After 22 years turning men into women, New Zealand's only sex change surgeon is hanging up his scalpel. Peter Walker talks about changing bodies, minds and lives:
It is striking, says Peter Walker, how very many of his patients, before they finally decided to become women, had chosen to live stereotypically masculine lives. Walker has operated on airline pilots, commandos, people who were in the SAS, "and if they didn't join the forces, they'd buy the biggest, gruntiest Harley Davidson, just to prove how macho they were.
"They've tried to deny they are transgendered, and done everything they could to demonstrate to the world that they're not. But finally they have to face themselves, and become the female they know they should be."
Walker is a plastic surgeon. Until recently he was part of a three-surgeon team based in Christchurch that has performed 62 male-to-female gender-reassignment surgeries. During a four-hour operation, colorectal surgeon Richard Perry creates the vagina, urologist Stephen Mark reorganises the urinary plumbing, and Walker deals with the external bits - removing or repurposing the male genitalia to create a simulacrum of female genitalia.
61 KIWIS STILL ON THE WAITING LIST
Since 1992, the surgeons and a surrounding squadron of geneticists, endocrinologists, psychiatrists and psychologists have provided the only such service in New Zealand. They've assessed hormonal and mental states, cut and folded flesh and skin, altered identities and transformed lives.
At the start, when the dollar was weak and the operation rare, private patients flocked from abroad, but of late, most of the unit's work has been publicly funded operations on New Zealanders.
But in February this year, Walker retired and the operations stopped. His eyesight is still excellent, his hands still steady, but at 72 it was time to wrap up.
For the 61 New Zealanders on the waiting list for state-funded gender-reassignment surgery, progress has always been painfully slow. Every two years the state pays for three male-to-female operations (at around $50,000) and one female-to-male (performed abroad for around $100,000).
But with Walker gone, the male-to-female wait-list has now completely stalled. The Ministry of Health says operations will resume once a suitable surgeon is found, however Walker has written to all the plastic surgeons in the country to no avail.
"Until someone comes back from overseas with an interest in transgender surgery, I'm afraid nothing is going to happen. New Zealand might just have to send the patients overseas."
Walker is a dapper fellow; white-haired, polysyllabic and gentlemanly. He has a refined English accent, perhaps a relic of the private schools he attended in Egypt until he was 10, or the New Zealand boarding schools he attended after that. His father was a Dutch diplomat, his mother an art teacher from Christchurch.
He has a whispery, halting way of speaking that can make him seem diffident, yet there's no mistaking the huge pride he takes in his work.
Gender reassignment was only ever a sideline. His bread and butter has been breast reductions and augmentations, nose jobs and tummy tucks, and reconstructive surgery in the wake of skin cancer.
THE SCIENCE OF HIS 'GOLD STANDARD' OPERATION
In 2012, I interviewed him about one of his patients - a 90-year-old whose burn scars from a fiery wartime plane crash had turned cancerous. Then, Walker's delight in his handiwork was evident, as he tenderly touched the grafts on his patient's face and hands, and described the operative techniques with wide eyes. He is similarly animated when describing gender reassignments.
If detailed descriptions of surgery make you squeamish you might like to skip the next paragraph, but the details, says Walker, do matter.
While many male-to-female surgeries turn the penis inside out to make a vagina, the Christchurch unit builds a vagina out of a section of colon. Meanwhile, genitals are reconfigured: a piece of glans becomes the clitoris, the labia majora are fashioned from the scrotum, and penile skin is used to make the labia minora. The operation is longer and more complex than the 'penile inversion' technique, but the result, Walker says, functions far better.
If the ministry ends up sending male-to-female patients abroad, they're unlikely to get his "gold standard" operation, says Walker. "[It] would be a big shame for the expertise to dissolve away without anyone picking it up."
'FROM AIRCRAFT PILOTS TO PROSTITUTES'
Walker is fascinated by the mechanics of the operation, but he's not so close to the skin he cuts that he doesn't see the people inside. "I really do want to help them. They're the most interesting group of patients," he says. "If I can help them live their life in the correct body, that gives me a great deal of personal satisfaction. Otherwise they're on the fringes of society.
"I want them to join the mainstream so they are able, for example, to be in changing rooms without getting embarrassed. I want them to be able to take their place as a female in society.
"A child born with a cleft lip and palate - they can expect an operation. That's a congenital abnormality, and being transgender is equally a congenital abnormality. In the case of male to female, it's just because an enzyme was missing at the time of gestation, which was needed to make the hormones that make the male brain think it's male."
(In fact, experts aren't in total agreement about the causes of 'gender identity disorder', also known as 'gender dysphoria'. Genetics and prenatal hormones appear to be hugely important, but social factors may also play some part.)
Walker hasn't exactly befriended his patients - "I'm a professional person, so I can't get too close" - but he certainly admires them. "My patients have been aircraft pilots, electronics technicians, computer operators, accountants. They've been merchant mariner captains. Unfortunately, there is still a residuum who have been ostracised at school and left as early as they could and ended up at the bottom of the heap, and had to, for example, become prostitutes. You have from aircraft pilots to prostitutes - the whole range."
Private patients have come from the UK, Singapore, Hong Kong, Australia and the US. He's operated on a Texan police officer. He's in email contact with an American pastor who has "a great following in her church - I think they probably do know she's transgender."
NOT EVERYONE IS A GOOD CANDIDATE
Not everyone who wants an operation is a good candidate, and the Christchurch unit had a rigorous screening protocol - that's where all the other specialists come in.
