Trans people have existed through all of recorded history. There are some records of us among the cultures with the earliest writing as with the Sumerians. Often the earlier recorded descriptions of trans people are associated with fulfilling a particular religious and social role in their respective societies and in some cases what we retain from those descriptions include accounts of surgeries and even, effectively, hormonal treatments, the earliest forms of gender affirming medicine.
Our earliest records of body modifications in service of transgender roles come from such religious subgroups within cultures around the Black Sea over two thousand years ago. In Scythia, around 600 BCE, there was a hereditary class of transfeminine fortune tellers of the cult of Artimpasa (Persian: Arti) known as ἐναρής (Eng: enaree or enarei), (from Persian for “not masculine”), who were assigned male at birth but took on traditionally feminine social roles in addition to their religious roles. They are also said to have taken various herbal anti-androgens and possibly even mare urine derived treatments for a degree of physical feminization. In the early twentieth century, estrogens were first isolated in the urine of pregnant women, then later in pregnant mares, and then marketed in pill form (whence comes “Premarin”).
A few hundred years later, around 200 BCE, on the opposite side of the Black Sea in what is now Turkey, the Phrygians had a trans feminine priesthood of the goddess, Cybelle, known as the galli/gallae. They aren’t known to have taken herbal treatments, but rather submitted to ritual castration on a date near the Spring Equinox. Their name resonates with that of a similar transfeminine priesthood from over 2000 years prior among the Sumerians, the Gala of Inanna, though there is no definitive record of the Sumerians performing similar surgeries. The priesthood of Atargatis is Syria in 200 CE, however, were also trans feminine and castrated.
1889 Charles-Edouard Brown-Se´quard injected himself with extracts from the crushed testicles of a dogs and guinea pigs for the first recorded androgenic hormone therapy for cisgender men, prior to the isolation of testosterone. He recorded a restoration of physical strength. The “juices” of animal testicles and ovaries were used for cisgender therapies from here forward prior to the isolation of specific hormones.
In the early 1900s xenotransplants of animal gonads into people were being attempted for the same effects. In 1920 Alexis Carrel performed the first xenotransplants of ape testicular material into human cisgender men for androgenic therapy. He performed similar xenotransplants of ovarian material into cisgender women later.
c. 1928 Ewan Forbes, a Scottish noble and trans boy, was given treatment of a synthetic testosterone at age 15 as a result of touring various medical facilities in Germany with his mother.
On the Clinics and Bars of Weimar Berlin
After decades of less pure extracts of animal "juices", in 1928, a mix of Estriol (E3) and estrone (E1) were extracted first from ovarian and fetal tissue and put into pill form in Germany by Adolf Butenandt, and marketed as Progynon. Soon the formulation switched to being derived from the urine of pregnant women, and, as demand outpaced that supply in 1941, the pharmaceutical companies switched over to using the urine of pregnant mares as the Scythians may have used and as lies behind the brand name Premarin.
The estrogens were independently isolated and developed as the pill Emmenin in Canada in 1930.
Physician and trans woman, Otto Spengler, sought and was prescribed Progynon by Harry Benjamin in New York in 1928, though Benjamin didn't begin more regularly prescribing his trans feminine patients hormone therapy until the 1940s
In 1935 Enrest Lacquer isolated testosterone from bull testes in Amsterdam. In the same year testosterone was chemically synthesized independently by Adolf Butenandt in Göttingen and Leopold Ruzicka in Basel.
1938 Dr. Michael Dillon began testosterone hormone therapy.
In 1938 or 1939, diethyl-stilbestrol, a synthetic estrogen, was synthesized and produced in pill form. Shortly thereafter, by 1941, it and Premarin became the dominant form of hormone therapy for cis women and for trans women soon after.
Circa. 1939-1940s: Cosmetic companies began incorporating estrogens into topical creams for various applications (eg: facial beauty, breast enhancement) for women.
Circa. 1948-1950: Christian Hamburger in Denmark and Harry Benjamin in the U.S. began using hormone therapy as a regular part of their treatment for transgender individuals. Benjamin had been an associate with Magnus Hirschfeld when living in Germany and then emmigrated to New York. He had been prescribing hormones as early as 1928 occasionally for patients such as Otto Spengler and later opened up a bicoastal second office in San Francisco. Hamburger later became Christine Jorgenson’s surgeon
Experimental use of puberty pausers (blockers) began in the 1960s and 1970s, initially intended for cisgender kids with precocious puberty. They've been used on cis kids more regularly since 1980 as the use of GnRHa's for blockers became standardized. That usage extended to trans kids in Europe in the late 80s and in the U.S. since the late 90s, officially endorsed by WPATH (under it's then name, HBIGA) in 1998. Puberty pausers are just that - they pause the progression of puberty while a person takes them, and it resumes once one stops. Standard practice is to wait until the person has reached Tanner Stage 2 in development before starting and to stay on them for one to two years. At that point if they confirmed they were transgender, then hormone therapy might begin.
