Dear Ann Landers,
our letter to the mother who wanted to know what her children should call their dad after a sex change operation was too low-key. Why, after all these years, do you still insist on advising kooks as if they were rational people? Give up, Doll. It won't work. Can you imagine what life would be like for those kids at school? You should have suggested that the woman either threaten to have a sex change operation herself so the children would still have both a mother and father, or better yet, she should have the nut de-clared legally dead. ALSO CON-CERNED

DEAR ALSO,
Your "advice" wouldn't play in Peoria-or anyplace else, (a) An empty threat is meaningless, (b) The law would not permit a man who is alive to be declared "legally dead." But thanks a lot I know you meant welL A Transsexual Tells What It's Like to Be Changed from a Man to a Woman The John Wayne Tennis Club in Newport Beach, California, is a tasteful blend of tradition and today: Whites only, with television consoles monitor-ing the court action, and the latest in instructional equipment And the club's best player, perhaps, is Renee Richards, M.D., formerly Richard Raskind, M.D., who provoked an uproar when she unsuccessfully tried to enter the women's division of the U. S. Open tennis championships. Dr. Richards said she is taking a one-year leave of absence from her oph-thalmology practice to hit the tennis tournament trail and "keep transsex-ualism in the news. I want people to know we're people, that we have feel-ings, that we have rights-and that we're not two-headed psychotics or freaky." "I've found the hard way," Dr. Richards said, "that people in sports or en-tertainment can have a public impact far greater than other people. I am a talented tennis player, and I plan to take advantge of this to enlighten peo-ple about transsexualism." Dr. Richards, forty-two, was leaving for La Costa, California, for two weeks of tennis training under Pancho Segura, who trained men's champion Jimmy Connors, among others. In the future she was expecting to win or place high in several of the major women's championships, including the Australian, French and Italian opens, and Wimbledon. Such a record, she believed, would bring her an invitation to the U. S. Open, which, ironically, was held at Forest Hills, New York, where the former Dick Raskind grew up into the epitome of male success. "In the abstract," Dr. Richards said, "it might well have appeared that I had it all as Dick Raskind-a big career, big income, big professional reputa-tion, beautiful wife and son, considerable success as a tennis player. But I was miserable. I wanted to be a woman. I had always wanted to be a woman." Dr. Richards was always a star athlete as Dick Raskind. In high school she recalls, "I was a star pitcher on the baseball team, good enough to attract at-tention from major league scouts. And I was a good end on the football team. I had great anticipation, hands like glue and good eye and hand co-or-dination. But I couldn't stand the physical contact, which is why I gave up wrestling, at which I also excelled." Tennis was her real game and as Dr. Richards remembers, "I was always captain of the tennis team, at Yale, in the Navy, during the Maccabiah Games (the Jewish Olympics). "I was a very good tennis player as a man," Dr. Richards said, "but I cer-tainly did not become a woman so that I could become the best woman player." In 1973, Dr. Raskind was a finalist in the U.S. national finals for those thirty-five and older. "I was the only one of the top ten who did not make his living from tennis." He was a highly successful ophthalmologist "I had been on female hormones for about eight years and looked pretty strange. Many people thought I had cancer or something and had to take the hormones as therapy." Dr. Richards traces her quest for fulfillment as a woman. "My mother was a Freudian psychiatrist," she said, "and when I was sixteen, my freshman year at Yale, I told her about my psychosexual difficulties. Well, Freudian in-terpretations were the vogue then, and she suggested analysis, which I started during my senior year at Yale. When I entered medical school at Rochester, New York, I went into full-scale analysis. I was very innocent, very naive about transsexualism, but I learned that psychiatry had little to offer me and that this particular therapist had scarcely a clue as to what my problem was. "During my internship, I declared a moratorium on therapy because of the rigors of the internship year. After completing it, however, I took four and a half years of therapy with a prominent New York psychiatrist, Robert Bak, M.D. He thought I was a normal young man except for a compartmentalized, isolated crazy wish to be a woman. Because of all the disappointments-nine years of futile psychotherapy, the pullback at Casablanca, the reluctance of Johns Hopkins to act on my case-I was distraught. In the backlash, I mar-ried. I can recall going to Chicago once in 1969 on a cold, cold day to visit a private hospital and having to be furtive, dressing one way on the flight, an-other for the hospital interview, trying to sell them on my need, seeing that they knew little about the problem-the hiding, the furtiveness and the pain of it all. I gave up and got