"It's important that we as the surgeons not make the diagnosis by ourselves, because it would be a disaster to do the operation on the wrong patient. You have people who may get some sexual thrill from dressing as a woman, and they think they want to take it further. That's a cross-dresser, and that's the wrong patient."
Defining sex is complex, says Walker. There are genes: XX for female and XY for male (as well as midway variations such as Klinefelter syndrome, where a male with XXY genes exhibits some female physical or psychological characteristics). There's anatomy - whether your body and reproductive organs are male or female. There's psychological sex - whether you feel male or female. Then there's what Walker describes as "the sex of other people's perception": "If a person who is six foot four and bald, with huge hands, comes to me and says, 'I want to be female,' well, it's pretty difficult for me to change them in such a way that they are convincing as a female. The operation is most successful if the patient is five foot two and demure and has a female shape and has female mannerisms."
Sometimes, half the operation is enough. Walker has had patients say they're not particularly interested in penetrative sex - they just want to be able to go to the swimming pool and change. "So we do an operation where we attend to the external genitals, but no vagina. For a 65-year-old, that might be quite enough."
The point, quite simply, has been to allow people to have the body that matches how they feel on the inside.
"I've had patients who've been married and had children, and when the kids are leaving home the transgender man goes to his wife and says, 'Look, all these years, I didn't think I was male. I truly think I'm female.' Then they have to follow where their brain is taking them."
A PATIENT'S TALE: THERESA THE TRUCK DRIVER - 'THE SURGERY FREED ME'
Theresa (not her real name) was the final patient of Christchurch's gender reassignment unit, undergoing surgery two years ago. Now aged 51, she started living as a woman in her mid-20s, soon after completing treatment for alcoholism at Hanmer Springs, and was on the waiting list for more than two decades. She lives in the central North Island and works as a truck driver:
"I was born in Hawke's Bay in 1962. My name was Dave, but in 1988 I changed it by deed poll. Before then, I'd drifted from place to place, from job to job. I'd been a high-country tractor driver, drove bulldozers. I worked as far down as Middlemarch and as far north as Auckland.
In school plays I would always try to get a female role. I told some of my friends I felt I wasn't meant to be a boy.
I took up gymnastics after watching Olga Korbut at the 1972 Olympics. I never wanted to be like the women that I worshipped. I wanted to be them. Another was Suzanne Lynch from The Chicks.
GYMNASTIC GRACE: Olga Korbut. Dave wanted to 'be' her.
When I was 14, Mum found a box of my sister's clothes that I'd taken. My secret was out, but I put it from my mind. By 16 I was an alcoholic. A psychologist might say the drinking was because I was hiding stuff from myself, but I would say I was an alcoholic because I was an alcoholic.
Shearing gangs are a good outfit for alkies, because you drink all the time. We were pretty hard case. Every now and then I might crossdress and go to the pub for a laugh, but no one suspected, because I was too masculine. I was terribly homophobic. I got barred from a place once because a guy held my hand, so I whacked him.
In those days I would have said I was attracted only to women. I had relationships with women; I lived with women. Having said that, I did have some homosexual encounters with school friends.
God has impeccable timing. There was a transgender person at Hanmer when I was there, and I summoned the courage to talk to her. She gave me the contacts so I could look into it. After Hanmer I did a lot of work on myself; and realised I was living a lie.
Simply cross-dressing wasn't an option. By the end of 1988 I was living full-time as a woman. Breasts? I grew my own - a doctor prescribed me hormones. Everyone knew I was a bit different, especially before the hormones took hold and I had electrolysis. I was fortunate that I wasn't a very hairy person.
Living as a woman gave me a sense of freedom. It was a case of 'Right, I'm me now.' I was with a guy for 18 years. We met when I was a guy, we started our romantic thing when I changed, and the relationship ended four or five years before I had the operation. Now we're just good mates.
I found out that the best surgery was done in Christchurch and set my heart on it. In the end it all happened within 12 months. I went down and met the psychologist and psychiatrist. A few months later I went back down and met the surgeons, and I had the operation on my mother's birthday.
Mum and Dad were landing in Christchurch as I came out of post-op. My father in particular had quite strong issues with it, and for a long period we didn't talk. He'd probably still say he's not comfortable with it, but we have a relationship now, which we didn't before.
Before the operation, I had good self-esteem, but there were parts of me I wasn't happy with. I had gone from wanting to chop all the bits off myself, to tolerance. I guess it might be like someone who has a deformity - you just got on with life. I've got good friends, good family, I've had good jobs and good relationships with employers.
I had the choice of having a vagina created or not, and I chose to have it, because hopefully, long-term, I'll maybe get married and so forth. If I hadn't had it I would feel there'd be a part missing.
The hardest part was the post-operative dilation, which was initially twice a day, and hurt like hell initially. But there was nothing I hadn't expected. And the emotional stuff I'd done years and years previously. The surgery gave me liberty. It freed me. And I can wear yoga pants that are clingy! I wish it had happened 20 years ago.
I'm quite comfortable in my own company, but if the right person comes along, I'd be willing to have a relationship. I've had offers. But I love myself too much to just go with anybody. The outcome of my journey is that I'm totally comfortable with myself.
Some people know my history. Some don't. You don't need to tell people. On my birth certificate it tells me I'm female now. Some people may see me as transgender, but I think most people see me as a woman. You know people see you as a woman when they ask if you have any spare tampons - and I've been asked a few times.
I never had any qualms about surgery. Mr Walker and the whole team are such gentle, loving people. My only regret is that this didn't happen sooner. I wasn't scared at all, because it was like journey's end; it was a liberation for me. It was like wow, I'm free now.
- Sunday Magazine
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