1962 Early treatments for precocious puberty among cisgender children began using medroxyprogesterone acetate (MPA), which was effective in some ways, but did not slow down height gain and resulted in unwanted and unhealthy side effects. Its use was discontinued.
1975 Danazol was tried in small trials for to treat precocious puberty among cisgender children and had similar effects as MPA and also masculinized girls. Thus its use was short lived and discontinued.
1976 Cyproterone acetate (CA) began to be used to treat precocious puberty among cisgender children. It appeared to work without the bad outcomes of the other treatments but was later determined to have some negative effect on adrenal function. CA does, however continue to be used in a number of cases including as an antiandrogen for transfeminine people and cisgender women, as well as in the treatment of prostate cancer.
Between 1981 and 1985 multiple small studies on the use of gonadotropin-releasing hormone analogs (GnRHa) on cisgender children with precocious puberty demonstrated their effectiveness, their lack of side effects, and their reversibility, and they became the standard treatment.
1988: GnRHa began to be used in Denmark as puberty blockers for transgender youth. The effects of this treatment were published a decade later in 1998. This article is a 22 year case study follow-up for a trans man who started puberty blockers in 1991.
By the early 90s, GnRHas were being used as pausers for trans kids in Germany as well, before being used in the U.S.
1998 April The HBIGA’s updated 1998 Standards of Care (SOC 5) included:
Unlike the earlier 1990 SOC (SOC 4), it explicitly provided guidelines for the care of trans youth.
Guidelines for trans youth to begin hormone blockers after the onset of puberty.
Guidelines for trans youth to not begin hormone therapy beyond blockers before age 16 and not to begin real life tests before age 16
1906 Karl M. Baer, assigned female at birth but probably intersex, having male features, had surgeries sometimes described as the first gender confirmation surgeries, involving removal of ovaries & uterus and some degree of masculinizing gender confirmation surgery.
1919-1933: Institut fur Sexualwissenschaft - This was the premier location for research and medical practice related to sex and gender. Under the direction of Magnus Hirschfeld, the earliest medical transitions were supervised here.
1917: In the U.S., Dr. Alan Hart had his first gender affirming surgery, a hysterectomy.
1922: Through the Institut, Dora Richter had her first gender affirming surgery, an orchiectomy.
The History of Gender-Affirming Vaginoplasty Technique is a very extensive article on the History of Gender-Affirming Vaginoplasty for the journal: Urology.
1931: The first trans women's vaginoplasties were performed on Dora Richter and Lili Elbe
Dr. Harold Gillies performed the first phalloplasty on trans man Dr. Michael Dillon, aka Lobzang Jivaha, in a series of operations between 1946 and 1949. The First FTM Phalloplasty Revisited. Dillon had been taking testosterone since 1938 and had top surgery in 1942. In 1950 Dillon secretly performed an orchiectomy on automobile racer and WWII RAF pilot Roberta Cowell, giving her the legal cover to claim she was intersex in order for her to become the first trans woman in Britain to have vaginoplasty in 1951, also performed by Sir Gillies.
1958: Coccinelle, (stage name of Jacqueline-Charlotte Dufresnoy) became the first French person to have bottom surgery.
1965 Johns Hopkins Hospital opened its Gender Identity Clinic and became the first hospital in the United States to perform gender confirmation surgeries on trans patients. Trans patients had previously been sent out of the country, unless they were mistaken for intersex patients, as with Agnes Torres in 1959 at UCLA. Melanie Fitz and Nat Mulkey give an overview of The rise and fall of gender identity clinics in the 1960s and 1970s for the American College of Surgeons in this article.
1969 July During the First International Symposium on Gender Identity, “psychiatrist John Randell stated that he never offered surgery or used the word “transsexual” with patients, and told applicants who requested surgery it was “up to them to prove” they could pass as the gender they desired and be successful (EEF, 1969a, pt. 2). “Success” was not defined by clinicians in the literature, but connoted passing as a binary gender, being heterosexual, and attaining a middle- to upper-class financial status. If applicants lost their jobs or their families rejected them, this was “their problem” (EEF, 1969a, pt. 2)”
By 1973 it was becoming standard practice through Johns Hopkins, to recommend to trans teens a two year real life test prior to any bottom surgery, but allow for top surgery and testosterone treatment for trans boys to make such a test easier. Bottom surgery, while aggressively performed on intersex children, was still generally not endorsed for trans folks prior to age 18. Still, some practitioners would perform bottom surgeries on trans girls as young as 16. A number of clinics did not require as long of a real life test prior to some level of medical transition for adults.
