 IMAGES OF HEALTH 

One Size Does Not Fit All

in the Transgender Community
| Elizabeth Fee, Theodore M. Brown, and Janet Laylor

RICHARD RASKIND HAD BEEN
captain of Yale’s tennis team and
enjoyed some success on the
American amateur circuit. He
went to medical school, became
an ophthalmologist, served in the
United States Navy, married,
gained a pilot’s license, and com-
peted in the US Open. Then, at
age 41, after 10 years of psycho-
analysis and a divorce, he under-
went a sex change operation and
emerged as Dr Renée Richards.1
Renée Richards moved to Cali-
fornia and joined a new medical
practice. But when she was rec-
ognized playing in the women’s
section of a local tennis tourna-
ment, the press attention became
overwhelming. At this point, she
decided to become a professional
tennis player, on the women’s
tour. When several women pros
complained of what they thought
would be unfair competition, the
resulting fracas was only settled
by a 1977 New York State
Supreme Court decision, ruling
that, because of her sex reassign-
ment surgery (SRS), she was in-
deed legally a woman.2
Richards went on to reach the
women’s double finals at the
1977 US Open. She returned to
a career in pediatric ophthalmol-
ogy in New York and still serves

Below left: Richard Raskin; below right, Renée Richards. Courtesy of

Renée Richards.

June 2003, Vol 93, No. 6 | American Journal of Public Health Fee et al. | Images of Health | 899
  IMAGES OF HEALTH 

on the editorial board of the
Journal of Pediatric Ophthalmol-
ogy and Strabismus. “I am quite
happy with the way my life has
turned out,” she recently told
Elizabeth Fee. “I made the deci-
sion after a lot of soul searching.
Hopefully, with the progress
being made in psychopharmacol-
ogy, such drastic moves as sex-
men and women may experience
to a greater or lesser degree.
Counseling for “gender dyspho-
ria” should help each individual
clarify what troubles him or her,
what he or she wants, and what
steps, if any, will help him or her
get there.5 The medical, surgical,
legal, and emotional issues in-
volved need expert interpretation,
umich.edu/people/conway/TS/
Warning.html. Accessed February 8,
2003.
5. The Harry Benjamin International
Gender Dysphoria Association’s Stan-
dards of Care for Gender Identity Disor-
ders, Sixth Version, February 2001.
Available at: http://www.hbigda.org/
soc.html. Accessed February 8, 2003.
6. Feinberg L. Trans Health Crisis:
For Us It’s Life or Death. Am J Public
Health. 2001;91:897–900.

reassignment surgery will not be including the odds of achieving

necessary for everyone.” In
1999, she gave an Associated
Press interview in which she
said, “I wish there could have
been an alternative way, but
there wasn’t in 1975. . . . Today
there are better choices, includ-
ing medication, for dealing with
the compulsion to cross-dress
and the depression that comes
with gender confusion.”3
People who have undergone
SRS vary in their satisfaction with
the results. Some Web sites con-
tain warnings “for those consider-
ing MtF [male-to-female] SRS,”4
warning, for instance, of reduc-
tion or loss of sexual feeling and
appetite, for both emotional and
anatomical reasons. SRS may
sever nerves in an area where
nerves are essential to sexual
arousal and response, although
surgical techniques continue to
improve. Some male-to-female
transsexuals who go through SRS
experience problems because,
after the operation, they still pos-
sess masculine facial features de-
spite the obvious feminization of
the rest of the body. Although fa-
cial feminization surgery can ad-
dress this particular problem,
such procedures may cost up-
wards of an additional $30 000.
But surgery should not be re-
garded as the gold standard for
all. Indeed, the example of Renée
Richards is but one specific case
in a continuum of responses to
“gender dissatisfaction” that both
what one seeks, exploration of the
risks and practicalities involved,
and the likely financial and legal
consequences. Counseling re-
quires skilled professionals who
can integrate detailed and accu-
rate information with psychologi-
cal skill and sensitivity.
Legal requirements for SRS as
a condition of changing one’s
gender need to be carefully reex-
amined. Overall, encouraging a
Lesbian, Gay, Bisexual,
greater diversity of transgender and Transgender
options seems the best policy for Health Issues
the near and more distant future
in terms of increasing the success
Selections from the American
rate of transgender care and ex- Journal of Public Health
panding the possibilities for Introduction by Anthony Silvestre, PhD, LSW
human happiness.6
T his important publication looks at
health issues affecting the lesbian,
gay, bisexual, and transgender communi-
About the Authors ties. Included with the selections from
Elizabeth Fee is with the History of Medi-
the American Journal of Public Health are a
cine Division, Janet Laylor is with the Of-
fice of the Director, National Library of previously unpublished piece dealing
Medicine, National Institutes of Health, with discrimination and its effect on the
mental health of the LGBT community,
Bethesda, Md. Theodore M. Brown is with
the Departments of History and of Com- and an introduction by Dr. Anthony
munity and Preventive Medicine at the Silvestre, Director, Center for Research
University of Rochester, Rochester, NY. on Health and Sexual Orientation at the
Requests for reprints should be sent to University of Pittsburgh. This volume re-
Elizabeth Fee, PhD, Building 38, Room
ports the latest scientific research and
1E21, 8600 Rockville Pike, Bethesda,
provides great insight into this neglected
MD 20894 (e-mail: elizabeth_fee@nlm.
yet critical public health issue. Excellent
nih.gov).
for classroom use.
ISBN 0-87553-014-1 • 198 pages
References
1. Richards R. Second Serve. New York, spiral-bound • 2001
NY: Stein & Day; 1984. $17.50 APHA Members plus s/h
$24.50 Nonmembers plus s/h
2. Richards v United States Tennis As-
sociation, 400 NYS 2d 267 (NY Sup Ct
American Public Health Association
1977).
Publication Sales
3. Richards R. Cited in: Liaison legacy. Web: www.apha.org
Tennis Magazine. March 1999:31. E-mail: APHA@TASCO1.com
Tel: (301) 893-1894
4. A warning for those considering
FAX: (301) 843-0159 LGBT03J6
MtF SRS. Available at: http://ai.eecs.

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