Book Review: Sex Changes: The Politics of Transgenderism

By Al Preston

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“This book was written with the hope that someday gender will be a voluntary system for self-expression, used chiefly to enhance the pleasure we take in one another’s unique realities.

-Pat Califia (Page 10, Sex Changes)

            Over my entire life, the world has changed so much. The rights of LGBT+ people have also changed for the better so much. I was born in 1996, in the middle of the 90s which was a formative decade for the LGBT+ community. The way academia, society, culture, and legality viewed LGBT+ subjects was changing rapidly.

            The actions of activists, the sharing of knowledge, and the ability to build communities were forever changing thanks to the internet. However, because this was such a formative and rapidly changing period of time, the way we study, consider, and interact with LGBT+ subjects back then is a strange amalgamation of today’s views and older views.

            In history, fields of study create these ‘state of the field’ books. A quick study of a subject and how academia has researched and presented that field over time. They cover major authors, theories, and works of the field and the way the time period they were written, the other works written, and the authors’ own biases affected those works. So, these types of books are not only a collection of all of the major works in a field, but also a study of why and how they were written.

            Sex Changes: The Politics of Transgenderism by Pat Califia is a ‘state of the field’ kind of writing, with some important notes to make. Califia is a therapist, not a historian. She was trying to find historical works about transgender people and found a lacking amount and decided to write this book to talk about what she could find. Additionally, she admits her faults when she can, knowing that she has limits when it comes to this subject and field.

            The other thing I would like to note is that I benefit from almost three decades of progress in the field of LGBT+ studies. I started researching in 2014 and, as of writing, the year is 2025. Over that decade, I watched the way LGBT+ subjects have morphed and changed into something very different from 1997. Califia wrote about books and subjects that I have read, some of which have been updated since 1997.

            So, with the benefit of foresight and a different time and place, I have some issues with the way Califia approaches and analyses some works and subjects. Yet, I completely agree with other views because the 90s were the formative years that led to how we think today. I have something of a love-hate relationship with this book and that may come out in my own analysis of it.

            Thankfully, that is how the field of history, and academia at a grander scale, works. When we read each other’s works, we criticize, expand, and make new arguments, based off of them. Sex Changes is a product of its time, and I will try my best to explain what I mean by that as I go through what the book actually contains.

            So, buckle up, this is a long one!

Let’s start with what I liked and agreed with in this book. Collectively, I have read or read a vast majority of the works Califia talks about within this book. Two of which are book reviews on this website; Gender Outlaw by Kate Bornstein and Transexual Empire by Janice Raymond.

            Califia’s analysis of Transexual Empire is spot on. To quickly recap, Transexual Empire is a horrifically transphobic work written by a radical lesbian feminist. It’s an older work that argues that transgender women specifically are villainous people who are trying to invade women spaces in order to spy on them and reinforce the gender roles society was forcing on women. To the extreme, Raymond accuses the doctors offering and performing sex reassignment surgery are attempting to replace biological women with transgender women. At the absolute worst, she compares transgender people and their doctors to the Nazis.

            Califia is stronger than I. She was actually able to read Raymond’s chapter comparing transness to Nazism. Granted, she admits that she had to walk away from the book for long periods of time in order to get through it. I wasn’t able to read it at all. Califia criticizes all of Raymond’s arguments and breaks them down as the bigotry they clearly were.

            Califia also had some really interesting looks at the first kinds of primary sources about transgenderness in the past such as the autobiographies from transwomen such as Christian Jorgensen, a transgender woman from the 1940s. A lot of misinformation was created and spread about Jorgensen during her time. A lot of that misinformation was spread further when historians contemporary to Califia read the publicity surrounding Jorgensen rather than her autobiography.

            Califia points out those misreadings of Jorgensen but is also critical of how Jorgensen framed her presentation of herself due to the work she was able to find after her transition. Jorgensen only ever wanted a quiet life but was unable to once the press found out about her in America. She was a performer for a long time after her transition and wanted to present herself as the perfect example of an American woman. She knew that she represented an entire community of people who were just like her.

            Califia points out that this perfect image dismisses the very real problems that sex reassignment surgery can cause for transgender people. The surgery itself is unsatisfactory for the physical needs some transgender people may want and the way transgender people are treated as subjects of study rather than people with wants and desires is harmful.

            Jorgensen never talks about her sex life or if she even wanted one when she got her sex reassignment. She is presented as a ‘successful’ experiment. A person with some kind of ‘sexual deviance’ remaking themselves into the picture-perfect heterosexual woman. Califia argues that there is more to transgender people and their romantic and sex lives.

            With sympathy towards transgender people, Califia is extremely critical when speaking about the doctors who research and give sex reassignment treatments. She is harsh with the most supportive of doctors like Harry Bengimen who was the main source of sex reassignment in the US for a very long time. In talking about these doctors, Califia insists that some empathy towards their patients should have been in order.

