The month of February is celebrated in some countries as LGBT History Month, and in that spirit we want to reflect on the history of transgender healthcare. Check out our key highlights below.

From left to right: Michael Dillon, Roberta Cowell, Christine Jorgensen

1919: Magnus Hirschfeld establishes the Institute for Sexual Research

German physician Magnus Hirschfeld was a pioneer of gender-affirming healthcare, unlike most of his contemporaries. Hirschfeld didn’t seek to force transgender people to live in their assigned sex, but rather affirmed them in their gender. He was among the first to recommend hormone therapy and provide gender-affirming surgery for trans people at his Institut für Sexualwissenschaft (Institute for Sexual Research). Hirschfeld’s work was sadly undone when the Nazi party came to power in 1933, his institute was sacked, and Hirschfeld fled to France, where he died in 1935. 

Hirschfeld and other doctors at this institute helped to pioneer surgical interventions for transgender patients. Dora Richter is known as the first person to have undergone a vaginoplasty performed by the clinic’s surgeons Erwin Gohrbrandt and Ludwig Levy-Lenz. She also underwent the first known orchiectomy, or removal of the testicles, ten years earlier. These surgeries were considered highly experimental at the time, so to undertake these risks would have taken a lot of courage. Richter is believed to have fled back to Prague after the sacking of Hirschfeld’s Institute, and her whereabouts after 1939 are unknown at time of writing. 

Danish painter Lili Elbe also holds the honour of crossing a surgical milestone, being the person to undergo the transplant of a uterus - just weeks after Gohrbrandt had performed the first vaginoplasty on Dora Richter. While the surgery was unfortunately not successful and Elbe ultimately died from complications three months after, this surgery was an important stepping stone in the ongoing development of uterus transplant surgery for trans women. Elbe’s semi-autobiography Man into Woman: An Authentic Record of a Change of Sex was published posthumously in 1933, and a film based on her life called The Danish Girl was released in 2015. 

1940s: Michael Dillon becomes one of the first trans men to undergo gender-affirming hormone therapy and surgeries

Michael Dillon was a transgender man born in London to an Irish family, and is known as the first transgender man ever to undergo phalloplasty and among the first to access masculinising hormone therapy. Dillon started on testosterone at the direction of physician George Foss, but according to Dillon’s account, he was outed as transgender by his psychiatrist. This made Dillon the subject of public discussion because, as his brother was a Baronet to Lismullen, this would have made Michael Dillon next in line for this inheritance of this position if his legal transition was to be fully recognised.

Perhaps seeking to avoid this public attention, Dillon moved to Bristol, where he lived as a man and worked in a garage while undergoing testosterone therapy. In 1945, Dillon enrolled in the School of Medicine at Trinity College Dublin to retrain as a physician. Shortly thereafter, he published Self: A Study in Ethics and Endocrinology as a medical, psychological, and philosophical exploration of gender and sexuality. This book affirmed the bodily autonomy of trans people, remarking that people should have the right to change their gender and their bodies.

Prior to being licensed as a physician, Dillon performed an orchiectomy on Roberta Cowell, making her the first British trans woman to receive gender-affirming bottom surgery. This was perhaps one of, if not the, first gender-affirming surgery performed by a trans person for a trans person.

Dillon’s autobiography Out of the Ordinary was published fifty years after his death, which helped re-energise interest in Dillon’s extraordinary life - from Baronet, to engineer, to doctor, to monk. 

1950s-1970s: Christine Jorgensen accesses gender-affirming care and influences the development of the World Professional Association for Transgender Health (WPATH)

Progress in trans healthcare continued as Christine Jorgensen became the face of transgender healthcare in America. Jorgensen was a singer, actress, and activist who sought gender-affirming hormone therapy and surgeries in Denmark. She influenced the model of transitioning that we know today, and helped to popularise the term transgender, which she came to call herself later in life. 

Christine Jorgensen’s doctor, Harry Benjamin, began working with transgender patients in 1948 through an affirming model of care. In 1979, he founded the Harry Benjamin International Gender Dysphoria Association, which has since become the World Professional Association for Transgender Health (WPATH). This organisation still sets the internationally best recognised standard of care for transgender people to this day. In the preface of Benjamin’s autobiography, he credited Jorgensen’s input into his medical practice for much of his success, demonstrating the effectiveness of a patient-led model of care for transgender people. WPATH has seen many iterations and developments on how best to treat transgender people as Benjamin’s ideas were adapted and expanded on. 

Christine Jorgensen published Christine Jorgensen: A Personal Autobiography in 1967, a personal memoir of her experience and her life. 

2000s: Clinics pioneer the informed consent model for gender-affirming care

The early 2000s saw the growth of the informed consent model, particularly in clinics across the United States. Callen-Lorde Community Health Center in New York, United States began as the St. Marks Clinic in 1969 and merged with the Gay Men’s Health Project in 1983 to combat the HIV/AIDS epidemic. Callen-Lorde pioneered an informed consent protocol for the care of transgender people. Howard Brown Health was established in 1976 as an LGBTQ+-centred health clinic in Chicago and uses an informed consent model for gender-affirming hormone therapy. And finally, beginning as a volunteer service in 1971, Fenway Health established the Transgender Health Program in 2004 offering gender-affirming care based on informed consent.

Today

This leads us to the modern state of transgender healthcare. In 2022, the World Health Organisation’s  International Statistical Classification of Diseases and Related Health Problems (ICD) 11 reclassified gender-affirming care as sexual health. The latest version of the WPATH Standards of Care, released in 2022, advocates for a patient-centred approach and supports the informed consent model facilitated by primary care providers. These two documents eliminate the historical requirement for transgender people to undergo psychiatric screening to access care.

While Ireland retains a de facto centralised “gender clinic” model that requires psychiatric assessments before treatment, countries around the world have been adopting an informed consent model for gender-affirming care delivered by primary care providers. For example, Aotearoa New Zealand released their Primary Care Gender Affirming Hormone Therapy Initiation Guidelines in 2023. This set of guidelines helps primary care doctors and nurses administer hormones to trans people on an informed consent basis, centering their right to bodily autonomy. This model, which Trans Healthcare Action advocates for, is supported by the trans community and experts in transgender health across the globe.

Tomorrow

It’s time for Ireland to make history by enacting an informed consent model for gender-affirming care, facilitated by our local community and primary care practitioners. The bodily autonomy, self-determination, and decision-making power of trans people must be at the centre of policymaking as we move into the future. Nothing about us without us!

The inspiring histories of transgender people contextualise our efforts today for easily accessible, informed consent-based gender-affirming care as part of a decades-long push for change. 

While we can’t cover the full history and modern practice of transgender healthcare in this article, we can recommend a few ways to learn more:

• Transgender History by Susan Stryker is a good run-down of the pathologisation of transgender people in the 1850s to the beginning of modern recognition in the 1990s. This book offers a broad historical overview of trans existence, from legal and social status to medical access. 

• Trans Medicine by Stef M Schuster dives deeper into the modern practice of transgender healthcare, how medical professionals are crafting treatment plans, and the challenges they face from a lack of research and community engagement. 

• The Care We Dream Of by Zena Sherman is a collection of essays and prose speaking of transgender people’s experience when approaching medical care and the barriers faced by them. This book illuminates the personal experience of what it feels like to be trans and seeking care. 

• You can also learn more by joining Outhouse’s series of talks for LGBTQ+ history month.