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October 14, 2022

Queer & Trans Medical History: Featuring Elizabeth Tate, LCMHCA, NCC, BC-TMHP

At Avance Care, we provide comprehensive care for all. Avance Care Behavioral Health Therapist, Elizabeth Tate, wrote her reflections on the month from her own personal experience.

Queer & Trans Medical History: Featuring Elizabeth Tate, LCMHCA, NCC, BC-TMHP

Happy LGBTQ History Month! For this observance, I set out to write a blog listing interesting figures, advancements, and challenges in queer and trans medicine and mental health. I wanted to capture the fullness of queer and trans folks’ experiences in medicine: the good, the bad, and the ugly. Of course, as any queer or trans person knows, there is a lot of ugly in that history. Discrimination, marginalization, and misinformation characterize much of our history in the medical fields, my own field of clinical mental health included. That said, our fields also have a proud history of advocating for and celebrating the queer and trans community as well.

I was sitting and writing this timeline when I realized I was sitting with a knot in my chest, a lump in my throat, and an ache in my heart. I was feeling sadness for the generation of my elders I never got to meet. In 2021 I visited the Stonewall Inn, location of one of the most famous protests of the mistreatment of queer and trans folks in society. I had wanted to visit since I realized I was bisexual, sometime in my teen years. Far from feeling the righteous pride I expected I felt that same knot, lump, and ache. Reflecting on the history of my community, as a bisexual woman, often comes with pain.

It was not until 1973 that homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM). Gender dysphoria is still in the DSM. Gender dysphoria is the discomfort of feeling as though your body is the wrong sex or gender in some way, and while that distress certainly can benefit from therapeutic intervention, it is only a facet of trans experience. The presence of gender dysphoria in the DSM contributes to the myth that being trans is a mental illness, when in fact being trans is a natural variance of humanity that has been present throughout history. I have learned more about being a woman from some of my trans clients than anyone else. The fullness in which they describe and experience gender is revelatory. Trans identity is not a disorder, it is a beautiful variance of humanity.

As you read through this brief retrospective on big moments in queer and trans medical history, consider how your own field may have perpetuated discrimination, marginalization, and misinformation. After that reckoning, consider how your field has advocated for, protected, and celebrated queer and trans people – and how you can continue that proud tradition. While I have felt pain in these reflections, I have also felt the breadth of queer and trans joy. I am proud to work for and with the queer and trans community in living open, full, vibrant lives.

1886: The first medical study on homosexuality was published in Germany. More research was done in pre-War Germany, but during the Third Reich this research was discontinued and even destroyed.

1943: Dr. Alfred Kinsey published his first work on human sexuality which posited sexual orientation as a spectrum, rather than two discrete categories.

1952: Christine Jorgensen, a transgender woman, becomes the first American to undergo a “sex change” surgery, now referred to colloquially as “bottom surgery.”

1966: Dr. Henry Benjamin, an endocrinologist working with trans folks in Berlin, writes “The Transsexual Phenomenon” positing that trans folks needed affirming treatment instead of a curative psychotherapy. His research is the basis of modern transgender healthcare.

1973: After long debate and an anonymous psychiatrist providing personal testimony, the American Psychological Association voted to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM) third edition.

1977: The Bay Area Physicians for Human Rights, one of the first queer medical societies, was founded.

1979: The first Standards of Care are published by the Harry Benjamin International Gender Dysphoria Association, now known as the World Professional Association of Transgender Healthcare (WPATH). These standards of care are what guide providers in helping trans clients make informed healthcare decisions.

1981: The first cases of what came to be known as AIDS were recorded. It was first noted that a clutster of Pnuemocystic carinii was found in five homosexual men in Los Angeles.

1983: The first AIDS hospital ward was opened by a group of nurses in San Francisco. The ward revolutionized patient care in a time where physicians were afraid to shake the hands of someone positive for HIV.

1992: 75,000 people died of AIDS annually in the United States.

1995: A variety of protease inhibitor drugs became available, leading to anti-retroviral therapy. These therapies revolutionized the treatment of HIV/AIDS.

2002: The US Department of Health and Human Services (DHHS) named sexual orientation as one of six factors correlated with lower health outcomes.

2004: The American Academy of Pediatrics released a paper on sexual orientation in adolescents, warning of danger from others, isolation, and increased suicide risk among queer and trans adolescents.

2005: The President of the American Medical Association, Edward Hill, became the first AMA president to address the Gay and Lesbian Medical Association.

2012: The Food and Drug Administration approves PrEP (pre-exposure prophylaxis) for the prevention of HIV. This therapy further revolutionized the management of HIV/AIDs and has been shown to be effective in reducing chances of contracting HIV.

2012: In local history, Charlotte clinicians from various healthcare backgrounds founded the Charlotte Transgender Healthcare Group, including Avance Care Midtown’s Dr. Rhett Brown! Today, many Avance Care professionals are trans-informed providers that provide transition related care including hormone replacement therapy and psychotherapy.

2020: The Gay, Lesbian, Straight Education Network (GLSEN) released their biannual school climate survey, conducted in 2019. They survey school age queer and trans youth across the United States to understand bullying, marginalization, and performance in academic realms. Notably, GLSEN found in this study that 98.9% of queer and trans youth hear homophobic and transphobic language in school. Marginalization stress such as this contributes to poor health outcomes, as noted by the US DHHS report above.

2022: WPATH released the Standards of Care, version 8.

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