Modern times ...

Despite its growing prevalence in Europe, surgeons in the United States were hesitant to perform the operation, primarily for fear of prosecution, both civil and criminal. Without an officially recognized diagnosis making SRS a valid medical cause, it could be seen as being the crime of "medical mayhem" (the permanent maiming or mutilating of an individual, rendering that individual partly or wholly defenseless).

In 1958, a group of UCLA doctors, Robert Stoller, Harold Garfinkel and Alexander Rosen, performed feminization surgery on an intersexual woman named Agnes.
SRS finally came to America with the help of a FTM, Reid Erickson. Born female, Reid inherited a fortune from his father, and began transitioning to live as a male under the supervision of Dr. Harry Benjamin.

Erickson formed an organization, The Erickson Educational Foundation, to promote the study of transsexualism. A group of doctors at Johns Hopkins University were among the first to benefit from the generosity of the EEF. Doctors John Money, Howard Jones and Milton Edgerton started America's first Gender Identity Clinic. There, in 1965, after receiving permission from a Baltimore court, Phillip Wilson underwent the first SRS in the U.S. to become Phyllis Wilson.

In 1966 Dr Harry Benjamin, a personal friend of Christina Jorgensen published "The Transsexual Phenomena." It outlined the nature of the condition, the differences between transsexuals and transvestites, and described the successful results of treatment with hormones and surgery.
Benjamin made the it easier for thousands of transsexuals to obtain treatment. He outlined the standards of care for the transsexuals and founded the Harry Benjamin International Gender Dysphoria Association, which still sets the standards for treatment.

In 1966, the Johns Hopkins Gender Clinic announced its success to the New York Times. In addition, that year Dr. Harry Benjamin wrote his penultimate work, The Transsexual Phenomenon.
Now, the floodgates opened, as over the next couple years several universities opened gender clinic: Stanford (under Psychiatrist Norman Fisk and surgeon Donald Laub), UCLA (headed by Dr. Robert Stoller), Northwestern, and the University of Minnesota (Dr. Hastings). The Stanford clinic in particular was noted for its pioneering work, involving both the sigmoid colon resection vaginoplasty, and advances in phaloplasty techniques.

Since 1966 many more patients began to seek sex reassignment treatment, and many more Doctors began to provide it. However many members of the medical community were the uneasy with what they saw as supporting the delusion of psychotic people with the mutilation of otherwise healthy bodies.

In 1969, the first private practicioner began performing SRS in America: Dr. Stanley Biber, working from drawings from the Johns Hopkins Clinic. His practice was seen as an alternative to the gender clinics, where prospective transsexuals were expected to meet sometimes strict criteria before being awarded with SRS.

Other countries soon became more relaxed about SRS. In 1967, a change in British law allowed Charing Cross Hospital to begin performing SRS, under Dr. Phillip, and in 1969, Germany decriminalized the procedure. In 1971, Dr. Lion Perel performs the first sex reassignment at the Saint-Francois hospital in Paris.

The Erickson Educational Foundation began sponsoring a series of International Symposia on Gender Identity. The first was held in London, in 1969. Future meetings took place in Denmark - 1971, Yugoslavia - 1973, Stanford - 1975, Norfolk - 1977, and finally in San Diego - 1979.
In 1972, the AMA first officially sanctions SRS as the treatment for transsexualism. "Gender Dysphoria Syndrome" was coined a year later by Norman Fisk.

In the late 1970s, however, the climate began to change. The first signs were seen at Johns Hopkins, where the chairman of the Psychiatry department, Dr. Joel Elkes, was replaced by Dr. Paul McHugh. McHugh saw SRS as unnecessary mutilation, and set out to kill the program. He assigned Dr. John Meyer to do a long-term follow-up study of 50 transsexuals who underwent SRS at Johns Hopkins. Meyer's report, issued in 1977, claimed that SRS confers no objective advantage in terms of social rehabilitation for transsexuals. Although the paper was widely criticized as flawed, it led to the October 1979 closing of the Johns Hopkins Gender Identity Clinic.

Transsexuals came under fire at this time from both the lesbian/gay community and feminist groups. A prime example was the 1979 publication of Janice Raymond's book The Transsexual Empire: The Making of the She-Male, wherein she attacked transsexuals from a feminist angle. In short, she criticized TSs for reenforcing gender roles, and complained that men (the TSs) were only transitioning to dominate and further oppress "true" women.

Sensing political pressure, other universities began to taper off their own gender programs. Some were discontinued completely. Others, such as Stanford's, were removed from the university, becoming non-affiliated, nonprofit foundations. In 1977, the Erickson Educational Foundation dissolved, leaving even the ISGE with an uncertain future.

In 1979 Meyer and Reter2 published a paper in a reputable Scientific journal in which they concluded that the transsexuals who were treated by hormones and surgery were no better off than those treated by psychotherapy to help them accept their original birth gender.
However many researchers have attempted to follow up transsexuals after treatment and only Meyer and Reter came to this conclusion. Many researchers3 in the have pointed out a large number of flaws and prejudices in this study. For example he allocated positive and negative points for a number of lives and added them together, however a relationship with someone of the same sex was considered to be a negative point. People who had middle class jobs were allocated more points than people in manual jobs. Most members of the medical profession would consider that homophobic and prejudice of this nature have no place in modern medicine.
Critique from Feminists

In 1979 Janice Raymond published "The Transsexual Empire". In this book she stated that the entry of male to female transsexuals in to women only spaces made the women feel violated. She also argues that effeminate men should remain men and challenge societies conception of what it means to be male, rather than becoming feminine females and reinforcing societies perceptions of what it means to be female. She claimed female to male transsexuals were victims of the misogynistic society. This view is also held by academics such as Germaine Greer.
The vast majority of transsexuals that transitioned in the 1960's and 70's were previously living as gay men they became heterosexual women. If they were able to effectively appear though they were born female then they would have been able to obtain work and earn a decent living. April Ashley one of the first British transsexuals who came to the attention of the media was able to work as a underwear model however once a friend sold her story to the press she recalls that she couldn't even get a job in a shop!!!

In the early 1990's the medical profession began to realise that just as not every man who was born male was attracted to women, neither did every man who was born female, and the Gay and Lesbian transsexual began to emerge. More and more people who felt that they did not fit into either of the two genders felt that they did not need to and began to identify as transgender4.

Legal progress was made in the UK after a landmark case in the European Court in 1999 it became illegal to discriminate against someone on the basis of their transsexuality. By this time the majority of transsexuals were able to remain in their old jobs whilst they transitioned from one gender to another. By now ones passport and driving license could be changed. The only thing that could not be altered was the birth certificate, with that came the right to marry and to adopt a child with a partner of the opposite sex.

After a recent European Court ruling that the refusal to change birth certificates is unlawful soon it should be possible to achieve full legal equality.