We Have Always Existed

Creating a comprehensive page on transgender and gender diverse history is a significant task, given the complex and often painful legacy of oppression transgender individuals have faced. This oppression stems from societal power dynamics, particularly the imposition of gender through a reductionist framework known as gender essentialism. Gender essentialism prioritizes the body and external appearance over the inner self—treating gender as something determined solely by physical traits rather than lived experience or internal truth. In this framework, there is space for a body, but not for a self. This erasure dehumanizes transgender people and upholds systems of control that invalidate one’s right to self-definition and the freedom to live in alignment with that truth.

Transgender people have not only been marginalized throughout history but also vilified—frequently accused of deceit merely for expressing their authentic selves. In psychoanalytic terms, the self—like the soul in spirituality—is the core of one’s being: the organizing center of identity, memory, and desire. To live in alignment with that self is a profound act of integrity. Yet this authenticity is often mischaracterized as deception, perpetuating harmful stereotypes and, tragically, fueling violence against transgender individuals.

The history of transgender lives has been systematically gatekept, leading to widespread erasure and marginalization. Much of this history remains obscured or buried in records not easily accessed through mainstream narratives. What follows is a selection of significant people, places, and developments—as well as an overview of current progress—to help illuminate these stories and honor the contributions and resilience of transgender individuals across time. For a more comprehensive historical record, see the Digital Transgender Archive: https://www.digitaltransgenderarchive.net/

Links to Transgender History:

Gender Diversity Across Cultures and History

Sumerians: The Sumerians, one of the earliest known civilizations, recognized gender diversity in their society. Ancient texts and artifacts indicate that individuals who did not conform to binary gender categories were not only present but also held important roles in their religious and social structures. In Sumerian times, priests for Inanna known as the gala were said to have been created by the god Enki to sing laments for her, one of their central roles in her temple. This recognition reflects a more fluid understanding of gender in ancient Mesopotamia. Learn more.

Two-Spirit People and the North American Berdache: The term “Two-Spirit,” coined in 1990 during the third annual inter-tribal Native American/First Nations gay/lesbian conference in Winnipeg, refers to Indigenous North Americans embodying traditional mixed gender roles. Historically, the term “berdache” was used to describe Native American individuals who fulfilled one of many mixed-gender roles in their tribes. These roles involved wearing clothing and performing tasks associated with both men and women, representing a cultural understanding of gender that differs from Western binary concepts. The term “Two-Spirit” is now preferred as it respects the cultural significance and spiritual aspects of these identities, emerging to reclaim and affirm Indigenous gender diversity and cultural practices, challenging colonial and Western gender norms imposed on Indigenous communities. Read more.

Hijra Community in South Asia: The Hijra community, recognized as a third gender in South Asia for centuries, plays unique roles in cultural and religious ceremonies. They are often invited to bless weddings and births, reflecting their respected and spiritually significant status in society. Despite facing discrimination, Hijras continue to be a vital part of South Asian cultural heritage. Read more.

Fa’afafine of Samoa: In Samoan culture, Fa’afafine are individuals who embody both male and female traits and roles. Traditionally recognized and respected, Fa’afafine often take on caregiving roles within their families and contribute to the community through various means. Their existence challenges the Western binary gender concept and highlights the cultural richness of Samoa. Read more.

Bakla of the Philippines: Bakla is a term used in Filipino culture to describe individuals assigned male at birth who adopt feminine gender expressions and roles. Historically respected in pre-colonial society, Bakla individuals often occupy significant social spaces, particularly in the beauty and entertainment industries today. They reflect the cultural acceptance of gender diversity in the Philippines. Read more.

Kathoey in Thailand: Known colloquially as “ladyboys,” Kathoey in Thailand are individuals assigned male at birth who present as female or non-binary. Highly visible in Thai culture, they often work in entertainment and fashion, and their presence challenges Western notions of gender conformity. Despite facing legal and social hurdles, Kathoey are an integral part of Thai society. Learn more.

Bissu in Bugis Culture (Indonesia): The Bugis people of Sulawesi recognize five genders, including Bissu, who embody both male and female characteristics and hold important spiritual roles. Bissu are considered intermediaries between the spiritual and physical worlds, performing rituals and preserving oral traditions. Their existence underscores the cultural richness and gender diversity of the Bugis people. Read more.

Ashtime in Maale Culture (Ethiopia): Ashtime are males in Maale culture who adopt female roles and gender expressions. Often holding significant ritualistic and spiritual roles, they are vital to the cultural and religious practices of their community. Their acceptance reflects the nuanced understanding of gender in Maale society. Learn more.

Sekrata in Madagascar: The Sekrata are individuals assigned male at birth who take on female gender roles within the Sakalava people of Madagascar. Believed to possess special spiritual powers, Sekrata are integrated into the social and spiritual fabric of their communities. Their roles highlight the cultural acceptance of gender diversity in Madagascar. Learn more.

Māhū in Hawaiian and Tahitian Cultures: Māhū are individuals in Hawaiian and Tahitian cultures who embody both male and female spirit and roles. Traditionally respected as caretakers of culture and knowledge, Māhū play a crucial role in maintaining cultural traditions and practices. Their recognition challenges Western gender binaries and emphasizes the cultural importance of gender diversity. Read more.

Ancient Judiasm: The Talmud identifies eight genders; Zachar (male), Nekevah (female), Androgynos (both male and female traits), Tumtum (indeterminate traits), Aylonit hamah (female at birth, develops male traits naturally), Aylonit adam (female at birth, develops male traits through intervention), Saris hamah (male at birth, develops female traits naturally), and Saris adam (male at birth, develops female traits through intervention). Additionally, rabbinic literature includes the concept of the first human being created as both male and female. For more details, visit My Jewish Learning.

Gender Diversity in Ancient Rome

Ancient Rome exhibited a complex understanding of gender and sexuality, with instances of gender diversity recorded in historical texts and practices. While Roman society was predominantly patriarchal and adhered to strict gender roles, there were notable exceptions and unique cultural nuances regarding gender and sexuality (https://academic.oup.com/ahr/article-abstract/105/4/1250/87940).

The 1703 engraving “Isis Changing the Sex of Iphis” by Bauer illustrates a myth from Ovid’s Metamorphoses, which explores themes of gender, transformation, and love. In the story, Iphis, assigned female at birth but raised as a boy, is transformed into a man by the goddess Isis, allowing the relationship with a woman to continue without the constraints of societal norms (https://classics.washington.edu/sites/classics/files/documents/research/kamen_2012_iphis.pdf). In ancient Rome, same-sex relationships were accepted within certain frameworks, with a focus on maintaining power dynamics, particularly male dominance. The myth of Iphis aligns with these expectations, making the love story socially acceptable by Roman standards. Today, it resonates with trans and nonbinary people, highlighting the timeless themes of gender fluidity and self-discovery.

Gallae Priests:

The Gallae were priests of the Phrygian goddess Cybele who were noted for their ritual castrations and adoption of female clothing and behavior. These priests, often viewed as a third gender, played a significant role in Roman religious life.
Sources: Ancient History Encyclopedia – Cybele

Same-Sex Relationships:

Roman society acknowledged same-sex relationships, particularly among men. While these relationships were usually framed within specific social hierarchies and power dynamics, they highlight the fluidity of sexual norms in ancient Rome.
Sources: Same-Sex Relationships in Ancient Rome

Legal and Social Attitudes:

Roman law and social norms were complex and often contradictory. While cross-dressing and gender non-conformity were generally frowned upon in public, certain religious and cultural contexts provided space for such expressions.
Sources: https://pressbooks.bccampus.ca/unromantest/chapter/transgender/

These examples illustrate that while ancient Rome was largely conservative and patriarchal, there were significant exceptions and contexts where gender diversity was acknowledged and even respected. This complexity reflects the broader diversity of human cultures and the ways in which different societies have navigated and understood gender and sexuality throughout history.

Pivotal Moments

Compton’s Cafeteria Riot: A Pivotal Act of Transgender Resistance

The Compton’s Cafeteria Riot erupted in August 1966 in San Francisco’s Tenderloin District, marking one of the first recorded instances of transgender resistance against police harassment in the United States—three years before Stonewall. The riot began when a transgender woman threw hot coffee at an officer attempting to arrest her, triggering a larger confrontation in which patrons overturned tables and broke windows in defiance of police brutality. At a time when cross-dressing was criminalized, the riot became a turning point in LGBTQ+ activism, leading to the formation of the National Transsexual Counseling Unit (NTCU) and inspiring future movements. In 2024, the site at 101 Taylor Street was added to the National Register of Historic Places, cementing its legacy in transgender history.
Source: San Francisco Chronicle

The Stonewall Uprising and the Erasure of Transgender History

The Stonewall Riots, which began on June 28, 1969, were a series of spontaneous demonstrations by LGBTQ+ individuals in response to a police raid at the Stonewall Inn in New York City. At the time, homosexual acts were illegal in nearly every state, and LGBTQ+ spaces faced frequent police harassment. The uprising sparked days of protests and violent clashes with law enforcement, serving as a catalyst for the modern LGBTQ+ rights movement. It led to the formation of advocacy organizations and the initiation of annual Pride marches to commemorate the resistance.

However, in February 2025, the National Park Service (NPS) removed all references to transgender and queer individuals from its website for the Stonewall National Monument. This action followed Executive Order 14168, signed by Donald Trump, which mandated the elimination of so-called “gender ideology” from federal recognition. LGBTQ+ advocacy groups have condemned this as a deliberate act of political violence, silencing the contributions of transgender activists who played a critical role in the uprising. The erasure of transgender history from a monument meant to honor LGBTQ+ resistance represents a dangerous step toward broader state-sponsored oppression.
Sources: AP News, Them, Reuters

Gender Diverse People Throughout History

Emperor Elagabalus (203–222 AD)

Emperor Elagabalus, also known as Heliogabalus, challenged traditional Roman norms by openly expressing a non-binary to feminine gender identity and using she/her pronouns. She served as Roman emperor from 218 to 222 AD. Notably, she arranged a marriage with a charioteer named Hierocles, publicly declaring herself Hierocles’ wife, which defied societal expectations and shocked Roman society. Elagabalus’s reign was marked by controversy and criticism for behaviors considered unconventional by Roman standards, including religious reforms centered on the Syrian sun god Elagabal. Her defiance of gender norms and open declaration of a same-sex marriage challenged Roman patriarchal traditions, making her a controversial figure in ancient history. More about Elagabalus

Eleanor Rykener (arrested in 1394, London)

Eleanor Rykener, also known as John Rykener, was a medieval sex worker in 14th-century London, whose case provides a rare glimpse into gender and sexual diversity in the Middle Ages. Arrested in 1395 for engaging in sexual relations with men and women while cross-dressed as a man, Rykener’s confession during interrogation detailed a life that defied conventional gender norms of the time. Rykener reportedly solicited clients while presenting as both male and female, highlighting a fluidity of gender expression and sexual orientation that challenges modern assumptions about medieval attitudes towards gender and sexuality. Rykener’s case is documented in legal records of the period, offering a unique historical perspective on how individuals navigated and negotiated their identities in a society governed by rigid religious and social codes. More about Eleanor Rykener