For adult transitioners, Johns Hopkins required proof that at least one member of the trans person’s family could corroborate their gender history and was supportive of their transition.
1875 Dr. Charles Michel described the technique of removing hairs through "electrolysis" the application of direct current to the follicle.
1908: By 1900 the technique had spread and was being done in barber shops. In 1908, a multi-needle technique began use in Germany by Dr. Ernst Kromayer
1916 Paul M. Kree developed a multiple needle method of applying direct current electrolysis, then called Galvanic electrolysis, to the follicle.
1923 Dr. Henri Bordier described the alternating current method of electrolysis, called thermolysis (later also "Ray Treatment", which became more practical after vacuum tube technology became more wide spread in the 1930s.
1938? 1945? 1948? : St. Pierre and Hinkle patented the Blend technique of using AC & DC for electrolysis publishing their method much later in 1968.
Radiation
1885: Leopold Freund began using X-rays for hair removal on patients, publishing results in 1901.
1920s: X-ray depilation became more common.
In the 1940s and 50s, trans feminine patients were directed to hair removal treatments involving exposure to radiation, but even in the 1940s, the cancer risks of such treatments were becoming well known.
1990s
1862 Karl Heinrich Ulrichs used the term Urning (Uranian) to refer to his status as being gay. While Ulrichs used different related terms to refer to other sexual orientations and gender variations, other authors grouped all forms of homosexuality, transness, nonbinariness, and intersex status under “urning” as more of a catch-all term.
1878-1882 A variety of psychiatrists, journalists, and sexologists describe sexual inversion, meaning men who have women’s souls or behaviors or women who have men’s souls or behaviors and use it to describe homosexuality and being transgender with those fitting any of those descriptions being called “inverts”
1886 Richard Freiherr von Krafft-Ebing published Psychopathia Sexualis, which introduced the terms sadism and masochism, while describing them, and sexual inversion (which included and did not make named distinction between homosexuality, bisexuallity, androgyny, transsexuality, and transvestism) as paraphilias - mental disorders, which he did for any behavior deemed sexual which would not allow for procreation.
1910: Magnus Hirschfeld published his book Die Transvestiten. Some suggest that he coined the word transvestite there, but it has close etymological antecedents predating him by as much as 250 years. This word serves as an umbrella term encompassing who we would today call crossdressers, as well as transgender people including those whom we have called transsexuals. In the United States, such folks along with gays, lesbians, and bisexuals were bundled together as “sexual inverts”.
1913: Havelock Ellis proposed the term sexo-aesthetic inversion as a better descriptor to what Hirschfeld called transvestism and what would now be considered being transgender. “Sexual inversion” had been a term describing both trans behavior and homosexuality from the 1880s
1914: Ernst Burchard apparently coined the term “cisvestitismus” or “cisvestism” in an academic sexology text called "Lexikon des gesamten Sexuallebens" or "Encyclopedia of the Whole Sex-life", in opposition to “transvestite” and meaning one who conforms to social norms of gendered presentation and expression for their birth designated sex (or does so but in clothing of a different age, profession or ethnicity for sexual relief).
1920 Havelock Ellis having previously proposed “sexo-aesthetic inversion”, then proposed the term eonism after the Chevalier d’Eon to describe people who were trans feminine. More particularly “On the psychic side, as I view it, the Eonist is embodying, in an extreme degree, the aesthetic attitude of imitation of, and identification with, the admired object. It is normal for a man to identify himself with the woman he loves. The Eonist carries that identification too far, stimulated by a sensitive and feminine element in himself which is associated with a rather defective virile sexuality on what may be a neurotic basis.”
1923 Hirschfeld described “seelischem Transsexualismus” “psychic or mental transsexuality”in “Die intersexuelle Konstitution from the Jahrbuch für sexuelle Zwischenstufen”
(Source some of the information on Hirschfeld and related work is here.)
1948 Alfred Kinsey published Sexual Behavior in the Human Male which includes his famous zero to six scale of sexual attraction. This scale was later used as a model for Harry Benjamin’s scale for classifying trans people.
1948 Louise Lawrence, a trans woman, began working with Kinsey and aids in his research on transvestism and transsexuals. She had an extensive national network of social contacts among the trans community which she drew upon both to educate Kinsey and later to establish her periodical, Transvestia. Lawrence also put Harry Benjamin in contact with those in her network who were seeking medical transition. She avoided such measures herself, having transitioned socially and kept the label “transvestite” even after “transsexual” became a more widely known term.
1952: The Diagnostic and Statistical Manual (DSM 1) was published by the American Psychological Association (APA) and included transvestism as a diagnosable condition. Nothing is said relating to transsexual people directly but are presumed to be included under transvestism. It was grouped along with pedophilia and homosexuality as a form of sexual deviation..