married in 1970 and fathered a son. Since the age of eighteen I had always been living with one girlfriend or another. They were all aware of my dilemma, but thought they could talk me out of it However, since 1965 I had been on female hormones and looked a little pe-culiar in men's clothing. In many ways, I looked then just as I do now, except that I dressed as a man. Once, in 1969, I was visiting a state park with a girlfriend and when I came out of the men's room a state trooper wanted to know what the devil did I think I was doing. "I was married for four years, but by 19741 knew I couldn't continue as a man. I went back to Dr. Laidlaw and Dr. Benjamin, who was in his eighties by then. They decided, 'You know, Richards, the last thing you need is the screening program offered by a university gender identity clinic. You've had that ad nauseam. You need three things: skilled surgery, minimum red tape, and anonymity.' "I was thinking of going to Stanford, but I found all three requirements in New York. Three days later my surgical reassignment was performed by Roberto Granato, M.D., at a private hospital in Queens. "God, the postoperative recovery was painful, unbelievably so, but I was happy, wonderfully happy that it was done. I'm not so foolish as to think I'm a total woman, like one with a uterus and ovaries, but Tm happy being 80 percent woman, or 75 percent, or 25 percent. It's better than zero, and I'm as much of a woman as one who has had a hysterectomy. "You know, some psychiatrists think that transsexualism is caused by a castration complex, that the cross-dressing is symbolically, ceremoniously acting out the fear, so as to be relieved to find later that the male genitals are intact Well, after I had my surgery (August 4, 1975), I thought, God for-bid, that that would be the case with me, that I'd miss my male genitals, break down, become psychotic-and it certainly hasn't been the case. I don't regret for one moment becoming a woman. Except when I reach back for that extra power on a first serve and wish I still had Dick Raskind's strength." credit: Dennis Breo, American Medical News, October 18,1976. Transvestism As used in this article the term "tranvestism" means fetishistic cross-dressing; it therefore refers only to people who become sexually excited by garments of the opposite sex. It almost never occurs in females, so this discussion will focus on males in whom women's clothes produce sexual excitement, leading usually to masturbation and orgasm. Within the category are two different styles of behavior. People in the first group are excited by wearing a single garment or a few garments, and the preference for these particular items remains constant throughout life. Indi-viduals in the second group start in the same manner, but over the years there is a gradual spread to the use of more and more garments, until finally the man enjoys dressing from the skin out in the clothes of the opposite sex. When this stage is reached, the pleasure in cross-dressing is not simply erotic but also a more generally felt enjoyment in imagining oneself to be a woman. The man who does this wishes to be successful in appearing as a member of the opposite sex. He will go to great lengths to select the most feminine ap-parel available. Moreover, he tells himself that he is a woman when he is cross-dressed, though he is aware of his male genitals and receives intense pleasure from them. It should be noted that women who cross-dress (usually transsexuals or masculine lesbians) do not become sexually excited by the garments they put on. Most transvestites are married, prefer intercourse with women (that is, they are not homosexual), and have children. It is rare for homosexual men to be sexually excited by women's clothes. Transvestites, except when cross-dressing, are masculine. They are found in all the masculine professions and rarely in the professions preferred by effeminate homosexuals. Their behavior, quality of vocal expression, choice of language and style of clothes when not cross-dressing are masculine. For these men, not only are their penises the source of the greatest erotic pleasure but they also consider themselves men (not just males). Their ex-citement is expressed through their penises; more important, the presence of the penis, as sensed beneath the women's garments, is exciting. They never quite forget the trick they are trying to put over-that they are hiding their penises. The thought that they are fooling the world is surpassed in enjoy-ment only by the moment when they can reveal the secret Since this may be a dangerous secret to tell, it can only be shared with a co-operative wife or girlfriend. Thus, maleness and masculinity are not only an unavoidable part of the masquerade but an essential ingredient. Case One: This patient in his thirties, married, the father of three children, and a precision machine operator, remembers his first cross-dressing as a tre-mendously exciting sexual experience in which, as a punishment, an aunt forced him to cross-dress at age seven. Although he has no conscious mem-ory of it, he has learned that he was first cross-dressed by another aunt at age four. From puberty on, sexual excitement was invariably and intensely induced by putting on women's shoes. As