Xica Manicongo (16th century, documented in 1591)

Xica Manicongo, originally named Francisco Manicongo, was an enslaved person from the Kingdom of Kongo who was brought to colonial Brazil in the late 1500s. They are considered one of the earliest documented transgender or gender-nonconforming individuals in the Americas. In 1591, Xica was investigated by the Portuguese Inquisition in Bahia for wearing traditionally feminine clothing and engaging in same-sex relationships, defying rigid Catholic and colonial gender norms. Their story challenges the misconception that transgender identities are modern, instead highlighting pre-colonial traditions of gender fluidity that were forcibly erased. Today, Xica Manicongo is remembered as a symbol of resistance in both transgender and Afro-Brazilian history. More about Xica Manicongo

Catalina de Erauso (1592-1650)

Catalina de Erauso, known as the “Lieutenant Nun,” was a remarkable figure born in the Basque Country around 1592. Escaping from a convent at a young age, she adopted a male identity and lived as a soldier and adventurer in the Spanish colonies of South America during the 17th century. Catalina’s life was marked by daring exploits, including duels and military campaigns, where she gained fame for her courage and skill. Her story captured the imagination of contemporaries and later historians, fascinated by her unconventional life and the challenges she faced navigating gender roles in a patriarchal society. Catalina de Erauso’s memoir, “The Lieutenant Nun: Memoir of a Basque Transvestite in the New World,” written in her later years, provides a vivid account of her experiences and remains a testament to her resilience and determination to live on her own terms. More about Catalina de Erauso

Chevalier d’Éon (1728–1810)

Chevalier d’Éon was born in Tonnerre, France. She was a diplomat, spy, soldier, and Freemason who served as a member of the French embassy in Russia, working as a spy for King Louis XV. In 1777, after years of living as a man, d’Éon began living publicly as a woman, claiming she had been assigned female at birth but raised as a boy to ensure an inheritance. The French government acknowledged d’Éon’s claim and provided financial support for her transition, including a pension and funds for a new wardrobe. D’Éon continued to live as a woman until her death in 1810. Her life and gender identity were subjects of much intrigue and speculation, and after d’Éon’s death, a post-mortem examination revealed male anatomy, adding to the complexity and mystery of her life story. More about Chevalier d’Eon

Dr. James Barry (1795-1865)

Dr. James Barry’s life seems fit for a television drama: a roguish doctor aiding the sick and poor, engaging in duels, and challenging authority figures. Despite his sharp tongue, Barry was compassionate toward his patients, earning his MD from the University of Edinburgh in 1812 and later joining the British Army as a Hospital Assistant. Barry rose to the rank of Inspector General, responsible for military hospitals, and was known for improving conditions and advocating for better sanitation. It was only after his death that Barry was discovered to have been assigned female at birth, adding another layer of complexity to his remarkable life. More about Dr. James Barry

Albert Cashier (1843–1915)

Albert Cashier was born in Clogherhead, Ireland, and immigrated to the United States, where he began living as a man. Cashier enlisted in the Union Army in 1862 during the American Civil War, serving in the 95th Illinois Infantry. He fought in approximately 40 battles and was noted for bravery and dedication, with his identity as a man not questioned during his service. After the war, Cashier continued to live as a man, working in various jobs such as a farmhand, janitor, and street lamplighter, and received a veteran’s pension, living in a soldiers’ home in later years. Cashier’s assigned gender at birth was discovered when he was admitted to a hospital in 1911 for a broken leg and later to a mental institution. Despite the discovery, many of Cashier’s comrades and community members continued to support and respect him, and his story has since been recognized as a significant example of transgender history, particularly in the context of military service. More about Albert Cashier (new link)

Alan Hart, MD (1890–1962)

Alan Hart, MD, a transgender man and physician, underwent one of the earliest known gender-affirming surgeries in the United States—a hysterectomy performed in 1917. This procedure was conducted by Dr. J. Allen Gilbert at the University of Oregon Medical School, now known as Oregon Health & Science University (OHSU). Dr. Gilbert’s involvement was crucial as he supported Hart’s transition, which was groundbreaking at a time when societal views on gender and sexuality were highly conservative. This pioneering surgery marked a significant advancement in the medical treatment of transgender individuals, setting a precedent for future gender-affirming healthcare. More about Dr. Alan Hart

Lili Elbe (1882-1931)

Lili Elbe was a Danish painter and one of the first known recipients of gender confirmation surgery, making her a pioneer in the transgender community. She gained recognition as an artist before transitioning. In the 1920s, Elbe learned of the possibility of permanently transforming her body from male to female at the German Institute for Sexual Science in Berlin. Dr. Magnus Hirschfeld founded the clinic in 1919 and coined the term “transsexualism” in 1923 (although some reports indicate that Elbe was the very first sex reassignment surgery recipient, she was not). There she underwent the first of four operations in 1930. The next three surgeries were conducted in 1930 and 1931 by Dr. Kurt Warnekros at the Dresden Municipal Women’s Clinic. Her story, which highlights the challenges and courage involved in her transition, was later chronicled in the book “Man into Woman.” Elbe’s life and legacy continue to inspire and resonate, underscoring the struggles and triumphs of early transgender pioneers. More about Lili Elbe

Michael Dillon (1915-1962)

Michael Dillon was a pioneering British physician and the first trans man to undergo phalloplasty, significantly advancing medical treatment for transgender individuals. Born in 1915, Dillon’s transition began in the 1940s, culminating in a series of groundbreaking surgeries performed by Sir Harold Gillies. Dillon also authored “Self: A Study in Endocrinology and Ethics,” one of the earliest books exploring transgender identity from a personal and scientific perspective. As a medical doctor, he worked tirelessly to support and provide care for marginalized communities. Dillon’s trailblazing journey and contributions to transgender healthcare remain influential, marking him as a significant figure in the history of LGBTQ rights and medical science. More about Michael Dillon

Reed Erickson (1917–1992)

Reed Erickson was a pioneering transgender philanthropist and businessman who used his wealth to advance LGBTQ rights and transgender visibility. Born in 1917, he transitioned in the 1960s and became one of the earliest openly transgender men in the United States. Erickson founded the Erickson Educational Foundation in 1964, which funded groundbreaking research on gender identity and supported numerous LGBTQ organizations and projects. His foundation played a pivotal role in advocating for transgender rights and funding medical and psychological research that helped shape understanding and acceptance of transgender individuals. Erickson’s legacy continues to impact the LGBTQ community, reflecting his dedication to advancing equality and recognition for transgender people worldwide. More about Reed Erickson

Christine Jorgensen (1926-1989)

Born in the Bronx, New York, Christine Jorgensen felt like a girl despite being assigned male at birth. After serving in the U.S. Army, she pursued gender confirmation surgery in Sweden, undergoing a series of hormone treatments and surgeries at the Karolinska University Hospital in Stockholm under the guidance of Dr. Christian Hamburger, from whom she took her name. Karolinska was one of the leading centers for gender affirmation surgery at the time. Jorgensen’s transition received widespread media attention, making her one of the first publicly known trans women in the United States. Her openness and advocacy played a significant role in advancing public understanding of transgender issues. More about Christine Jorgensen

Marsha P. Johnson (1945-1992)

Marsha P. Johnson was an influential American LGBTQ activist and drag performer, best known for her pivotal role in the Stonewall Riots of 1969, which marked a significant turning point in the LGBTQ rights movement. Born in 1945, Johnson was a prominent figure in the gay liberation movement and co-founded the Gay Liberation Front and the Street Transvestite Action Revolutionaries (STAR) alongside Sylvia Rivera. More about Marsha P. Johnson

Sarah McBride: Breaking Barriers in Transgender Political Representation

Sarah McBride is a pioneering transgender activist and politician, known for her leadership in LGBTQ+ rights. In 2020, she became the first openly transgender state senator in U.S. history, representing Delaware’s 1st Senate District. Prior to her election, she served as National Press Secretary for the Human Rights Campaign (HRC) and was instrumental in securing nondiscrimination protections in Delaware. McBride first gained national recognition in 2012 when, as student body president at American University, she came out in an op-ed and later became the first openly trans White House intern under the Obama administration.

Throughout her career, McBride has championed healthcare access, LGBTQ+ protections, and broader political representation. Her memoir, Tomorrow Will Be Different, details her personal and political journey, cementing her as a leading voice for transgender rights. In 2025, she made history once again as the first openly transgender person elected to the U.S. Congress, marking a major milestone in trans political visibility.
Source: AP News

Historical Context of Gender Affirming Care

Early Gender Clinics and the Changing Body of Research

These early clinics focused on gender and sexual diversity often operated under challenging societal and legal constraints. To continue their work, they sometimes had to adopt clandestine measures. Discretion and secrecy were crucial, not only to protect the individuals involved but also to ensure the continuation of their important work. This covert approach was essential in an era with limited understanding and acceptance of gender and sexual diversity.

The British Society for the Study of Sex Psychology

Though not a clinic, the British Society for the Study of Sex Psychology, founded in 1913, played a crucial role in the advocacy and academic discussion surrounding sexual and gender diversity in the UK. This society was instrumental in advancing the understanding of human sexuality and challenging the legal and social barriers faced by the LGBTQ+ community. Its members, including notable figures like Havelock Ellis and Edward Carpenter, were at the forefront of advocating for legal reforms and greater acceptance of diverse sexual and gender identities. Their activities had to be carefully managed to avoid public outrage and legal troubles, often limiting their meetings and publications to private circulation to ensure safety and continuation of their work. Read more about the British Society for the Study of Sex Psychology.

Magnus Hirschfeld’s Institute for Sexual Science

Established in 1919 in Berlin, Germany, the Institute for Sexual Science was one of the pioneering facilities in the world dedicated to the study and treatment of sexual and gender diversity. Founded by Dr. Magnus Hirschfeld, a prominent sexologist and advocate for the rights of homosexual and transgender individuals, the institute was groundbreaking in its comprehensive approach. It provided hormone therapy, psychological counseling, and gender confirmation surgeries, which were revolutionary at the time. The institute not only offered medical and psychological support but also functioned as a research center and a hub for advancing civil rights for the LGBTQ+ community. Its existence was a beacon for progressive treatment and acceptance until it was tragically shut down and looted by the Nazis in 1933. The iconic images of Nazis burning books depict the tragic destruction of this institute’s invaluable library, which included thousands of volumes on sexual science. Read more about the Institute for Sexual Science.

Vienna Austria 1920’s

In the interwar period—especially the 1920s—Vienna was an important center for research and public fascination with endocrine science and the “sex glands.” One of the most prominent figures was the Austrian physiologist Eugen Steinach, whose laboratory work helped establish key ideas about gonadal hormones and their effects on physiology and sexual behavior.

Steinach is especially associated with the “Steinach operation” (a vasoligation/vasectomy-based rejuvenation procedure) that became widely discussed in the 1920s and 1930s. Although later discredited as a rejuvenation cure, it drew major medical and cultural attention, and it was reportedly pursued by notable figures including Sigmund Freud.

