of agents, objects, networks and procedures. Practice thus encompasses, creates, whole worlds. These worlds become implicated in the historical genealogies that their various elements materialise through. Practice allows us to pursue varied lines of investigation by opening up the intellectual, technological, disciplinary, and social histories that converge in laboratories and clinics.My research endeavours to think expansively about medical transition and related medical-scientific practices in an effort to adequately historicise both British transsexuality and the medico-legal architecture that developed therefrom in the later twentieth-century. In so doing, I trace the 'roads not taken' as much as the path to the present.