Medicalization, Sensationalization and Self-Expression: Narratives of Intersex and Gender-Affirming Surgeries

By Ezgi Saritaş

An earlier version of this essay was presented at the International Gender Studies in Turkey Conference, 9-10 December 2023, Sabancı University.

In March 1937, the Izmir newspaper Anadolu ran the headline: “The woman [sic.] who wore male clothes before Greta Garbo. Mrs. Ismet hopes to become Mr. with an operation.”[1] According to the news story Ismet, a trans-masculine person from a rural background, started wearing male clothes in order to earn their living after leaving their second husband. Despite this survival rhetoric employed by the journalist, Ismet said that he[2] was by creation a man. Pointing out that their chest and hips were of male construction, he expressed his desire to undergo surgery to “become a full man.”[3] The story featured Ismet in both female and male rural clothing, although the story reported that he always wore male clothing in everyday life. The female-clad photograph was a striking match for the stereotypical image of a peasant girl carrying a water jug on left shoulder; plausibly taken at the behest of the photojournalists who wanted to create a sensational imagery of a person subverting the gender binary.

In this essay, through the reading of popular medical writing on intersexuality alongside newspapers of the time, literary allusions and transgender self-expression such as that of Ismet, I will attempt to map how the emerging medical discourse on normative gender and sexuality was reflected and negotiated in various narratives on sex reassignment and gender-affirming surgeries.[4]  Although it is difficult to discern how much of Ismet’s story was altered by the journalists to create a sensational read, Ismet’s reference to an operation as a palpable option is notable. Ismet’s remarks were not unique, and allusions to sex reassignment and gender-affirming surgeries appeared sporadically in different texts during the early years of the Republic of Turkey. With the news of sex reassignment surgery for intersex people publicized by popular medical writings and the press, I will demonstrate, how the topic also found its way into literary works. The coverage of intersex surgeries not only made the headlines, but also paved the way for trans-self-representation in first-person narratives and made it possible to allude to surgical gender affirming healthcare.

Medicalization and plea for pity

In 1933, a Sıhhat Almanakı (Health Almanac) was edited by the leading neuropsychiatrist Mazhar Osman and published with the words “A gift from our doctors to our people on the occasion of the tenth year of the Republic.” Aimed at an educated lay readership, the Almanac contained popular information on diseases as well as the modern scientific developments introduced by the new Republic. As Mazhar Osman was the founder of the modern psychiatric institution, Bakırköy Mental and Neurological Diseases Hospital and invested in modern health institutions, the almanac included extensive information on several modern medical institutions and their photographs, documenting how the Republic contributed to the achievements in modern healthcare.

One of the contributions to the Almanac was by Ahmet Fahri Arel, a general surgeon who was the head of the surgical clinic at Haseki Hospital at the time. Arel is known with his specialisation in thoracic surgeries; however, he contributed to the Almanac with a chapter entitled “Hünsalık” (Hermaphroditism). In the chapter, Arel provides detailed information on intersex embodiment and touches on intersex surgery without going into much technical detail, saying that it was “only of interest to practising doctors.”[5] Since the Almanac documents the latest advances in medicine, it appears that surgical sex reassignment is considered one of these advances.

Arel defined hünsâ, often taken as the Arabic equivalent of hermaphrodite, as follows:

“Hünsaiyet [hermaphroditism], which is almost as old as the human species, is a developmental disorder [sic.] resulting from the interruption of development or over-maturation of the sexual organs of the foetus. The history of medicine records that the wretches [sic.] who have combined the sexual forms of both sexes in their bodies have sometimes found themselves in very disastrous, sometimes very ridiculous and curious situations.”[6]

This initial definition sets the tone of the narrative on intersex, oscillating between medicalisation, pity and spectacularization. Arel says the new science of embryology shows that intersex people are victims of a malformation resulting from a disruption that occurs during embryonic development. Criticizing non-scientific superstitious beliefs that demonize and ostracize intersex people, Arel pleads for pity and reveals a condescending understanding within a scientific framework. He argues that, although it is not known for certain, when one of the parents has syphilis or is an alcoholic -the two usual suspects of the degeneration theory that was still popular in the 1930s- it was likely that such unnatural development occurs resulting in the emergence of a “true hünsâ.”[7]