Steinach’s work intersected with other Austrian researchers in reproduction and endocrine theory. Historian Cheryl A. Logan documents a Steinach–Paul Kammerer collaboration and places these studies within contemporary endocrine debates.

Another key Austrian physiologist, Ludwig Haberlandt, is widely cited as an early pioneer of hormonal contraception. He also appears in the Nobel Prize nomination archive as a nominator of Steinach (1927), reflecting professional linkage within Austrian physiology/endocrinology networks.

The Distinction Between Research in Vienna and Hirschfeld’s Work

While Steinach and his colleagues in Vienna focused on physiological and hormonal studies, Magnus Hirschfeld in Berlin took a more holistic approach, integrating social, psychological, and medical perspectives on gender and sexuality. Hirschfeld’s Institute for Sexual Research, founded in 1919, offered comprehensive services, including hormone therapy, gender confirmation surgeries, and extensive research on sexual health and gender identity.

Societal and Religious Influences

In Vienna, the work was often conducted discreetly due to Austria’s conservative social and religious landscape. The church’s influence emphasized traditional views on morality and sexuality, often conflicting with the principles of autonomy and consent in scientific research. In contrast, Hirschfeld’s institute operated in the more liberal Weimar Germany, advocating for sexual reform and human rights, and emphasizing personal autonomy and informed consent in medical treatments.

Autonomy and Consent in Medicine and Research

Vienna’s research faced significant barriers due to societal and religious norms that conflicted with autonomy and consent. The church’s stance on morality and sexuality hindered open discussion and treatment of gender and sexual identity issues. Conversely, Hirschfeld in Berlin championed the rights of individuals to make informed decisions about their bodies and identities, promoting a more inclusive approach to gender diversity.

Polarization and the Rise of Fascism

The polarized views between Hirschfeld’s progressive approaches in Berlin and the conservative views in Vienna and other parts of Europe created significant social tension. The liberal approach promoted inclusivity and human rights, while the conservative stance, influenced by religious doctrines, sought to maintain traditional gender and sexual norms. This polarization contributed to the rise of extremist ideologies, with Nazi rule exploiting these tensions spreading fascism, leading to the persecution of marginalized groups and the suppression of progressive sexual science, including the targeting of Hirschfeld’s institute. (https://www.imdb.com/title/tt27906298/)

Impact on Scientific Advancements

These opposing camps highlight the significant impact of societal and political climates on scientific advancements and the treatment of marginalized groups. This polarization is reminiscent of current societal divides, which will be discussed later. For more information, you can explore sources like the Scientific American and articles discussing the broader sex reform movement in Weimar Germany, such as those found on the UNC’s History Department.

The Endocrine Clinic at Johns Hopkins Hospital

In 1935, Dr. Lawson Wilkins opened the Endocrine Clinic at Johns Hopkins Hospital in Baltimore, Maryland, located at the Harriett Lane Home. This clinic emerged as a pioneering institution in the United States for providing hormone therapy, initially to treat intersex children. This marked a significant advancement in endocrinology during a time when societal views on gender and sexuality were highly conservative. The clinic’s efforts laid the foundation for future advancements in transgender healthcare, later providing hormone therapy to help transgender individuals align their physical bodies with their gender identities.

One notable figure associated with Johns Hopkins who played a crucial role in transgender healthcare was Dr. John Money. Although his work began in the 1950s, his influence and the clinic’s pioneering efforts in the 1930s contributed significantly to the field. In 1966, Dr. Money founded the Gender Identity Clinic at Johns Hopkins University, starting an extensive research program on the “psychohormonal treatment of paraphilias” and “sex reassignment.” He coined and developed the term “gender role,” later expanding it to “gender identity/role” (G-I/R), helping to establish protocols for treating transgender and intersex individuals.

One of the most controversial cases in Dr. Money’s career was the treatment of David Reimer. Born Bruce Reimer, David was subjected to a failed sex reassignment experiment after a botched circumcision in infancy. Dr. Money advocated for raising David as a girl, Brenda, as part of his research on gender identity. Despite initial claims of success, David Reimer later experienced severe psychological distress and rejected the female identity imposed on him, ultimately dying at age 38. This case significantly impacted the field, highlighting the complexities and ethical considerations involved in gender reassignment, particularly for intersex individuals before their gender identity is realized. It underscored the importance of respecting individual autonomy in gender identity development and challenged some of Dr. Money’s theories and practices, emphasizing the need for a more nuanced and ethically informed approach to gender identity and medical interventions.

The medical community’s approach to intersex individuals has often prioritized societal comfort over the rights of the individual. Surgeries and hormonal treatments have been carried out to “normalize” intersex bodies, usually decided by doctors and parents without the patient’s input. These practices have raised ethical concerns, as they often disregard the principles of informed consent and bodily autonomy.

Advocacy groups and intersex activists have increasingly called for a shift in medical practices, emphasizing the importance of deferring non-urgent surgeries until the individual can participate in the decision-making process. They argue for a patient-centered approach that respects the rights of intersex individuals to make informed decisions about their own bodies. This shift aligns with broader movements within sexual and gender diversity fields that prioritize autonomy and consent.

The impact of Johns Hopkins’ early efforts within endocrinology, intersex treatment, and transgender healthcare is still felt today. In more recent years, the Johns Hopkins Center for Transgender and Gender Expansive Health continues to provide comprehensive, evidence-based, and affirming care for transgender individuals. This center offers a wide range of services, including hormone therapy, gender-affirming surgeries, and mental health support, building on the legacy of the clinic’s pioneering work from the 1930s.

For more information, you can explore LGBTQ History at JHU.

Trinidad, Colorado and the Legacy of Dr. Stanley Biber

Trinidad, Colorado became a world-recognized center for gender-affirming surgery thanks to Dr. Stanley Biber, a general surgeon who began offering this care in 1969. Over the next three decades, Biber operated on thousands of patients, transforming the small mining town into what became known as the “sex-change capital of the world.” His pioneering and compassionate approach—sometimes providing surgery at reduced or no cost—made Trinidad a lifeline for many trans people who had been turned away elsewhere.

In 1979, Johns Hopkins Hospital—which had hosted one of the first academic gender-identity clinics—closed its program. The closure was driven by psychiatry chair Paul R. McHugh and justified through a controversial study by Jon K. Meyer and Donna Reter, published in the Archives of General Psychiatry, which claimed that surgery produced “no objective advantage.” This decision led many major hospitals to stop offering gender-affirming care, pushing patients toward independent surgeons like Biber.

Biber continued performing gender-affirming surgery at Mt. San Rafael Hospital until his retirement in 2003, when Dr. Marci Bowers—herself a trans woman and one of Biber’s surgical protégés—took over the program. She practiced in Trinidad until 2010, when she relocated her clinic to the San Francisco Bay Area.

Dr. Biber’s legacy remains a defining chapter in U.S. transgender healthcare history, representing how individual physicians stepped in to meet medical needs when institutional systems withdrew.

Sources and Further Reading

Pioneering and Notable Doctors in Transgender History

These doctors, through their research, advocacy, and writings conducted across Britain, Australia, and the United States, helped lay the groundwork for understanding transgender identities within evolving scientific and social perspectives. Their efforts challenged societal norms, paving the way for future advancements in transgender rights, bodily autonomy, and healthcare worldwide:

Dr. James Barry (1795-1865)

Dr. James Barry’s life significantly influenced society, particularly in challenging and redefining traditional gender roles. As a military surgeon, Barry was not only responsible for implementing important medical reforms but also for advocating improved sanitary conditions, which broadly contributed to advances in medical practice. However, the posthumous revelation of his assigned female birth ignited significant discussions and controversies surrounding gender identity, marking a pivotal moment in societal acknowledgment of gender non-conformity.

Historically, Barry’s gender identity led to a profound reevaluation of his contributions to medicine and society. Initially celebrated for his professional accomplishments, the discovery of his gender identity following his death shifted the focus, turning his life story into a central theme in discussions about gender non-conformity, particularly within professional and military contexts. This shift in discourse, reflecting the rigid societal views on gender and sexuality of his time—and long afterward—often led to his portrayal as either deceitful or as an extraordinary deviation from normative gender expectations depending on the social contexts.

In the aftermath of his death, Barry’s story was at times ignored or sensationalized, but it also gradually helped to forge a more inclusive understanding of gender, influencing both medical and social perspectives. This evolution in understanding highlighted the arbitrary and restrictive nature of traditional gender roles, indirectly prompting early gender theorists and advocates to push for greater acceptance and understanding of transgender individuals.

Despite the scarcity of detailed writings from the period immediately following his death that delve into these themes, the ongoing discussions signal that while Barry’s life did challenge societal norms, it took considerable time for these challenges to permeate broader societal and academic discussions about gender. The significant impact of Barry’s gender and life story on societal views of gender roles and identity has been more comprehensively explored in modern times, as societal views have evolved to more openly consider and respect gender diversity.

Dr. James Barry’s legacy is a testament to the profound influence that professionals can wield in shaping societal perceptions and norms. His ability to maintain a highly respected professional status and effect substantial medical and social changes, all while concealing his gender identity, underscores the unique power that professionals have in navigating and challenging societal structures. Barry’s story serves as a poignant reminder of the potential for professionals to both reinforce and challenge societal norms, significantly influencing how gender roles are perceived and constructed in professional and broader societal contexts. Read more about Dr. James Barry

Edward Carpenter (1844-1929)

Edward Carpenter was a prominent advocate for homosexual rights and gender non-conforming individuals, conducting much of his work in England. His writings on gender variance and the social construction of gender influenced broader perceptions of gender diversity, contributing to early discussions of transgender identity and expression. Carpenter’s book “The Intermediate Sex” was groundbreaking, offering one of the first positive representations of homosexuality and advocating for the acceptance of diverse gender identities. More about Edward Carpenter

Havelock Ellis (1859-1939)

Havelock Ellis’s work, particularly in “Studies in the Psychology of Sex,” was foundational in exploring a wide range of sexual behaviors and identities. Based in Britain, his recognition of diverse sexual orientations and gender identities challenged societal norms and laid the groundwork for understanding transgender experiences within a scientific framework. Ellis’s contributions extended beyond academia; his advocacy for sexual education and open discussions about sexuality helped reduce stigma and promote acceptance of gender diversity. More about Havelock Ellis

Magnus Hirschfeld (1868-1935)

Magnus Hirschfeld, a pioneering German physician and sexologist, founded the Scientific-Humanitarian Committee in 1897, the first gay rights organization globally. His Institute for Sexual Science, established in 1919 in Berlin, provided comprehensive services for transgender individuals until it was tragically destroyed by the Nazis in 1933, marking a significant setback for gender studies. Hirschfeld’s advocacy for legal and social recognition of transgender people was revolutionary, and his extensive research continues to influence contemporary gender studies. More about Magnus Hirschfeld

Dr. J. Allen Gilbert (1867–1948)

Dr. J. Allen Gilbert was a significant figure in the early 20th century for transgender healthcare in Oregon. As a psychiatrist at the University of Oregon Medical School, Gilbert played a pivotal role in the transition of Alan Hart, a transgender man and physician. In 1917, Hart underwent one of the earliest known gender-affirming surgeries in the U.S., a hysterectomy performed by Dr. Gilbert. Despite the prevailing conservative views on gender and sexuality, Gilbert supported Hart’s decision to live as a man, marking a groundbreaking step in transgender healthcare.

