Several themes run through the clinical treatment of transgender-related behavior from the 19th century to today:

• A shift away from a purely mental-health framing of gender dysphoria, toward an increasingly medical one

• Rising politicization of treatments (surgery, hormone therapy, puberty blockers)

• Availability that has shifted over time — some providers ceasing treatment, some states banning it

• Evolving terminology (transvestite, transgenderism, transsexual, transgender, gender identity disorder, gender dysphoria)

• Ongoing bioethical debate around treatment

• Tension between a patient-rights framing and a patient-safety framing — especially for minors, where clinicians weigh a young patient's wish to pursue treatment quickly against a slower, more diagnostically precise approach meant to reduce the (relatively rare) risk of later regret, given that some changes are irreversible

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Timeline: 19th century origins

• People uncomfortable with their biological sex and associated gender roles have appeared in medical literature since the mid-1800s (Koh, 2012).

• Johns Hopkins opened the Brady Urological Institute in 1915, developing a surgical protocol — under surgeon Hugh Hampton Young — for assigning binary sex to patients diagnosed with "hermaphroditism" (today's term: intersex), a distinct condition from gender dysphoria, but one whose treatment history intersected with later transgender care (Gill-Peterson, 2018).

 

Early clinics and terminology (1917–1957)

• Alan Hart transitioned with medical assistance from the University of Oregon in 1917–18 (Gill-Peterson, 2018).

• Endocrinologist Harry Benjamin treated his first patient described as a "transvestite" in the late 1920s (Gill-Peterson, 2018)

• New synthetic hormones (e.g., stilbestrol, 1938) began to be used at the Brady Institute starting in the 1930s.

• By 1938, people we might now describe as transgender were seeking treatment at the Brady Institute, having heard that hermaphroditism could be treated with surgery or medication.

• The DSM's first edition (1952) included "transvestism" as a sexual deviation, but nothing resembling gender identity disorder.

• Terminology sharpened through the 1950s: Benjamin distinguished "transvestism" from "transsexualism" (1954); John Oliven proposed "transgenderism" (1955); John Money argued gender is a social construct, distinct from biological sex (1957) (Koh, 2012).

 

First gender clinics and standards of care (1966–1979)

• The first U.S. gender identity clinic opened at Johns Hopkins in 1966, founded by John Money.

• Harry Benjamin published The Transsexual Phenomenon (1966), arguing transsexuals were distinct from transvestites and advocating hormone therapy and surgery over psychotherapy alone.

• Eight more university-based clinics opened through the 1970s, including one at Baptist Medical Center in Oklahoma City.

• The Harry Benjamin International Gender Dysphoria Association (HBIGDA) formed in 1978, publishing the first Standards of Care in 1979; it was renamed WPATH in 2006.

• By the early 1970s, two clinics (University of Washington, University of Minnesota) had already stopped offering these services.

• In 1977, after learning that Baptist Medical Center surgeons were performing gender-affirming surgery, the Baptist General Convention of Oklahoma voted to prohibit it going forward — despite surgeons' own argument that "if Jesus Christ were alive today, undoubtedly he would render help and comfort to the transsexual."

• Johns Hopkins announced in 1979 it would close its clinic, citing Jon Meyer's study finding the surgeries "subjectively satisfying" but offering "no objective advantage in social rehabilitation."

 

Diagnosis, insurance, and terminology (1980–2016)

• DSM-III (1980) added "gender identity disorder" and "transsexualism."

• "Gender identity disorder" was renamed "gender dysphoria" in DSM-5 (2013) — a compromise with advocates, including from social work, who wanted it removed entirely.

• Medicare ended its blanket denial of coverage for transition-related surgery in 2014.

• The federal government extended ACA Section 1557 non-discrimination protections to gender identity in 2016.

• Media reports in 2016 noted a "second wave" of U.S. hospitals beginning to offer gender-affirming surgery.

• Johns Hopkins restarted gender transition surgeries in 2017.

• The WHO reclassified gender identity disorder as "gender incongruence" in 2019, moving it out of the mental disorders chapter of ICD-11 and into the sexual health chapter.