Hünsâ had a wide range of contemporary meanings in the first half of the twentieth century. Its use ranged from encompassing bisexuality and female and male homoeroticism to transgender identity and intersex embodiment in both medical and popular discourse. For example, in all editions of his Tabâbet-i Rûhiye (Psychiatric Medicine), a key text in medical psychiatric education published three times, Mazhar Osman used the Ottoman Turkish terms gulâmperest, lûtî, puşt, ibne and mahbûbdost in addition to hünsâ to translate the sexological categories of male homoeroticism, such as the Uranist and the homosexual.  He also used hünsâ when he introduced the category of bisexuality as rûhî-i tenâsülî hünsâ as a translation of “psychosexual hermaphrodite.”[8] In certain non-medical contexts, hünsâ also referred to the loss of masculinity or feminisation.[9] In political commentary it also had its place, indicating a mixture of binary traits without either being truly like the one or the other.  The poet Ahmet Muhip Dıranas, for example, referred to the false Westernisers of the Ottoman Empire during the Tanzimat era as social hünsâs, contrasting them with the true Europeanism and Turkishness of the newly established Republic.[10] Although its widespread use in popular writing, literature and political commentary usually had negative connotations, as I will explain below, its multiple meanings and inherent ambiguity have provided a language and framework for self-expression of gender non-conformity and the possibility of gender-affirming health care.

However, such space was largely framed by normative discourses of cis-heteronormal gender identity. Medical information about the intersex embodiment given at different popular medical publications served as an entrenchment of the binary understanding of biological sex in the light of the most recent scientific research. Such entrenchment was reflected in the categorisation of intersex embodiment as true and pseudohermaphroditic, which has been the widely accepted and persistent medical categorisation since it was coined by Edwin Klebs in 1876. Arel defined true hünsas as having the reproductive glands of both sexes, who are rare cases, and pseudo (kazip) hünsas, who are actually male or female in their reproductive glands but have unnatural external reproductive organs. Those who are assigned female at birth because the “bulge” (çıkıntı) have not grown as it should have are called “man-woman,” while those with an overgrown “bulge” who are incorrectly assigned male at birth are called “woman-man.”[11] The bulge, which refers to the external genitalia, is not only a euphemism for penis or clitoris, but also reinforces the idea of arrested development, something short of a proper organ. These people, says Arel, are the subject of ridiculous and curious incidents that are reported in the newspapers.[12]

Sensationalization and Spectacularization through Newspapers

The terms “man-woman” and “woman-man” were indeed widely used by the newspapers to denote various forms of gender non-conformity. While some of the stories covered individuals with intersexual embodiments others were about transgender people. Newspapers tried to capture readers’ interest in stories about intersex people with the following titles: “Boy=Girl, a girl wearing man’s clothes,”[13] “Both woman and man. An unheard of freak of nature is exposed,”[14] “The girl who has become a man. Cemil says they have their eye on the neighbour’s daughter,”[15] “A freak of nature. An Armenian girl has become a man.”[16] The last one’s emphasis on the Armenian identity of the person in question does not seem to be accidental as it strengthens the association between racial and sexual otherness.[17]

While some of these individuals underwent sex reassignment surgeries, others were reported to have to live in the “wrong sex” assigned to them because it was surgically impossible to turn them into man.[18] The doctors who examined them, mainly gynaecologists and general surgeons, were reported to have based their decisions about gender assignment not only on the individuals’ statements about their gender identity, but also on their physical appearance, the operability of their reproductive organs, and their lives and sexual relationships.

