Alan L. Hart - Transition

Transition

Upon reaching adulthood Hart sought psychiatric counselling and radical surgery to live as a man. Hart's was the first documented FTM case in the United States, though FTM sex change surgeries had been carried out earlier in Germany, including on one man, treated by German sexologist Magnus Hirschfeld, who had won the right to serve in the German military. The 1906-7 case of Karl M. Baer, born Martha Baer, had set a new precedent for sex change surgery by enlisting simultaneous support from psychiatric, legal, and surgical quarters. There was now medical and legal precedent for transforming an otherwise healthy female body into a male one; Hart's approach to his own transition appears to have drawn on the Baer case.

In 1917 Hart approached Dr. Joshua Gilbert at the University of Oregon and requested radical surgery to eliminate menstruation and the possibility of ever becoming pregnant. He also presented Gilbert with a eugenic argument, that a person with "abnormal inversion" should be sterilized. Gilbert was initially reluctant, but accepted that Hart was "extremely intelligent and not mentally ill, but afflicted with a mysterious disorder for which I have no explanation". He accepted that Hart experienced himself only as a male, who described himself using phrases including "the other fellows and I" and asking "what could a fellow do?" Gilbert wrote, in case notes published in the Journal of Nervous and Mental Disorders in 1920, that "from a sociological and psychological standpoint she is a man" and that living as one was Hart's only chance for a happy existence, "the best that can be done." He added, "Let him who finds in himself a tendency to criticize to offer some constructive method of dealing with the problem on hand. He will not want for difficulties. The patient and I have done our best with it." Hart's was the first case in America where a psychiatrist recommended the removal of a healthy organ based solely on an individual's gender identification.

Early FTM surgeries involved the implanting of testicular tissue in place of the removed ovaries. Crystalline male hormones had been extracted in usable quantities from male urine by 1903, but it represented an infection risk. Synthetic male hormone was not manufactured until 1920 (by Bayer), and there is no evidence that Hart took hormones as part of his treatment.

Hart's surgery was completed at the University of Oregon Medical School over the 1917-1918 winter vacation. He then legally changed his name, and in February 1918 married his first wife Inez Stark and moved with her to Gardiner, Oregon, to set up his own medical practice.