Hart’s transition and subsequent career highlighted the importance of autonomy and the need for compassionate medical care that respects individual identity. This work contrasted sharply with the more conservative and religiously influenced views prevalent in Vienna, where similar research was conducted but often faced greater social and institutional resistance.

Gilbert’s approach was influenced by the liberal attitudes of the time, which clashed with the conservative, religiously motivated views that dominated society. This polarization created a social environment that allowed extremist ideologies, including fascism, to gain traction by promising to restore traditional values and order. The rise of Nazi rule exploited these tensions, leading to the suppression of progressive sexual science and persecution of marginalized groups.

Gilbert’s work, along with the collaborative efforts of scientists like Dr. Eugen Steinach, Ludwig Haberlandt, and Paul Kammerer in Vienna, laid the groundwork for future advancements in endocrinology and transgender healthcare. These early efforts demonstrated the critical need for medical practices that prioritize patient autonomy and informed consent, pushing against the restrictive societal norms of their time.

For more information, you can explore sources like, Scientific American, GLAPN, National Park Service, and the OHSU history.

Dr. Harold Gillies (1882-1960)

Dr. Harold Gillies, a British plastic surgeon, began performing gender confirmation surgeries in the late 1940s. His pioneering work primarily focused on individuals with genital injuries sustained during World War I and World War II, laying the foundation for modern gender confirmation surgeries. Gillies’s innovative techniques in reconstructive surgery not only advanced the field of plastic surgery but also provided transgender individuals with the possibility of aligning their physical appearance with their gender identity. Dr Gillies performed the first known phalloplasty on Dr. Michael Dillon in the 1940’s. More about Dr. Gillies

Harry Benjamin (1885-1986)

Harry Benjamin, a pioneering endocrinologist, profoundly shaped transgender healthcare. He founded what is now known as WPATH, originally the Harry Benjamin International Gender Dysphoria Association. While his approach initially included gatekeeping, Benjamin’s work was instrumental in legitimizing transgender medical care. His book “The Transsexual Phenomenon” was one of the first comprehensive texts on transgender issues, providing both medical professionals and the public with crucial insights into transgender health and identity. More about Harry Benjamin

Norman Haire (1892-1952)

Based in Australia, Norman Haire was a leading advocate for birth control and sexual health. His involvement in the British Society for the Study of Sex Psychology (BSSSP) and broader medical discussions helped legitimize early medical approaches to transgender issues, advocating for gender affirmation within the limited understanding of the time. Haire’s progressive views and his work in reproductive health also opened up conversations about bodily autonomy and the right to self-identify. More about Norman Haire

Dr. Elmer Belt (1893-1980)

Dr. Elmer Belt, a urologist based in the United States, provided empathetic and progressive treatments to transgender individuals during an era marked by social and medical conservatism. His pioneering work in gender-affirming care contributed to advancements in understanding and treating transgender patients with dignity and respect. Belt’s advocacy for patient-centered care and his willingness to challenge prevailing medical opinions helped to create more compassionate healthcare environments for transgender individuals. More about Dr. Elmer Belt

Dr. David Oliver Cauldwell (1897–1959)

David Oliver Cauldwell was a prolific and pioneering sexologist who coined the term “transsexual” as used in its current definition. Born in Cleveland, Ohio, Cauldwell studied medicine at the Chester College of Medicine and Surgery and at Universidad Nacional Autónoma de México. His career included roles as a general practitioner, Associate Medical Officer of the Department of War, and neuro-psychiatrist. Cauldwell’s work in sexology began in the 1940s, and in 1949, he introduced the term “transsexual” in his essay “Psychopathia Transexualis” to describe individuals whose sex assigned at birth was different from their gender identity. He distinguished between “biological sex” and “psychological sex,” seeing the latter as determined by social conditioning. Despite his controversial views on “sex reassignment surgery,” which he opposed, Cauldwell was an early advocate for the acceptance of homosexuality and “transvestism.” His contributions significantly influenced the understanding of gender identity and transgender issues during his time. More about Dr David Oliver Cauldwell.

Dr. Christian Hamburger (1904-1992)

Dr. Christian Hamburger was a renowned Danish endocrinologist who played a crucial role in the development of transgender medical care. Born in Copenhagen, Denmark, Hamburger specialized in hormone therapy and endocrinology. He gained international recognition in the early 1950s when he performed the gender confirmation procedures for Christine Jorgensen, one of the first individuals to undergo such surgery. Jorgensen chose her new name in honor of Dr. Hamburger, highlighting the significant impact he had on her life and the broader field of transgender healthcare. His work not only provided medical support but also helped to destigmatize transgender identities during a time of widespread misunderstanding and prejudice. More about Dr. Christian Hamburger.

Dr. Michael Dillon (1915-1962)

Michael Dillon was a pioneering British physician and the first trans man to undergo phalloplasty, significantly advancing medical treatment for transgender individuals. Born in 1915, Dillon’s transition began in the 1940s, culminating in a series of groundbreaking surgeries performed by Sir Harold Gillies. Dillon’s self-advocacy and determination to undergo phalloplasty not only advanced surgical techniques but also brought greater visibility and legitimacy to transgender medical care. He also authored “Self: A Study in Endocrinology and Ethics,” one of the earliest books exploring transgender identity from a personal and scientific perspective, which has had a lasting impact on both the medical community and the broader understanding of transgender experiences. More about Michael Dillon

Dr. Lawson Wilkins (1894–1963)

Dr. Lawson Wilkins was a pioneering pediatric endocrinologist who significantly influenced the field of endocrinology and the understanding of gender. He founded the first pediatric endocrinology clinic at Johns Hopkins Hospital, where he made groundbreaking advancements in treating children with endocrine disorders. Wilkins’s work was crucial in managing conditions like congenital adrenal hyperplasia (CAH).

Wilkins recommended that children with CAH be raised as male if it seemed more beneficial, based on the idea that the “better” sex assignment depended on the child’s overall well-being, social expectations, and available medical interventions. This approach often led to gender assignment and surgical interventions before the child could consent, which we now consider genital mutilation. These surgeries aimed to “normalize” the child’s appearance according to societal standards, without considering the child’s future identity and autonomy.

The practice of early gender assignment and genital surgery without consent has had lasting implications for intersex individuals. Many who underwent such procedures experienced physical and psychological harm. This challenged the notion that these interventions were in the child’s best interest and the imposition of gender identity through surgical means has been widely criticized for disregarding the principles of informed consent and bodily autonomy.

Wilkins’s methods predated and influenced the work of Dr. John Money. Despite the intentions behind Wilkins’s work, the practice of imposing a gender identity through surgical intervention raised significant ethical concerns. These procedures were conducted at a time when societal views on gender and sexuality were rigid and conservative, often prioritizing societal comfort over individual health, and autonomy. Read More Here

Despite the historical context and the ethical issues raised by early practices, Wilkins’s advances and mistakes helped inform understandings of gender and contributed to developing more inclusive and affirming medical practices for intersex and transgender individuals.

For more detailed information about Lawson Wilkins and his contributions, you can refer to the Johns Hopkins Medical Archives and a research article from the University of Zurich.

Dr. John Money ( 1921–2006)

Dr. John Money was a pioneering sexologist and psychologist known for his significant contributions to the study of gender identity and the treatment of transgender individuals. Born in New Zealand, Money’s work at Johns Hopkins University from the 1950s onwards was instrumental in developing modern concepts of gender identity. He introduced and popularized the terms “gender identity” and “gender role” and was a key figure in establishing protocols for gender-affirming treatments, including hormone therapy and surgery. Money’s research and clinical practices laid the groundwork for the field of gender identity studies, though some aspects of his work, particularly his handling of the controversial John/Joan case, have been subject to criticism and ethical scrutiny. His contributions have had a lasting impact on how gender identity and health are understood and treated in medical and psychological contexts, leading to more consensual and informed practices. More about John Money.

Shaping Transgender Healthcare

World Professional Association for Transgender Health

Originally founded in 1979 as the Harry Benjamin International Gender Dysphoria Association, WPATH has played a crucial role in establishing standards of care and advocating for transgender health. The organization’s recent evolution signifies a shift towards more affirming and inclusive healthcare models, moving away from the earlier gatekeeping attitudes that once dominated trans healthcare.

Notable Presidents of WPATH:

Dr. Richard Green: Founding president and psychiatrist.
Dr. Peggy T. Cohen-Kettenis: Contributed significantly to understanding transgender youth.
Dr. Walter Bockting: Advocated for depathologizing transgender identities.
Dr. Jamison Green: A transgender activist who focused on social justice and inclusivity.
Dr. Vin Tangpricha: Promoted transgender healthcare access and education.
Marci Bowers: A transgender surgeon and advocate, Dr. Marci Bowers has significantly advanced the field of gender-affirming surgery, transforming the landscape of transgender healthcare.”
More about Marci Bowers

From Early Sexology to Modern Standards: How Evidence Built Gender-Affirming Care

In research, the p-value is often treated as a gatekeeper for whether a finding is “real” (statistically significant) and therefore “worthy” of publication, coverage, or clinical availability—but it answers only a narrow question: if there were truly no effect, how unlikely is the result we observed? (Taylor & Francis Online) Whether a study reaches “significance” depends not only on the size of benefit or harm, but also on sample size and how common the outcome is in the sample—so rare outcomes can look “non-significant” even when clinically important, while very large samples can make trivial differences look “significant.” (Taylor & Francis Online) This matters for gender-affirming care because insurance coverage and policy are routinely built on evidence review and medical-necessity frameworks (e.g., Medicare’s “reasonable and necessary” coverage analysis and insurer medical policies), which means the statistical evidence base directly shapes access. (CMS BlueShieldCA) At the same time, the field of psychology, psychiatry and medicine has moved away from trying to force transgender people to “align” with sex assigned at birth because those practices function as sexual orientation and gender identity change efforts—i.e., conversion therapy—which major professional bodies describe as biased/coercive and associated with harm. (American Psychological Association) These approaches often begin from a predetermined endpoint (discouraging transition regardless of the client’s needs) rather than supporting self-determination—raising clear ethical concerns about undue influence in a population already exposed to stigma and structural pressure. (American Psychological Association) Finally, because regret after gender-affirming surgery is typically rare (e.g., 2.8% in a postoperative cohort using a validated measure), studies may have too few regret cases to detect predictors reliably—another reason p-values must be interpreted alongside effect sizes, confidence intervals, and the proportion of the sample affected, rather than used as a single “yes/no” switch for access. (PubMed)

References
Centers for Medicare & Medicaid Services. (2016). Decision memo for gender dysphoria and gender reassignment surgery (CAG-00446N).CMS

Wasserstein, R. L., & Lazar, N. A. (2016). The ASA statement on p-values: Context, process, and purpose. The American Statistician, 70(2), 129–133. Taylor & Francis Online

American Psychological Association. (2021). Resolution on gender identity change efforts.American Psychological Association

American Academy of Child & Adolescent Psychiatry. (2018). Conversion therapy (policy statement).

