The content of this book spans continents and centuries. Despite this breadth and depth, the book has a common theme or arc, allowing readers to see clear connections from one section to the next. . Please consider the following paragraphs as you shape your contribution to fit into the general arc of the book.

Although transgender people have been described throughout the world since early-recorded time, the history of Western medical intervention for individuals with gender dysphoria dates back just to the start of the 20th century. Medical and mental health providers have spent the last one hundred years developing an understanding of transgender people, inventing and reinventing language that describes the patient experience while allowing for diagnosis and treatment within the Western medical model of care.

Despite evidence that gender diversity occurs naturally across time, cultures, and socioeconomic/ethnic groups, a constant theme has been the struggle to legitimize medical care, and hence legitimize the lives of transgender people themselves. Patients have been and continue to be labeled mentally ill, and the providers who treat them considered suspect.

The history of transgender healthcare in the U.S. is tied to the history of medical research and technology, the popular press, academic thought, and various human rights movements. It is peppered with accounts of extraordinary individuals whose voices have shaped social change and improved medical methods, often at great personal risk. Over the last century, scientists, mental health and medical providers have struggled to answer the following questions about what we now refer to as gender dysphoria: What is this? What do we call it? Why are people like this? Is this a reflection of nature or nurture? As a medical or mental health provider, what is the appropriate response to requests for assistance? The manner in which these questions have been answered over time has been shaped by the era, the social/political climate, the point of view of those asking and answering the questions, and the historical context.

This book begins with the history of the earliest recorded attempts to describe and respond to gender diversity in North America. We discuss the origins of hormonal and surgical care in Europe and how gender medicine crossed the Atlantic and evolved into our present-day practice.

The published history of transgender medicine, like all published history, has largely been written by white, cisgender men. This is true despite the fact that people of all genders, races, ethnicities, religions, professions, sexual orientations, and socioeconomic classes have been integral in developing transgender medical practices and have been profoundly affected by the presence or absence of trans-affirming medical care. To understand the history of transgender medicine one must explore the sociopolitical context in which that history evolved. To understand the roots of current practices, medical care for transgender people must be considered through the lenses of erasure, enslavement, Jim Crow, Christianity, patriarchy, colonialism, structural racism, and intersectional violence. Throughout this volume, readers will reflect on how race, class, criminalization, religion, sex, labor, and categories of personhood as determined by white, European ancestors defined and differentiated persons “worthy” of treatment from the “unworthy,” and “appropriate” intervention from “inappropriate”.

Further, this book will challenge authors and readers to move beyond understanding and toward response. Throughout this text, key questions will continue to emerge: who writes our history? Whose stories are told and whose are silenced? Which words get chosen, and what meanings do they convey? Why do we practice transgender medicine this way? Perhaps most important of all: how does knowledge of the past inform our future?

The pieces in this book will not provide all of the answers. However, they will begin to fill in the gaps purposefully carved out of popular history, coloring in a vibrant mosaic of passionate, courageous, and joyful individuals determined to live authentically and fully.

It is only through an honest, unflinching, holistic view of history relayed by a wide array of witnesses that we will begin to know where we’ve been, where we are, and where we are going, together.