From the DSM 1:
“OOQ-x63 Sexual deviation This diagnosis is reserved for deviant sexuality which is not symptomatic of more extensive syndromes, such as schizophrenic and obsessional reactions. DEFINITION OF TERMS 39 The term includes most of the cases formerly classed as "psychopathic personality with pathologic sexuality." The diagnosis will specify the type of the pathologic behavior, such as homosexuality, transvestism, pedophilia, fetishism and sexual sadism (including rape, sexual assault, mutilation).”
1954 and beyond: Having defined transsexualism as a psychological disorder, several attempts were made to “cure” the condition through various conversion therapies. Studies of such attempts revealed that they fundamentally did not and do not work. Harry Benjamin and Elmer Belt developed protocols to screen out anyone from surgical candidacy whom they thought would have “bad outcomes” essentially anyone that they thought would not conform to heterosexual norms of being only attracted to men (for trans women) and their beauty standards and those who conformed to stereotypical gendered behavior.
1964 Reed Erickson, a trans man, established the Erickson Educational Foundation (EEF) which funded much of trans medicine from the 60s through the 80s. He had met Harry Benjamin in 1963. In 1977 the EEF was reorganized into the Janus Information Facility, which two years later became the Harry Benjamin International Dysphoria Association. The Benjamin Association published the Standards of Care for trans people and in 2007 was renamed the World Professional Association for Transgender Health (WPATH).
1964 Dr. Robert J. Stoller of UCLA, promulgated the term “Gender Identity” in a paper titled “A Contribution to the Study of Gender Identity”.
1965 Psychiatrist Dr. John F. Oliven introduced the term “transgender” as a middle ground between “transvestite” and “transsexual” in the 1965 revision of his reference work Sexual Hygiene and Pathology.
1966 Harry Benjamin published The Transsexual Phenomenon which includes The Benjamin Scale classifying transvestites and transsexuals along a 0 to 6 scale (modeled after Kinsey). Among other things it associates transvestism with being attracted primarily to women and transsexual surgery candidates with being primarily attracted to men, whereas the true range of sexual orientation among both transsexuals and crossdressers is much more varied. This is illustrative of the sort of medical gatekeeping that has long been in place regarding prescriptions and surgeries for trans people, though Benjamin is often lauded as leading the only group of physicians of the era in the United States to provide services for transgender people. For instance, only those trans women who were attracted primarily to men, were recommended for medical interventions such as hormone therapy and surgeries and he still considered such “true transsexuals” to be fundamentally gay or bi men. In many cases those interventions were further restricted to those whom the physician thought were pretty and would likely pass for cisgender following treatment. For trans women primarily attracted to women, he saw transness as something to “cure” potentially through conversion therapy. The successor to scales like this is the diagnosis of gender dysphoria in the DSM 5
1968 DSM-II: The classification of Transvestic Fetishism did not change significantly with the publication of DSM-II (1968). The condition was still classified as a sexual deviation, and the sexual deviations remained classified as a subgroup of the personality disorders. The DSM-II (1968) emphasized that at the core of Transvestic Fetishism was a lack of attraction to people of the opposite sex but, instead, attraction for sexual acts not associated with coitus or for “coitus performed under bizarre circumstances” - from Should Transvetic Fetishism be Classified in the DSM V?
1968 Dr. Robert Stoller, of UCLA, after decades of study and interactions with trans patients, reluctantly concluded that surgical interventions for trans people were more useful than attempts at conversion therapies or other purely psychiatric management of trans feelings, writing “if there were any psychiatric treatment that was even partly useful, it would probably be better than this disquieting ‘psychosurgery’”.
Stoller continued, through the 1970s, to believe that gender identity was mutable up to a certain age and conducted studies known as the “Feminine Boy Project”. This project hypothesized that the degree of masculinization a boy was exposed to through his mother affected the degree of adhering to a cisgender orthopraxis. Still, Stoller felt that by ages five to seven, any conversion therapy interventions would become increasingly futile and that by adolescence gender identity was set. He saw trans identities as failures.
1969 John Money and Richard Green of Johns Hopkins, collaborated with over two dozen others to write Transsexualism and Sex Reassignment
1969 July The First International Symposium on Gender Identity: Aims, Functions and Clinical Problems of a Gender Identity Unit, took place at the Piccadilly Hotel in London, July 25-27, 1969 and was co-sponsored by the EEF and the Albany Trust of London. It was chaired by Professor C.J. Dewhurst of Queen Charlotte's Hospital, London. A later such symposium became the springboard from which the Harry Benjamin Society (which became WPATH) was formed. During the Symposium, “psychiatrist John Randell stated that he never offered surgery or used the word “transsexual” with patients, and told applicants who requested surgery it was “up to them to prove” they could pass as the gender they desired and be successful (EEF, 1969a, pt. 2). “Success” was not defined by clinicians in the literature, but connoted passing as a binary gender, being heterosexual, and attaining a middle- to upper-class financial status. If applicants lost their jobs or their families rejected them, this was “their problem” (EEF, 1969a, pt. 2)”
1971 Physicians and psychiatrists continued to develop screening criteria for medical interventions for trans individuals based on a rehabilitation model. Rather than aiming to help trans people more satisfyingly embody their identities, they looked to intervene when results would lead to economic and social “improvements” in their lives such as fewer interactions with the legal system, steadier employment, and marriage.
