Insights on Gender-Affirming Care
Foundation board members Dr. Kluchin (left) and Dr. Fennoy.
Tracing the path to inclusive healthcare practices
Pride Month is truly a cause for celebration. Most women in medicine can remember a time when gender identity, gender expression, and sexual orientation were not a part of the national dialogue, leaving many people feeling invisible, misunderstood, and marginalized.
The Women in Medicine Legacy Foundation was founded with the strong belief that understanding our history plays a powerful role in shaping our future. The resolute stand women took to establish their place in these fields propels our vision forward. We serve as stewards to the stories from the past and take pride in sharing them with the women of today.
Toward this end, we asked two Foundation board members for their insights about the historical role the medical community has had in advancing the understanding and acceptance of transgendered individuals, and to share their observations of the current environment for those who seek gender-affirming care.
Foundation board member Rebecca Kluchin, PhD is a professor of history at California State University, Sacramento. Her academic focus has been on reproductive justice and reproductive health care, as well as teaching lesbian, gay, and intersex history.
By 1950, gender-affirming surgeries were still unavailable in the United States, so a Bronx-born George Jorgenson, having always felt uncomfortable in her body assigned at birth, traveled overseas. Addressing the broader historical context of the Christine Jorgenson story, Dr. Kluchin states:
“Jorgensen ends up going to Europe and having gender-affirming surgery. It's a pioneering surgery. It's not the first, but it's the first American to undergo it. Then comes back to the United States to - you wouldn't imagine it- but to a fanfare! This becomes the biggest news of the year - Jorgensen coming back to New York being greeted by throngs of people.
And the story is: Medicine turned a man into a woman. [It’s a] part of this larger narrative of the Golden Age of American medicine.”
Despite this astounding reception, and new hope for transgendered people, general societal attitudes towards the trans community did not follow suit. Dr. Kluchin continues, “In that early period, it was very heteronormative. People [were still] needing [others] to be in ‘proper’ places.”
“More than a decade after Jorgensen’s surgery, in 1966, Johns Hopkins University opened its Gender Identity Clinic and became the first US academic institution to begin performing gender affirmation surgeries. Over the course of the following decade, more than 1000 Americans underwent gender affirmation surgery at the hands of surgeons at major American university clinics.” (Ethically Navigating the Evolution of Gender Affirmation Surgery, Kelsey Mumford, 2023)
Many years later, as Ilene Fennoy, MD, Foundation board member, board-certified pediatric endocrinologist, and professor of pediatrics at Columbia University Irving Medical Center was beginning her practice, she remembers the challenges that faced those seeking gender-affirming care:
“I have always been concerned about making services available for patients. I have often delved into providing services where nothing else was being provided. So that's the major reason I've gotten involved with the LGBTQ+ community in terms of making sure that services were available for those who needed them.”
Dr. Kluchin, acknowledging the prevailing issue of access to care for trans individuals, correlates this to the challenges that existed for achieving reproductive justice, more generally, in America.
“The Reproductive Justice movement comes primarily out of the black feminist movement of the 70s and 80s. Advocates like Loretta Ross who take the term reproductive justice and think about it more broadly...[addressing] all of the barriers and the structural inequalities that prevent people from having access to gender-affirming care, abortion care, prenatal care.
That is the movement that has embraced the trans community and the trans experience. It's saying ’We all deserve this right. This is what everybody should have access to when they seek medical care.’”
Dr. Fennoy recounts her early experiences as a pediatric endocrinologist,
“At the beginning, the group I dealt most with was a group that has a chromosomal abnormality known as Klinefelter syndrome. Parents were frequently seeking hormone therapy because individuals with Klinefelter syndrome are identified as persons who have reproductive hormonal deficits as adults. I started providing services first for Klinefelter and then for LGBTQ [individuals], and then our institution developed a site program fully for gender issues. I started working with [the psychiatrists and psychologists] to understand better the psychological [aspect], but also because I was providing hormone care to patients who needed to have ongoing psych support. It was good to work with [the psychiatrists and psychologists] and get confirmation that it was appropriate to be using medication for these patients, but also to help inform them about what we really could and could not do and what we knew and did not know from the hormonal perspective. It proved to be a good working relationship.”
Addressing the progress that has been made since this time, Dr. Fennoy states,
“I think there are more services readily available now than there used to be. I think parents have done a lot of research on their own, and in some cases banded together and provided their own social support. But certainly, within the endocrine community, many services, research and information sharing has been going on that wasn't there 20 years ago. This makes things very exciting, because there is real science going on helping us to improve our care delivery.”
As societal attitudes continue to change, Dr. Fennoy credits public figures — such as Dr. Rachel Levine, the U.S. Assistant Secretary for Health, and the first openly transgendered 4-star officer who has been a vocal advocate. She also credits doctors such as endocrinologist Julie Ann Sosa, MD, MA, FACS, who has used her own experiences to expose the challenges faced by LGBTQ+ residents in US general surgery training programs.
Despite the progress that has been made in the last 60 years, the recent setbacks are hard to ignore. Since the 2022 Dobbs decision, basic rights involving bodily autonomy are routinely threatened. Dr. Kluchin poses the question, “Who gets to decide what constitutes health care? Because oftentimes it's not the providers, it's the politicians. So the type of health care that is available in the present depends upon where you live. And that's been true in the past as well.”
Dr. Fennoy echoes this concern, “We're in a time where people are threatening basic infertility treatments, contraception and the focus is on just trying to maintain what we've already achieved and not go backwards.”