However, it is difficult to tell from the news reports which factor played a greater role in the doctors’ judgement and how much the person’s own will was decisive. Arel, at the end of the “Hünsa” chapter, gives more clues about the decision of surgery:

 “In the case of male hermaphrodites [sic.], the results we have achieved through surgery are not suitable for most of them to play the role of an active and full man. The erection of this small organ puts the owner in a rather ridiculous situation in the male role. What we are doing is declaring the masculinity of a person who has lived as a woman for many years and has grown up with that upbringing, and then we are taking him out of the environment he has lived in and throwing him into a foreign environment. In such cases it is better to take the opinion of the hermaphrodite himself. Does he enjoy his life, does he want to continue living like this, or does he want to correct his reproductive form and his registration in the population register, but probably to become a sexually inferior man? As for female hermaphrodites, here too it is better to ask the individual’s opinion.”[19]

Later Arel goes on to explain that it is a viable option to operate on female hünsas if their vaginal opening is wide enough, and especially if they can have a child, in which case the clitoris must be “cut out” (istisal). However, if their vaginal opening is small, they should live as a man, as they are very similar to an infertile man who had had a disease of the testicles. Although Arel claims to advocate individual choice, his ultimate criteria revolve around the extent to which a male hünsa can assert an active sexual role as a potent penetrator and how a female hünsâ can be successfully penetrated and fulfil the reproductive role of pregnancy without challenging female sexual role with a large clitoris. The criteria for being a full man (or woman) seem to depend on the person’s sexual and reproductive role, while their personal choice against the doctors’ is framed as choosing to be “inferior.” It is worth asking whether this is how the doctors had presented the alternatives to the intersex people in question, as such framing must have influenced their decisions, given the authoritative position of the doctors.

When talking about an intersex person admitted to Haseki Hospital from an Anatolian village, Arel does not clearly articulate whether the person actually wished for an operation. The person, assigned female at birth, was diagnosed as “actually being male” after their husband complained of infertility.[20] According to Arel, the person themselves applied to be admitted for operation. Arel claims that they articulated enjoying sex with their husband, while noting that they also liked spending time with neighbouring women, without clearly articulating to what this referred. After a physical and psychiatric examination, Arel and his colleagues performed the operation, after which the individual reportedly said they would return to their village to marry a woman.

It is striking that the majority of people featured in the news reports I mentioned earlier were also from rural backgrounds. One likely reason is that middle-class urban families were probably able to manoeuvre the interest of the press by being financially able to afford the discretion of private medical practices. But there was another reason too. Although much of the population of 1930s Turkey was rural, the literate newspaper consumers were the urban middle classes, for whom rural Anatolia was largely an exotic, uncharted territory. The republican elite praised rural Anatolia as the essence of Turkishness and the Turkish people, but it also signified a locus of anxiety with the power to challenge republican rule and its authoritarian modernisation project.[21] The bodies of intersex individuals signified an unruliness that challenged the modern gender binary.  Exoticizing, spectacularising and sensationalizing the rural intersexual body perhaps, served to alleviate the anxieties aroused by this unruliness. Almost all of the stories were accompanied by pictures of the intersex individuals, with their faces clearly visible. While one person was portrayed in typical peasant clothing, many were photographed in white hospital gowns that deprived the intersex body of any identity or agency.[22] While the newspapers reported that these individuals, many of whom were adolescents, were willing to be operated on and were happy with their new bodies, given the mistreatment of poor Anatolian peasants in modern state institutions at the time, it is not impossible that their consent to the operation was at best obtained under duress. [23]

Literary Narratives

Literary narratives of the time introduced, fed and popularised the idea of surgical sex reassignment. In a 1928 serialised novel by Peyami Safa, Havva’nın Üvey Kızları (Eve’s Stepdaughters), which is initially written under the pseudonym Server Bedi and deals with love and eroticism between female assigned persons, the characters mention a Mr Saim who has transitioned from Ms. Saime. Although it is not clear whether an operation had taken place.[24]  The contemporary writer and archivist Serdar Soydan notes that this incident is also recalled in the memoirs of the writer Mahmud Yesari, where a “Lady Saime has become a Mr Saim with an operation.”[25] Memduh Şevket Esendal mentioned a transmasculine character in the 1935 story “Sofu Adamın Kızı” (The Pious Man’s Daughter) as follows: “This mother had a sister [sic.] who had a nervous breakdown. She thought of herself as a man, asked doctors to turn her into a man with an operation. Her voice is deep. Maybe the depth of her voice gave her the idea of being a man.”[26] Although the literary narratives of gender-affirming surgery do not seem to have a dismissive or judgmental tone, they also allude to this medical possibility as a curiosity that upsets normativity. None of these literary pieces talk about actual surgery but reflect transgender people’s awareness of and desire to take advantage of new surgical possibilities, and, as Soydan claims,[27] may be based on some actual transgender people’s self-representation of gender-affirming healthcare. Meanwhile, as in Ismet’s case, transgender self-expression in relation to surgical sex reassignment has found a place in the press.