Little Miss Dysphoria An Essay about Transgender Women and Madness, by Leah Tigers looks at the interlaced considerations of homosexuality, and transsexuality in the 1970s among the APA, and the UCLA Gender Identity Clinic doctors such as another researcher involved in the Feminine Boy Project Dr. Richard Green.
1974 Homosexuality was removed as a diagnosis from the then current revision of the DSM-2, having been depathologized by the APA (American Psychiatric Association) the previous year. TAO pressed to depathologize transsexualism as well.
1974 Following the depathologizing of homosexuality, the “Feminine Boy Project” shifted from studying attempts at conversion therapy of “pre-homosexuals” to conversion therapy of “pre-transsexuals”. The project continued through 1986 reluctantly concluding that there was no conversion therapy that actually worked.
1977 February The Erickson Educational Foundation closed down and transferred its transgender oriented programs to the newly formed Janus Information Facility run by sexologist, Paul Walker. Walker had been associated with the soon to be shuttered Johns Hopkins Gender Clinic and had relocated to Texas. In two years much of Janus would be renamed the Benjamin Association, before folding as an individual institution in the mid 1980s.
1979: The Harry Benjamin International Gender Dysphoria Association (HBIGDA) was formed out of the Janus Information Facility, itself reorganized from the Erickson Education Foundation. It developed the Standards of Care for the medical treatment of transgender people. These standards defined who should be eligible for hormone therapy and surgery, when, and through what practices. While they established medical procedural care and proper dosages and such, they also outlined a gatekeeping framework. This framework tended to limit medical interventions to those trans people whom the physicians believed would pass for straight cisgender people, engaged in traditional, stereotypical gender roles following initial treatments, which in turn led trans folks seeking interventions to roleplay to their physicians in order to be treated, to be discouraged from seeking medical interventions entirely, or to seek them on the black or gray markets. Stereotyped behavior was encouraged and in many cases, still is, by the medical community, as for many doctors, the only way they would prescribe hormones or authorize surgeries would be if the trans person conformed to their idea of what a woman or man should be - in many cases of trans women, they made judgements on whether they met their standards of beauty pre-transition and whether the physicians thought they would be able to pass as cisgender.
Harry Benjamin himself retired that year, and Jeanne Hoff, a psychiatrist and trans woman, took over his practice, possibly the first out trans person to oversee so large a patient body of trans people.
This HBIGDA was later (2006) renamed as the World Professional Association for Transgender Health (WPATH).
1980: The DSM III (Diagnostic and Statistical Manual) added Gender Identity Disorder (GID) as a diagnosis with two broad types of transsexualism (adult and child) and with a focus on further classifying by what gender (generally ignoring bisexuality) the person is attracted to and with a lack of clarity as to whether those homosexual and heterosexual terms are gendering a trans woman as male or as female (or gendering a trans man as male or as female). (Evolution of the DSM’s GID diagnosis between the DSM III and DSM IV)
“Transsexualism” was considered “very rare” with contemporary studies suggesting on the order of 0.01% to 0.003% of people desiring medical transition.
Transvestism was a separate diagnosis (Evolution of the DSM's Transvestism diagnosis in the DSM III to Transvestic Fetishism in the DSM IV to Transvestic Disorder in the DSM IV)
1986 UCLA's “Feminine Boy Project” - a research study which sought to make conversion therapy away from homosexuality and transsexuality for children assigned male at birth to be viable, shut down. It failed. The following year Dr. Richard Green published The Sissy Boy Syndrome, summarizing his interpretations of the results of the project which still favored conversion therapy.
1987 The DSM III-R was published, updating the American Psychiatric Association’s diagnoses of transsexualism, gender identity disorder, and reclassifying transvestism as transvestic fetishism.
1988 Dr. Richard F. Docter, a psychologist and sexologist, wrote Transvestites and Transsexuals: Toward a Theory of Cross-Gender Behavior
1988 Therapists involved in implementing the Standards of Care version 3 (1981), and screening trans people for hormone therapy were encouraged to deny hormone treatment to trans women who were married, even if they had spousal support, until such marriages “were resolved” due to the effects that hormones would have upon fertility, sexual performance, and appearance.
