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A small but growing number of people are identifying themselves as transgender. Richard/Renee Ramsey is likely the oldest to make the surgical switch.

Transsexual Renee Ramsey at her Wallington, N.J. home. ( April Saul / Staff Photographer )
Transsexual Renee Ramsey at her Wallington, N.J. home. ( April Saul / Staff Photographer )Read more

On June 15, Richard Ramsey checked into Lower Bucks Hospital in Bristol Township for major surgery. When he left three days later, Ramsey was no longer Richard, but Renee. Her first words to her doctor when she awakened after the operation were, "Now I'm the lady I always knew I was."

Ramsey, a tall, lean woman, neatly turned out in black tailored pants and a lavender turtleneck sweater that used to be her wife's, is likely the oldest person in the United States to have surgery to change genders, experts say. She is 77.

He couldn't have the surgery when he was in his 20s or 30s because he didn't know about it then. He was still groping for his identity in his 40s. And he couldn't have the procedure in his 50s or 60s because he was in love with his second wife. When she died in March, there was no longer a reason to delay.

"I would have liked to be a lady a long time ago," says Ramsey, a U.S. Navy veteran of 20 years who also says he served in special operations in the Army.

"Now, the hardest thing I have to do is learn to be a lady," said Ramsey, who grew up in northern New Jersey and still lives there. "Little girls learn it from the time they're 5 or 6 or even younger. I'm just starting out. I have to learn and unlearn. When I get angry at someone, I have to practice acting like a lady instead of sounding off like I used to do.

"But now I feel calm, happy, and relaxed. And do you know what makes me feel the best? When I get on a train and the conductor says, 'May I have your ticket, ma'am?' I feel like a million dollars."

Ramsey is one of a small but growing group of people in this country and around the world who are identifying themselves as transgender. No one knows exact numbers because many people are still secretive about it.

Mara Keisling, executive director of the National Center for Transgender Equality, estimates that at least 700,000 in the U.S. would describe themselves as transgender. The American Psychological Association puts the prevalence rate at 1 in 10,000 for male-to-female and 1 in 30,000 for female-to-male, although Washington-based psychologist Michael Hendricks, who specializes in gender issues, says those numbers are decades old. Males still switch more, but the differential is not nearly that great, he says.

These calculations do not include those who are merely cross-dressers, who get a thrill from wearing their wives' silk underwear, or like to go public in a dress and high heels. They refer only to those who identify as being of the opposite sex from their birth and who may or may not have had sex-reassignment surgery.

In any case, according to a recently completed four-year study in Britain, a rise in the incidence of transgender people may be around the corner. "Our data provide strong evidence that the trans population is growing," concluded Stephen Whittle, professor of equalities law at Manchester Metropolitan University in Britain, the study's lead author.

Sherman Leis, the Bala Cynwyd plastic surgeon who performed Ramsey's surgery, is not surprised. "Hormone advances and new state-of-the-art plastic surgery techniques make it possible for more people to fulfill a lifelong yearning," he says. "And the greater acceptance of gay men and lesbians makes it less of a stretch to be OK with those who feel compelled to change their gender."

Leis has performed more than 250 of what he calls "bottom surgeries" (changing the genitals) on men and women since he opened his Center for Transgender Surgery in 2004, an additional 1,000 or so "top surgeries" (breast augmentation or reduction), and 1,000 or more additional procedures, primarily on male-to-female patients to alter facial features that will make them more feminine - fuller lips, more delicate noses, narrower chins, lower frontal hairlines.

None of his patients has ever returned with regrets, he says. "I'm selective in whom I choose to operate on," Leis says, "to make sure they are certain about their decisions. They have all waited a long time to change gender and have given it a lot of thought. . . . They are eager to do it and happy after they've had it done."

Ramsey says he knew from the time he was 5 or 6 that he was "different." He shunned trucks and toy soldiers, preferring to dress up and play house with his two younger sisters. "I felt like I was their big sister, not their big brother," he says. "I liked doing lady things like cooking, sewing, and doing laundry. I didn't go for rough-and-tumble sports, never went out for baseball or football."