AACAP American Medical Association. (2025). Issue brief: Sexual orientation and gender identity change efforts (so-called “conversion therapy”).

American Medical Association American Medical Association. (2025). Issue brief: Health insurance coverage for gender-affirming care.

American Medical Association Blue Shield of California. (2025). Gender affirmation surgery (medical policy).

BlueShieldCA Hung, Y.-C., et al. (2023). Multidimensional assessment of patient-reported outcomes after gender-affirming surgeries using a validated instrument. (Reports 2.8% regret.)PubMed

Bruce, L., et al. (2023). Long-term regret and satisfaction with decision following gender-affirming mastectomy. JAMA Surgery.JAMA Network

The Politics of Fitting In; Decision Making

In medicine and ethics, informed consent and assent are distinct concepts with major implications for children, for people whose capacity is temporarily impaired, and for groups whose bodily autonomy has historically been overridden. Informed consent requires decision-making capacity, adequate and accurate information about risks, benefits, and alternatives, comprehension of that information, and a voluntary decision free from coercion. Assent, by contrast, applies when a person cannot legally provide informed consent but can still express understanding, preferences, or objections; it is an ethical safeguard that recognizes agency without pretending a child has full legal authority. This distinction matters because some interventions are irreversible, deferrable, and identity-affecting—and the ethical threshold for proceeding should rise as stakes and irreversibility increase. This is precisely where intersex history is instructive: intersex infants and children were routinely subjected to “normalizing” genital surgeries through proxy decision-making, often without meaningful attention to the child’s future autonomy or to assent (which is developmentally impossible in infancy), and intersex advocates and human-rights organizations have documented lasting physical and psychological harms from medically unnecessary procedures performed before the person could participate in the decision. KFF

Today, a parallel ethical failure is unfolding through efforts to criminalize or heavily penalize medically indicated care for transgender minors, replacing individualized clinical assessment and youth assent with categorical bans and punitive interference aimed at enforcing rigid sex/gender norms. Policy analyses and legal trackers document that many state-level restrictions have targeted clinicians and families with professional sanctions and, in some cases, criminal penalties—shifting decisions away from the patient-family-clinician relationship and into the realm of ideological enforcement. Williams Institute+2KFF+2 In both contexts—intersex “normalization” surgeries and political bans on transgender youth care—the shared pattern is coercive conformity: people are pressured to fit society’s expectations without regard for how they feel in their bodies, what they express, or what individualized care would support their long-term wellbeing and autonomy. The contrast becomes even clearer when you look at how the medical system handles comparable distress in a politically uncontroversial group: cisgender adolescent boys with gynecomastia are routinely evaluated for treatment, and when indicated, can receive male breast reduction surgery as a quality-of-life intervention—often discussed in clinical and professional contexts without massive political campaigns, criminalization efforts, or broad accusations of social contagion. (American Society of Plastic Surgeons) The ethical point is not that every intervention is identical, but that society’s “protection” narratives are applied selectively: when the patient’s needs align with gender norms, care is treated as ordinary; when care challenges gender norms, the state moves to control bodies and silence assent and informed consent.

References
Human Rights Watch. (2017). “I want to be like nature made me”: Medically unnecessary surgeries on intersex children in the U.S. KFF
American Society of Plastic Surgeons. (n.d.). Briefing paper: Plastic surgery for teenagers (includes gynecomastia surgery data and description). American Society of Plastic Surgeons
American Society of Plastic Surgeons. (2022, May 25). Male breast reduction surgery improves quality of life for teens… American Society of Plastic Surgeons
Lemaine, V., et al. (2013). Gynecomastia in adolescent males. Plastic and Reconstructive Surgery. PMC
Williams Institute. (n.d.). Prohibiting gender-affirming medical care for youth (notes criminal penalties in some bans). Williams Institute
KFF. (n.d.). Policy tracker: Youth access to gender-affirming care and state policy restrictions (tracks penalties, litigation, and status by state). KFF
Movement Advancement Project. (n.d.). Bans on best-practice medical care for transgender youth (map and policy summary, including felony provisions in some states). LGBT Map

Current Challenges

Naming the Harm

We are currently witnessing a resurgence of hate and propaganda against transgender people and gender-affirming healthcare, particularly with the rise of extremist movements globally. Websites such as Trans Data Library and Health Liberation Now document the individuals and groups spreading this harmful rhetoric, which often originates from fascist ideals, misogyny, and fear-mongering.

Misogyny and toxic masculinity drive a pervasive form of gender-based discrimination and hatred that’s deeply embedded in social structures and ideology. At its core is gender essentialism—the belief that gender is fixed, binary, and determined solely by physical traits—often advanced by people preoccupied with defining others’ identities while denying their sense of self. Some proponents even label themselves “radical feminists,” despite reinforcing the very systems of control they claim to oppose. A particularly insidious tactic is their appropriation of that term to obscure their real agenda: by co-opting feminist language, they mask efforts to exclude and vilify transgender women under the guise of “protecting women and children,” using inflammatory rhetoric like “mutilation.” They selectively invoke feminist principles to frame women as weak, fragile, and in need of protection, using that claim to justify excluding people from “single-sex spaces” like bathrooms and locker rooms, while aligning with broader systemic discrimination—including reliance on the gay and trans panic defense—that ultimately reflects deeply misogynistic motives. This pattern echoes what happened in 1955, when Carolyn Bryant claimed victimhood and her accusation against Emmett Till was used to legitimize an act of racial terror that ended in his murder; she later recanted key aspects of her account. (https://www.pbs.org/wgbh/americanexperience/features/emmett-biography-roy-carolyn-bryant-and-jw-milam/). Today trans people are avoiding bathrooms nationwide out of fear of harassment and assault (https://www.reuters.com/article/world/us-transgender-people-harassed-in-public-restrooms-landmark-survey-idUSKBN13X0BJ/). The oppression described here extends beyond individual acts of sexism into systemic patterns, including the infantilization of women and the dehumanization of gender-nonconforming and transgender people; it shows up through violence, exclusion, and institutionalized inequality that reinforces the subordination of women and transgender people across social, political, and economic spheres, and it endangers both transgender and gender-diverse people and the professionals who care for them.

References:

Trotta, D. (2016, December 8). U.S. transgender people harassed in public restrooms: Landmark survey. Reuters. https://www.reuters.com/article/world/us-transgender-people-harassed-in-public-restrooms-landmark-survey-idUSKBN13X0BJ/ (Reuters)

PBS. (n.d.). Getting away with murder. American Experience (PBS). https://www.pbs.org/wgbh/americanexperience/features/emmett-biography-roy-carolyn-bryant-and-jw-milam/ (pbs.org)

Recognizing and calling out The spread of propaganda

Propaganda is often used by extremists to confuse the public about transgender rights and gender-affirming care through several key tactics. One form is grey propaganda, which blends elements of both black and white propaganda, making it more difficult to discern the truth. Grey propaganda can include information that is not entirely false but is presented in a misleading way, often omitting crucial context or exaggerating certain aspects to serve a specific agenda. This agenda, driven by sexism and misogyny, involves a power grab by regressive individuals who aim to impose gender on transgender people and erase transgender people’s autonomy, self determination and access to gendered spaces. These individuals use propaganda to assert their dominance and influence over societal norms, often at the expense of transgender rights and well-being (Information Disorder, 2017).

Misinformation and Disinformation: Propaganda campaigns spread false or misleading information about transgender people and gender-affirming care. This includes exaggerating risks, misrepresenting medical procedures, and using unverified statistics to paint a negative picture of transgender health care.
Fear-Mongering: By emphasizing extreme and rare cases, propagandists create a climate of fear and uncertainty. They may highlight instances of regret or negative outcomes while ignoring the overwhelming majority of positive and affirming experiences reported by transgender individuals.
Emotional Appeals: Emotional manipulation is a common strategy. Propaganda often appeals to parental fears, suggesting that gender-affirming care will harm children or disrupt family dynamics, despite evidence showing the benefits of supportive environments for transgender youth.
Misrepresentation of Science: Propaganda often involves cherry-picking or distorting scientific studies to support anti-transgender narratives. Legitimate research supporting gender-affirming care is downplayed or ignored, while flawed or biased studies are amplified.
Language Manipulation: Using loaded and stigmatizing language, such as “mutilation” instead of “surgery” or “confused” instead of “transgender,” propagandists seek to de-legitimize transgender identities and medical care.
Political and Ideological Framing: Propaganda frames transgender rights and gender-affirming care as ideological issues rather than human rights or medical concerns. This can polarize public opinion and turn medical care into a battleground for cultural or political wars.
False Equivalency: Presenting both sides of the issue as equally valid, even when one side is based on misinformation or biased beliefs, creates a false sense of debate. This tactic can confuse the public and give undue weight to anti-transgender perspectives.
Erasure of Transgender Voices: Propaganda often sidelines or silences the voices of transgender individuals and supportive professionals. This marginalization prevents authentic representation and understanding of transgender experiences and needs.

These tactics collectively contribute to a misinformed public, which can lead to harmful policies and social attitudes that undermine transgender rights, target gender affirming healthcare providers, and restrict access to gender-affirming care. The power grab by extremists relies heavily on manipulating public perception to sustain their control, framing their opposition to transgender rights as a moral or cultural imperative, rather than a baseless and harmful stance.

References:

Jowett, G. S., & O’Donnell, V. (2015). Propaganda & persuasion (6th ed.). SAGE Publications. https://csmeyns.github.io/propaganda-everyday/pdf/odonnell-jowett-2018-what-is-propaganda.pdf

Wardle, C., & Derakhshan, H. (2017). Information disorder: Toward an interdisciplinary framework for research and policy making. Council of Europe. https://edoc.coe.int/en/media/7495-information-disorder-toward-an-interdisciplinary-framework-for-research-and-policy-making.html

McLamore, Q., & Fuller, K. (2025). Dynamics of transphobic content and disinformation: Introduction to the special issue. Bulletin of Applied Transgender Studies, 4(1–3), 1–14. https://doi.org/10.57814/ktm8-sh84

Channon, L., & Mathieson, N. (2025). Automated detection of mainstreamed transphobic content on YouTube. Bulletin of Applied Transgender Studies, 4(1–3), 41–75. https://doi.org/10.57814/49jz-0663

The Anti-Trans “Medical–Legal” Ecosystem: A Structural Description

A small cluster of tax-exempt 501(c)(3) “advocacy” organizations repeatedly appear in U.S. and international debates over transgender healthcare. The organizations are not identical in mission, branding, or constituency. However, when examined as a system, they function as a repeatable pipeline for moving a set of policy claims from organizational messaging into legislation, litigation, and media.

This is not an allegation of a unified conspiracy or shared intent. It is a description of observable division of labor: different organizations specialize in different tasks (medical-sounding branding, narrative framing, litigation support, or policy messaging), and their outputs are frequently reused across venues (e.g., testimony, briefs, op-eds, and public “guidance”).