1989: Ray Blanchard published “The concept of autogynephilia and the typology of male gender dysphoria. (1989)” Blanchard’s theory is widely discredited and is considered transphobic and hurtful. Still it is often referenced by those opposing trans rights and those who deny trans people’s gender identities. See: The Case Against Autogynophilia, by Julia Serano (2010)
1990 The HBIGDA published its 1990 Standards of Care, aka the SOC 4.
1991 Zissexual was coined in German by Volkmar Sigusch, followed shortly by “cissexual” in English, to mean someone whose birth designated sex is the same as their gender. This follows the earlier terms cisvestitismus and cisvestite coined in 1914 a few years after transvestite was coined, and at a time when transvestite had a meaning encompassing all manners of transsexual, transgender, and cross-dressing people.
1994 May 24 Earliest known appearance of the term “cisgendered” on the internet alt.transgendered May 24 1994 in a post by Dana Leland Defosse. The term was used with the expectation that the meaning was understood suggesting it had been previously been in use, but Defosse claims credit for coining it for the post. The similar term “cisvestite” was being used by at least 1914, in opposition to “transvestite” which in the era filled similar umbrella roles as “cisgender” and “transgender”. “Cissexual” had been coined in 1991, some forty years after “transsexual”.
1994: August DSM IV: Gender Identity Disorder diagnosis added; Transvestism was reclassified as Transvestic Fetishism. “There are no recent epidemiological studies to provide data on prevalence of Gender Identity Disorder. Data from smaller countries in Europe with access to total population statistics and referrals suggest that roughly 1 per 30,000 adult males and 1 per 100,000 adult females seek sex-reassignment surgery.”
From the 1998 Benjamin SOC (SOC 5): “In 1994, the DSM-IV committee replaced the diagnosis of Transsexualism with Gender Identity Disorder. Depending on their age, those with a strong and persistent cross-gender identification and a persistent discomfort with his or her sex or a sense of inappropriateness in the gender role of that sex were to be diagnosed as Gender Identity Disorder of Childhood (302.6), Adolescence, or Adulthood (302.85). For persons who did not meet the criteria, Gender Identity Disorder Not Otherwise Specified (GIDNOS)(302.6) was to be used. This category included a variety of individuals--those who desire only castration or penectomy without a concomitant desire to develop breasts; those with a congenital intersex condition; those with transient stress-related cross-dressing; those with considerable ambivalence about giving up their gender roles. Patients with GID and GIDNOS were to be subclassified according to the sex of attraction: attracted to males; attracted to females; attracted to both; attracted to neither. This subclassification on the basis of orientation was intended to assist in determining over time whether individuals of one orientation or another fared better in particular approaches; it was not intended to guide treatment decisions.”
1998 April The Harry Benjamin International Gender Dysphoria Association’s updated 1998 Standards of Care (SOC 5) included:
Unlike the earlier 1990 SOC (SOC 4), it explicitly provided guidelines for the care of trans youth.
Guidelines for trans youth to begin hormone blockers after the onset of puberty.
Guidelines for trans youth to not begin hormone therapy beyond blockers before age 16 and not to begin real life tests before age 16.
Requirements of either at least three months of a “real life experience” or at least three months of psychotherapy prior to prescription of hormones for those above 18.
An allowance that, unlike with the prior 1990 standards of care, hormone therapy may be prescribed to those above 18 who do not initially want surgery or a “real life experience".
2001 February The HBIGDA published the SOC 6.
2006 The Harry Benjamin International Gender Dysphoria Association was renamed the World Professional Association for Transgender Health (WPATH)
2009 June 9 In the United States, The Endocrine Society published clinical practice guidelines “for the treatment of transsexual persons” which included the use of GnRH puberty pausers for trans youth starting at the onset of puberty with Tanner stage 2, increasing how broadly they were prescribed. These guidelines also included beginning hormone therapy at age 16.
2012 WPATH published the seventh version of the Standards of Care (SOC 7)
2013 DSM V: “Gender Identity Disorder” diagnosis was removed and renamed “Gender Dysphoria”, effectively depathologizing transgender identities in the United States. However “Transvestic Disorder” replaced “Transvestic Fetishism” and now problematically explicitly has a connection to Blanchard’s “autogynophilia” as well as “autoandrophilia”.
It appears to significantly undercount the people who experience Gender Dysphoria:
“The DSM-5 indicates that the prevalence of gender dysphoria is 0.005-0.014% for adult born as males, whereas it is 0.002-0.003% for adult born as females (American Psychiatric Publishing, 2013). Among children, it is higher in those born as boys, where it is 2-4.5 times greater than those born as girls. Among teenagers, there is no real difference between males and females.” - Current surveys suggest between 0.3 and 2.1% (most often given as 0.6% to 1.3%) of people are trans - though the higher skew among the younger population suggests that the true numbers may be closer to or even beyond the higher end, with younger folks having less social suppression of the idea that they could be trans and more awareness of what being trans means, the gender skew being minimal, and a lower selective attrition rate due to the AIDS crisis’s and health care discrimination’s disproportionate effect on Boomer & older GenX trans folks. Part of the lower rates of identification of trans males may be related to the more challenging aspects of gender confirmation surgery.
