The following essay is reprinted with the permission of The conversationan online publication covering the latest research.
In the last century, there have been three waves of opposition to transgender health care.
In 1933, when the Nazis came to power, took strong action against Transgender medical research and clinical practice in Europe. In 1979, a research report critical of transgender medicine led to closure of the most respected clinics in the United States. And since 2021, when Arkansas became the first US state. between now at least 21 other states By banning gender-affirming child care, we have been living in a third wave.
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In my work as transgender history scholarstudy the long history of gender-affirming care in the United States, which has been practiced at least since the 1940s. Puberty blockers, hormone therapies, and anatomic surgeries are neither experimental nor untested and have been safely administered to cisgender, transgender, and intersex adults and children for decades.
On the other hand, the archives of transgender medicine demonstrate that the reaction against these practices has historically had its roots in pseudoscience. And today, an anti-science movement that aims discredit science completely is fueling the fire of the current wave of anti-trans panic.
1930s: Eugenics and sexology collide
In the 1920s, the new science of hormones was just coming of age and entering general consciousness. In the field of sexology – the study of human sexuality, founded in 19th-century Europe – scientists were excited by animal research showing that the removal or transplantation of gonads could effectively change the sex of an organism.
In 1919, the German sexologist Magnus Hirschfeld founded the Institute of Sexual Sciences in Berlin, which became the world’s leading center for queer and transgender research and clinical practice. Hirschfeld worked closely with trans women as co-researchers during the 1920s. Several trans women also received care at the institute, including orchiectomies which stopped the production of testosterone in their bodies.
Within months of Hitler’s rise to power in early 1933, a crowd of far-right students broke in and closed the institute for being “not german.” Some of the most famous images of Nazi book burnings show the institute’s library set on fire in an open-air square.
Nazi ideology was based on another prominent field of science of that time: eugenics, the belief that certain superior populations must survive while inferior populations must be exterminated. In fact, Hirschfeld’s sexology and Nazi racial science had common roots in the Enlightenment-era effort to classify and categorize the ways of life of the world.
But at the end of the 19th century, many scientists went one step further and developed a hierarchy of human types based on race, gender and sexuality. They were inspired by social darwinism, a set of pseudoscientific beliefs that apply the theory of survival of the fittest to human differences. While racial scientists imagined a fixed number of human races of different intelligence, sexologists simultaneously sought to classify sexual behaviors as innate and inherited states of being: the “homosexuals” in the 1860s and the “transvestite” term coined by Hirschfeld himself, in 1910.
But while Hirschfeld and other sexologists saw the classification of queer and trans people as justification for legal emancipation, eugenicists of the early 20th century In the USA and Europe believed sexually transgressive people must be sterilized and finally eradicated.
Starting from this premise, the Nazis murdered thousands of LGBTQ people in the Holocaust.
The 1970s: creating model citizens
In the 1950s and 1960s, transgender medicine revived in the United States. Scientists and doctors from various universities began to experiment with new hormonal and surgical interventions. In 1966, Johns Hopkins became the first university hospital in the world to offer trans health care.
In the 1970s, trans medicine became mainstream. Nearly two dozen university hospitals they operated gender identity clinics and treated thousands of transgender Americans. Several trans women and men wrote popular autobiographical stories of their transitions. Trans people were even in TVtalking about their bodies and fighting for their rights.
Behind the scenes, however, trouble was brewing. Jon Meyer, a psychiatrist at Johns Hopkins, was skeptical about whether medical interventions really helped transgender people. In 1979, Meyer, together with his secretary Donna Reter, published a short academic work that marked the beginning of the second wave of historic reaction to trans medicine.
In their study, Meyer and Reter contacted previous patients at the Johns Hopkins Gender Identity Clinic. To understand whether the surgery had improved patients’ lives, the authors developed an “adjustment scoring system.” They assigned points to patients who were in heterosexual marriages and had achieved economic security since their operations, while deducting points from those who continued to engage in gender nonconformity, homosexuality, criminality, or sought mental health care.
Meyer and Reter believed that gender-affirming surgeries were only successful if they turned transgender people into model citizens: heterosexual, married, and law-abiding.
In their results, the authors found no negative effects of the surgery and no patients expressed regret. They concluded that “sex reassignment surgery does not confer any objective advantage in terms of social rehabilitation,” but is “subjectively satisfactory” for the patients themselves. This was not a damning conclusion.
However, within two months, Johns Hopkins had closed his clinic. The New York Times reported that universities would feel pressure to “restrict their operations and discourage others from starting to do so” in a similar way. In fact, only one there were a handful of clinics left by the 1990s. Transgender medicine did not return to Johns Hopkins until 2017.
By requiring trans patients to marry heterosexual people and have gender-appropriate jobs to be considered successful, Meyer and Reter’s study was homophobic and classist in design. The study exemplified the pseudoscientific beliefs At the heart of transgender medicine between the 1960s and 1980s, patients had to conform to social norms – including heterosexuality, gender conformity, domesticity, and marriage – in order to receive care. This was an ideology rooted not in science but in intolerance.
The 2020s: distrust in science
As in the 1930s, opposition to trans medicine today is part of a broad reactionary movement against what some far-right groups consider the “toxic normalization”of LGBTQ people.
Legislators have Deleted books with LGBTQ content of libraries and He despised them as “filth”.” A recent law in Florida threatens to arrest trans people to use public bathrooms. Both Florida and Texas have made efforts to collect data on your trans citizens. donald trump campaign platform calls for a nationwide ban on trans healthcare for minors and severe restrictions for adults.
And just as in the 1970s, opponents of trans medicine today frame gender-affirming care as a “debate,” even though all major US medical associations support these practices as medically necessary and save lives.
But widespread distrust in science and medicine in it in the wake of the COVID-19 pandemic has affected the way Americans perceive trans healthcare. Bans on gender-affirming care have come simultaneously with the easing of pandemic restrictions, and some academics argue that the anti-trans healthcare movement is part of a wider movement aimed at discrediting the scientific consensus.
However, the saying “believe in science”is not an effective response to these anti-trans policies. Instead, many trans activists today call for completely diminishing the role of medical authority in Trans Healthcare Access Control. Medical control occurs through strict guidelines that govern access to trans healthcare, including mandatory psychiatric evaluations and long waiting periods that limit and control patient choice.
Trans activists have fought with the World Association of Professionals for Transgender Health, the organization that maintains these standards of care, by demanding greater bodily autonomy and depathologizing transsexuality. This includes turning toward a informed consent model where patients make decisions about their own bodies after discussing the pros and cons with their doctors. Trans activists have demonstrated against medical authority since the early 1970s, even calling for access to hormones and surgeries on demand.
It is unclear how the current third wave of backlash to transgender medicine will end. For now, trans healthcare remains an issue dominated by medical experts, on the one hand, and people who question the science, on the other.