1) Observed Communication Pathways

Across multiple campaigns, the system often resembles a relay:

Medical branding / “evidence” nodes: publish critiques, “guidance,” or risk narratives framed as clinical analysis.
Legal / policy nodes: translate those narratives into proposed statutes, legislative testimony, and court-facing “advocacy” (including amicus participation).
Media nodes: convert these claims into simplified story formats that circulate broadly.
Infrastructure: staffing, communications, and fundraising capacity sustain repeated campaigns over time.

The cumulative effect is that “advocacy” outputs can enter policymaking and judicial records as if they were independent clinical consensus, especially when briefs and hearings emphasize credentials, acronyms, or medical-sounding institutional names.

2) Authority Signaling Mechanisms

Certain organizations explicitly position themselves as medical-professional authorities or “evidence-based” evaluators. They commonly publish leadership rosters (e.g., “fellows,” “advisors,” “advisory boards”) and highlight professional credentials as credibility anchors. Those rosters and titles are then carried into policy contexts where decision-makers reasonably rely on credential cues.

This page documents these titles and structures as the organizations publicly represent them (see Part I). The analytical concern is structural: authority signaling can substitute for transparent guideline methodology or broad professional consensus, particularly when “advocacy” products are framed as medical evidence rather than policy argument.

3) Litigation and Case-Support Functions

Some organizations operate primarily as policy and litigation actors, including public-facing discussion of lawsuits, case support, and donor-backed filing activity. Sponsorship and case support can function as case-shaping infrastructure — funding filing costs, sustaining publicity, and pursuing precedent — regardless of the ultimate merits outcome or disposition.

4) Cross-Venue Reuse of Claims

Across the network, several repeatable moves are commonly observed:

Frame claims as “medical concern” (ethics, safeguarding, “evidence-based,” “protect kids”).
Move claims into legal and policy venues (testimony, model policies, briefs, amicus filings).
Amplify claims through repetition across outlets and cross-referencing between “advocacy” sources.
Apply institutional pressure through “concern” submissions, complaints, or targeted campaigns (methods vary by organization and are sometimes explicitly invited on organizational websites).

This structure does not require majority professional support to be influential. It requires:
(1) credible-sounding branding,
(2) repeatable claims,
(3) distribution capacity, and
(4) legal and policy throughput.

5) Contested “Evidence-Based” Nodes and Citation Loops

Some organizations position themselves explicitly as “evidence-based” authorities. Independent reporting shows that these nodes can become influential while also being strongly contested — praised by some actors and criticized by others. Regardless of one’s view of any individual organization, the structural issue remains: cross-citation loops can cause a small set of sources to appear like broad, independent medical consensus when cited repeatedly across filings, hearings, and media.

References

Organization pages (self-description, leadership rosters, public activity)

Do No Harm. (n.d.). Do No Harm (official website).
https://donoharmmedicine.org/

Do No Harm. (n.d.). Team / Fellows.
https://donoharmmedicine.org/team/

American College of Pediatricians. (n.d.). American College of Pediatricians.
https://acpeds.org/

American College of Pediatricians. (n.d.). Meet Our Board.
https://acpeds.org/meet-our-board/

Society for Evidence-Based Gender Medicine. (n.d.). SEGM.
https://segm.org/

Society for Evidence-Based Gender Medicine. (n.d.). About / Leadership.
https://segm.org/about_us

Genspect. (n.d.). Genspect.
https://genspect.org/

Genspect. (n.d.). Meet the Team.
https://genspect.org/meet-the-team/

Genspect. (n.d.). Advisory Board.
https://genspect.org/meet-the-team/advisory-board/

Genspect. (n.d.). Genspect USA.
https://genspect.org/international/usa/

Therapy First. (n.d.). Therapy First.
https://www.therapyfirst.org/

Therapy First. (n.d.). About.
https://www.therapyfirst.org/about/

Therapy First. (n.d.). Team.
https://www.therapyfirst.org/team/

Therapy First. (n.d.). Statement.
https://www.therapyfirst.org/statement/

Gender Dysphoria Institute. (n.d.). Leadership.
https://www.gdinstitute.org/leadership

Gender Dysphoria Institute. (n.d.). Partners.
https://www.gdinstitute.org/partners

Women’s Liberation Front. (n.d.). Women’s Liberation Front.
https://womensliberationfront.org/

Monitoring / contextual sources

Southern Poverty Law Center. (n.d.). Southern Poverty Law Center.
https://www.splcenter.org/

Southern Poverty Law Center. (n.d.). American College of Pediatricians (Extremist Files profile).
https://www.splcenter.org/fighting-hate/extremist-files/group/american-college-pediatricians

Reporting sources (ecosystem / contested-node coverage)

Undark Magazine. (n.d.). Undark.
https://undark.org/

WIRED. (n.d.). WIRED.
https://www.wired.com/

Mainstream clinical and ethics standards

WPATH. (2022). Standards of Care v8 (SOC-8) + FAQs/chapters. WPATH

Endocrine Society. (2017; guideline page updated). Endocrine treatment guideline + guideline page. UW Departments

ACOG. (2021). Committee Opinion: Health Care for Transgender and Gender Diverse Individuals. ACOG

AMA. (2021). AMA reinforces opposition to restrictions on transgender medical care. American Medical Association

American Psychological Association. (2024). Policy statement on affirming evidence-based inclusive care (PDF). American Psychological Association

AAP. (2018; reaffirmed 2023). Policy statement + reaffirmation news item. AAP Publications

AACAP. (2024). Policy statement on access to gender-affirming healthcare. AACAP

American Psychiatric Association. (2025). Position statement on gender-affirming care for transgender and gender diverse youth (PDF). American Psychiatric Association

ACA / ALGBTIC. (2009/2010). Competencies for counseling with transgender clients (PDF) + ACA nondiscrimination statement. www.counseling.org

AMA Code of Medical Ethics / AMA Journal of Ethics. (2016–). Nondiscrimination and obligations regarding disparities, including gender identity. Policy Finder

Religious fragility is the defensive posture people take when their belief systems are questioned—especially when those beliefs are tied to power, privilege, or control. It mirrors white fragility and male fragility: a reactive discomfort that arises when a dominant worldview—often treated as “normal,” “moral,” or “untouchable”—is challenged. This fragility shows up when disagreement is mistaken for persecution, or when people claim they are being discriminated against simply because the harm caused by their beliefs is being named. While many individuals within religious communities genuinely seek to do good, those in power have long used religion as a tool to justify subjugation—reinforcing hierarchies, restricting autonomy, and resisting social progress under the guise of moral authority. This is especially evident in the treatment of queer and trans people, as well as others who live outside rigid norms of gender, sexuality, belief, or behavior. Their existence is often framed as a threat to religious values, leading to exclusion, discrimination, and systemic violence—all defended as acts of faith, while the real harm to human dignity, safety, and self-determination is ignored or denied. https://canopyforum.org/2021/05/13/christian-nationalism-and-recent-anti-trans-state-laws/

Over-protection and Infantilization of Transgender People:

Ableism and discrimination often manifest in the over-protection and infantilization of transgender individuals, particularly in medical, social, and educational settings. This approach can be seen in several ways:

Medical gatekeeping: Transgender and gender-diverse people seeking gender-affirming care are often subjected to heightened scrutiny—such as mandatory psychological “readiness” assessments, repeated evaluations, or requirements that exceed what comparable medical decisions typically demand. In practice, this can function as a paternalistic test of “fitness” rather than a support for informed consent, implicitly treating trans people as less capable of making autonomous decisions about their own bodies. Gatekeeping is also reinforced by pathologizing narratives—e.g., framing trans identity as a symptom of mental illness or as caused by sexual trauma—despite the fact that higher rates of sexual violence among trans people are well documented and are plausibly explained by disproportionate victimization tied to stigma, discrimination, and exposure to violence (https://pmc.ncbi.nlm.nih.gov/articles/PMC4689648/). Ultimately, these practices infantilize trans people and delay or deny medically necessary care.
Limiting Autonomy: In educational settings, and now in certain states, transgender people might be overly monitored or restricted in their choices, such as bathroom access or participation in sports. This over-protection stems from an ableist view that trans individuals are inherently vulnerable and need special care, undermining their autonomy and agency. (Sports Ban, School Policy, Bathroom Ban, APA Policy)
Social Paternalism: In social contexts, well-meaning allies may impose their own views on what is “best” for trans individuals, often disregarding their wishes and perspectives. This can manifest as advice or actions that limit the freedom and self-determination of trans people, treating them as if they cannot navigate their own lives without constant support. (https://www.tandfonline.com/doi/full/10.1080/15538605.2012.648583)

Vilification of Transgender People: (Content Warning)

Conversely, ableism and discrimination can also vilify transgender individuals, portraying them as threats or burdens to society. This vilification takes several forms:

Pathologizing Trans Identities:
Trans individuals are often framed as mentally ill or unstable, an ableist perspective that undermines their identities and justifies exclusionary practices. This pathologization suggests that being transgender is a disorder, leading to societal and institutional rejection.
Stereotyping as Deceitful:
Trans individuals, particularly transgender women, are frequently vilified through stereotypes that depict them as deceitful or dangerous. This narrative is used to justify exclusion from gender-segregated spaces and can incite fear and hostility toward trans people. (https://www.texastribune.org/2025/12/12/texas-bathroom-bill-implementation-policy-capitol/)
Framing as a social threat (moral panic):
Trans people—especially trans women and trans girls—are often cast as a danger to “public safety,” “privacy,” or “fairness,” even when the claim is unsupported by evidence . This shows up in efforts to bar trans participation in public life (e.g., bathrooms and locker rooms, sports, or the military) by implying that inclusion creates risk for others (https://abcnews.go.com/Politics/mace-effort-ban-transgender-women-capitols-womens-restrooms/story?id=116009034). Functionally, this rhetoric manufactures a threat narrative to activate fear and justify exclusionary policy—an approach widely analyzed as a form of moral panic, where a minoritized group is positioned as a symbolic menace to social order. Empirical research on restroom policies, for example, finds no evidence that trans-inclusive nondiscrimination protections increase safety or privacy violations; instead, trans people report higher rates of harassment and violence when accessing these spaces (https://williamsinstitute.law.ucla.edu/publications/safety-in-restrooms-and-facilites/).
Manufactured “extremism” trope vs. evidence-based public safety
The claim that “trans activists” should be treated as violent extremists is a manufactured moral-panic narrative, not an evidence-based conclusion of law enforcement. The Heritage Foundation’s Oversight Project has promoted the trope it calls “Transgender Ideology–Inspired Violence and Extremism” (TIVE) and has urged the FBI to create a new domestic terrorism frame—casting transgender people or their allies as “domestic terrorists” or “nihilistic violent extremists.” GLAAD This propaganda strategy relies on familiar authoritarian dynamics: invent a threat (“gender ideology”), circulate emotionally loaded allegations (“extremism,” “terrorism”), and then use the resulting moral panic as pretext for crackdowns, rights retraction, and institutional exclusion. Outright International
That storyline directly conflicts with what the strongest available data show about violence and trans communities. Federal hate-crime reporting tracks bias incidents motivated by gender identity, reflecting that trans and gender-diverse people are commonly targets of bias-motivated crime rather than drivers of organized violence. Federal Bureau of Investigation National victimization estimates also indicate transgender people experience substantially higher rates of violent victimization than cisgender people, underscoring that the public-safety reality is one of vulnerability, not extremist threat. Williams Institute In other words: branding trans people as “violent extremists” reverses the victim/perpetrator reality and functions as a political weapon—an authoritarian playbook move designed to justify repression under the language of “security.” GLAAD

The “Gay Panic” / “Trans Panic” Defense (includes trans people):
The so-called gay/trans “panic” defense is a trial strategy that asks jurors to blame a victim’s actual or perceived sexual orientation or gender identity for the defendant’s violent reaction, often to reduce culpability. It pathologizes LGBTQ+ identity as inherently provocative or threatening, converts prejudice into mitigation, and reinforces victim-blaming by implying LGBTQ+ people “caused” the violence against them. americanbar.org

Discrimination fuels two complementary dynamics toward trans people: paternalistic gatekeeping that treats them as incapable of self-determination, and vilification that frames them as a social threat. These narratives connect to earlier legal and cultural patterns—such as the gay/trans “panic” strategy—that have excused harm by casting LGBTQ+ identity as provocative or dangerous. Together, they reinforce a layered system of marginalization against people who fall outside rigid gender norms.

