A brief (pre) history of the real life test

By Os Keyes

The “real-life test” (or real-life experience) is one of the more infamous pieces of gatekeeping around trans medicine. As the name suggests, the idea is that trans people seeking to access surgery (or, originally, hormones, electrolysis, and any other form of medical intervention) were required to first live for a certain period of time - often 1-2 years - in their desired gender, to the satisfaction of a clinician. This produced innumerable problems you can probably imagine, and was (and is) rightly heavily criticised. One of the central problems was the gauge of what it meant to have a “real life”, and the way that proving you could “make it” as a woman or man often meant reworking oneself into a very particular (white, middle class) idea of what a “proper” woman or man was. This is ontologically interlinked with one of the historic purposes of the test; to ensure that the trans person could “make it”, with “make it”, again, defined as vanishing into the aether - normalising into a “productive citizen”.

I’m working on a longer piece on this but did just run into a historical tidbit it’s worth surfacing. As with much of trans history, the pathway of the real-life test is pretty shrouded, but the best writeup I know of is Justin Cascio’s “Origins of the Real-Life Test”. Cascio traces it back to 1966, specifically to Harry Benjamin’s The Transsexual Phenomenon, and documents briefly how it percolated from there into Transsexualism and Sex Reassignment and other early medico-scientific works before finally making it into the Standards of Care. In a formal, genealogical sense this is true. But there are older examples of it being put into practice, even if it’s not a formalised and authoritative recommendation as a standard.

While going through some of the Kinsey Institute archives, I ran into the exchange of letters between a young trans woman (let’s call her S), Kinsey and Harry Benjamin back in the early 1950s. S struggled to access medical care, as a lot of people did - Kinsey himself was actively opposed, and largely interested in conversing for research purposes rather than due to any interest in relief (aside from the relief that could come from social knowledge and abstract normalisation; see Sarah Igo’s great book) But one story S recounted to him, as part of her work to access care, stood out. In a letter of 11 January 1953, over a decade before Benjamin’s book, S talks about finally succeeding in getting an appointment with a gynaecologist:

He advised me to go away from Chicago and live as a woman all the time saying that he did not see any wrong in such a thing. Then he added that if I should find a man who loved me very dearly and wanted me to be the woman of the house I should come to him and he would remove the testicles and create a vagina adding that castration would result [sic] side effects.

Reading too much into it: one can imagine seeing the “live as a woman”, in practice, as a necessary precondition for finding that man who “wanted [S] to be the woman of the house” - my guess is a gay-coded couple would not have been accepted by the gynaecologist. So what we have here is if not the first instance of the real-life test (over a decade prior to what was previously thought), then at least an ancestor of it. “Ancestor” may be the wrong word - although Kinsey and Benjamin consulted regularly (particularly over certain Chicago-based patients), I’ve got no sense of whether these letters were passed on to him, or whether this particular passage lodged in his mind if so. So it’s most likely a case of “parallel evolution” - of people in similar dynamics of normalisation and normality reaching for the same tool and conclusion. But: interesting nonetheless!