            From here, I’ll pivot to the chapter I took the most issue with in this book. Chapter 4 is focused on the way the history of trans-ness has been covered by gay and lesbian historians in academia. Specifically, Califia focuses on the way queer historians were talking about two-spirit people of pre-colonial America (a note for those who may try to read this book, as the term ‘two-spirit’ was not yet wildly used by non-Indigenous Americans at the publishing of this book, Califia does not use the term often and instead uses older, more outdated terms).

            When presented with the topic of two-spirit peoples of some Indigenous American groups, historians of the 70s and 80s did tend to view those people as gay and lesbians over any kind of third gender or other gender system. That is a critic that has long been held over those historians as transgender identities were not readily welcomed into LGB groups until more recently. Califia shares this criticism and harshly points out how these historians tended to speak about Indigenous Americans as a collective and only acknowledge good examples of two-spirit peoples. As Califia rightfully points out, those few examples do not apply to every group.

            While some groups did have two-spirt identities, others did not. Gender between different sections of pre-colonial America differed significantly. Some had up to six genders, which encompassed what we would define as gay and lesbian relationships as well as transgender ones. Others had only two genders, men and women and those genders were defined by work ethic or the physical ability to carry children.

            That is all very important criticisms to level against these historians. Many of them treated pre-colonial America as a far better time, where Indigenous Americans were far superior peoples which can be just as bad as harsh stereotypes. The reality lies somewhere in the middle where the people of North America had a very different system of living than the white colonizers that came to their lands. Was it perfect? No. Was it better in some places than Europeans such as gender? Sometimes. It’s always worth mentioning that nothing is universal, but the existence of ‘good’ and ‘bad’ things in a historical moment does not entirely discount that there were genuinely good and bad things occurring simultaneously.

            Multiple things can be true at one time. Which is where I believe Califia missteps in her analysis within this chapter. She pokes holes into gay historians’ arguments by only pointing out the negative reactions Indigenous people had to two-spirit people without acknowledging that there is nuance to all of these examples. She heavily criticizes these authors for their generalization of Indigenous Americans while proceeding to do the exact same thing in the opposite direction.

            Instead of acknowledging that perhaps some groups honored and loved their two-spirit members, she insists that we will ‘never really know’ how they were looked at or treated and that the most likely response was negative. Although these people clearly had societal roles and respect, she insists that no family would be happy to have a two-spirit child. She only brings up violence against two-spirit people among Indigenous American groups without acknowledging some important nuance such as, was that two-spirit person interacting with people of their own group? Did they claim two-spirit identity by way of their people or because of white colonists?

            In arguing the fact that those gay historians refused to acknowledge two-spirit identities, she generalizes all of Indigenous America herself which is a rather disingenuous and counter-productive way of making her argument. To insist that respectability and love of two-spirit identities and even the possibility of matriarchal societies as impossible is just as bad as insisting that all of Indigenous America was a gender and sexual utopia.

            The reality is always somewhere in the middle and far more complicated than it first appears. This is the first instance where this book is a product of its time. In the 1990s, the work that we take for granted today that untangles colonization from Indigenous history had just begun. Groups of historians from Indigenous peoples were just starting to form and really analyze the history they had managed to pass down and the written history of colonists.

            While we may never truly know the whole picture, we do know that there was more gender equality than Califia insisted and that if a group had two-spirit people, they were usually well loved and respected. Take the Great Lakes region for example. Of the groups that lived there, only a handful had two-spirit gender identities. Regardless, all of those groups save one had matrilineal and matrilocal systems, meaning that inheritance, family titles, and locations were maintained through the mother’s line. Additionally, we know that women became leaders and had the most say in how their people utilized land, trade, and food.

            That information was still unknown to Califia. However, to dismiss one argument by arguing the exact opposite isn’t exactly a good thing. While, yes, we didn’t know as much in 1997, to assume the worst is just as bad as only assuming the best.

            Which takes me to the other piece of Califia’s work that I struggle to hate or like. She also has a close analysis of Kate Bornstein’s Gender Outlaw. Which, for those of you who read that book review, know that this book is one of my favorites and I struggle to be completely neutral about it. It’s the first book I read where I felt like there were people like me out there, and it has a special place in my academic heart as well as personal one.

            Additionally, I benefit from being able to read two different updated copies of the book. Califia only had the first edition to read from, and she is very critical of it. At first, I was a bit defensive and needed to think less with my personal love of the book…and I still found Califia’s reading of the book lacking and disingenuous.

            This is also the point in the book where I realize that Califia, I think, failed to really lay out her true argument of this book.

            Within Gender Outlaw, Bornstein does make some overarching arguments about how to fix society as a whole. One of which is; if we were to do away with gender, a lot if not all of the world’s oppression and injustice goes away with it. To Califia’s credit, this is a hard argument to sell and definitely not one that is well supported. Califia points out that even if we were to do away with gender, something else would replace it, which is a very true statement.

