A Look Back: When did gender-affirming surgery start in the US?

September 28, 2025 •

3 min read

While groundbreaking publicly known surgeries occurred in the mid-20th century, the history of gender-affirming surgery in the U.S. dates back even further, with one of the earliest documented cases being a transgender man in 1917. The journey of when did gender-affirming surgery start in the US reveals a long history of both medical innovation and social challenges.

Quick Summary

The first documented instances of gender-affirming surgery in the U.S. trace back to the early 20th century, though the practice became more visible and organized with the public opening of clinics in the 1960s, most notably at Johns Hopkins University.

Key Points

Early Beginnings: The earliest documented gender-affirming surgeries occurred in the US in the early 20th century, though they were rare and mostly covert.
Pre-1950s Pioneers: Key early figures include Dr. Alan Hart, one of the first documented trans men to undergo surgery (1917), and Dr. Elmer Belt, who performed procedures for trans women in the 1950s.
1960s Institutionalization: The first public academic clinic to offer gender-affirming surgeries was established at Johns Hopkins University in 1966, sparking a wave of similar clinics at other universities.
The WPATH Standards: Founded in 1979 as the Harry Benjamin International Gender Dysphoria Association, WPATH created the first formal standards of care that still influence medical practice today.
Modern Advancements: The overturning of Medicare exclusions in 2014 and increasing medical specialization have significantly improved access and surgical techniques, though challenges remain.

Early beginnings in the US

Before the mid-20th century, gender-affirming procedures in the U.S. were often performed in secrecy by a few pioneering physicians. While advancements were occurring in Europe, particularly in Berlin, American medicine saw early interventions such as the hysterectomy and gonadectomy performed on Dr. Alan Hart, a transgender man, in 1917. This case highlights that transgender individuals sought medical care long before it was widely accepted. Another early figure was Dr. Elmer Belt, who reportedly performed surgeries for transgender women in California during the 1950s. These early efforts were foundational but remained on the fringes of mainstream medicine.

Increased visibility and medical discussion

The mid-1950s brought increased public awareness through the case of Christine Jorgensen, a transgender woman who had surgery in Denmark in 1952. Although her surgery wasn't in the U.S., her story received significant media attention and helped pave the way for greater understanding and medical interest in transgender care. Around this time, endocrinologist Dr. Harry Benjamin significantly contributed to legitimizing the medical field's approach with his 1966 book, The Transsexual Phenomenon, which detailed a framework for care including hormones and surgery.

Formal clinics and later challenges

Following increased public and medical discussion, major institutions began to offer gender-affirming care. Johns Hopkins University opened its Gender Identity Clinic in 1966, becoming the first public academic institution in the U.S. to offer a multidisciplinary approach including surgery. Other universities also established gender identity clinics, expanding access but often operating with restrictive criteria. However, this institutionalization faced setbacks. Johns Hopkins closed its surgical program in 1979, partly due to biased research. This led to a shift back towards private practitioners.

Dr. Stanley Biber in Colorado became a prominent private surgeon during this period. To help standardize care, the Harry Benjamin International Gender Dysphoria Association (now WPATH) was founded in 1979, establishing Standards of Care that remain influential today. You can find more on the history of WPATH at https://www.wpath.org/about/history.

Comparison of eras


Feature	Early 20th Century (pre-1950s)	Modern Era (post-2000s)
Access	Extremely limited, often covert and at high personal risk.	More widespread, though still with significant barriers related to cost and regional access.
Medical Acceptance	Generally unrecognized or seen as a psychological issue; practice was on the fringe.	Largely accepted by major medical and professional associations; considered medically necessary.
Surgical Techniques	Early, rudimentary, and risky, particularly for phalloplasty.	Significantly advanced, safer, and with more options for both feminizing and masculinizing procedures.
Standards of Care	Non-existent; relied on individual practitioners' ethics.	Guided by established professional guidelines from organizations like WPATH.
Surgical Volume	Very few known cases.	Growing number of procedures as awareness and acceptance increase.

Modern advancements and ongoing challenges

The 21st century has seen significant progress, including the removal of Medicare exclusions for gender-affirming surgery in 2014, improving access. There's also a greater understanding of gender diversity beyond a binary. Surgical techniques have advanced, and many academic medical centers have re-established or expanded their gender services. Despite these advancements, challenges such as legal restrictions, discrimination, and issues with access and cost persist. The history of gender-affirming surgery in the U.S. reflects a complex interplay of medical progress, social shifts, and ongoing advocacy.

Conclusion: A history of resilience

The origins of gender-affirming surgery in the U.S. trace back to quiet, early efforts in the 20th century. Figures like Dr. Alan Hart paved the way for later developments. While institutionalization in the 1960s marked a period of increased recognition, setbacks occurred. Despite challenges, the field has progressed significantly, driven by advocacy, medical advancements, and the resilience of transgender individuals seeking care. The history continues to be shaped by ongoing efforts for equitable access and acceptance.

Frequently Asked Questions

One of the earliest documented cases of gender-affirming surgery in the US involved Dr. Alan Hart, a transgender man, who underwent a hysterectomy and gonadectomy around 1917.

No, Christine Jorgensen, a key public figure who raised transgender visibility in the U.S., had her surgeries in Denmark in the early 1950s. She is, however, credited with increasing public awareness in the U.S., which spurred medical interest.

The Johns Hopkins clinic, which opened in 1966 as the first public academic gender clinic in the US, pioneered a multidisciplinary approach to care. However, it controversially closed its surgical program in 1979 based on biased research, which set back academic medical care for several decades.

Early surgeries were often experimental, high-risk, and performed without standardized guidelines. Today, modern gender-affirming surgery utilizes highly advanced techniques, extensive patient preparation, and follows established standards of care from organizations like WPATH.

Dr. Harry Benjamin was a key figure who helped legitimize medical care for transgender people in the mid-20th century. He published The Transsexual Phenomenon in 1966, providing a framework for treatment that included hormones and surgery. He was also a founding figure for WPATH.

Acceptance grew significantly from the 1960s onward, but faced major setbacks, particularly in the late 1970s. Greater acceptance and access returned in the 2010s, following improved surgical techniques and landmark decisions like the 2014 overturning of Medicare exclusions.

No, the desire for gender-affirming care and even early surgical interventions has a documented history spanning well over a century in the U.S. and longer in Europe. The practice has simply evolved significantly in technique, safety, and acceptance over time.