Possibilities for self-expression

Before it was regulated in 1988 by the addition of a paragraph to the Civil Code, gender-affirming surgery for transgender people was mostly carried out haphazardly, depending on the incentives of the surgeons. It remains to be historically established how surgeries were carried out on transgender people before 1988, but during the period in question, i.e. the 1930s, it appears that sex reassignment surgeries were mainly carried out on intersex people but provided a framework for transgender people. As the word of sex reassignment surgery spread, some people saw it as an opportunity for gender-affirming medical care. One of these was a trans-masculine person, Kenan Çinili, who was featured extensively in the newspapers in 1935 and 1937, and whose memoirs were published in instalments in the daily Haber in 1937-8.[28]  When confronted by their fiancé with the fact that they had been assigned female at birth, they claimed that they were hünsâ and could be operated on to become a man.[29] However, Kenan had not followed up on this claim, nor had they twice mentioned their willingness to undergo the operation.

Here, the allusion to sex reassignment surgery of the intersex body seems to offer a safe solution to sexual transgression and gender non-conformity by framing them as the consequence of a medical condition. However, such allusions also opened up a space for imagining medical care that is not limited to the views of medical professionals, but to the desire of gender non-conforming people to claim their right to be comfortable with their bodies and gender identifications. Although statements of self-identification made through the sensationalizing language of the press should always be read with caution, when read against the grain, statements such as Ismet’s reveal that gender non-conforming people have been able to manoeuvre through medicalisation, pathologisation, sensationalization and spectacularization to imagine a gender-affirming healthcare.

Conclusion

In this essay, I examined an early Republican medical text on intersex surgery by conflating it with news reports of the time and some literary narratives. While the medical discourse on intersex surgery claimed to prioritise the will of intersex individuals, on closer examination normative understandings of gender dimorphism as well as patriarchal sexual roles seemed to play a greater role. It is fair to say that people from poorer and rural backgrounds appear to have been more susceptible not only to sensationalising interest of the press but also unwanted genital mutilation. Nevertheless, as the press and popular medical narratives spread the word about surgical sex reassignment, gender non-conforming people were able to imagine the possibility of gender-affirming health care.

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References

[1] Şahap Göksel, “Greta Garbo’dan Evvel Erkek Elbisesi Giyen Kadın. Bayan Ismet Ameliyattan Sonra Bay Olacağını Ümid Ediyor,” Anadolu, 4 March (1937), 3.

[2] Turkish is a gender-neutral language. I use gendered pronouns when there is a clear reference to gender identity. Although Ismet identifies as a man, his remarks should be read with caution, as it is not clear to what extent they are distorted by journalists.

[3] Göksel, “Greta,” 7.

[4] I use sex reassignment surgery to refer to surgery that aims to reassign a body’s sex, regardless of whether it is gender affirming or not, including intersex surgery. I use gender-affirming surgery only in reference to surgeries that are requested by the individual.

[5] Ahmed Fahri Arel, “Hünsalık” in Sıhhat Almanakı, (İstanbul: Kader Matbaası, 1933): pp. 191-9.

[6] Arel, “Hünsalık,” p. 191.

[7]  Arel, “Hünsalık,” p. 192.

[8] Mazhar Osman, Tabâbet-i Rûhiye, vol.I (İstanbul: Matbaa-i Hayriyye, 1909): p. 270.

