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    Trans People Have Existed For Thousands Of Years And Other Things You Should Know About Trans People

    A brief history of the first documented cases of transgender individuals, hormone replacement therapy, gender confirmation surgeries, and trans rights.

    An image of hands holding up flags for Trans Rights
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    In 2021, it seems that the LGBTQ community is massive. Every year (with the exception of 2020), people in every major city in the United States, and many countries all over the world, get together to celebrate Pride Month. I have spoken to many individuals who don’t recall having heard of transgender people until the early 2000s, when countries all over the world (and some US states) began to pass anti-discrimination laws protecting trans people and the trans community became more robust. But if we take a look at the history of being trans, we actually find a rich and complex history of identity and transition. I'll be your trans guide today as we go through a sampling of trans history!

    Going as far back as 12,000 years ago during the Neolithic and Bronze Ages, unearthed drawings and sculptures give us some insight into the early existence and depictions of potential trans people in ancient civilizations. In some indigenous cultures, they are called Two-Spirit. In India, they are called Hijra. Trans people have existed and do exist in cultures around the globe. Let's look at 10 modern examples of trans women and men who have paved the way and contributed to science through their transitions.

    A black and white image of Lili Elbe
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    1. Lili Elbe (1882–1931)

    Lili Elbe is perhaps one of the more famous trans women in the last few centuries. She was one of the first-known recipients of gender confirmation surgery. Lili began experimenting with dressing as a woman after her wife Gerda asked her to pose for a painting wearing women's clothing. Lili quickly realized how at home she felt dressing as a woman and began doing so full-time. She received several surgeries from 1930 to 1931 and died of complications from a failed uterus transplant. She was the second-known trans woman to undergo vaginoplasty. In 2015, Eddie Redmayne starred in the film adaptation of Lili's life titled The Danish Girl.

    2. Dora Richter (1891–1933)

    Dora began displaying more feminine desires and characteristics at a young age, and attempted to remove her penis at age 6. She was allowed to live as a female after this incident. Throughout her life, she was arrested several times for cross-dressing and was eventually referred to Dr. Magnus Hirschfeld, a Jewish German doctor who was studying the relationships between gender identity and biological sex and who had performed gender confirmation surgeries. Dora is the first-known trans woman to undergo gender confirmation surgery and the first to undergo vaginoplasty. In 1933, the Nazis attacked Institut für Sexualwissenschaft (translated as "Institute for Sexology"), the institute founded by Dr. Hirschfeld that also employed trans people. Dora perished in the attack.

    3. Lucy Hicks Anderson (1886–1954)

    Lucy Hicks was one of the first-known Black trans women. She was born in Kentucky and wanted to present as a girl from a very young age. Surprisingly, a doctor recommended she be raised as a girl to offset the gender dysphoria. She fought for her own marriage equality, as she had been accused of lying under oath for not disclosing she was born male. She was quoted in saying, "I defy any doctor in the world to prove that I am not a woman."

    4. Coccinelle (1931–2006)

    Coccinelle was a French actor and showgirl, and was one of the first trans women to receive hormone replacement therapy and undergo gender confirmation surgery. Her surgery and marriage led France to not only allow trans people to marry but also allow trans people to alter their birth certificates after undergoing gender confirmation surgery. Coccinelle later founded a number of trans-related organizations.

    5. Christine Jorgensen (1926–1989)

    Christine Jorgensen was a World War II veteran who began transitioning after military service. She received several surgeries and, upon returning to the United States, was instantly famous. She went on to perform as an actor and nightclub entertainer, as well as a singer. She spoke on being transgender and wrote an autobiography in 1967, and was considered the first transgender celebrity in the United States.

    6. Jack Bee Garland (1869–1936)

    Jack Bee Garland, also known as Beebe Beam, joined the US Army in 1899. While accompanying the army in the Pacific theater of the Spanish-American War, he was discovered as having been born a female by the captain of his ship and wasn't allowed to board the ship again. His fellow soldiers hid him on board until they were sailing away from Hawaii. He spent time in the Philippines working as a nurse and interpreter before returning to the United States and becoming an author. He spent the rest of his life doing charitable organizational work.

    7. Dr. Alan Hart (1890–1962)

    Dr. Alan Hart was born and raised in Oregon. As an adult, he sought medical assistance to help him transition and live as a man full-time. Dr. Joshua Gilbert eventually performed a full hysterectomy on Hart to prevent pregnancy and stop menstruation, although synthetic testosterone wasn't yet available. After the surgery, Dr. Hart went on to get married, publish several books, and have two medical practices. He is best known for his work as an epidemiologist whose research helped diagnose and treat tuberculosis cases, lowering the death toll significantly. After World War II, Dr. Hart was able to begin hormone replacement therapy, which allowed his voice to deepen and facial hair to grow.

    8. Reed Erickson (1917–1992)

    Reed Erickson inherited his family's businesses in 1962 at age 50 and ran them successfully throughout the decade. He began his transition under the care of Dr. Harry Benjamin the following year and two years later founded the Erickson Educational Foundation. His foundation later funded numerous other organizations, including the Harry Benjamin International Gender Dysphoria Association (now known as the World Professional Association for Transgender Health).

    9. Dr. Michael Dillon (1915–1962)

    A British physician, Michael Dillon is considered the first trans man to undergo phalloplasty and receive testosterone therapy. He was also likely the first trans man to have a double mastectomy. In 1946, he published a book titled Self: A Study in Ethics and Endocrinology, in which he discussed being a trans man and the idea that it is innate and can only be treated through medical transition.

    10. Lou Sullivan (1951–1991)

    Perhaps one of the more influential trans men of the 20th century, Lou Sullivan not only helped form a community for trans masculine people, but he also helped make it easier for trans men to transition. Previously, being homosexual excluded trans men from receiving gender confirmation surgery. Lou fought this and made it possible for other gay trans men to obtain surgery services as part of their transition. He began taking testosterone in 1979 and had genital reconstruction surgery in 1986. He also founded FTM International, an organization specifically devoted to supporting female-to-male individuals, and was diagnosed with AIDS later the same year. He died in 1991 from AIDS-related illness.

    Every transition looks different, but many trans people opt to medically transition in order to treat their gender dysphoria. Here is a look at some of the history behind gender-confirming surgeries and hormone replacement therapy.

    An image of a bottle of testosterone
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    1. Vaginoplasty

    Some of the most historical work in gender transition came from Dr. Magnus Hirschfeld, a German physician who believed that gender identity was separate from biological sex. While many of the treatments for trans individuals during the 19th and early 20th centuries involved shock therapy and other inhumane treatments, Dr. Hirschfeld believed that the only reasonable treatment was to support social and medical transition. He believed that trans people should live according to their nature, which went beyond biological sex and into gender identity. His work led him to performing some of the first vaginoplasties on trans women like Dora Richter and Lili Elbe. He founded Institut für Sexualwissenschaft, which not only contributed to the advancement of understanding about the trans identity, but it also employed trans people. Unfortunately, the institute was destroyed by Nazis in 1933 and Dr. Hirschfeld was forced into exile. Its destruction erased years of research from our trans history. In 1956, Dr. Georges Burou developed his own technique for creating a vagina on trans women and performed more than 800 surgeries during his lifetime.

    2. Phalloplasty

    The first phalloplasty performed on a trans man was reportedly completed by Dr. Harold Gillies. Dr. Gillies had been performing the surgery on injured soldiers during World War I, but he agreed to perform several surgeries on Michael Dillon from 1946 to 1949 to help him fully realize his trans identity. Dr. Gillies later performed one other surgery on a trans woman using his own technique, which became a surgical standard for 40 years. These would be his only two gender-confirming surgeries during his career.

    3. Breast Removal

    During the 1970s, trans men were often unable to receive plastic surgery to remove breasts. An American surgeon named Dr. Michael Brownstein began performing these surgeries on trans men, much to the disapproval of his colleagues. The trans community benefited from his experience for 35 years. He retired at the end of 2012. Breast removal (also referred to as top surgery) is now widely performed by many plastic surgeons as a treatment for gender dysphoria.

    4. Hormone Replacement Therapy (HRT)

    Synthetic testosterone and estrogen didn't become available for use until the 1930s. They allowed trans individuals to receive a more-complete physical manifestation of gender identity. HRT for trans women encourages breast development, softer skin, redistribution of fat, and a decrease in body hair, while HRT for trans men can cause scalp hair loss, a deepening voice, and facial and body hair growth. While not all trans individuals opt for HRT, it can be a great way to obtain those secondary sex characteristics that help us appear more feminine or masculine.

