In the 1950s and early 1960s, Harry Benjamin and his colleague Elmer Belt corresponded at length about which transsexuals they would and would not approve for genital surgery. Benjamin defined transsexuality primarily through a desire for medical transition, but merely being a transsexual in this definition did not automatically result in surgical eligibility. Benjamin and Belt remained preoccupied with the possibility that transsexuals would regret their surgeries and seek legal or personal revenge, and thus their assessments of who should have surgery focused more on the possibility of a bad outcome than adherence to gender norms or classification as transsexual. The informal clinical practices they worked out to protect themselves in these early years of American trans medicine would ultimately go on to structure more formalized Standards of Care. Benjamin and Belt's fears, and their resulting decision-making processes, thus played a crucial role in the production of the category “transsexual.” Throughout their correspondence and clinical practice, the transsexual emerged as a threat to medical providers, and a subject incapable of making their own bodily decisions, needing to be protected from themselves. While assessments of gender identity and gendered behavior factored into these decisions, their decisions about who might regret transition treated gender as primarily practical and functional, and made an unshakable internal gender identity a necessary but insufficient criterion for granting a patient access to surgery.

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