 

Expanding protections, then legislative restrictions begin (2020–2021)

• In June 2020, federal non-discrimination protections for transgender health coverage were briefly eliminated, then a federal judge blocked that removal two months later — sandwiched between a Supreme Court ruling the same month that sex discrimination law covers sexual orientation and gender identity in employment.

• President Biden signed an executive order on gender identity and sexual orientation discrimination in January 2021; HHS extended related protections under Title IX in May 2021.

• Starting January 2021, multiple state legislatures began considering bills restricting youth treatment; Arkansas passed the first in March 2021. By February 2023, five states had such laws in effect, with Alabama's among the strictest (a felony for providers). By April 2023, thirteen states had restricted youth care. A current state-by-state list is available.

• The VA reversed its 2013 ban and began covering gender confirmation surgery for veterans in June 2021.

 

Restrictions extend to adults, and legal challenges begin (2023)

• In February 2023, five states introduced bills restricting adult care; Missouri became the first to enact such restrictions in April 2023, requiring 18 months of psychiatric assessment before care. By April 2023, seven states restricted Medicaid coverage for gender-affirming care at any age, while Maryland expanded its Medicaid coverage instead.

• By June 2023, 17 states had banned or significantly restricted youth care; the same month, a federal judge struck down Arkansas's ban — a closely watched case expected to eventually reach the Supreme Court.

• The U.S. Conference of Catholic Bishops voted in June 2023 to begin drafting its first bioethics directives on transgender care for Catholic hospitals.

• The American Academy of Pediatrics reaffirmed support for youth gender-related treatment in August 2023 while commissioning its own systematic evidence review, echoing similar European reviews weighing patient rights against patient safety.

• Transgender youth and families in Tennessee petitioned the Supreme Court in November 2023 — the first such case to reach that level.

 

International shifts and U.S. Supreme Court rulings (2024–2025)

• England's NHS restricted youth gender treatment in April 2024 after a four-year review citing insufficient evidence of benefit — the fifth European country to do so since 2020.

• In January 2025, the federal government restricted gender-affirming care for those under 19; hospitals began postponing or canceling related appointments, though a federal judge temporarily blocked the order weeks later.

• In May 2025, HHS released a report questioning WPATH's standards of care and favoring behavioral therapy over broader gender-affirming care; a November 2025 update disclosed that all its authors had previously criticized youth medical transition.

• The Supreme Court upheld Tennessee's youth-care restriction law in June 2025 (6–3), shielding similar laws in 20+ other states.

• In July 2025, several major hospital systems — including Children's Hospital LA, UChicago Medicine, Children's Hospital DC, and UPMC — announced reductions in youth gender-related treatment, spanning both politically conservative and liberal regions.

• Also in July 2025, King's College London announced a major longitudinal study of up to 3,000 transgender and gender-nonconforming youth in NHS care.

• In August 2025, twelve states sued the federal government over the related executive order, and the DOJ subpoenaed hospitals for extensive patient records.

 

Most recent developments (2025–2026)

• HHS proposed rules in December 2025 that would strip Medicare/Medicaid funding from hospitals providing gender-related care to minors — a significant threat given these programs account for nearly 45% of U.S. health spending.

• In February 2026, the American Society of Plastic Surgeons and AMA recommended delaying gender-related surgery for minors until age 19, a shift from the AMA's earlier position (May 2025) against banning care; the American Academy of Pediatrics has not adopted a similar blanket recommendation.

• In March 2026, the Supreme Court rejected a Colorado law banning conversion therapy for minors, with implications for 20 other states' similar laws.

• In May 2026, as part of a settlement, Texas Children's Hospital announced plans for the nation's first clinic focused on detransition care; the same month, NYU Langone disclosed a federal subpoena seeking records on adolescent patients from the past six years.

• In June 2026, Mount Sinai received a similar subpoena; by month's end, a federal judge ordered the DOJ to stop seeking such records from NYC-area hospitals.

 

The citations on this page come from the research literature and other publications and are available upon request.