Gender-affirming care is established medical practice

A timeline of transgender medicine & endocrinology

Gender-affirming care — medical care for the purpose of affirming a person’s gender regardless of their sex assigned at birth — developed with endocrinology, the study of hormones. The same field of medicine gave us the birth control pill, treatments for menopause, and insulin, all of which came after the 1889 discovery that underpins gender affirming care: Hormone injections can affect human sex organs. Here is some of that history.

1889: Like many medical practitioners of the day, Dr. Charles Edward Brown-Se?quard — the “Father of Endocrinology” — takes an experimental approach to medicine. Treating his own erectile dysfunction by injecting extracts from guinea pig and dog testicles, he discovers the effects of hormones on human sex organs. Today, experts consider treatment for erectile dysfunction gender-affirming care too.

1890s: Merck & Company uses powdered cow ovaries to produce Ovariin, a treatment for symptoms of menopause.

1905: Ernest Starling coins the term “hormone” in a series of lectures at the Royal College of Physicians in London.

1910: Eugen Steinach, an Austrian endocrinologist, discovers that cross-sex hormones change the behavior of rats. He begins developing the use of hormones in people of the same and opposite sex.

1916: The Association for the Study of Internal Secretions is established. It is now known as the Endocrine Society.

1918: Dr. Magnus Hirschfeld opens the Berlin Institute for Sexual Science, where, with the help of Steinach and others, he would later administer the first hormone therapy to patients. Visitors to the institute include Dr. Harry Benjamin, the father of transgender medicine. Benjamin learns the practice of hormone therapy to treat transgender patients from Steinach and Hirschfeld in the 1920s and brings it to the United States.[1]

1921: Researchers at the University of Toronto discover insulin, extracting the hormone from the pancreases of animals such as oxen and pigs.

1926: Scientists synthesize the hormone thyroxine, and later estrogen, testosterone and progesterone, leading to treatment for menopause and the birth control pill.

1931: The first male-to-female genital surgery is performed on Dorchen Richter, which is arranged by the Berlin Institute.[2]

1933: Nazis burn down the Berlin Institute for Sexual Science. Hitler targeted Dr. Hirschfeld himself, once calling him “the most dangerous Jew in Germany.”

Key Context: The same pseudo-scientific eugenics movement that informed the Nazis’ white supremacy also classified “sexual deviance” as an “undesirable trait.” LGBT people were among those targeted for extermination in the Holocaust.[3]

1942: Wyeth Ayerst introduces Premarin, an estrogen medication used to treat symptoms of menopause.

1948: The hormone cortisone is used for the first time, as a treatment for rheumatoid arthritis.

1952: Christine Jorgenson, the first American to become famous for their gender transition, begins her transition using hormone therapy and surgeries. Dr. Harry Benjamin begins using the word “transsexual” to describe people who seek medical intervention.

1979: The Harry Benjamin International Gender Dysphoria Association is founded. The organization sets international standards of care for the health of transgender and gender diverse people, and is now the World Professional Association for Transgender Health (WPATH).

1973-74: Homosexuality is removed from the DSM-II, and the diagnosis is replaced with the category of “sexual orientation disturbance” rather than a disorder. Transgender identity remains as Gender Identity Disorder (GID).

1981: The term “Gay-Related Immune Deficiency” is coined to describe what we now call AIDS. The HIV/AIDS crisis eventually led to a new focus on LGBT health care.

1987: ACT UP (the AIDS Coalition to Unleash Power) is founded at New York’s Lesbian and Gay Community Services Center. The grassroots group fundamentally changes the course patient advocacy in the United States. Today, HIV/AIDS is a treatable, preventable condition affecting 1.2 million in the U.S. across race, sex, age, and socioeconomic status.

1991: The Federal Policy for the Protection of Human Subjects is published. Known as the “Common Rule,” it regulates human-subject trials and research. The rule set many of the standards for how research in clinical trials is done today and established modern rules around informed consent.

2013: Gender Dysmorphia replaces Gender Identify Disorder and is added to the DSM-5, stating explicitly that it is not a mental disorder. This definition also changes to specify that one must have a strong desire to be the other gender — an important addition that was not included in the definition until this time.

Key Context: Evolving language means that historical studies may not correctly distinguish between transgender people and, for example, non-binary people or gay men. As a result, the data and findings of these studies may not be reliable.

2023: In the last year, lawmakers around the United States have introduced more than 500 anti-LGBT+ bills. As of November 2023, 14 have passed legislation banning or limiting access to this care, and many other states are actively considering the legislation.

Gender-affirming medicine is older than the birth control pill, therapeutic use of insulin, and synthetic cortisol. Many of the gender-affirming medical procedures done today are an established part of endocrinology with more than 100 years of international use.

Notes:

Transgender people — including trans and intersex children — existed long before gender-affirming care. Their long-documented history in the U.S. dates back to as early as the 1700s.

The historic exploitation of Black people and intersex people in the development of medical care must be acknowledged in any overview of this history.

In the U.S., the exploitation of Black women during American slavery developed much of the modern field of gynecology. Much of this knowledge is also used today in American medicine, both in treatment for cisgender and transgender women. However, Black women, including Black transgender women, still have significant health disparities that result in higher mortality rates.

When the procedures were first being developed in the 1930s and 40s, doctors regularly performed nonconsensual genital surgeries on intersex newborns to align their anatomy. Many of these procedures, which were done before standardized informed consent in the 1970s, contributed to the development of genital reconstruction today.

Even now, many intersex newborns in the U.S. are still given genital surgeries that they cannot consent to. This is not gender-affirming care. Instead, these surgeries align the child with one sex or the other at birth, based on a doctor’s judgement at the time — a practice that many intersex people reject.

Read more:

Transgender History by Susan Stryker, 2008, with a 2nd edition in 2017.

Histories of the Transgender Child by Jules Gill-Peterson, 2018.

Medical Apartheid by Harriet A. Washington, 2008.

“For years, Black trans women have been told their life expectancy is 35 years. That’s false.” The 19th, Kate Sosin, 2022.