References:

Brake, D. L. (2022). Title IX’s Trans Panic. William & Mary Journal of Race, Gender, and Social Justice, 29(1), Article 1590. William & Mary Law School Scholarship Repository. https://scholarship.law.wm.edu/cgi/viewcontent.cgi?article=1590&context=wmjowl&
GLAAD. (2025, September 25). Understanding anti-trans tropes: “Transgender Ideology-Inspired Violence and Extremism” (TIVE). https://glaad.org/understanding-anti-trans-tropes-transgender-ideology-inspired-violence-and-extremism/ GLAADHolden, A. (2020, March 31). The gay/trans panic defense: What it is, and how to end it. American Bar Association. https://www.americanbar.org/groups/crsj/resources/newsletter/archive/gay-trans-panic-defense-what-it-how-end-it/American Bar Association
Outright International. (2025, October 6). Equating respect for trans people with terrorism is as dangerous as it is absurd. https://outrightinternational.org/insights/equating-respect-trans-people-terrorism-dangerous-it-absurd Outright International
Wired. (2025, September 26). Heritage Foundation uses bogus stat to push a trans terrorism classification. https://www.wired.com/story/heritage-foundation-uses-bogus-stat-to-push-a-trans-terrorism-classification/ WIRED
Federal Bureau of Investigation. (n.d.). Hate crime statistics: Definition of a hate crime (includes gender identity bias). https://www.fbi.gov/how-we-can-help-you/more-fbi-services-and-information/ucr/hate-crime Federal Bureau of Investigation
U.S. Department of Justice, Civil Rights Division. (2025, January 29). 2023 hate crime statistics. https://www.justice.gov/crs/news/2023-hate-crime-statistics Department of Justice
Williams Institute. (n.d.). Transgender people over four times more likely than cisgender people to be victims of violent crime. https://williamsinstitute.law.ucla.edu/press/ncvs-trans-press-release/ Williams Institute

Paid influence ecosystem

A key feature of today’s anti-trans backlash is a paid influence ecosystem that elevates a small number of “personal story” messengers into policy weapons. Despite evidence that regret after gender-affirming surgery is low—for example, a 2023 Vanderbilt cohort using the validated VMP-G measure reported 2.8% regret among postoperative respondents—this ecosystem continues to drive outsized public narratives against care (PubMed). One plausible explanation is that systemic discrimination and denial of support (including barriers to competent care, social stigma, and socioeconomic instability) can leave people with fewer safe options and therefore more vulnerable to paid and amplified roles in anti-trans healthcare campaigns—illustrated in public reporting on paid speaking and sponsorship structures around prominent messengers (https://pmc.ncbi.nlm.nih.gov/articles/PMC4802845/ )(USC Global Health Inequalities). In a context where discrimination drives economic and social vulnerability, paid speaking opportunities and organizational sponsorship can raise ethical questions about payment functioning as undue influence—not necessarily through overt threats, but through incentives and support that can shape whose stories are amplified and how they are used in policy campaigns (Belmont Report HHS).

Elisa Rae Shupe (Oregon-linked example of “story” cultivation and later repudiation): Elisa Rae Shupe (formerly known as Jamie Shupe) illustrates how detransition narratives can be cultivated and deployed—and how that can later be repudiated. In Oregon, Shupe became nationally known after a Multnomah County judge granted legal recognition of a “non-binary” sex designation. (KLCC) Shupe later detransitioned and was brought into conservative “pro-family” political spaces, including Family Policy Alliance’s Statesmen Academy (which FPA describes as providing “training, mentorship, support and coordination” for “pro-family legislators”). In later reporting (Uncloseted Media), Shupe described the “wink-wink theatrical relationship of playing the victim,” saying the aim was to make the detransition story sound “as bad as [she] could,” and she ultimately disavowed those affiliations; multiple outlets describe her later release/leak of internal communications as shedding light on coordinated anti-trans strategy and messaging.
Ky Schevers (and collaborator Lee Leveille) — Schevers has spoken about previously being part of online detrans spaces that fed anti-trans politics, and later organizing to push back against how detransition narratives get weaponized as policy talking points ABC News.
Prisha Mosley — The Washington Post reports that Mosley testified repeatedly and that private groups helped financially with travel to testify; separately, Mosley is quoted describing regret about trusting people “making money” off her distress/vulnerability.

And even where individual payment isn’t documented, major reporting has described the broader pattern: detransitioners being elevated through conservative events and documentaries “often sponsored by right-wing groups,” functioning as persuasive “personal story” messengers in campaigns to restrict care The Washington Post.

Summary:
Taken together, these examples map a paid-and-amplified influence pipeline that turns a small number of individual narratives into repeatable policy assets. The point is not to blame the people whose lives are being showcased—many are approached during periods of intense disruption, stigma, and social or economic instability, when discrimination has already narrowed their safe options and support. In that setting, the ecosystem functions less like an organic groundswell and more like a social false-flag dynamic: actors with money, platforms, and legal strategy recruit, incentivize, and script testimony that will travel, then present it as representative. A common through-line in these spaces is ideological conditioning: individuals are told that no trans identity is valid, that transition is inherently delusion or pathology, and that their value lies in repeating a simplified “lesson” on cue—refining their account into a portable narrative that can be delivered again and again to legislators, media, and courts. That is precisely why this fits undue influence: not necessarily coercion by threat, but the strategic use of authority, social pressure, rewards, and controlled story-templates to shape beliefs and choices at a moment of heightened vulnerability, and to direct those shaped narratives toward predetermined policy ends.

Links to Transgender History

Tudor, A. (2021). Decolonizing trans/gender studies? Teaching gender beyond the human. TSQ: Transgender Studies Quarterly, 8(2), 238–253. Duke University Press.
https://read.dukeupress.edu/tsq/article-abstract/8/2/238/173627

Digital Transgender Archive. (n.d.). Digital Transgender Archive.
https://www.digitaltransgenderarchive.net

New York City Trans Oral History Project. (n.d.). Handbook.
https://nyctransoralhistory.org/about/handbook/

GenderGP. (n.d.). Non-binary people in history.
https://www.gendergp.com/non-binary-people-in-history/

Gender Diversity Across Cultures and History

Academus Education. (n.d.). Ancient Mesopotamian transgender and non-binary identities (gala priests/Inanna).
https://www.academuseducation.co.uk

Milne, D. (1999). Two-spirit: History, identity, and context. American Indian Culture and Research Journal.
https://escholarship.org/content/qt6r4990x3/qt6r4990x3.pdf

Harvard Divinity School, Religious Literacy Project. (n.d.). Hijra / third gender.
https://rpl.hds.harvard.edu

Utopia Washington. (n.d.). Fa’afafine.
https://utopiawa.org

Foreign Policy. (n.d.). Gender diversity and third gender.
https://foreignpolicy.com

Silkworm Books. (n.d.). Kathoey in Thailand.
https://silkwormbooks.com

ResearchGate. (n.d.). Bissu and the Bugis five genders.
https://www.researchgate.net

Scholarly Publishing Collective. (n.d.). Ashtime / Maale culture.
https://scholarlypublishingcollective.org

University of California Press. (n.d.). Sekrata / Sakalava.
https://link.ucop.edu

Vasey, P. L., & Bartlett, N. H. (2017). What can the Samoan fa’afafine teach us about the Western concept of gender identity disorder? Archives of Sexual Behavior.
https://pubmed.ncbi.nlm.nih.gov/26966855/

My Jewish Learning. (n.d.). Gender categories in rabbinic literature.
https://www.myjewishlearning.com

Gender Diversity in Ancient Rome

[Author unknown]. (n.d.). Gender and sexuality in ancient Rome. The American Historical Review. Oxford University Press.
https://academic.oup.com/ahr/article-abstract/105/4/1250/87940

Kamen, D. (2012). Iphis in Ovid’s Metamorphoses. University of Washington.
https://classics.washington.edu/sites/classics/files/documents/research/kamen_2012_iphis.pdf

World History Encyclopedia. (n.d.). Cybele.
https://www.worldhistory.org

Italy Segreta. (n.d.). Same-sex relationships in ancient Rome.
https://italysegreta.com

BCcampus Open Education. (n.d.). UnRomanTest: Transgender.
https://pressbooks.bccampus.ca/unromantest/chapter/transgender/

Pivotal Moments

San Francisco Chronicle. (n.d.). Compton’s Cafeteria Riot.
https://www.sfchronicle.com

Associated Press. (n.d.). Stonewall and transgender history.
https://apnews.com

Them. (n.d.). Stonewall and transgender history.
https://www.them.us

Reuters. (n.d.). Stonewall and federal recognition.
https://www.reuters.com

Gender Diverse People Throughout History

GLAAD. (n.d.). Marsha P. Johnson.
https://www.glaad.org/marshapjohnson

Biography.com Editors. (n.d.). Lili Elbe.
https://www.biography.com

Historic England. (n.d.). Eleanor (John) Rykener.
https://www.historicengland.org.uk

Associated Press. (n.d.). Sarah McBride.
https://apnews.com

University of Victoria. (n.d.). Reed Erickson and the Erickson Educational Foundation.
https://www.uvic.ca

Science History Institute. (n.d.). James Barry.
https://www.sciencehistory.org

National Park Service. (n.d.). Albert D. J. Cashier.
https://www.nps.gov/subjects/lgbtqheritage/albert-d-j-cashier.htm

Oregon Health & Science University. (n.d.). Queering OHSU.
https://www.ohsu.edu

Bienal de São Paulo. (n.d.). Xica Manicongo.
https://www.bienal.org.br

Etxepare Euskal Institutua. (n.d.). Catalina de Erauso.
https://www.etxepare.eus

National Library of Medicine. (n.d.). Elagabalus.
https://pmc.ncbi.nlm.nih.gov

Pioneering and Notable Doctors of Early Gender-Affirming Care

Routledge Encyclopedia of Modernism. (n.d.). Havelock Ellis.
https://www.rem.routledge.com