2019 Transgender identities were depathologized by the W.H.O.’s ICD-11 (International Classification of Diseases – 11th Revision) and in doing so replaced diagnostic categories like ICD-10’s “transsexualism” and “gender identity disorder of children” with “gender incongruence of adolescence and adulthood” and “gender incongruence of childhood”, respectively. Gender incongruence has thus broadly been moved out of the “Mental and behavioural disorders” chapter and into the new “Conditions related to sexual health” chapter. While the U.S. relies on the DSM 5, that manual references the analogous diagnoses within the IDC-10 and U.S. medical record keeping relies on the codes and names from the IDC rather than the DSM.
2022 September WPATH published the eighth version of the Standards of Care (SOC 8)
We have had trans kids socially transitioning all through history before medical options were available.
Dr. Robert Stoller continued, through the 1970s, to believe that gender identity was mutable up to a certain age and conducted studies known as the “Feminine Boy Project”. This project hypothesized that the degree of masculinization a boy was exposed to through his mother affected the degree of adhering to a cisgender orthopraxis. Still, Stoller felt that by ages five to seven, any conversion therapy interventions would become increasingly futile and that by adolescence gender identity was set. He saw trans identities as failures.
Following the depathologizing of homosexuality in 1974, the “Feminine Boy Project” shifted from studying attempts at conversion therapy of “pre-homosexuals” to conversion therapy of “pre-transsexuals”. The project continued through 1986 reluctantly concluding that there was no conversion therapy that actually worked.
This is not experimental.
Some of the following repeats information described above, with a focus on care for minors.
Trans teens have been prescribed hormone therapy since the late 1920s, when hormones were first on the market, more regularly from the mid 1960s onward.
This is decades before we had puberty pausers (also known as puberty blockers).
1927 Ewan Forbes, a Scottish noble and trans boy, was given treatment of a synthetic testosterone at age 15 as a result of touring various medical facilities in Germany with his mother.
1952: Agnes Torres, then thirteen years old, began stealing some of her mother's Premarin, taking estrogen therapy clandestinely throughout adolescence, such that when she was 18 years old and started seeing Dr. Robert Stoller at what would become the UCLA gender clinic, she was able to convince him that she was intersex. Intersex kids had subject to gender confirming surgeries for a couple of decades but they remained out of reach for transgender adults in the U.S. in the 1950s still. Agnes was able to have bottom surgery in 1959.
Puberty pausers were experimental - in the 1960s and 1970s when they were first used for cis kids with precocious puberty. They've been used on cis kids more regularly since 1980 and for trans kids in Europe since the late 80s and in the U.S. since the late 90s.
1962 Early treatments for precocious puberty among cisgender children began using medroxyprogesterone acetate (MPA), which was effective in some ways, but did not slow down height gain and resulted in unwanted and unhealthy side effects. Its use was discontinued.
1962 UCLA’s Gender Identity Research Clinic was founded under the auspices of the Psychiatry department. Throughout the 60s when trans kids were brought in, often by parents concerned that their child might be gay, they were subjected to some manner of conversion therapy if they were pre-adolescent, but upon reaching adolescence it was presumed that gender identity was no longer malleable and the trans teens were often then prescribed hormone therapy and the clinic acquiesced to their social transitioning.
Harry Benjamin remained reluctant to prescribe hormones to teens throughout the 60s. At the same time, children from less supportive and less affluent homes, particularly Black trans kids, were institutionalized.
1975 Danazol was tried in small trials for to treat precocious puberty among cisgender children and had similar effects as MPA and also masculinized girls. Thus its use was short lived and discontinued.
1976 Cyproterone acetate (CA) began to be used to treat precocious puberty among cisgender children. It appeared to work without the bad outcomes of the other treatments but was later determined to have some negative effect on adrenal function. CA does, however continue to be used in a number of cases including as an antiandrogen for transfeminine people and cisgender women, as well as in the treatment of prostate cancer.
Between 1981 and 1985 multiple small studies on the use of gonadotropin-releasing hormone analogs (GnRHa) on cisgender children with precocious puberty demonstrated their effectiveness, their lack of side effects, and their reversibility, and they became the standard treatment.
1988: GnRHa began to be used in Denmark as puberty blockers for transgender youth. The effects of this treatment were published a decade later in 1998. By the early 90s, GnRHa's began to be used in Germany as well.
