COMMENTARY

A Brief History of Gender Diagnoses

Jack Drescher, MD

Disclosures

September 25, 2017

Hi. I am Dr Jack Drescher, speaking for Medscape. I am a clinical professor of psychiatry at Columbia University and a distinguished life fellow of the America Psychiatric Association. I was a member of the DSM-5 workgroup on gender and sexual identity disorders, and I am currently a member of the World Health Organization's workgroup on sexual disorders and sexual health.

Today I want to talk briefly about the history of gender diagnoses. The diagnosis of people with what today we call gender dysphoria began in the 19th century with Richard Von Krafft-Ebing who, in his book Psychopathia Sexualis, called it homosexuality. In the beginning of the diagnostic period, people did not distinguish between a sexual orientation and gender identity, so the two groups were conflated. This confusion continued until the beginning of the 20th century, when the German psychiatrist Magnus Hirschfeld began to separate the desire to be with someone of the same gender, which is homosexuality, from the desire to be the other gender, which today we call gender dysphoria—or being transgender, in popular parlance.

Although Hirschfeld made these distinctions in the 1920s, they did not reach the popular imagination until the 1950s, when an American ex-GI George Jorgensen went to Denmark, had surgery, and came back to the United States as Christine Jorgensen. This made international headlines; the New York Daily News blared, "Ex-GI Becomes Blonde Beauty." This was the entrance into popular imagination of transsexualism and transgender presentations.

At the time Jorgensen made her appearance, American psychiatry, and many psychiatrists around the world, did not really know much about gender dysphoria or transgender presentations. Many psychiatrists thought that homosexuality and transgenderism were illnesses. People who wanted to be the other gender were considered delusional, psychotic, or severely neurotic. One 1960s survey of about 400 psychiatrists, obstetricians, and general practitioners showed that they were opposed to providing transition services. This was the state of mind and the state of the profession in the middle of the 20th century.

All of that changed by the beginning of the 1970s as more and more research began to show that the major way to treat people with gender dysphoria is to provide them with what we think of today as transition services, whether they be medical or surgical. Keep in mind: Not everyone gets medical or surgical treatment, but these are now standard practices, not only in the United States but around the world.

Thank you for listening to me today.

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