When I was eight, a man who had undergone a sex change was making news by suing the United States Tennis Association to gain the right to compete in the 1976 US Open as a woman. I’m not sure where I heard of the story, but I do remember being aware of it and wondering about the concept of a sex change.

Back then, the terminology in use was sex change which eventually became sex reassignment, then gender reassignment, and now goes by gender confirmation, a softer and more affirming designation.

It was at age 34, the mother of a 6-year-old boy and twin 3-year-olds, when I was again reminded of my skepticism of the possibility of sex change. One of my twins, who are biologically female, would say with some regularity, “I wish I were a boy.” Internally, I always winced and thought, “God, let’s not let that happen. In this day and age, people think that just because they can do something, they should.”

Now that I’m 50, both of my twin girls identify as male, take testosterone, and one has undergone a double mastectomy, frequently called “top surgery.”

I’ve recently spent some time studying the history of sex reassignment surgery and the major figures involved in its genesis. It’s fascinating reading, though it has not yet reconciled my misgivings about the efficacy and best practice of surgery as treatment for cross-gender identification.

Sexology, the scientific study of human sexuality, including human sexual interests, behaviors, and functions, began in the late 19th century as a response to a clash between sexually liberal laws and laws that criminalized “deviant” sexual behavior, including homosexuality and transvestism, throughout Europe. Psychopathia Sexualis is the work which established sexology as a scientific discipline, and was written in 1886 by German psychiatrist Richard von Krafft-Ebing (1840-1902).

Magnus Hirschfield (1868-1935) was a German physician who many consider the father of transgender healthcare. He was of Jewish heritage and an outspoken advocate for sexual minorities, was himself gay, and treated many patients who dealt with the complicated issues of gender and sexuality. In a world where his contemporaries were trying to cure transgender patients, Hirschfield’s theory supported those who wanted to live according to the gender with which they felt most aligned, rather than the gender associated with their biological sex. Much of his work with the Institute of Sexual Science (1919-1933), which Hirschfield founded, was destroyed in the Nazi book burnings of World War II.

The first known sex change surgery was completed by Hirschfield’s practice in 1906 on a female-identified child born in 1885, who transitioned socially to male prior to his surgical transition. His story is told in a part autobiographical and part fictionalized work published in German in 1907 under the pseudonym, N. O. Body, entitled Memoirs of a Man’s Maiden Years. Translated to English, and with the addition of a contemporary preface and afterword, it was republished in 2009. It is interesting to note that at birth, the baby was described by her doctor as having “such strange” characteristics that it was impossible for him to actually determine her gender.

Christine (George) Jorgensen was the first person to become widely known in the US for having sex reassignment surgery in 1952 at age 27, completed in Denmark under the care of endocrinologist, Christian Hamburger (1904-1992).

Jorgensen was seeing Dr. Harry Benjamin (1885-1986) in the US prior to her treatment in Denmark, but sex reassignment surgery was not yet legal in the United States. Dr. Benjamin is the author of the 1966 book, The Transsexual Phenomenon, was the founder of what is now known as WPATH (World Professional Association for Transgender Health), and was also German-born. He met Magnus Hirschfield through a mutual friend. Though sexual medicine was not part of his medical studies in endocrinology, the topic interested him and became his main focus after he failed to start a medical career in New York in his 30s.

Sexologist Alfred Kinsey (1894-1956), who founded the Kinsey Institute for Research in Sex, Gender, and Reproduction, was a contemporary of Dr. Benjamin. He referred a case to him of a young boy who wanted to become a girl and whose mother wanted to assist. Dr. Benjamin disagreed with the psychiatrists with whom he consulted and helped the mother travel to Germany to complete the sex change procedure.

An emigrant from New Zealand, John Money (1921-2006), is credited with the development of the terms gender identity and gender role. He is a controversial figure in gender reassignment due in large part to the case of biological twin boys, Bruce and Brian Reimer, in which one twin’s circumcision was botched so badly that the parents sought counsel due to the irreparable damage. Money recommended gender reassignment at age two with no communication with the child that she was actually born a boy. He promoted the success of the procedure using aliases to protect the identity of the family, however the procedure was not even close to successful, and when Brenda was informed of her birth sex, she decided to transition back to male through a second gender reassignment at age 21. Both twins ultimately committed suicide as adults within two years of each other.

A few articles decry these practitioners as using controversial methods, supporting their own ideologies, and some even suggesting they subscribed to questionable moral values including the defense of pedophilia, while most celebrate them as pioneers and heroes.

I have learned a great deal about the history behind the debated treatment, and I can even understand to a degree the move towards a surgical option to mitigate the psychological duress of a mismatched gender and body, especially when contrasted with the rigidity of society when the study of sexology was born. I still continue to question whether it is a best practice, or something that is a passing solution that will ultimately be replaced by something less invasive and more holistic. That is my hope.