The official policy of the Trump administration is essentially that transgender citizens do not exist and will not be recognized by the federal government. The publication last month by the State University of New York Press of A History of Transgender Medicine in the United States: From Margins to Mainstream is thus especially welcome.
At 783 pages, this text covers a lot of ground, beginning with the roots of transgender identities around the world starting in precolonial times through 18th-century Europe and continuing all the way to the present — or at least to December 2022, when the manuscript was completed. That gap is significant, given what has happened in just the first few days of the new Trump presidency. I doubt that the authors could have imagined the degree of retrenchment that would occur in such a short time. The president has vowed to eliminate health-care services for transgender adolescents, even though all major medical societies endorse such care.
The book’s editors are Carolyn Wolf-Gould, Dallas Denny, Jamison Green, and Kyan Lynch. Wolf-Gould is a family physician who founded a rural gender wellness center in Oneonta, N.Y and is a part-time resident of Wellfleet. Three of the editors regularly attend Trans Week in Provincetown; Denny is one of its organizers. Wolf-Gould leads a writing group at the annual gathering.
The editors go out of their way to ensure that the voices of transgender people are represented here; all but one member of the editorial team identify as transgender. The introduction does a nice job of transparently describing the way they navigated a complex history of transgender people engaging with medical professionals, many of whom saw their patients’ identities as inherently pathological.
The insistence of early trans pioneers that they be seen as the people they really were shines through this volume; it also acknowledges that many transgender people were (and continue to be) traumatized by their interactions with clinicians. The tension between wanting to meet the needs of one’s patients without clear, established science on how best to provide medical interventions is a theme here and sheds light on the current debates about what appropriate gender-affirming care is, especially for minors, where the science is still evolving.
The editors provide abundant citations befitting an academic text. And yet the hefty volume is interesting and informative, even for a nonacademic reader. For example, the connections between Weimar Germany, where observational analyses of human sexuality began at Magnus Hirschfeld’s Institute for Sexual Science, and the work of Alfred Kinsey, who was chronicling the sexual behavior of Americans in the 1950s, are fascinating. Throughout the book are short biographical sketches of trans individuals who helped to inform the historical narrative of transgender medicine in this country.
This is not a book about medical procedures as much as how those procedures came into being. There is abundant literature for those interested in the specifics of gender-affirming medical approaches. Instead, this book tells the story of the critical role that transgender people played in demanding that they be seen and of the clinicians who were brave enough not just to see them but to hear them and agree to do what they could to help them “change their bodies to match their minds.”
This is not new or unique to transgender medicine. It is how medicine has always evolved. A clinician is asked by a patient to confront a need, in this case a disconnect between their gender assigned at birth and their gender identity as it became known to them. The clinician looks for established and evidence-based protocols for addressing the identified clinical need, and in the absence of established science, carefully, and with the informed consent of the patient, works to address the need. In that process, clinicians and patients help to build the scientific evidence for the effectiveness of an intervention.
The book serves as a reminder of this unique aspect of the fight for transgender rights, which differs from the gay rights battle. Transgender people who want to fully transition require the interventions of physicians: endocrinologists for gender-affirming hormones and surgeons for mastectomies, vaginoplasties, phalloplasties, and other surgeries. Gays and lesbians had no such gatekeepers in their journeys to coming out and fully integrating their identities. How the medical and psychological fields went from observational case studies to creating protocols for gender affirmation is at the heart of this text.
The book also highlights how that power over something so essential to one’s being as sexual identity remains outside the control of transgender people — and how that fundamental right is being threatened in our present political climate. The idea of the state being able to deny individuals access to the means of aligning their gender with their bodies is scary, and it is being played out in the current debates, laws, and actions by those who believe they can oppose the very existence of a transgender identity.
We are reminded of just how tenuous the progress laid out beautifully in this well-researched book remains. What’s needed is empathy for those engaged in gender journeys — whether or not you understand how or why a person may identify as trans or when it is appropriate to suppress puberty until young people are able to make decisions for themselves about their physical beings.
A History of Transgender Medicine in the United States gives us the story of how we have come to this moment in the struggle for trans rights and empowers the reader to do what the clinicians of the last century tried to do: listen to, see, understand, and ultimately aid those who are asking only to be allowed to be themselves.
Christopher Bellonci, M.D. is a child, adolescent, and adult psychiatrist. He lives in Truro.
