Consciousness

• In the past century, there have been three waves of opposition to transgender health care.
• In 1933, when the Nazis rose to power, they cracked down on transgender medical research and clinical practice in Europe.
• In 1979, a research report critical of transgender medicine led to the closure of the most well-respected clinics in the United States.

The 1930s − eugenics and sexology collide

• In the field of sexology – the study of human sexuality, founded in 19th century Europe – scientists were excited about research on animals demonstrating that removing or transplanting gonads could effectively change an organism’s sex.
• Several trans women also received care at the institute, including orchiectomies that halted the production of testosterone in their bodies.

• Nazi ideology was based on another prominent field of science of that time: eugenics, the belief that certain superior populations should survive while inferior populations must be exterminated.
• In fact, Hirschfeld’s sexology and Nazi race science had common roots in the Enlightenment-era effort to classify and categorize the world’s life forms.
• But in the late 19th century, many scientists went a step further and developed a hierarchy of human types based on race, gender and sexuality.

The 1970s − making model citizens

• In 1966, Johns Hopkins became the first university hospital in the world to offer trans health care.
• By the 1970s, trans medicine went mainstream.
• Nearly two dozen university hospitals were operating gender identity clinics and treating thousands of transgender Americans.
• Jon Meyer, a psychiatrist at Johns Hopkins, was skeptical of whether medical interventions really helped transgender people.

• Meyer and Reter believed that gender-affirming surgeries were successful only if they made model citizens out of transgender people: straight, married and law-abiding.
• In their results, the authors found no negative effects from surgery, and no patients expressed regret.
• They concluded that “sex reassignment surgery confers no objective advantage in terms of social rehabilitation,” but it is “subjectively satisfying” to the patients themselves.

The 2020s − distrust in science

• Legislators have removed books with LGBTQ content from libraries and disparaged them as “filth.” A recent law in Florida threatens trans people with arrest for using public restrooms.
• Donald Trump’s campaign platform calls for a nationwide ban on trans health care for minors and severe restrictions for adults.
• But widespread distrust in science and medicine in the wake of the COVID-19 pandemic has affected how Americans perceive trans health care.

• Instead, many trans activists today call for diminishing the role of medical authority altogether in gatekeeping access to trans health care.
• Medical gatekeeping occurs through stringent guidelines that govern access to trans health care, including mandated psychiatric evaluations and extended waiting periods that limit and control patient choice.
• For now, trans health care remains a question dominated by medical experts on one hand and people who question science on the other.

G. Samantha Rosenthal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.