the years passed, he added a few more fem-inine pieces of clothing. Now he dresses completely as a woman and, with proper makeup to hide his beard, passes in society as a woman for a few hours at a time. He has never had a homosexual relationship and has no interest in male bodies. Although looking at women excites him, lying next to a woman is more complicated. He can then only maintain full potency either by putting on women's garments or by fantasizing that he has them on. Most transvestites, when questioned about the first experience, report it was a girl or woman who cross-dressed them. When a man was responsible, it was generally the father who made the child cross-dress, as a punishment. Transvestites, however, do not always report that their first cross-dressing was done to them by another person. Some with no memory of having been cross-dressed in childhood discover it nonetheless did occur. They learn this by seeing photographs in the family album that go back before their memo-ries began, or on having it reported to them later by their mothers, or sisters, or aunts, etc. It seems, therefore, that transvestism usually follows an attack on the boy's masculinity by someone, usually a woman, who puts females' clothes on him in order to humiliate him (demean his masculinity). In addition, one finds that tranvestites do not have loving and warm relationships with their fathers. What is reported, instead, is disruption: a father who is distant and passive or a father seen by his son as a cold, rigid, powerful, usually an unreachable man who punctuates his distance with moments of all-too-close rage. At times transvestites' fathers, whether distant and passive or distant and angry, introduce rare amounts of tenderness with their sons. And so the boys hunger for their fathers, loving them despairingly and with an almost sexual tinge; that is, with a yearning so intense that there is created an eroticized state of frustration. Other conditions in which cross-dressing occurs can be differentiated from transvestism: (1) transsexualism, in which one feels oneself to be truly a member of the opposite sex and would like his body changed by surgery; (2) effeminate homosexuality, in which one cross-dresses in order to mimic women; (3) intersexuality, in which a biological abnormality of sex (for in-stance, abnormal sex chromosomes) induces cross-dressing; (4) psychosis- or severe mental illness. In none of these other conditions does cross-dressing produce sexual excitement Children occasionally try on the clothes of the opposite sex without sexual excitement, and without thoughts of changing sex. Such behavior should be treated casually since it falls in the same category as "play acting." Adults may behave similarly under carnival conditions, such as costume parties and Mardi Gras. In summary, transvestites are heterosexual men who put on woman's clothes because that is their preferred, indeed often necessary way of becom-ing sexually excited. They do this, however, with full knowledge that, beneath the clothes, they are males. They are not erotically interested in people of the same sex. Because they do not need a partner who must be physically harmed, humiliated or otherwise damaged, this condition is not dangerous. credit: Robert 1. Stoller, M.D., Department of Psychiatry, University of Cali-fornia, Los Angeles. Excerpted from Dr. Stoller*s article which appeared in Archives of Psychiatry, March 1971. Tubal Ligation (Tying the Tubes) A METHOD OF BIRTH CONTROL Recent widespread demand for a simple, effective and inexpensive method of female sterilization has resulted in the adoption of several traditional opera-tions for ligation of the fallopian tubes. This is commonly referred to as "having the tubes tied." The use of a local anesthetic, for example, has re-duced problems and shortened the recovery time. New equipment per-mits a variety of approaches. Simpler procedures have brought the number of tubal ligations up to equal the number of vasectomies (male vas ligations) done each year (approximately 600,000 each, in the U.SA.). The first technique of tubal ligation was described in 1880 and involved simple ligation (tying) of the tube. A standard four- to six-inch vertical inci-sion (opening) was made in the lower abdomen, and extended from the belly button to just above the pubic area. This early technique had a high failure rate (up to 20 percent), so in 1919, Madlener both ligated and crushed the fallopian tube in an effort to increase its effectiveness. Further refinements have included ligation, and division and burial of the tube, as well as ligation and resection. The most popular is the Pomeroy technique, in which a loop of the tube is tied and then the top of the loop is cut off. The failure rate for this method is less than 0.5 percent. This is the most frequently recom-mended technique when the traditional abdominal incision is used, and is usually done immediately after delivery. In the past fifteen years, the operative procedure (laparotomy) has been reduced to a smaller operation (mini laparotomy). Instead of an incision, and scar that is five to six inches long, the incision is now only one inch long. A further reduction of the incision size has been accomplished with the use of an