Parent and Teacher Guideline for
Gender Dysphoric Youth
Figure 8. Brief History of Trans
Magnus Hirschfeld & Karl Baer
Karl M Baer, raised as Martha Baer suffered from hypospadias, a birth defect that results in the displacement of the urethra on the penis, producing ambiguity in the appearance of patients’ genitals. Baer underwent genital surgery at the Institute for Sexual Research, led by German sexologist and physician Magnus Hirschfeld. Though he was raised as female due to his condition, Baer was born male with a difference in sex development (or intersex condition).
1910
Treatment of "Psychological
Sex Disorders"
Dr. Hirschfeld opens the Institute for Sexual Science in Berlin, a first-of-its-kind clinic treating physical and psychological sexual disorders.
1922
Kurt Warnekros & Lili Elbe
Born Einar Wegener, Lili Elbe, was the first known individual to undergo a series of sex-reassignment surgeries, which were performed by German gynecologist Kurt Warnekros under the direction of Dr. Magnus Hirschfeld in 1930. Wegener died from complications from the fifth surgery in 1931. He is said to have had what we now know as Klinefelter Syndrome, also a difference in sex development.
1936
Alfred Kinsey & Sexual Revolution
Dr. Alfred Kinsey, an entomologist, started the Kinsey Institute in 1947 where Christine Jorgensen, the first American “transexual” was a client, later referred to John Money (below)
Kinsey “studied” the “sexual arousal of children” through experiments pertaining to masturbation and by collecting “data” from convicted pedophiles, ultimately proclaiming that “children are sexual from birth”
Alfred Kinsey’s research was funded by the Rockefeller Foundation who also funded Margret Sanger, founder of Planned Parenthood, the leading dispenser of synthetic sex hormones.
1952
John Hopkins Gender Clinic Opens
John Hopkins announces the opening of its gender clinic in 1966, later shut down by Dr. Paul McHugh in 1979. [This is where John Money worked].
1978
Transsexualism in the DSM
Transsexualism was included in the DSM-III.
1981
The Dutch Protocol Introduced
The puberty suppression experiment, later known as the Dutch Protocol, is first conceived of in an Amsterdam clinic with the case of “FG,” a teenage lesbian whose Italian father disapproves of her masculinity. Dr. Henriette Delemarre-van de Waal prescribes triptorelin, a puberty blocker, to FG at age 13. FG will continue with puberty suppression until age 18, followed by testosterone, a bilateral mastectomy, hysterectomy, oophorectomy, and metoidioplasty.
1988
Blanchard Coins Autogynephilia
Canadian sexologist, Ray Blanchard coins the term “autogynephilia,” meaning “love of oneself as a woman,” to describe the paraphilia experienced by heterosexual males who are aroused by the image of themselves as women, which can lead many to seek hormonal and surgical interventions.
1989
Puberty Blockers
Aimed at Younger Children
Cohen-Kettenis and Delemarre-Van de Waal begin working together to treat gender dysphoric adolescents with puberty blockers. Cohen-Kettenis uses the poor outcomes she observed in the 1988 adult study to justify early intervention in adolescents.
1993
Gender Identity Disorder Coined
Gender Identity Disorder replaces transsexualism in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders).
1997
HBIGDA Rejects
Assessment Protocols
Dr. Stephen B. Levine chairs the HBIGDA committee working on its Standards of Care 5 (SOC5) and recommends that the guidelines require patients to obtain two letters from mental health professionals before commencing hormones. HBIGDA president, Dr. Richard Green, is unhappy with this requirement, so immediately commissions SOC6.
1999
Puberty Blockers
Introduced in Canada
The CAMH clinic in Toronto Canada first treated youth with puberty blockers. The treatments were experimental and less than a dozen Canadian children were treated per year (at this time).
2006
Yogyakarta Principles Published
Yogyakarta Principles are published, advocating for the right of transgender people to self-identify as a member of the opposite sex and the right to access medical treatment to align the body with a self-declared gender identity.
2007
Gender Identity Disorder Depathologized
WPATH issues a statement urging the “depsychopathologization” of gender identity disorder, defining being transgender as a normal variation of human existence, making recommendations to the APA to change the diagnosis of gender identity disorder to gender dysphoria, a move aimed at destigmatizing transgender identities.
2012
Gender Identity Disorder
Becomes Gender Dysphoria
The APA publishes its DSM-5, redefining gender identity disorder as gender dysphoria, under pressure from activist groups including WPATH.
2014
US Medicare Ban Lifted
for Gender Affirming Care
The ban on Medicare coverage for gender affirming treatments is lifted in the US and one year later marks the uptick (up to 5000% by the early 2020's) of children and adolescents presenting to gender clinics.
