Transgender History, Part II: A Brief History of Medical and Surgical Gender-Affirming Care

Abstract

The history of gender-affirming care (GAC) dates back millennia. Ancient records acknowledged gender variance and early attempts at medical/surgical treatment. The twentieth century saw significant advancements in GAC, particularly in the success of gender-affirming surgeries. The emergence of centers like the Johns Hopkins Gender Identity Clinic in the 1970s marked a turning point in GAC's recognition and acceptance. However, their sudden closure after just a few years hampered progress in GAC for the next several decades. In 2014, the Department of Health and Human Services overturned its prohibition on Medicare coverage for gender-affirming surgery, leading to greater access. The World Professional Association for Transgender Health (WPATH) guidelines have played a significant role in shaping contemporary GAC. The Standards of Care 8 (2022) emphasises patient-centered care and guideline flexibility. While challenges have marked the historical trajectory of GAC, it has also witnessed significant evolution which we review in this article.