endoscope (a viewing scope) inserted below the belly button into the ab-domen (laparoscopy), or through the cervix into the uterus (hysteroscopy), or through the vaginal cul-de-sac (culdoscopy). These techniques, however, make direct ligation difficult, so the fulguration (coagulation) technique was developed. Fulguration involves using a special instrument for grasping the tube, and then a small point of burning heat is applied by a concentration of electric current. Electro-coagulation of the tubes, with or without division or excision, is very effective with failure rates of less than 1 percent Unfortu-nately, there is a risk of bum or perforation of nearby structures, such as the bowel. Done through the uterus (hysteroscopy) into the orifices of the tubes, electro-coagulation is quick and does not require an incision, but it carries a risk of perforating the uterus and has a high failure rate (10 to 35 percent). Finally, all methods of fulguration usually bum the entire tube, which causes irreversible sterilization. Chemicals such as Quinacrine and silver nitrate, have been used to solidify the tube. These chemicals are dangerous, with varying degrees of effec-tiveness, and usually result in irreversible occlusion of the tubes. With all the current problems associated with the simpler, less permanent, contraceptive methods, many women are turning to other techniques, includ-ing "temporary" tubal ligation. The "pill" increases (a) the rate of throm-bophlebitis (blood clots in legs), (b) the rare development of liver tumors, (c) uterine cancers (1 percent), and (d) coronary artery disease, especially in smokers. The I.U.D. (intrauterine device) has failure rates of 4 percent and can cause uterine perforation and infection if pregnancy occurs. There-fore, the possibility of "temporary" or reversible tubal sterilization has stimu-lated interest in these methods for contraception. Two easy techniques of "temporary tubal obstruction" use clips and bands. The clips (tantalum, spring-loaded stainless steel, or plastic) are effective and can be applied by either laparoscopy or culdoscopy procedures. Clips are po-tentially reversible by removing the clipped segment and having the two remaining ends of the tube sewed together during an operation. The bands axe made of silicone rubber and can be applied during an outpatient proce-dure, as can the clips. Bands have a low failure rate and are potentially re-versible (15 to 20 percent successful reversals with surgery). The most unique method of fertility intervention has been the use of solid plugs (silastic, polyethylene, ceramic, Dacron, and Teflon) placed into the fallopian tubes, either directly from inside the utems (hysteroscopy) or through a mini laparotomy. Although these plugs appear to be effective and reversible, the necessary specially designed instruments and specially trained operators will probably prevent their widespread acceptance. At the present time the most common technique of tubal ligation is a dip or band placed during laparoscopy or electro-coagulation through the laparo-scope. However, if the patient has had multiple surgical procedures in the past, or had pelvic inflammatory disease (gonorrhea) or peritonitis (inflam-mation in the abdomen with adhesions), then a mini laparatomy with band-ing or clipping is a safer procedure than the use of a laparoscope. The Pomeroy technique is used commonly as an additional procedure during some other operation and is the most preferred for permanent tubal ligation after delivery. CREDIT: John Najarian, M.D., Chairman, Department of Surgery, University of Minnesota, Minneapolis, Minnesota. Twins* Years before I dreamed of becoming an advice columnist, I promised myself I would one day write a book on rearing twins. I know how it looks from the inside, because my twin sister and I were practically Siamese from the day we were bom to the day we married (and naturally it was a double wedding). As Ann Landers, I receive a great many letters from twins. It is disturbing to me that in the past twenty-three years I have encountered so few twins whose parents are doing an enlightened job of raising them. I do not say this critically. If the parents knew better, they would do better. But unfortunately there has been precious little information available to help parents raise twins. The most common (and damaging) mistake is to assume that because twins came into the world together they must be dressed alike, encouraged to do the same things, and instructed to stick together, come what may. This is precisely what should not be done. It is of course easier to treat twins as a single unit rather than as two indi-viduals. Extra time, energy and imagination are required to steer children of the same age in separate directions. It is infinitely simpler for the parents if the twins go everywhere together, share each other's friends, clothes and in-terests. And then, too, twins boost the parental ego. It makes them feel "spe-cial" (for Dad, a better word is virile). A multiple birth falsely suggests ex-traordinary sexual prowess. So how do you let the world know? By dressing your twins alike, parading them as a unit and keeping them together. This may do wonders for Mama and Papa, but it triggers serious problems for