2015
Early Intervention Study Buried
Dr. Polly Carmichael, head of the UK’s Tavistock clinic, presents the results of the Early Intervention Study launched in 2011. The findings show that the psychological functioning of some study participants deteriorated. The Tavistock clinic only publishes the results in 2021 after significant pressure from researcher Dr. Michael Biggs.
2017
ROGD Coined by Lisa Littman
Dr. Lisa Littman coins the term “rapid onset gender dysphoria", outlining the ROGD hypothesis, suggesting that the recent sudden surge in adolescent females identifying as transgender could have a strong peer and online influence and garnering backlash from proponents of the affirmative care only model.
2019
Detransitioner Keira Bell
Launches First Law Suit
British detransitioner Keira Bell launches the first legal action after being harmed by gender-affirming care. Many detransitioners follow suit.
2020
Finnish Review Recommends Psychosocial Support
Over Medical Interventions
A Finnish Health Authority systematic review concludes that “in light of available evidence, gender reassignment of minors is still an experimental practice,” recommending psychosocial support as the first-line treatment for adolescents with gender dysphoria, with medical intervention severely restricted.
2021
"Low" Strength WPATH
Systematic Review Released
WPATH commissions a systematic review which concludes that the evidence that hormonal treatment improves quality of life, depression, and anxiety among transgender individuals was of "low" strength, stressing the need for further research, particularly for adolescents, noting the inability to make definitive conclusions regarding the effects of hormone therapy on suicide risk.
2022
WPATH SOC-8 Removes
Age Restrictions for Children
WPATH publishes its SOC8, with a whole chapter on “eunuch” as a valid gender identity (even for children), a non-binary surgeries chapter (recommending nullification and bigenital surgeries), removing all lower age limits for hormonal and surgical interventions for minors, and omitting a chapter on ethics.
2022
Denmark Shifts Away
from Affirmation Only Care
The Journal of the Danish Medical Association confirms a marked shift in Denmark’s approach to treating gender dysphoria in youth, no longer prescribing puberty blockers, hormones, or surgery to the majority, but focusing on psychotherapeutic support instead.
2023
Birth Place of Puberty
Suppression Questions Protocol
The Netherlands, the birthplace of the "Dutch Protocol" in 1998 (effectively the gender affirming care model), questions the use of puberty blockers citing poor research on their long-term effects.
2024
WHO Announces that Global Guidelines Only Apply to Adults
The World Health Organization announces that its global guidelines on gender medicine will only apply to adults, as “the evidence base for children and adolescents is limited and variable regarding the longer-term outcomes of gender affirming care for children and adolescents.”
2024
Britain Bans Puberty Blockers
The British government indefinitely bans puberty blockers for children after independent experts cite "an unacceptable safety risk".
2025
US Gender Clinics Closing
US youth gender clinics begin to close after Executive Orders and withdrawal of federal funding.
2025
1906
Magnus Hirschfeld & "Transvesitism"
German sexologist and physician Magnus Hirschfeld, a friend and mentor to Harry Benjamin (below), is best known for his theory of sexual intermediaries, actively advocating for many types of naturally occurring sexual variations in humans including “transvestism”. He is credited with coining the term “transvestite” in a 1910 book on the subject.
1919
Origin of Orchiectomy
Dora Richter undergoes an orchiectomy under the care of Hirschfeld.
1930
Introduction of
Synthetic Testosterone
German scientists successfully synthesize testosterone. Two years later, it is commercially available.
1947
Jorgensen in the Daily News
In Dec, 1952 New York Daily News runs a front-page story about Jorgensen on December 1st under the headline “Ex GI Becomes Blond Beauty,” triggering the first mini epidemic.
1966
Early WPATH Launches
The Harry Benjamin International Gender Dysphoria Association (HBIGDA) forms, later to become the World Professional Association for Transgender Health (WPATH). International Journal of Transgenderism launched in 1979.
1980
US Medicaid Coverage Banned
The U.S. Department of Health and Human Services (HHS) bans Medicaid coverage for sex reassignment surgery after an investigation concludes that “[b]ecause of the lack of well controlled, long-term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexualism, the treatment is considered experimental. Moreover, there is a high rate of serious complications for these surgical procedures.” The ban will not be lifted until 2014.
1988
Dutch Study Published
The Dutch publish the first long-term follow-up study of patients who underwent medical transition. The study concludes that “sex reassignment surgery is no panacea,” and the “[a]lleviation of gender problems does not automatically lead to a happy and lighthearted life.” On the contrary, “SRS can lead to new problems.”
1989
Tavistock Clininc Opens
The Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Trust in London opens with the aim of serving children and adolescents who suffer from gender distress. In its first year, the clinic receives two referrals.
1990
Bill of Gender Rights Introduced
The International Bill of Gender Rights (IBGR) is drafted and adopted by the International Conference on Transgender Law and Employment Policy in Houston, Texas. The bill outlines the right of every person to define their own gender identity, “the right to change their bodies cosmetically, chemically, or surgically, so as to express a self-defined gender identity,” and the right not to “be subject to psychiatric diagnosis or treatment solely on the basis of their gender identity.”