    The journey for trans rights hasn’t been easy, and is far from over, but we’re now seeing more and more support for the trans community and trans individuals. This includes providing trans people with adequate healthcare, reducing stigmatization, providing legal avenues for transition, such as gender markers and name changes, and reducing discrimination. Let’s explore each of these individually.

    An image of a march for transgender rights
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    1. Standards of Care

    Dr. Henry Benjamin, an endocrinologist from the United States, was studying trans issues and helping pave the way for trans healthcare across the country. He had spent time with Hirschfeld and also believed that the treatment for gender dysphoria was a medical one, rather than psychotherapy. He went on to found the Henry Benjamin International Gender Dysphoria Association in 1979, which is now widely known as the World Professional Association for Transgender Health (WPATH). WPATH has provided doctors and therapists with standards of care in treating transgender patients. This includes guidance on hormone therapy, surgeries, and other treatments for trans individuals.

    2. Stigmatization

    In 1980, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-3) included a controversial diagnosis of gender identity disorder, which would later be updated to gender dysphoria in the 2013 DSM-5. This stigmatized the trans identity and further perpetuated the idea that being trans was the result of a mental illness. Although the current understanding is that being trans is not, in of itself, a mental illness; rather, the distress felt from the gender dysphoria is. In 2019, the WHO determined that gender identity disorder was no longer a mental illness. This was, in part, due to the stigma it was causing, as well as an overall better understanding of the transgender identity.

    3. Legal Implications

    In recent years, we've seen a real turning point in trans rights and access to healthcare. In 2012, Argentina enacted a law that allowed anyone over age 18 to choose their gender identity, have legal documents changed, and go through gender confirmation surgeries and hormone therapy. Other countries around the world began enacting similar laws to remove barriers for trans people to seek and receive treatment. In the United States, trans people have many rights and protections for seeking transition-related healthcare.

    4. Discrimination

    While there have been significant strides forward, trans people still report that they are facing discrimination at work, including harassment, refusal to hire, and physical and sexual assault. Additionally, trans children face bullying in school, and many feel unsafe, are unable to use the correct name and pronoun, and either avoided using bathrooms due to safety concerns or were forced to use a bathroom or locker room that did not align with their gender identity. But as the world changes and our understanding of what it means to be trans changes and expands, we'll see more social, medical, and legal awareness and protections that will help trans people live authentic and fulfilling lives.

    So you've read this article on the history behind the trans identity. We've covered the history of trans individuals, transition, and rights. What's next? If you're a trans individual reading this, this is me reminding you that you are worthy, deserving of care. If you're cisgender, I have a mission for you: Commit to being an ally today and every day you're alive. Let's talk briefly about how to do that!

    An image of a hand holding up a sign that says, "United for trans equality"
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    1. Know that there are many ways people express their gender identity. This may or may not include medical transition, changes to name and pronouns, updates to legal documentation, mannerisms, and physical expression through clothing, hair, etc. There is no right or wrong way to be trans so make sure you're not engaging in gatekeeping behaviors.

    2. Get in the habit of introducing yourself by your name and pronoun. This helps make it safer and more comfortable for trans people to do the same, and it normalizes the common use of introducing oneself this way. Speaking of pronouns, be sure to not assume someone's pronouns. If you make a mistake, apologize sincerely (and briefly). In other words, don't make your mistake a big deal.

    3. Be polite and don't ask trans people personal questions such as what surgeries they've had, how they have sex, or about their genitalia. A good rule of thumb is if you wouldn't ask a cis person you don't know about it, don't ask a trans person. If you are still curious and you know them already, you can ask something like, "Do you mind if I ask you some personal questions regarding your transition?" Just make sure to be respectful if they decline.

    4. Probably one of the most important ways you can be an ally is keeping confidentiality. This means that if you know a person is trans, don't gossip or share that information with anyone. Like superheroes, their trans identity is a secret and sharing that information with someone else could create a dangerous situation for them.

    If you are a trans person in crisis, reach out to the Trans Lifeline at (877) 565-8860. Additionally, the National Suicide Prevention Lifeline can be reached any time at (800) 273-8255. You are not alone and you are worthy of love and life.