the twins. The chances of having quintuplets are 1 in 57 million, so it's unlikely that anyone who reads this will be faced with that problem. The chances of hav- • From Since You Ask Me by Arm Landers Â� 1961 by Prentice-Hall, Inc., Englewood Cliffs, New Jersey. mg twins, however, are about 1 in 87. K it happens to you, the most impor-tant thing to keep in mind is this: Remember that each is a person. Each has an ego. Encourage them to be individuals. RULE NUMBER ONE FOR REARING TWINS: DO NOT DRESS THEM ALIKE! Dressing twins alike is an exploitative and attention-getting device to ac-centuate their similarities. This defeats the prime objective: to encourage the development of separate personalities. When I have suggested in my column that twins not be dressed alike, irate mothers let me know that their twins want to dress alike. Of course they do. But it should not be permitted. A mother in Madison, Wisconsin, wrote to say her twin daughters made a great effort to look as much alike as possible. One had a natural mole on her left cheek. The other twin penciled in a matching mole with a crayon. "They spend hours pinning up their hair exactly alike," the mother wrote. "I don't think this is good. Why do they do it?" I gave the mother this answer: "Your twins are using their twinhood as a gimmick to attract attention. It works. It sets them apart from the crowd at once. Identical twins are on stage at all times. The average singleton hasn't a chance in a room with a pair of identically dressed twins. Don't let your twins use an accident of nature to put themselves over. Encourage them to develop individual personalities. They may resist your efforts at first, but in the long run they will be much happier because you laid down the law." RULE NUMBER TWO: SEPARATE YOUR TWINS IN SCHOOL IF IT IS POSSIBLE. Twins in a classroom (a) get more than their share of attention, (b) con-fuse the teacher, (c) lean on one another for support, (d) work less effec-tively than if they were strictly on their own. My twin sister and I were in our second year at North Junior High School in Sioux City, Iowa, when two enlightened teachers decided that we should be split up. No teacher had thought of it before. When we received our home-room assignments and discovered we were to report to different rooms, we kicked up such a fuss that one would have thought the school officials had plotted to send one twin to Siberia and the other to Venezuela. Hand in hand we marched to the principal's office and presented a picture of solidarity that would have made Damon and Pythias look like strangers. "You can't separate us," we sobbed. "We'll just die!" The principal was a gentle souL He listened patiently and made a major concession. We could be together for two subjects, but we had to remain in separate home-rooms. This was a partial victory but we were less than jubi-lant However, during the first week of separation, my twin was elected presi-dent of her home-room. This was the first time either of us had been given individual recognition, and I'm sure it was one of the happiest days of her life. When we entered Central High School, we had the privilege of selecting subjects and teachers, and I am sorry to say we slipped back to the sure-fire, attention-getting tricks. We selected every course together, once more casting ourselves in the roles of Kate and Dupli-Kate. For the next three years we were side by side in every dass-confusing the teachers, overwhelming the boys, antagonizing the girls, and playing the double exposure for all it was worth. RULE NUMBER THREE: ENCOURAGE TWINS TO FOLLOW SEPARATE INTERESTS AND DEVELOP THEIR INDIVIDUAL TALENTS. Because two people may look alike to the casual observer does not mean they think alike or that they have identical personalities, work habits or talents. My twin sister and I both studied the violin. Half of our dear father's money was wasted. The half spent on lessons for me went down the drain. I had little interest in the violin, but it takes two to make a duet and I guess we looked pretty cute playing our violins together. Small wonder my sister played the violin better than I. In addition to having a natural talent for the instrument, which I lacked, she took a good many more lessons. My twin fre-quently substituted for me because I didn't like to practice. I realize now that I lacked the initiative in my teen years to develop my own special talents-writing and public speaking. Instead of fiddling around with the fiddle and being part of a duet, I should have been on the debating team, working on the yearbook, or writing editorials for the school paper. I loved to write, I loved to talk, and I loved to crusade for causes. But it wasn't until many years later that I was able to break up the vaudeville act and func-tion as my own person. RULE NUMBER FOUR: SEPARATE FIELDS OF ENDEAVOR WILL AVOID HEAD-ON CLASHES OR-WORSE YET-BELOW THE SURFACE HOSTILITIES. In my opinion, twins should not compete in the same field. Such competi-tion may produce a champion, but it is far more important to produce two healthy personalities. The following letter from a mother of twin sons was interesting because she wrote for help with a problem which was actually only a symptom of the main trouble. She wrote: