Gender-affirming care has a long history in the US – and not just for transgender people

Gender-affirming care has a long history in the US – and not just for transgender people

On 27 March 2023 published an article about the long history of gender-affirming care, by G. Samantha Rosenthal. As a scholar of transgender history and trans woman, Rosenthal has spent much of the past decade studying these issues. Although this article is about the situation in the USA, the same sort of questions are being heard more and more in The Netherlands as well. Therefore Principle 17 publishes a brief summary of this history below. (Click here to read the full article, with links.)

When politicians today refer to gender-affirming care as new, “untested” or “experimental,” they ignore the long history of transgender medicine in the United States. It’s been nearly 60 years since the first transgender medical clinic opened in the U.S.. Dr. Milton Edgerton had cut his teeth caring for transgender people at Johns Hopkins University in the 1960s.

Treating gender in every population

Hormone replacement therapy has been around for generations, and is often prescribed to cisgender women. In fact, many providers have a long record of prescribing hormones to cis women, primarily women experiencing menopause.
Gender-affirming hormone therapies have been prescribed to cisgender youths for generations. Disability scholar Eli Clare has written of the history and continued practice of prescribing hormones to boys who are “too short” and girls who are “too tall” for their gender. The use of hormonal therapies to make children conform to gender stereotypes have been approved since at least the 1940s.

For over half a century, authorities in the U.S. have also approved and administered surgeries and hormone therapies to force the bodies of intersex children to conform to binary gender stereotypes. In most cases, intersex surgeries are unnecessary for the health or well-being of a child.
Historians have shown that early advances in transgender medicine in the U.S. are deeply interwoven with the nonconsensual treatment of intersex children. Therefore, the current political focus on prohibiting gender-affirming care for transgender people is not about the safety of specific medications or procedures, but rather their use specifically by transgender people.

How transgender people access care

Many transgender people in the U.S. have deeply complicated feelings about gender-affirming care. This complexity is a result of over half a century of transgender medicine and patient experiences in the U.S.
In the 1970s, medical gatekeeping meant that trans people had to prove their suitability for gender-affirming care to a team of primarily white, cis male doctors before they would give them treatment. They had to mimic language invented by cis doctors studying trans people. They had to affirm they would be heterosexual and seek marriage and monogamy. Many trans people still need to jump through similar hoops today to receive gender-affirming care.

“Transgender people undergo more evaluations to obtain gender-affirming care than do cisgender people.”

The future of gender-affirming care

In many states governors and legislatures are introducing bills to ban gender-affirming care in ignorance of history. The consequences of hurried legislation extend beyond trans people.
Prohibitions on hormone therapy and gender-related surgeries for minors could mean ending the same treatment options for cisgender children. The legal implications for intersex children may directly clash with proposed legislation in several states.
Prohibitions on hormone replacement therapy for adults could affect access to the same treatments for menopausal women or limit access to hormonal birth control. Prohibitions of gender-affirming surgeries could affect anyone’s ability to access a hysterectomy or a mastectomy.

Almost every major medical organization in the U.S. has come out against new government restrictions on gender-affirming care because they know that these treatments are time-tested and safe.
Trans and intersex people are important voices in this debate, because our bodies are the ones politicians opposing gender-affirming care most frequently treat as objects of ridicule and disgust.


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