The medical history of gender transition

A brief overview of procedures from the 1930s to today

Kieran guimond SCIENCE EDITOR

With the start of 2023 ushering in a wave of anti-transgender bills in the United States, it’s never been more important to understand the rich medical history linked to gender transition. Multiple states are currently in the process of trying to ban hormone therapy and gender-affirming surgery for minors, and two states are attempting to ban any form of medical transition to those under 26. Gender transition is a rich and fascinating field of medical research, and there have been great advancements over the years.

1931: Vaginoplasty

There have been many different forms of this surgery, all of which entail the creation of a vagina. It is believed that the first example of this was performed at the Institut für Sexualwissenschaft (Institute for Sexual Science) on a woman named Dora Richter. This is considered one of the first full gender reassignment surgeries. In 1956, Dr. Georges Burou innovated the surgery and developed the penile inversion vaginoplasty. This method is still commonly used today.

1933/1939: Hormone Replacement Therapy

The use of hormones as a part of gender-reassignment surgery is quite interesting, as the majority of research on the history of this procedure relates to cisgender women taking estrogen post-menopause. Estrogen was first purified and isolated in 1929, and five years later, it became available as a commercialised medication. It is unknown when estrogen was first used by transgender people, but it was reportedly used at the Institute for Sexual Science, which means that it must have been used prior to the institute’s destruction by Nazis in 1933.

In 1929, it was discovered that testosterone could be isolated from urine, and then in 1939, testosterone was artificially synthesised. This was used as a method of treating hormone deficits in cisgender men from the 1930s to the 1970s; the first recorded use of this for a transgender man occurred in 1940.

1936/1946: Phalloplasty

The first example of phalloplasty—the creation of a penis—occurred in Russia in 1936. A doctor was able to reconstruct a penis using an abdominal flap and rib cartilage. However, it was not until 1946 that the surgery became popularized by an English doctor named Harold Gillies. Abdominal flaps were used for reconstruction until the 1980s, when surgeons switched to using skin from the forearm—a technique which is still used today.

The Future

There are still many areas of research to explore in regard to gender-affirming care—for example, uterine transplants. This procedure is already possible for cisgender women who are born without a uterus; there have even been examples of people with transplanted uteruses giving birth. According to an article published by researchers from Temple University, uterine transplants may become available for transgender women sooner than we think. Although different forms of surgery and treatment have changed and improved over the past 90 years, there is still plenty of room for progress.