            Doing away with gender does not prevent racism, it doesn’t prevent classism. However, something that I think Bornstein clears up in revisions of Gender Outlaw is that she is very aware of this. Her argument is more that if we are able to do away with gender as an oppressive force by treating it as we have treated the fight against classism, we would have a lot more luck in eventually getting rid of all oppression, although it is doubtful that we could manage such a thing.

            Where I begin to take issue with Califia’s analysis of Gender Outlaw is in her interpretation of Bornstein’s ideas of a genderless society. Califia both hits and then misses the point Bornstein is trying to make.

            As the quote at the top of this review states, Califia wants to see a world where gender doesn’t matter. In my many readings of Gender Outlaw I know that Bornstein wants the same thing. However, Califia misses that reading of the book.

            More the once, Califia is critical of Bornstein’s idea of what a genderless world could be like. She misunderstands that Bornstein does not want do away with gender expression. In an uncomfortable argument, Califia insists that Bornstein’s feelings of being not a man and not a woman is just her struggle to handle transgender violence and that by defaulting to this androgynous identity while appearing entirely like a woman is against Bornstein’s argument and a lack of definitive feelings on her identity as a woman.

            However, for anyone who feels the same way as Bornstein and understands the point she is trying to make, they know that feeling androgynous while appearing entirely masculine and feminine is exactly to Bornstein’s point. Gender is, effectively, meaningless to Bornstein and to folks like myself. However, that doesn’t mean the way we express it doesn’t come with connotations or feelings that we are actively striving for. I don’t want to be perceived as a woman, I want to be perceived as a man, because that is where I feel comfortable and how I prefer to present myself. That doesn’t mean I necessarily feel like a man.

            This is another place where Califia is hypocritical in her analysis. She claims to want to understand a genderless society but seems discomforted in what that really would mean. Many cisgender people struggle to picture what a genderless society could really look like. Most seem to picture the sterile and uniform world of science fiction where everyone looks the same and their gender is impossible to tell.

            However, the reality is the one Bornstein is suggesting. We present however we want, we love and have sex with whoever we want, and no one cares. We cannot do away with gender (see our podcast about gender as construct for more on this specifically), but we can make it something that does not hinder or harm people.

            In misreading Bornstein like this, Califia misses that they are talking about the same ideas. This is also where Califia’s real argument comes in.

            Rightfully, Califia points out that sex and pleasure seeking for transgender people is vastly different and difficult than for cisgender people. Few talk about that fact as well. In 1997, Bornstein’s suggestion that sex reassignment surgery isn’t all it’s cracked up to be is the first time a transgender person actually acknowledges that fact. Throughout this book, Califia harps on how doctors don’t think or care if transgender people are having satisfactory sex lives. Which is Califia’s real reason for writing.

            In the introduction, Califia talks about her own gender struggles as it relates to sex and the kink community. That is the reason she started seeking out transgender studies in the first place. While this book reads like a ‘state of the field’ it’s actually arguing that sex reassignment surgery needs to be better so transpeople can enjoy sex as much as cisgender people.

            That’s not a bad argument, I just think the way we reached that argument or at least, how Califia presents it, is a little disingenuous and misleading. To give a bit of grave, she is a therapist attempting to write like a historian.

            When Bornstein is critical of sex reassignment surgery, going so far as to say that people shouldn’t need one to be seen as transgender, Califia almost gets defensive. She acknowledges that the surgery isn’t good for much, sex or actual gender transition, but she insists that it is an important facit of transgender life. At one point, Califia insists that bottom surgery for transgender men (the creation of a penis) would be better the second men started losing their own penises. This is an old argument. A transgender person isn’t transgender unless they have surgery, which we no longer completely believe today.

            I think the most interesting aspect of this book, then, is that Califia clearly went and did all of this research searching for herself. She hoped others who experience gender troubles, or gender mess as I like to call it, would be able to tell her how she is feeling. In her personal life, she struggles with her own masculine feelings and even considered becoming a transgender man at one point but found the surgeries lacking.

            When presented with Bornstein’s suggestion to do away with gender, it seemed to have poked this gender mess Califia admits to experiencing and became defensive of her own gender experience. She fought long and hard to come to the realization that she is a woman, to do away with that entirely would seem a bit upsetting.

            Califia is right in suggesting that doing away with gender or having honest conversations within the LGBT+ community about gender and gendered experiences is a hard sell that no one wants to take. At the end of the book, Califia has a chapter on the future of the community based on its trajectory in 1997. As a member of the future, I’m happy to say that, for the most part, the community has done it’s best to take a page from Gender Outlaw despite Califia’s and other feminists’ hesitation on the matter.

            All in all, this book does serve as a rather good ‘state of the field’ in 1997, despite not attempting to do so. It certainly serves that goal more than arguing for better sex reassignment surgery. It’s a dense book full of academic writing, so it might not be suited for a general audience, but it is a good read for anyone wanting to start research on transgender history and studies prior to today, just go into reading it with a critical mind.