Gender-affirming care has a long history in the US – and not just for transgender people
Published in Health & Fitness
In 1976, a woman from Roanoke, Virginia, named Rhoda received a prescription for two drugs: estrogen and progestin. Twelve months later, a local reporter noted Rhoda’s surprisingly soft skin and visible breasts. He wrote that the drugs had made her “so completely female.”
Indeed, that was the point. The University of Virginia Medical Center in nearby Charlottesville had a clinic specifically for women like Rhoda. In fact, doctors there had been prescribing hormones and performing surgeries – what today we would call gender-affirming care – for years.
The founder of that clinic, Dr. Milton Edgerton, had cut his teeth caring for transgender people at Johns Hopkins University in the 1960s. There, he was part of a team that established the nation’s first university-based Gender Identity Clinic in 1966.
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., and 47 years since Rhoda started her hormone therapy. Understanding the history of these treatments in the U.S. can be a helpful guide for citizens and legislators in a year when a record number of bills in statehouses target the rights of transgender people.
As a trans woman and a scholar of transgender history, I have spent much of the past decade studying these issues. I also take several pills each morning to maintain the proper hormonal balance in my body: spironolactone to suppress testosterone and estradiol to increase estrogen.
When I began HRT, or hormone replacement therapy, like many Americans I wasn’t aware that this treatment had been around for generations. What I was even more surprised to learn was that HRT is often prescribed to cisgender women – women who were assigned female at birth and raised their whole lives as women. In fact, many providers in my region already had a long record of prescribing hormones to cis women, primarily women experiencing menopause.
I also learned that gender-affirming hormone therapies have been prescribed to cisgender youths for generations – despite what contemporary politicians may think. 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 what is considered a “normal” range for their gender. Because of binary gender norms that celebrate height in men and smallness in women, doctors, parents and ethicists have approved the use of hormonal therapies to make children conform to these gender stereotypes since at least the 1940s.
Clare describes a severely disabled young woman whose parents – with the approval of doctors and ethicists from their local children’s hospital – administered puberty blockers so that she would never grow into an adult. They deemed her mentally incapable of becoming a “real” woman.
The history of these treatments demonstrates that hormone therapies and puberty blockers have been used on cisgender children in this country – for better or for worse – with the goal of regulating the passage from girlhood to womanhood and from boyhood to manhood. Gender stereotypes concerning the presence or absence of secondary sex characteristics – too tall, too short, too much body hair – have all led parents and doctors to perform gender-affirming care on cisgender children.