History of Urology Forum
Presentation Authors: Shannon Smith*, Justin Han, New Hyde Park, NY
Introduction: Gender confirming surgery (GCS), also known as transgender or gender reassignment surgery, has gained prominence in society at large in recent years. The evolution of GCS over the past millennia will be reviewed, with a discussion of the current aspects relevant to practitioners.
Methods: A comprehensive literature review (PubMed, Clinical Key, Google Scholar) was performed to elucidate relevant historical and clinical information.
Results: Transsexualism, gender dysphoria, and non-gender conforming identities have existed throughout history. Historical recordings of cross-dressing date as far back as Ancient Egypt in 1500 BC, with Queen Hatshepsut ascending to the throne wearing male clothing and a beard. In Ancient Rome in 220 AD, Emperor Elagabalus, known for his bisexual encounters, reportedly offered a reward for any doctor who could provide him female genitalia.
In 1922, Dr. Magnus Hirschfeld, widely considered to be the father of transgender health care, performed the first modern GCS for Dora Richter, the first transwoman to undergo vaginoplasty. His most famous patient was Lili Elbe, a Danish painter, who underwent multi-staged surgeries including penectomy, orchiectomy, attempted ovarian transplant, and vaginoplasty. Lili ultimately died from complications 3 months after her last surgery. She was the inspiration for the movie "The Danish Girl".
The first male to female GCS in the United States was performed in 1966 by an American urologist, Dr. Elmer Belt. Soon thereafter, Dr. John Money founded the first gender identity clinic at Johns Hopkins University, which closed in 1979. That same year, Dr. Harry Benjamin formed the organization that would become the World Profession Association for Transgender Health (WPATH), which provides uniform standards of care for the medical and surgical management of the transgender patient.
In 1980 the diagnosis "Gender Identity Disorder" was added to the DSM-5. Although at the time controversial, this provided a diagnosis that helped transgender patients gain access to the medical community with a defined condition. This term was subsequently replaced in 2013 with the term "Gender Dysphoria".
Conclusions: Currently, about 1000 GCS are performed in the US yearly. GCS is now covered by Medicare, Medicaid in 9 states, and certain private insurance companies. With its increasing insurance coverage, GCS is more accessible than ever before. With an estimated 1.4 million transgender people in the US, there is a growing need for practitioners trained to perform GCS.
Source of Funding: None