Grete and I believe we are dreaming, and are fearful of waking. It is too wonderful to think that Lili will be able to live, and that she will be the happiest girl in the world and that this ghastly nightmare of my life is drawing to an end. This wretched comedy as a man! – Lili Elbe
Einar Wegener picked the day he was going to kill himself: May 1, 1930. Months before the looming suicide date arrived, however, Einar was given an unbelievable opportunity. He found he could physically transform into his true self, Lili, with the help of innovative German doctors. The surgeries were risky, but at that point so was continuing life in the world as Einar. The stakes were high all around, and if there was a way to make Einar disappear so Lili could live, he was going to try it. February 1930, Einar wrote, “I am finished. Lili has known this for a long time. That’s how matters stand. And consequently she rebels more vigorously every day.”
Over the previous decades, the help of his wife artist Gerda Wegener (who was called “Grete” in diary entries,) Einar had been able to explore life as Lili. Gerda and Lili would go to parties together with Lili posing as Einar’s sister, and Lili became one of Gerda’s most inspiring muses.
Lili Elbe, the subject of the fictionalized novel and its film adaptation The Danish Girl, felt that it was time to truly transform into herself when she heard of the work of the trailblazing sexologist Magnus Hirschfeld. After answering a 130 questionnaire (which disgruntled him – Einar saw no spectrum to the situation, he felt the issue of gender was binary, and the either/or of Einar and Lili was at the crux of his pain), Einar was approved for one of the earliest male-to-female sex change operations. At the time the sex hormones estrogen and testosterone had not been discovered, so sex change operations not only involved things like removing the breasts and testes, but also removing the ovaries and uterus for female-to-male, and idea of transplanting uteruses into men who wanted to transition into women.
Under the supervision of Dr. Hirschfeld, Einar underwent several successful operations in Berlin and officially changed his name to Lili. Einar, who had felt a bit like a separate person, a separate part of Lili’s identity, had died. Lili had emerged, had been born after Einar’s 48 years on Earth. She was granted a divorce from Gerda, which came easily because Denmark didn’t recognized marriage between two women, and relished the dream of a life she felt she truly deserved. Einar had been a painter, but Lili wasn’t. Lili lived her art.
“It is not with my brain, not with my eyes, not with my hands that I want to be creative, but with my heart and with my blood.” – Lili Elbe
Around this time, Lili is thought to have begun a romantic relationship with an art dealer. She was thrilled with the surgical changes she had undergone, but something was still missing. She desperately wanted to be a “full woman,” in her view, and that included the ability to bear children, so she found a doctor who promised that possibility with a uterus transplant. Even as sexual transition surgeries have become more nuanced, safer and sophisticated since Lili’s time, the surgery that took her life, an attempted uterus transplant, has just in recent years been successfully attempted, but only in people who were born as biological women.
According to Rebecca Flyckt, an ob-gyn on the team that plans to perform the first U.S. uterus transplant (there have been several successful ones in Sweden since 2014,) this type of operation with a biological man could be done, but would still be extremely complicated:
Although theoretically this would be possible, it would be a huge surgical and endocrinologic undertaking and involve not just the creation of a vagina but also surgical reconstruction of the whole pelvis by someone skilled in transgender surgery.
After this procedure and the grafting of a donor uterus, a complex hormone regimen would be required to support a pregnancy prior to and after embryo transfer (although this could be done, as we provide similar hormone regimens to menopausal women to support a pregnancy). – Rebecca Flyckt
The biggest issue with Lili’s last surgery wasn’t just the feasibility of fertility. However, the life-and-death matter was organ rejection, a problem that wouldn’t be successfully addressed with anti-organ rejection drugs until 50 years later.
Because most of her medical records were destroyed by the Nazis, most of what we know of Lili’s life is from a posthumously published autobiography called Man Into Woman. In it, we see vivid glimpses of Lili’s inner life as she grapples with her body and her identity.
Here’s a letter she wrote soon after learning that she could begin a surgical transformation:
-29th January, 1930.
You have not heard from me for a long time, because I have been able to tell you nothing good about Lili. From time to time I have been examined by several doctors, but without result. Throughout they prescribed sedative remedies, which left me no better nor wiser than I was before: For I want to know what is happening to me, even if it hurts.
After consulting with Grete, Elena took me to one of her personal acquaintances who received me three hours before he was leaving Paris. Then something happened which sounds almost like a miracle! I had a consultation with the famous surgeon and woman’s doctor Professor Werner Kreutz, of Dresden. Strangely enough, he resembled you.
He examined me a long time, and then declared that my case was so rare that only one similar case had been known up till now. He added that in the condition in which I am at present, I could hardly be regarded as a living creature, because the ray treatment had been a great mistake, especially as it had not been preceded by microscopical examination.
Now he fears that this treatment in the dark may have destroyed my organs – male as well as female. Consequently, he wants me to go to Berlin as quickly as possible for the purpose of a microscopical examination. Some time afterwards he will operate on me himself. He wants to remove the dead (and formerly imperfect) male organs, and to restore the female organs with new and fresh material. Then it will be Lili who will survive!
Her weak girl’s body will then be able to develop and he will feel as young as her new and fresh organs.
Dear Christian, I am now sitting here and weeping like a child while I am writing you these lines. It seems so like a miracle that I dare not believe it. One thing however consoles me that were it otherwise I must soon die. Grete and I believe we are dreaming, and are fearful of waking. It is too wonderful to think that Lili will be able to live, and that she will be the happiest girl in the world and that this ghastly nightmare of my life is drawing to an end. This wretched comedy as a man!
Without Grete I should have thrown up the sponge long ago. But in these dark days I have had a fresh opportunity of seeing what a splendid girl she is… she is an angel. Overexertions, her own sufferings, have left her unscathed. She has contrived to work for two, now that I am no longer worth much.
I do what I am able, of course, and have exhibited and sold with success in all the important salons. But now all this is over. I am no longer fit for anything. I am like a wretched grub , which is waiting to become a butterfly. The operation is urgent and the doctor would like me to proceed to Berlin immediately, as some twenty days must elapse between the first examination and the operation and I must be in Dresden on the day he is ready to create Lili. He will send the medicine, which I am to take, in order to support the internal organs and thereby keep me alive until then.
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