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Origins of Gender Affirmation Surgery

The History of the First Gender Identity Clinic in the United States at Johns Hopkins

Siotos, Charalampos MD*; Neira, Paula M. JD, MSN, RN, CEN*†; Lau, Brandyn D. MPH, CPH†‡§∥¶; Stone, Jill P. MD*; Page, James MBA#; Rosson, Gedge D. MD*∥; Coon, Devin MD, MSE*†

doi: 10.1097/SAP.0000000000001684
Research: PDF Only

Background Gender-affirming care, including surgery, has gained more attention recently as third-party payers increasingly recognize that care to address gender dysphoria is medically necessary. As more patients are covered by insurance, they become able to access care, and transgender cultural competence is becoming recognized as a consideration for health care providers. A growing number of academic medical institutions are beginning to offer focused gender-affirming medical and surgical care. In 2017, Johns Hopkins Medicine launched its new Center for Transgender Health. In this context, history and its lessons are important to consider. We sought to evaluate the operation of the first multidisciplinary Gender Identity Clinic in the United States at the Johns Hopkins Hospital, which helped pioneer what was then called “sex reassignment surgery.”

Methods We evaluated the records of the medical archives of the Johns Hopkins University.

Results We report data on the beginning, aim, process, outcomes of the clinic, and the reasons behind its closure. This work reveals the function of, and the successes and challenges faced by, this pioneering clinic based on the official records of the hospital and mail correspondence among the founders of the clinic.

Conclusion This is the first study that highlights the role of the Gender Identity Clinic in establishing gender affirmation surgery and reveals the reasons of its closure.

From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine;

Johns Hopkins Center for Transgender Health, Johns Hopkins Medical Institutions;

Russell H. Morgan Department of Radiology and Radiological Science,

§Division of Health Sciences Informatics, and

Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore;

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; and

#Office of Diversity and Inclusion, Johns Hopkins Medical Institutions, Baltimore, MD.

Received June 18, 2018, and accepted for publication, after revision September 7, 2018.

Conflicts of interest and sources of funding: none declared.

Ethical approval: The article conforms to the Declaration of Helsinki.

Reprints: Devin Coon, MD, MSE, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Center for Transgender Health, 601 N. Caroline St, Baltimore, MD 21201. E-mail:

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