The ArQuives Digital Exhibitions

Medical Transitions in Canada in the 1970s and 1980s

Medical Transitions

In the early years of the 20th century doctors in Europe began experimenting with hormones and surgery to change physical sex characteristics. These treatments weren't available in the US until the mid-20th century because of legal prohibitions and widespread opposition in the medical community. The first major American gender identity clinic opened at Johns Hopkins in 1966 and the clinic at the Clarke Institute of Psychiatry in Toronto opened in 1969. Gender identity clinics researched gender identity and assessed transpeople for suitability for gender affirming surgeries. The majority of surgeons in Canada and the US would only operate on people who had been approved for surgery by a clinic or psychiatrist. OHIP (Ontario Health Insurance Plan) would only cover surgeries for patients approved by the Gender Identity Clinic at the Clarke Institute of Psychiatry in Toronto (aka "the Clarke"). There were also smaller gender clinics or specialists at Laval University, University of Calgary, and University of Manitoba. Some transpeople sought medical transition procedures outside of the gender identity clinics. In some cases, this involved travelling to other countries for surgery which was not covered by government insurance plans. Some of these surgeons did quality work and were respectful of their patients but others were exploitative and frequently botched their procedures. 

By the late 1970s hormones and most gender affirming surgeries were available. The one exception was phalloplasty, it was still experimental at this point - complications were common and even without complications the results were usually unsatisfactory. The use of hormones and surgery was a frequent topic in the pages of Gender Review. See:

Medicalization of Transness

Raj and others (including some doctors) argued that being trans was a medical condition and that medical transition (hormones and surgery) was the appropriate "treatment." Psychiatric and psychological treatments had unsurprisingly failed to "cure" transsexualism. Since transness couldn't be changed, the appropriate approach was to use hormones and surgery to align transpeople's bodies with their gender identity. This approach frequently improved the life of a transperson by relieving dysphoria and increasing the likelihood that their gender would be read correctly. See "On Transsexualism" Gender Review, vol. 3, no. 2 (page 8)

Gender Review's framing of transness as a medical condition was also strategic in terms of advocating for the acceptance of transpeople. Society is more sympathetic to people with medical conditions than it is to people who defy social norms or break the law. Gender variant behaviour is often considered transgressive or deviant and laws against cross-dressing were common in the US in the late 19th and early 20th centuries. 

The idea that being trans was a medical condition that could be helped through surgery led to a widespread assumption that surgery was the ultimate goal of transpeople. This was reinforced by contemporary ideas about gender: it was binary (i.e. there are 2 genders and a person can be either one or the other of them) and it was determined by physical sex characteristics. In the 1970s and 80s the prevalent view was that bottom surgery was what turned a transperson into a man or a woman because it changed their body. These views were fairly common amongst transpeople and their allies during the 1970s and 80s - many transpeople did not disclose their transness after surgery. This attitude has largely been replaced with the idea that someone's gender is based on how they identify and that surgery is one way of expressing that identity. 

The view of transness presented in Gender Review reflects the narrative of the gender identity clinics, in part as a way to communicate the expectations of the clinics to transpeople to help them access hormones and surgeries. This narrative is that a transperson knows that they belong to the "other sex" from a young age, this causes significant emotional distress and they want to transition medically. While this was the experience of many transpeople, it's not the experience of all transpeople. There was also the expectation that after transition a person would fit gender stereotypes, be straight, and be able to "pass." There are many articles in Gender Review that give advice on gender presentation but some articles by Raj and others push back against the expectation to conform to stereotypes. 

Gender Identity Clinic at the Clarke Institute of Psychiatry

The Clarke's approval process took over two years and included psychological and physical assessments. The Clarke would only approve people who were employed, heterosexual but unmarried, and without a criminal record. In many cases discrimination prevented transpeople from finding work and the criminalization of both cross-gender behaviour and sex work made transpeople more likely to have criminal records. The clinic also evaluated transpeople's emotional stability and ability to pass and conform to binary gender roles. If they judged someone to be lacking in one or more of these areas, the person would be denied surgery. 

Once a transperson passed this initial assessment, the Clarke required them to live and work in their "new" gender role full time for a year. After the year had elapsed the Clarke conducted another evaluation before prescribing hormones. Individuals would be on hormones for a year before the final evaluation to approve them for gender affirming surgery. Very few transpeople could meet these standards - the Clarke only approved 10% of the people it assessed. For a first-person account of a similar process in California, see "Bay Area Report" in Gender Review, vol. 2, no. 4 (pages 4-7).

Huxford was usually in agreement with the doctors at the Clarke - most other transpeople were critical of the clinic. Without naming the Clarke specifically, Raj wrote articles that were critical of gender identity clinics. See "Proper Doctor-Patient Relationship" and "Gender Dysphoria: Opposing Perspectives" in Gender Review, no. 5 (pages 5 and 13) and "Gender Dysphoria Clinics: Shoulds and Should Nots" in Gender Review, no. 6/7 (pages 5-6).

Medical Transitions