Relationships between transgender patients, their physicians explored in ‘Medicalization’ history

The endeavor of individuals who want to medically change their gender has become a hot-button topic in contemporary society. But it’s actually been part of the cultural dialog for more than a century.

“The understanding is that it has always been a one-sided relationship,” said Marta Vicente, a professor of history and of women, gender & sexuality studies at the University of Kansas.

“The argument has been that scientific and medical developments in the 20th century made ‘sex-reassignment’ surgery possible, which helped the patients. What I see instead is that people seeking medical help were part of a relationship with surgeons and physicians, and each group benefited from it.”

Her new article titled “The Medicalization of the Transsexual: Patient-Physician Narratives in the First Half of the Twentieth Century” explores the history of what was labeled in 1966 as “the transsexual phenomenon.” This study reveals how the newsworthy narrative was created from the intersection of interests from both patients and their physicians, and how the media’s coverage of this factored into the process. The article appears in the Journal of the History of Medicine and Allied Sciences.

“People’s lives are shaped so much by the possibilities medical technology has to offer,” Vicente said. “This dilemma concerns who is in control. Is the patient in control? The physician? Who has the agency to decide how a body is transformed? By examining the relationship between these doctors and their patients, it’s valuable to see how it was shaped by interest from both parties.”

Vicente’s piece analyzes three historical narratives: the medicalization of the homosexual, the birth of the transsexual and the physician-patient relationship in transsexual narratives.

Throughout these phases, the media took on a “very important role in shaping this conversation,” she said.

“Physicians and journalists had different audiences and targets. They were highlighting specific aspects of the transformation without really getting at the complexity of the experience. Especially for the American component of the media, it was the sensation of how bodies can be transformed by medical science. They all paid close attention to the surgery, while in fact, the journey of the transsexual started with endocrinologists and the emphasis on hormones.”

The media helped make celebrities out of several individuals during this formative medical era. The first was Lili Elbe, whose story provided the basis for the Oscar-winning 2015 biopic “The Danish Girl.”

“I didn’t care for that movie,” Vicente said. “But it’s based on a novel inspired by the lives of Lili Elbe and Gerde Wegener, and I was totally taken by the facts of the story. It’s very tragic. She died shortly after her last surgery (in 1931). While she was having the surgery, it was on the front page of American newspapers—like the Omaha World-Herald. Everyone knew about Lili.”

Even better known was the account of Christine Jorgensen, an American Army veteran seeking a sex change who became an international celebrity in the 1950s.

“Everyone was waiting for this case to happen—it had been building up for decades—and then it burst,” Vicente said.

Although Jorgensen’s surgery was successful, her engagement to Howard Knox stalled when New York refused to grant them a marriage license because her birth certificate listed her as male. She became a trailblazer for transgender rights, along with gaining fans as an actress and popular nightclub entertainer.

“Nowadays, transgender scholars have criticized Jorgensen as someone who fell into this feminine stereotype of the 1950s as the perfect housewife,” Vicente said. “While they recognized her role as a pioneer of transgender rights, they were critical of how much she tried to fit within the system. But if you look at all those cases carefully, you see that there are more nuances.”

As noted in Vicente’s article, “once sex-reassignment surgery was legalized in the United States, physicians, sometimes aided by the law, would refuse to operate on a body that did not fulfill the requirements of ‘the good transsexual,’ one that was white, heterosexual and displaying the expected middle-class characteristics of a good wife or husband.”

While the drama surrounding those standards appears somewhat antiquated, a contemporary controversy remains: language.

“How do you talk about gender identity, all those people and their experiences, when the current terms did not exist? How do you bypass the fact that ‘transsexual’ was a word not widely used until the 1960s? Now some individuals may find it offensive to be called transsexual instead of transgender. But before transsexual, people were using words such as androgynous, homosexual and hermaphrodite,” she said.

“So it’s a challenge using words that mean something only in a historical context while still being able to provide an umbrella to understand experiences that trespass different historical contexts.”

A native of Barcelona, Vicente has been at KU since 1997. She is the author of “Debating Sex and Gender in Eighteenth-Century Spain” (Cambridge, 2017). Her expertise centers on queer studies, queer theory, feminist history and sexuality.

“I hope this article adds to the new amount of research being done in how much we need the historical understanding of transgender history and how this is going to reveal more about the construction of gender,” Vicente said.

“Transgender history is not isolated from other issues. Ultimately, we’re all in this together.”