Although his father encouraged him to lift weights and exercise to develop his muscles, nothing worked. "Finally he gave up," Ramsey says. "He just shook his head when I told him, 'I'm not a boy. I'm a girl.' "

By 13, Ramsey was certain he had been given the wrong body, although he didn't know the name for what he was feeling. In school, he kept to himself and even got a medical note that excused him from gym because he was too embarrassed to get undressed in front of the boys. He felt he looked too feminine with his long, shapely legs and skinny body while the rest of the boys were more bulky and muscular.

When he was 15, his mother wandered into his bedroom and caught him slipping into her underwear. The next day, she made him an appointment with a psychiatrist. After months of therapy, the psychiatrist declared, "It is just a phase he's going through. . . . he'll get over it." Ramsey was devastated.

In 1952, he joined the U.S. Navy, thinking military service might make him more of a man. It didn't, and he endured being teased and called "little girl."

Two years later, while a boatswain third class in the Navy, and still struggling for conformity, he married his first wife; they remained together until he confessed to her that he believed he was a woman. Ramsey says that despite having four daughters, their sex life was "just OK - we could take it or leave it." They got a no-fault divorce in 1973 and Ramsey agreed to give his wife custody of the children. They moved to Arizona, and he has not seen them since.

Still dealing with denial, Ramsey married his second wife, Vesla, in 1982, a pretty 5-foot-1 woman he met at an American Legion convention in Wildwood. He didn't tell her he was transgender, but three years later she had figured it out. "She began wondering why there were so many panties and pantyhose in the laundry," Ramsey says, "and it finally dawned on her that I was wearing them too."

"We had a sex life," Ramsey says, "although I admit that when I was making love to her, I kept imagining what it would feel like to be her." Vesla had a daughter with a mental disability to whom Ramsey says he became a devoted stepfather. Recalling that now, she catches herself and smiles. "I should say stepmother." Ramsey says his birth daughters do not know that their father is now a woman.

It took Ramsey decades to make an appointment with a surgeon to discuss the possibility of transitioning from male to female. In keeping with the recommendations of the World Professional Association for Transgender Health, Leis referred him to a mental health practitioner for evaluation and guidance and to an endocrinologist to discuss hormone therapy.

Since that time, Ramsey has been swallowing both estrogen and testosterone-suppressing drugs daily and removing leg and body hair with depilatories. He has seen two mental health practitioners; one is still helping him wrestle with the disparity between his brain and his body. Before undergoing gender-reassignment surgery, each had to produce a letter verifying that Ramsey would be an appropriate candidate.

"I've been encouraging Renee to consider being able to live in both worlds," says her therapist, psychologist Jeanne Seitler who practices in Ridgewood, N.J. "Being Richard, being in the military, marching in parades, carrying the flag, and wearing the beret has been a big part of her life, and a lot of her supports are with those in the military. So a lot of her activities are in military dress. At the same time we're working on how she can be a woman, too, and feminize herself through dress and makeup. She really wants to be accepted as a woman."

Since having the surgery, Ramsey has not lost friends, but admits that many of them don't want to talk about her transition. "At home I dress like a lady and I always wear ladies' underwear, but most of the time when I go out with my friends, I dress like a man," Ramsey says.

With trepidation, she confided recently in her longtime buddy whom she sees every day. "He can't put his head around it," Ramsey says. "He's on the fence. But we go out together. It's like 'don't ask, don't tell.' "

No one in the medical community is certain what causes someone to be transgender, but Norman P. Spack, a pediatric endocrinologist at Children's Hospital Boston, says the condition is not a mental illness and should not be classified as such in the psychiatrists' bible, the Diagnostic and Statistical Manual of Mental Disorders. "It has something to do with the wiring in the brain," Spack says. "It could be a gene that is expressed at a certain stage of fetal development or hormones that have gone awry during gestation."

In any case, people who are transgender almost always know it, as Ramsey did, from the time they are young children.

Being transgender has nothing to do with being lesbian or gay. Ramsey says she is heterosexual: When she was a he, he was attracted to women. Now she is drawn to men, although, at her age, she says she isn't interested in a romantic relationship.

As Spack says, "It isn't who you go to bed with, it's who you go to bed as."