Transgender History Part One

There were a number of people asking me why our public plans in North Dakota don’t cover transgender surgery. The easy answer to this is that they don’t legally have to, but I feel it is more important to understand the history that led to there being no coverage. Specifically, I’ll be going over the history of being transgender by looking at how culture, medicine, and feminism have viewed transgender individuals and the effect these forces have had on each other and on trans lives.

Transgender history goes way, way back. Nearly all of recorded history features cultures that have had more than two genders. Oftentimes gender-variant individuals were the priests or priestess of a given society; honored and revered.

The United States has always had strict gender roles, but even in our own history, we have recorded cases of people living a gender different than what was assigned at birth. Our history books mention women dressing as men to enlist in time of war, but what they fail to mention is how many continued to live as men after the war was over.

There are people who think being transgender is something new or a fad, but that just isn’t the case. Instead, what we have are cultures that embrace our ability to be authentically ourselves and cultures that oppose that notion.

The United States strongly opposed that notion until the 1950s, when Christine Jorgensen made headlines with, “GI Becomes Blonde Bombshell”. She was the first American to undergo what was then called sexual reassignment surgery and surprisingly she came home to a country that was very warm and receptive to her. I think what contributed to the initial impression was it happened shortly after World War II, when we as a nation were ready for the future and the possibility of changing one’s sex was at the forefront of new technology.

While Christine became a figurehead for being transgender, the person behind the scenes was an endocrinologist and sexologist by the name of Dr. Harry Benjamin. He was the only person willing to help transgender individuals be their authentic selves. Before him, medicine treated transgender individuals as sexual deviants who were mentally ill, a foundation that ended up casting a long shadow of pathologization for transgender identity that still continues today.

The work of Dr. Benjamin was groundbreaking because there was no medical literature on the subject of transgender individuals or transitioning before his book “The Transgender Phenomenon.” His work on the subject eventually became known as the Standards of Care, which is the model that doctors follow when treating transgender patients, that has been updated a number of times since its inception.

Unfortunately, there was no shortage of sexism in the medical fields during the early nineteen-sixties. If someone wanted access to hormones or surgery they had to fit specific criteria: the person had to identify as a woman from a very young age, always wear dresses and makeup, be attracted to men, but not gay men, and live as a woman for two years prior to hormones. The two year period was known as the real life test. They had to disavow all contact with the people they knew before transitioning.

These criteria existed because that is what they believed a woman was, and they tried to force trans women into that narrow, hyperfeminine, sexist notion of being a woman. One endocrinologist at the time even said he only gave treatment to the transgender women he was attracted to, because, since he isn’t gay, they must be women. The criteria themselves became self-fulfilling prophecies, because transgender individuals desperate to get treatment had to following the script and the whims of the endocrinologists. Then, since they encouraged these trans women to move and start a new life after transitioning, we as a people became mostly invisible.

This was the common practice until 2011, when “Standard of Care, Version 7” came out and rebranded itself as a guideline that recognized there were plenty of ways to live authentically. It discouraged the real life test as a gatekeeping tool and no longer suggested the person move to blend in.

Around 2012, most major medical organizations decreed transgender treatment safe, effective, and medically necessary.

In 2013, gender identity disorder was finally removed as a medical classification and mental disorder, which helped to stop the stigma around transgender identity.

In 2016, the American military dropped its ban on transgender people being allowed to serve.

What happened over the last forty years to make such a rapid change in the last five years? Well, next week we’ll be looking at how these medical practices influenced and were influenced by feminism; and in doing so, find out why insurance companies continue to deny medically necessary surgery.

[Editor’s note: Faye Seidler is the North Dakota Safe Zone Project Spokeswoman]