1994
HBIGDA's Journal
of Transgenderism Introduced
HBIGDA establishes its peer-reviewed International Journal of Transgenderism, covering research on gender dysphoria, the medical and psychological treatment of transgender individuals, social and legal acceptance of sex reassignment, and professional and public education on transgenderism.
1998
UK Bans Bans on Sex-Change Surgery
A High Court ruling in the UK, North West Lancashire Health Authority v A, D and G, involved three trans identifying women who sued the North West Lancashire Health Authority after being denied gender reassignment surgery between 1996 and 1997, declaring it illegal for health authorities in England or Wales to impose a blanket ban on these surgeries.
2005
HBIDGA renamed WPATH
HBIDGA was renamed The World Professional Association for Transgender Health (WPATH). The purpose of this language change was to eliminate the term "gender dysphoria" as a mental illness and increase access to Gender Affirming Care.
2007
First Pediatric Gender Clinic
Opens in the US
The first pediatric gender clinic in the US opens at Boston Children’s Hospital. The same year, Barbara Walters introduces the world to the concept of the transgender child with 20/20 segment featuring Jazz Jennings.
2010
Affirmative Care Only
Begins via WPATH
WPATH publishes its SOC7, driving toward affirmative care only and deeming attempting to reconcile a person with his or her birth sex ineffective and unethical. Therapists effectively become facilitators for medical interventions.
2013
The Dutch Publish Study
on Puberty Blockers
The Dutch publish a deeply flawed yet groundbreaking study that forms the foundation of the puberty suppression experiment. THE EPIDEMIC BEGINS. Pediatric gender clinics all over the Western world start to observe an enormous surge in referrals.
2014
Assessments Deemed "Gatekeeping" & Puberty Blockers Deemed "Reversible"
The ban on Medicare coverage for gender affirming treatments is lifted in the US and one year later marks the uptick (up to 5000% by the early 2020's) of children and adolescents presenting to gender clinics.
2016
Endocrine Society
Endorses Gender Affirming Care
Endocrine Society publishes revised guidelines, endorsing gender-affirming care and earlier access to cross-sex hormones and bilateral mastectomies for adolescents, acknowledging that the guidelines are primarily based on evidence of “low” or “very low” quality. The American Academy of Pediatrics (AAP) follows suit in 2018.
2018
WHO Replaces Gender Dysphoria with "Gender Incongruence"
The World Health Organization (WHO) replaces the diagnosis of gender dysphoria with “gender incongruence” in its ICD-11. The diagnosis is moved out of the “Mental and behavioural disorders” chapter and into the new “Conditions related to sexual health” chapter, further attempting to depathologize the disorder.
2019
Keira Bell Wins High Court Case
British High Court rules in favor of Keira Bell, finding that children under 16 cannot consent to puberty blockers and those under 18 are unlikely to be able to give informed consent. The ruling states that there “is no age-appropriate way to explain to many of these children what losing their fertility or full sexual function may mean to them in later years.”
2020
Puberty Blockers
Restricted in Sweden
Sweden’s National Board of Health and Welfare determines after a systematic review that the risks of puberty blockers and treatment with hormones “currently outweigh the possible benefits” for minors, restricting access to puberty blockers and cross-sex hormones.
2021
Interim Cass Review Published
The Cass Review interim report is published in March, highlighting the lack of evidence to support puberty suppression and cross-sex hormones and concerns about the affirmative model of care, prompting the closure of the Tavistock GIDS clinic.
2022
France Withdraws
Support of Puberty Blockers
France joins the UK, Finland, and Sweden in urging “great medical caution” for the use of puberty blockers.
2023
Norway Deems Gender
Medicine for Youth Experimental
Norway's Healthcare Investigation Board (NHIB/UKOM) deems puberty blockers, cross-sex hormones & surgery for children & young people experimental, recommending a revision of the nation’s guidelines on youth gender medicine.
2024
Cass Review Final Report Published
The final report of this systematic review of evidence for the gender affirming care model was published on April 10, 2024. It's recommendations led to the closure of the Tavistock clinic, the UK's largest pediatric gender clinic.
2024
Alberta Restricts Gender
Affirming Care for Minors
Alberta becomes the first Canadian province to restrict access to gender-affirming care for minors.
2025
US President's Executive
Orders on Gender Issues
US President Donald Trump signs Executive Orders stating that there are only two sexes and that children must be protected from gender ideology in their schools.
2025
Two Canadian Systematic Reviews
Two systematic reviews out of Ontario show poor evidence for the use of both puberty blockers and cross-sex hormones for youths with gender dysphoria, citing low evidence of safety and efficacy and the protocols' experimental nature.