The story of the nation’s first gender-affirming surgery clinic offers both a lesson and a warning

An essay on the creation and subsequent closure of the nation’s first gender surgery (GAS) clinic in the United States offers a unique history lesson and cautionary tale for transgender physicians in the face of both existing institutional transphobia and emerging cultural backlash. The work was published in Annals of Internal Medicine.

The nation’s first GAS clinic was opened at Johns Hopkins Hospital in 1966. Its establishment was accompanied both by general academic interest and by the establishment of other university GAS clinics throughout the country. GAS was banned at Johns Hopkins in 1979, and the hospital cited a study that claimed GAS was ineffective, despite criticism of the study’s methodology and contemporary research demonstrating that GAS improved patient mental health outcomes.

Johns Hopkins School of Medicine’s Walker Magrath presents a spatial argument and analysis of why the closure of the first GAS clinic did not occur in empirical data one, but it has been manipulated to fuel political and institutional agendas. Analysis archival documents demonstrates the changing priorities and biases of the clinic’s leadership in the years before its closure, citing repeated public and private transphobic statements by both the clinic’s founding surgeon and Johns Hopkins’ head of psychiatry. The author also notes that in the same period Plastic surgery achieved several significant medical milestones, including the first kidney transplant and the appointment of a plastic surgeon as surgeon general in 1969. Archival documents suggest that the closing of the clinic was due to political and social pressure to distance plastic surgery and the institution as a whole from increasingly controversial and less respected medical procedures.

The accompanying editorial reiterates the importance of including transgender and gender diverse individuals at every stage and level of the development, planning, implementation, expansion, and maintenance of clinical services, curricula, research, and policy agendas for gender-affirming care. The authors also urge physicians to name and denounce institutional or government efforts to reduce access to gender-affirming care, offer welcoming and inclusive settings for transgender and gender-diverse patients, and require health systems to enforce non-discrimination policies that clearly reflect gender identity and expression .