1998: Gonadotropin-releasing hormone analogs (GnRHa), used to treat precocious puberty since the late 1970s, began to be used in the United States as puberty blockers for transgender youth. Pausers effectively stop puberty from progressing, pausing it until a person stops taking them, at which point puberty resumes. Typical treatment would begin their use in very early adolescence (as young as 9) and continue until the child was 16, though typically only one or two years, at which point if they confirmed they were transgender, then hormone therapy might begin.
1998 April The HBIGA’s updated 1998 Standards of Care (SOC 5) included:
Unlike the earlier 1990 SOC (SOC 4), it explicitly provided guidelines for the care of trans youth.
Guidelines for trans youth to begin hormone pausers after the onset of puberty.
Guidelines for trans youth to not begin hormone therapy beyond pausers before age 16 and not to begin real life tests before age 16.
2009 June 9 In the United States, The Endocrine Society published clinical practice guidelines “for the treatment of transsexual persons” which included the use of GnRH puberty blockers for trans youth starting at the onset of puberty with Tanner stage 2, increasing how broadly they were prescribed. These guidelines also included beginning hormone therapy at age 16.
Prescribing pausers is the compromise vs. just going straight to hormone therapy once you hit Tanner 2. We have trans adults in their 60s who went straight to hormone therapy now. We have Trans adults getting close to 40 who were on blockers.
This is not experimental.
2024: A Gallup Survey found that 2.8% of Gen Z members are trans & the 2023 Youth Risk Behavior Survey found that 3.3% of all high school students are trans.
2025 A JAMA Pediatrics study, found 0.36%, of all teens had a formal gender dysphoria diagnosis (about 1/9th of all trans teens) but only 1/6th of those (about 1/55th of all trans teens) had been prescribed puberty pausers or hormones.
Access is far below demand.
By 1973, it was becoming standard practice through Johns Hopkins, to recommend to trans teens a two year real life test prior to any bottom surgery, but allow for top surgery and testosterone treatment for trans boys to make such a test easier. Bottom surgery, while aggressively performed on intersex children, was still generally not endorsed for trans folks prior to age 18. Still, some practitioners would perform bottom surgeries on trans girls as young as 16.
This too is not experimental
There are about the same number of elective cosmetic surgeries for cisgender minors per person as medically necessary gender affirming surgeries for trans minors.
Numbers first, then the math, then the sources.
Cisgender teens under 17 years of age have elective, cosmetic plastic surgery procedures at a rate of 25 per 100,000 cis teens per yr
Transgender teens under 17 years of age have medically necessary gender affirming surgeries at a rate of 26 per 100,000 trans teens per yr
The math:
These data are for the U.S. primarily between the years 2019 and 2021.
In 2021, Gallup survey results indicated 2.1 % of the U.S. GenZ population is trans.
The U.S. census indicates that in 2021 the U.S. population of 6-17 year olds was 54.8 million.
With the Gallup data that means about 1.15 million trans GenZ minors between 6-17.
In 2021, there were about 300 gender affirming surgeries trans teens between the ages of 13-17 in the U.S., mostly top surgeries for 17 year old trans boys.
That's 0.026% of trans teens or 26 per 100,000 trans teens per year.
Respaut, Robin and Terhune, Chad, Putting numbers on the rise in children seeking gender care, Reuters, October 6, 2022
Most of the data I could find for cisgender cosmetic surgeries for teens were for teens 13-19, and were around 65,000 annually with an additional 165,000 non-surgical cosmetic procedures.
eg:
2017 Plastic Surgery Statistics Report
For 2019 cisgender cosmetic surgery for teens between 13-17 give numbers closer to 13,400. Those procedures include breast augmentation for girls, breast reduction, rhinoplasty, ear tucks & lipo.
That's about 0.025% or 25 out of 100,000 cis teens
aesthetic plastic surgery national databank - statistics
My total population numbers had included all U.S. kids from 6-17.
Revising to the 13-17 numbers as with the surgery data:
* 1 in 2000 minor cis teens/year have elective cosmetic surgery
* 1 in 2000 minor trans teens/year have gender affirming surgeries, mostly top surgery
Arguments against GAC for minors have included the notion that the brain isn’t fully developed until age 25. This is a misunderstanding.
The myth that the brain is so unfinished in its development prior to age 25 that youth are especially vulnerable to outside influence and poor decision making has been weaponized by the anti-trans movement to extend age restrictions beyond minors.
The Myth of the 25-Year-Old Brain
And it's especially frustrating when sources propagate this notion without understanding the damage that they are inadvertently supporting. (Including Picard Season 3 Episode 9)
General
Focus on care of minors
Gill-Peterson, Jules History of the Transgender Child, University of Minnesota Press, Minneapolis, Minnesota 2018
Serano, Julia Gender-Affirming Care for Trans Youth Is Neither New nor Experimental: A Timeline and Compilation of Studies, May 16, 2023