[9] Tanıl Bora, “Adnan Menderes,” in Türkiye’nin 1950’li Yılları (İstanbul: İletişim, 2015): p. 347.

[10] Tanıl Bora, Cereyanlar: Türkiye’de Siyasî İdeolojiler (İstanbul: İletişim, 2017): p. 83

[11] Arel, “Hünsalık,” p. 193.

[12] Arel, “Hünsalık,” p. 193.

[13] “Kız=Oğlan! Erkek Elbisesi Giyen Kız: Zeliha,” Vakit, 10 February (1933): p. 1.

[14] “Hem Kadın, Hem de Erkek: İşitilmemiş bir Hilkat Garibesi Meydana Çıkarıldı,” Cumhuriyet, 12 June (1934): pp. 1-3.

[15] “Erkek Olan Kız! Cemil Komşunun Kızını Gözüne Kestirdiğini Anlatıyor,” Tan, 6 June (1935): p. 6.

[16] “Bir Tabiat Garibesi: On Dört Yaşında Bir Ermeni Kızı Erkek Oldu,” Tan, 23 August (1937): p. 2.

[17] For a more detailed discussion on claims of Turkish racial superiority in the 1930s see Nazan Maksudyan, ‘The Turkish Review of Anthropology and The Racist Face of Turkish Nationalism’, Cultural Dynamics 17 (2005).

[18] “Hem Kadın, Hem de Erkek: İşitilmemiş bir Hilkat Garibesi Meydana Çıkarıldı,” Cumhuriyet, 12 June (1934): pp. 1-3.

[19] Arel, “Hünsalık,” p. 199. Emphasis is mine.

[20] Arel, “Hünsalık,” pp. 194-5.

[21] Asım Karaömerlioğlu, Orada Bir Köy Var Uzakta: Erken Cumhuriyet Döneminde Köycü Söylem (İstanbul: İletişim, 2021): p. 15.

[22] Ezgi Sarıtaş, “Creating a Space for Trans Self-Narrative in 1930s Turkey: Kenan Çinili’s Memoir,” Gender & History n/a, no. n/a (16 October 2023), https://doi.org/10.1111/1468-0424.12747.

[23] Sarıtaş, “Creating,” p. 9; Hale Yılmaz, Becoming Turkish: Nationalist Reforms and Cultural Negotiations in Early Republican Turkey, 1923–1945 (Syracuse: Syracuse University Press, 2013): p. 73.

[24] The novel was serialised in the newspaper, Son Saat in 1928. I would like to thank Seval Şahin for providing me with the unpublished manuscript of the novel’s transcription.

[25] Soydan, Manşetlerden, p. 11.

[26] Memduh Şevket Esendal, Gönül Kaçanı Kovalar (Ankara: Bilgi, 2005): p. 179.

[27] Soydan, Manşetlerden, p.11.

[28] For a more detailed discussion, see Sarıtaş, “Creating;” Serdar Soydan, Manşetlerden Gaipliğe: Bay-Bayan Kenan Çinili’nin Evrak-ı Metrukesi (İstanbul: Sel Yayınları, 2021).

[29] Kenan Çinili, “Bir Gün Olmadık Bir Şey Oldu: Hicran Beni Yatak Odasına Çağırttı,” Haber, 6 January (1938): p. 5.

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About the author

Ezgi Sarıtaş holds a PhD in Gender Studies from Ankara University where she is currently working as a research assistant.  In the academic year 2021/2022 she was a EUME fellow at the Forum Transregionale Studien through a stipend from the Gerda Henkel Foundation and a visiting scholar at the Center for Transdisciplinary Gender Studies at Humboldt-Universität zu Berlin. Her research focuses on sexual modernities of the Ottoman Empire and the Early Turkish Republic, and the women’s rights and feminist movements in modern Turkey.

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Citation: Ezgi Sarıtaş, Medicalization, Sensationalization and Self-Expression: Narratives of Intersex and Gender-Affirming Surgeries, in: TRAFO – Blog for Transregional Research, 26.03.2024, https://trafo.hypotheses.org/50890

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