JSTOR Daily. (n.d.). Magnus Hirschfeld and the Institute for Sexual Science.
https://daily.jstor.org

New York City LGBT Historic Sites Project. (n.d.). Harry Benjamin.
https://www.nyclgbtsites.org

Australian National University. (n.d.). Norman Haire.
https://www.anu.edu.au

Journal of Urology. (n.d.). Early surgical techniques.
https://www.auajournals.org

Trans Reads. (n.d.). David O. Cauldwell.
https://transreads.org

Duke University Libraries. (n.d.). Christian Hamburger.
https://dukespace.lib.duke.edu

Legacy Project Chicago. (n.d.). Michael Dillon.
https://legacyprojectchicago.org

FTM Surgery. (n.d.). Michael Dillon.
https://www.ftmsurgery.net

From Early Sexology to Modern Standards: How Evidence Built Gender-Affirming Care

Centers for Medicare & Medicaid Services. (2016). Decision memo for gender dysphoria and gender reassignment surgery (CAG-00446N).
https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=282

Wasserstein, R. L., & Lazar, N. A. (2016). The ASA statement on p-values. The American Statistician, 70(2), 129–133.
https://doi.org/10.1080/00031305.2016.1154108

American Psychological Association. (2021). Resolution on gender identity change efforts.
https://www.apa.org/about/policy/resolution-gender-identity-change-efforts.pdf

American Academy of Child & Adolescent Psychiatry. (2018). Conversion therapy.
https://www.aacap.org

American Medical Association. (2025). Issue brief: Sexual orientation and gender identity change efforts.
https://www.ama-assn.org

American Medical Association. (2025). Issue brief: Health insurance coverage for gender-affirming care.
https://www.ama-assn.org

Hung, Y.-C., et al. (2023). Multidimensional assessment of patient-reported outcomes after gender-affirming surgeries. Annals of Plastic Surgery.
https://pubmed.ncbi.nlm.nih.gov

Bruce, L., et al. (2023). Long-term regret and satisfaction following gender-affirming mastectomy. JAMA Surgery.
https://jamanetwork.com/journals/jamasurgery/fullarticle/2808129

The Politics of Fitting In; Decision Making

Human Rights Watch. (2017). “I want to be like nature made me”: Medically unnecessary surgeries on intersex children in the U.S. KFF
American Society of Plastic Surgeons. (n.d.). Briefing paper: Plastic surgery for teenagers (includes gynecomastia surgery data and description). American Society of Plastic Surgeons
American Society of Plastic Surgeons. (2022, May 25). Male breast reduction surgery improves quality of life for teens… American Society of Plastic Surgeons
Lemaine, V., et al. (2013). Gynecomastia in adolescent males. Plastic and Reconstructive Surgery. PMC
Williams Institute. (n.d.). Prohibiting gender-affirming medical care for youth (notes criminal penalties in some bans). Williams Institute
KFF. (n.d.). Policy tracker: Youth access to gender-affirming care and state policy restrictions (tracks penalties, litigation, and status by state). KFF
Movement Advancement Project. (n.d.). Bans on best-practice medical care for transgender youth (map and policy summary, including felony provisions in some states). LGBT Map

Current Challenges

Trans Data Library. (n.d.). Trans Data Library.
https://transdatalibrary.org

Health Liberation Now. (n.d.). Health Liberation Now.
https://healthliberationnow.com

Naming the Harm

PBS. (n.d.). Getting away with murder. American Experience (PBS). https://www.pbs.org/wgbh/americanexperience/features/emmett-biography-roy-carolyn-bryant-and-jw-milam/ (pbs.org)

Recognizing and Calling Out the Spread of Propaganda

Jowett, G. S., & O’Donnell, V. (2015). Propaganda & persuasion (6th ed.). SAGE.
https://csmeyns.github.io/propaganda-everyday/pdf/odonnell-jowett-2018-what-is-propaganda.pdf

Wardle, C., & Derakhshan, H. (2017). Information disorder. Council of Europe.
https://edoc.coe.int/en/media/7495-information-disorder-toward-an-interdisciplinary-framework-for-research-and-policy-making.html

McLamore, Q., & Fuller, K. (2025). Dynamics of transphobic disinformation. Bulletin of Applied Transgender Studies, 4(1–3), 1–14.
https://doi.org/10.57814/ktm8-sh84

Channon, L., & Mathieson, N. (2025). Automated detection of transphobic content. Bulletin of Applied Transgender Studies, 4(1–3), 41–75.
https://doi.org/10.57814/49jz-0663

Religious Fragility

Harvard Kennedy School. (2018). White fragility: Why it’s so hard for white people to talk about racism.
https://www.hks.harvard.edu/faculty-research/library-research-services/collections/diversity-inclusion-belonging/white

Walker B, Djupe PA, Calfano BR, Lewis AR, Sokhey AE. Religion Is Sometimes Raced: Christian Nationalism as In-Group Protection. Perspectives on Politics. Published online 2025:1-23. doi:10.1017/S1537592725102338 https://www.cambridge.org/core/journals/perspectives-on-politics/article/religion-is-sometimes-raced-christian-nationalism-as-ingroup-protection/F02458B4C14162ED36DF4B77012AE973

Miller, D. D. (2021, May 13). Christian nationalism and recent anti-trans state laws. Canopy Forum.
https://canopyforum.org/2021/05/13/christian-nationalism-and-recent-anti-trans-state-laws/

Over-Protection and Infantilization of Transgender People

White Hughto, J. M., Reisner, S. L., & Pachankis, J. E. (2015). Transgender stigma and health: A critical review. Social Science & Medicine, 147, 222–231.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4689648/

Movement Advancement Project. (n.d.). Bans on transgender youth participation in sports.
https://www.lgbtmap.org/equality-maps/youth/sports_participation_bans

GLSEN. (2017). Separation and stigma: Transgender youth and school facilities.
https://www.glsen.org/sites/default/files/2019-11/Separation_and_Stigma_2017.pdf

American Psychological Association. (n.d.). All-gender restrooms.
https://www.apa.org/topics/lgbtq/all-gender-restrooms

American Psychological Association. (n.d.). Resolution opposing discriminatory laws and policies targeting transgender and gender diverse people.
https://www.apa.org/about/policy/resolution-opposing-discriminatory-laws.pdf

Nadal, K. L., Skolnik, A., & Wong, Y. (2012). Interpersonal and systemic microaggressions toward transgender people. Journal of LGBT Issues in Counseling.
https://art.washington.edu/sites/art/files/documents/about/microaggressions_toward_transgendered_people.pdf

Vilification of Transgender People

Texas Tribune. (2025, December 12). Enforcement of Texas’ bathroom bill draws challenges.
https://www.texastribune.org/2025/12/12/texas-bathroom-bill-implementation-policy-capitol/

ABC News. (n.d.). Rep. Nancy Mace says Capitol restroom bill targeted first transgender member of Congress.
https://abcnews.go.com/Politics/mace-effort-ban-transgender-women-capitols-womens-restrooms/story?id=116009034

The Williams Institute. (n.d.). Safety and privacy in public restrooms and other gendered facilities.
https://williamsinstitute.law.ucla.edu/publications/safety-in-restrooms-and-facilites/

The Gay/Trans Panic Defense

American Bar Association. (n.d.). The gay/trans panic defense: What it is, and how to end it.
https://www.americanbar.org/groups/crsj/resources/newsletter/archive/gay-trans-panic-defense-what-it-how-end-it/

The Paid Influence Ecosystem Links

Hung, Y.-C., Park, B. C., Assi, P. E., Perdikis, G., Drolet, B. C., & Kassis, S. A. (2023). Multidimensional assessment of patient-reported outcomes after gender-affirming surgeries. Annals of Plastic Surgery, 91(5), 604–608.

Safer, J. D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., & Sevelius, J. (2016). Barriers to health care for transgender individuals. Current Opinion in Endocrinology, Diabetes and Obesity.

Reisner, S. L., et al. (2016). Global health burden and needs of transgender populations: A review. USC Global Health Inequalities Institute.

USC Global Health Inequalities Institute. (n.d.). Discrimination and denial of care: The unmet need for transgender health in South Los Angeles.

U.S. Department of Health & Human Services, Office for Human Research Protections. (1979/2018). The Belmont Report.
https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html

Mays, M. (2024, July 25). How California teen Chloe Cole emerged as a leader of the detransition movement. Los Angeles Times.

Do No Harm. (2023, February 28). Meet Chloe Cole, patient advocate.
https://donoharmmedicine.org

ABC6 On Your Side. (2024, July 20). Ohio HB 68 and detransition advocacy. WSYX.

Fox News. (2022, December 21). Detransitioner shares emotional story. Tucker Carlson Tonight.

Oregon Legislative Information System. (2023, February 14). HB 2458 – Witness registration report.

Women’s Liberation Front. (n.d.). Kiefel v. Ruff.
https://womensliberationfront.org

Women’s Liberation Front. (n.d.). Kiefel v. Ruff lawsuit FAQ.

KLCC. (2016, June 15). Oregon judge rules person can legally use non-binary as gender identity.
https://www.klcc.org

TIME. (2016, June 15). Oregon judge allows resident to change sex to non-binary.
https://time.com

Multnomah County Circuit Court. (2016, June 10). Order permitting non-binary sex designation.

Family Policy Alliance. (n.d.). Statesmen Academy.
https://familypolicyalliance.com

Uncloseted Media. (2024, September 28). How the far right leverages detransitioners against transgender healthcare.
https://unclosetedmedia.com

Xtra Magazine. (2023, March 15). The making of a detransitioner.
https://xtramagazine.com

Them. (2025, April 8). Elisa Rae Shupe has died.
https://www.them.us

ABC News. (2022, November 23). Former detransitioner fights anti-transgender movement she once backed.
https://abcnews.go.com

The Washington Post. (2023, December 6). How detransitioners are influencing conservative transgender care laws.

I created this page using knowledge gained from training and research. View my training certificates via the link on the Bio Page. This work also involved assistance from AI technology, which supported research, helped identify key figures, and provided editing support. While some have access to editors or research teams, I do not—so this tool allows me to offer more accurate, expansive information than I could produce alone.

I also recognize that AI technology depends on significant human and environmental resources, including the energy required to power large-scale data systems. As I integrate these tools into my work, I remain responsible for continuously evaluating their ethical integrity—especially in relation to algorithmic bias, community safety, and environmental impact. If any technology I rely on shifts in a way that reinforces harm toward marginalized groups or expands its footprint without accountability, I will discontinue its use.

I have been intentionally learning how to use AI over the past year to better support the communities I serve. This technology is here to stay, and rather than leaving its development solely in the hands of those who may not share our values, we can shape how it functions within our work—leveraging its benefits while actively addressing risks and environmental impact along the way.

This is a living, collaborative project—please feel free to use the information here in any classroom or educational space that affirms LGBTQ people.

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