Transgender is an umbrella category that emerged in the U.S. in the 1990s to encompass diverse gender identities that don’t fully correspond with an individual’s assigned sex at birth. Although local communities worldwide have adopted this term, it can also erase and collapse other diverse gender identities people have used across time, location and culture.
People who are today called trans, nonbinary and intersex have existed for centuries throughout the world. The rights of trans people have not always been up for debate in mainstream society, and nonnormative sex and gender categories appear in ancient Buddhist texts, as well as Jewish rabbinic literature. Yet colonial conquests have violently stamped out sexual and gender diversity globally.
Trans people’s right to exist has been challenged throughout time and across the world in multiple ways. Worldwide, trans people face disparities across many areas, including access to health care, legal support and economic security. Governments, global organizations and the legacies of colonialism also enact high levels of violence and stigma against them.
At the same time, 95% of global health-related organizations do not recognize or mention the needs of gender-diverse people in their work, resulting in the “near-universal exclusion” of trans people from health practices and policies. There is also a lack of holistic trans-inclusive research around the world. For instance, searching for the word “transgender” on the website for the Institute for Health Metrics and Evaluation, the global health metrics giant of the Bill and Melinda Gates Foundation that collaborates with the World Health Organization to improve global health data, currently returns zero results.
As a sociologist, I study how health outcomes are affected by various social conditions, including global economic policies, institutions and cultural values. In particular, I analyzed how government-endorsed medical tourism, or health-related travel, has affected Thai transgender women. Broadly, I seek to understand how the body acts as what French philosopher Michel Foucault calls an “inscribed surface of events,” imprinted upon by an ever-changing social context that can afford or withhold resources, rights, recognition and power.
With their health and well-being shaped by the social context worldwide, the bodies of transgender people are no exception.
History of gender-affirming care
Medical institutions and authorities are a major pathway to health and how one lives in one’s body. They define, classify and pathologize a range of human conditions, from male pattern baldness to fatness.
The German physician Magnus Hirschfeld coined the now antiquated term “transvestite” in 1910 to define those who desired to express themselves in opposition to their sex assigned at birth. At his Institute for Sexual Science, Hirschfeld offered people hormone therapy and performed the first documented genital transformation surgery. Adolf Hitler deemed Hirschfeld “the most dangerous Jew in Germany,” and the Nazis burned his research center after he fled for his life.
Despite this violence toward trans medicine, endocrinology in the U.S. and Europe advanced in the 1930s with the use of synthetic testosterone and estrogen for medical transitioning. Estrogen was first purified in 1923 and used for hot flashes, bone loss prevention and other reproductive health issues. Testosterone was isolated and synthesized in 1935 and first used to treat hypogonadism in men as well as tumor growth in women.
Puberty blockers, or gonadotropin-releasing hormone agonists, were first approved by the U.S. FDA in 1993 for children undergoing puberty too early. For trans adolescents experiencing gender dysphoria, or distress from a mismatch between their gender identity and sex assigned at birth, these medications can be critically important for their well-being. Far from being experimental, the medications have strong evidence for their overall beneficial effects for trans youths.