Doctor's Review: Medicine on the Move

November 18, 2017

Roberta Cowell and Dr Michael Dillon.

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Transgender tipping-point

Dr Michael Dillon: the first trans man to transition medically

The first trans man to transition medically was a patrician Briton who, at age 24, was studying at a women’s college at Oxford as Laura Dillon, and later became the physician Dr Michael Dillon.

In 1939, fully 14 years before world headlines blazed “Ex-GI Becomes Blonde Bombshell” and the news of Christine Jorgensen’s sex reassignment surgery, Laura Dillon was quietly exploring the new frontier of hormone therapy, secretly probing the mysteries of testosterone to see if they might manifest her dream to live more fully as a man.

When she got word of a doctor in nearby Bristol who specialized in “sex problems,” she fired up her motorcycle and roared off to get the earliest possible appointment. Dr George Foss was one of the very few physicians who had been experimenting with high doses of testosterone to treat women with uninterrupted menstruation. He’d had some success, but had noted that the treatment also produced swollen clitorises, shrunken breasts and deepened voices in many of his patients.

On first meeting, he was delighted with Laura. Here was an opportunity to ramp up the experiment and to find out what a continued high dose of testosterone might do to a woman’s body — and to her mind!

He assured Dillon that he could help but first, he would need to call in one of his colleagues, a psychiatrist, who would examine this unusual desire to become a man. The interview did not go well and, as a result, Dr Foss refused to take Dillon on as a patient. As a parting gift, however, he slid a package of testosterone pills across the desk and suggested she experiment with them on her own.

At the time, testosterone was all the rage, but not for use in gender reassignment. Instead, it had been heralded as a rejuvenation tonic by a Viennese doctor, Eugen Steinach, who developed a procedure — essentially a vasectomy — that he claimed stimulated the testes to produce more testosterone. Poet W.B. Yeats got “Steinached” in 1934 and even Sigmund Freud, perhaps the ultimate skeptic, succumbed to the craze though he begged his colleagues not to divulge the operation until after his death. Unfortunately for Laura, the psychiatrist Dr Foss had recommended gossiped about his unusual patient at an Oxford dinner party and soon the word was out: “Miss Dillon wants to become a man!” Under the circumstances, Dillon decided to leave the college and move to Bristol, take a job as a mechanic and self-administer the testosterone. With a deeper voice, bulkier muscles and the beginnings of facial hair, it wasn’t hard for Dillon to convince the boss at the garage to use male pronouns for him in the shop. Afterhours though, the other mechanics still teased him mercilessly and called him “she.”

An MD who cared

Hormones went a long way to helping Dillon pass as a man but he suffered from hypoglycemia and, in 1942, he collapsed in the street, hit his head and passed out cold. At the local hospital, confused staff examined his body and argued over which ward to put him in, but the matter ended there, no one went to the press. When he passed out in public a second time, he got lucky. The physician treating him introduced himself as a “plastic surgeon,” an extremely rare bird at the time. He sympathized with Dillon’s plight and, after agreeing to remove his breasts, introduced him to another plastic surgeon, Sir Harold Gillies, who was essentially writing the book on plastic surgery in England. He was much in demand at the time treating soldiers injured in the war, but agreed to transform Dillon’s genitals into a penis as soon as the war ended.

In 1946, true to his word, Sir Gillies got to work. Three years and 13 painful, infection-prone operations later, Dillon had what biographer Pagan Kennedy called a “semi erect, mostly numb sexual organ that resembled a small party balloon.” The appendage functioned beautifully for urination, which was of great concern for Dillon who wanted to share the lockers with the men on his rowing team. By this time, he had enrolled in medical school at Trinity College, Dublin, under a new legal name, Lawrence Michael Dillon, and his past as Laura Maud Dillon was finally behind him — or so he thought.

Also in 1946, he published a slim volume entitled Self: A Study in Endocrinology and Ethics. A rambling lecture on hormones in the first two chapters functions as a scrim to conceal the book’s true subject that emerges in chapter three and is an early manifesto for transsexuals. In it, he explains the loneliness of transgender people, argues for sex-change operations and puts the case that the British government should subsidize hormone treatments.

Initially, the book attracted very little attention. Dillon received a few letters from gay men and that was all. Then, in 1950, a significant letter arrived from a Miss Roberta Cowell, who had discovered Dillon’s book, devoured the information and begun dosing herself with massive quantities of estrogen — enough to transform her from Robert to Roberta. A flurry of letters was exchanged and they agreed to meet. Dillon had still not divulged the secret of his gender at birth, but as soon as he cast eyes on Roberta, he was smitten and told all.

Cowell was not similarly moved, though she kept up the steady stream of letters and seems to have tolerated Dillon’s declarations of love. While Dillon was busy obsessing over Cowell and picking out an engagement ring, all the while working furiously to pass his medical exams, Roberta was in search of a doctor who would agree to perform a bilateral orchiectomy. The removal of both testicles was an illegal operation under the common law mayhem statute, intended to prevent physicians from operating on the healthy body parts of potential soldiers. Though his experience as a surgeon was extremely limited, Dillon offered to do the operation, perhaps believing it would hasten Cowell’s legal name change and, Roberta willing, their ability to marry. The operation was a success. Dillon passed his exams and proposed to Cowell. He was kindly but emphatically snubbed and never spoke of her again. The rejection was a turning point for Dillon and he would never again risk baring his heart. Shortly after, he went to sea as a doctor aboard a ship bringing pilgrims to Mecca and eventually wound up on a freighter that shuttled cargo between the United States and India, returning only occasionally to England to care for his aging aunts.

Inheriting a peerage

When Michael’s older brother died in 1958, Debrett's Peerage listed him as heir to the baronetcy, while its competitor, Burke's Peerage, mentioned only a sister, Laura Maud. When the discrepancy was picked up by the press, he tried to explain it away by saying he was born male with a severe form of hypospadias, a congenital condition in which the opening of the urethra is on the underside of the penis, and had undergone a series of operations to correct the condition. The press didn’t buy it and the resulting fracas in publications as diverse as the tabloid Sunday Express and Time drove him to India where he hoped to start a new life.

In northern India he met Sangharakshita, an Englishman and founder of the Triratna Buddhist Community, and spent time with him and with a Buddhist sect in Sarnath. After several gender-related disappointments, he was finally accepted as a novice monk at the Rhizong monastery in Ladakh and given the name Lobzang. Over the next few years, he published several books on Buddhism including The Life of Milarepa and Imji Getsul, an account of life in a monastery, but his difficult life had taken its toll and he was in poor health. He died in a border hospital in India on May 15, 1962. He was 47.

Lawrence Michael Dillon was a transgender pioneer. As a doctor, he was one of the first to understand what medicine could do for people who felt as he did. He proposed, why not give patients the body they wanted? What’s most remarkable about his life is that he was the first in so many aspects of transitioning from a female body to a male one, aspects that are now par for the course for many trans men. Not only was he the first trans man to use hormones to medically transition, he was also the first to undergo modern genital reconstruction surgery.

At a time when the details of his transition were likely to attract a fierce amount of unwanted global attraction, which could easily result in prejudice and ill treatment, Michael’s life was shaped by a fear of exposing his past.

Transgender people still face many of the challenges that Dillon encountered, but cultural attitudes are evolving, particularly in the last two or three years. A 2014 Time cover story declared: “The Trans Tipping Point,” calling the pursuit of equal rights for transgender people the “new civil rights frontier.” Society is finally coming to accept the right, as Dr Dillon called it, “for the body [of the transsexual patient] be made to fit his mind.”

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