Illustrated by Sivan Ellman

Transgender Healthcare Has Always Been Feminist

In the early 1970s, a young woman walked into the Gender Identity Service in Boston. She was twenty-five years old, a “radical lesbian,” most likely wearing blue jeans and a t-shirt. 

She was angry.   

She told the clinic staff that there was a double standard for women like her. Over the past decade, physicians and psychiatrists had instituted a series of rules governing access to clinical care: you had to act femininely, dress modestly, be heterosexual and seek marriage with a man, avoid criminal activity. You had to undergo a series of psychological tests. Only then might you receive a diagnosis, and only then access medical care. 

All that feminists were fighting for—to free women from traditional gender roles and sex stereotyping, to support women making autonomous decisions about their bodies and sexualities—seemed to not apply to her. Why? Because she was transgender.  

She told the clinic staff that trans surgeries were no different than “that of a woman seeking an abortion or a tubal ligation and claiming the right to her own body and freedom to make choices that concerned her alone.” In other words, “my body, my choice” applied to her just as much as it did to cis women. 

Fifty years on, transgender healthcare has suddenly become a political lightning rod in the U.S. ‘culture wars.’ But it wasn’t really like that then. In the 1970s, dozens of well-respected university hospitals and medical centers operated Gender Identity Clinics where transgender patients received hormone therapies and surgeries. These practices were applied, studied, and refined by some of the leading researchers and clinicians in the country. News media reported breathlessly on the success of each new innovation in so-called sex reassignment.

But what anti-trans feminists failed to see, then and now, is how hard trans women were fighting to access medical care, and how deeply feminist that was.

A small minority of anti-trans feminists argued then, as they do now, that trans medicine is some kind of misogynistic ‘mutilation,’ part of a larger cultural project of erasing women’s bodies and destroying women’s spaces. The roots of this thinking formed in the 1970s, when feminist scholars such as Mary Daly and Janice Raymond published books attacking the medical-industrial complex. They highlighted the sexist and racist roots of gynecology and the straight male-dominated field of transgender medicine—all attempts by elite men to control women’s bodies. But what anti-trans feminists failed to see, then and now, is how hard trans women were fighting to access medical care, and how deeply feminist that was. 

In her groundbreaking essay, “The Transfeminist Manifesto,” the activist and writer Emi Koyama outlined the synergies between women’s reproductive freedom and transgender healthcare. Koyama argued that a key feminist tenet of bodily autonomy encompasses a diverse range of interrelated movement goals: access to birth control, access to abortion, opposition to forced sterilizations, and access to trans healthcare. If we support a women’s right to choose, her right to bodily autonomy, then this clearly includes her right to choose to change her body as she pleases. 

In fact, when we think about the mechanics of trans medicine, there is nothing extraordinary about the options on the table. For example, I take spironolactone every morning, which suppresses my testosterone, but it is also commonly prescribed for acne. I take synthetic estrogen, similar to what is in a birth control pill. If I receive surgeries to remake parts of my body, perhaps I will have breast augmentation or breast reduction, a gonadectomy or a mastectomy, a ‘nose job’ or facial feminization surgery. We cannot easily distinguish the types of treatments that cisgender women and transgender women request or receive. The distinction is not in the mechanics of care, but rather who is receiving the procedure and why. 

These linkages could not be clearer than in the current fight over mifepristone, an abortion medication. Mifepristone works by blocking progesterone in the body. It is a hormone blocker. In a court opinion supporting a federal ban on mifepristone, a Texas judge claimed, despite over twenty years of use in the United States, that mifepristone remained experimental and ‘unsafe.’ This is the same language politicians use to ban gender-affirming care—including similar hormone blockers—despite nearly sixty years of use in the United States. It is clear that the conservative position on hormones is that people should not have access to hormonal medications in any form: whether to prevent a pregnancy, to end a pregnancy, or to transform one’s body. 

Historically speaking, women’s access to healthcare is all tangled up among cisgender and transgender women. Joanne Meyerowitz, in her book How Sex Changed, demonstrated that intersex and trans people’s bodies set the stage for second-wave feminism’s emergence in the 1960s. Part of this shift was the development of new language around “gender” and “gender identity” that originated among doctors studying intersex and trans patients. The term “gender identity” was invented in the 1960s to recognize that a person’s internal sense of self may not conform with the stereotypical expectations associated with that person’s biological sex. This concept opened the doors for cis women to fight for their own autonomy to live and work and love in ways that similarly challenged normative expectations associated with their sex.

The birth control pill, which became available to women in 1960, set the stage for the so-called Sexual Revolution—supporting the idea that women’s sexual lives were no longer tied to biological reproduction. Trans women were also taking estrogen in the 1960s, consequently growing breasts and redistributing body fat—supporting the idea that women’s bodies were no longer determined by biological sex alone. 

In the 1970s, Black feminists made headway in articulating a critique of second-wave feminism that recognized the important differences among women. They challenged what is called essentialism, the false idea that all women share the same experiences. The Combahee River Collective, a Black feminist group based in Boston, famously put out a statement in 1977 arguing against the idea that one’s biological sex is determinant of their behavior. They stated “As Black women we find any type of biological determinism a particularly dangerous and reactionary basis upon which to build a politic.” Black feminist thought then provided the intellectual grounding for trans women to also articulate an anti-essentialist understanding of diversity among women’s bodies. 

Recently I visited the University of Virginia Medical School to learn more about the history of trans medicine. In their archives I discovered a film recording from 1977 documenting a school forum on transsexuality. At the front of the classroom sat four white male professors, all experts in the field. In the audience were medical students and residents interested in learning more about trans medicine.  

During the Q&A, two women from the audience came up, in turn, to share their reactions at the microphone. The first one wanted to talk about menstruation. Regarding trans women, she asked the panel, “How can a man who has never gone through this [menstruation], say he feels like a female?” “Unless you can put ovaries in the male and let him go through this every month,” she continued, “I don’t think he’s a complete female.” 

Then the other woman approached the stage. Actually, many women have had hysterectomies, she stated, facing back toward the audience. If I was in that situation, I’d sure still like to be considered a woman. She placed down the microphone and returned to her seat. 

That scene in a lecture hall over forty-five years ago reveals the ways that trans medicine has long challenged and shaped feminist thought and practice. The second woman challenged the essentialist beliefs of the first on the nature of women’s bodies. The protest of the lesbian feminist trans woman at the gender clinic in Boston a few years earlier clearly framed transitioning as a feminist issue. 

Trans medicine has a long and complicated history. It is a scientific and medical practice that inspired the idea that gender is not the same as sex, giving rise to a second-wave movement against assigned gender roles and sex stereotyping. It is an arena of medicine in which white cis men exercise great control, yet women have fought back in defense of their own bodily autonomy. It is a set of practices involving hormonal treatments and surgeries akin to the hormones and surgeries used to prevent and terminate unwanted pregnancies. Transgender healthcare is a feminist project. It benefits all of us in our collective fight for bodily autonomy. 

Dr. G. Samantha Rosenthal is Associate Professor of History, Coordinator of the Public History Concentration, and Co-Coordinator of the Gender and Women’s Studies Concentration at Roanoke College in Salem, Virginia. She is the author of two books, most recently Living Queer History: Remembrance and Belonging in a Southern City