Scientific transphobia

Scientific transphobia in the United States traces its early roots to the 1950s after the public transition of American actress Christine Jorgensen, which sparked widespread medical discourse regarding the legitimacy of "sex changes".^[3] While stories of gender transition were not absent from the news at the time, Jorgensen's story dominated the headlines and brought arguments regarding biological sex and gender identity to the forefront. Prominent sexologist and endocrinologist Harry Benjamin coined the term "transsexual" in his 1966 book The Transsexual Phenomenon after Jorgensen's transition to differentiate the act of cross-dressing and the medical transformation of gender,^[4] defying traditional conceptions of sex at the time as something that could not be changed. Critics, however, argued that transsexual people were "delusional" or had a perversion akin to homosexuality.^[5]

Janice Raymond's 1979 novel The Transsexual Empire: The Making of the She-Male argued that transgender women were not real women, but rather were agents of the patriarchy that aimed at perpetuating sexist attacks on cisgender women, and that gender transitions reinforced regressive gender stereotypes.^[6]

Published during a time of heavy criticism of gender transition and clinic evaluations, Raymond's anti-transgender rhetoric is considered to have contributed to the closure of the Johns Hopkins University's Gender Identity Clinic in 1979--the first U.S. program to offer gender-affirming surgeries--after director Jon Meyer and research partner Donna Reter reported insufficient psychological benefits based on follow-up studies.^[7] In particular, Meyers claimed that "surgery can't cure transsexuals. They never forget that they're only impersonating the other sex. What you're dealing with are deeply disturbed people whose problems won't vanish overnight." Of note, Paul McHugh, chair of psychiatry at Johns Hopkins at the time of the closure, was openly disapproving of gender-affirming surgeries and acknowledged that he intended to stop this practice at the clinic once he had become chair.^[8]

The closing of Johns Hopkins Gender Identity Clinic may have inadvertently led to the closure of several other gender identity clinics running at the time, including those at Northwestern University, Stanford University, and Washington University at St. Louis.^[8]

Following a wave of anti-transgender rhetoric in the nation, the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), published in 1980, formally introduced transsexualism and Gender Identity Disorder in Childhood (GIDC) under psychosexual disorders.^[9][10] Transsexuality was defined as a persistent discomfort with one's sex assigned at birth and a strong desire to live and be accepted as a member of the other sex, which includes a desire for hormonal and surgical intervention.^[11] GIDC described children who exhibited a strong and persistent cross-gender identification, with operationalized criteria for boys and girls.^[9]

The inclusion of transsexualism in the DSM-III was influenced by earlier work done by John Money, Harry Benjamin, Robert Stoller, and Richard Green, who argued that recognizing transsexualism could help standardize assessment and facilitate access to treatment.^[12] Despite this, these diagnoses were grouped with the section on psychosexual disorders, including paraphilias, psychosexual dysfunctions, and ego-dystonic homosexuality, furthering the public view of transsexuality as a sexual deviation rather than a natural gender variance.

In the DSM-V and ICD-11, transsexuality now appears as gender dysphoria and gender incongruence, respectively.^[12]

Canadian psychologist Ray Blanchard proposed his controversial autogynephilia theory of transsexuals in the 1980s, which classifies transgender women as either homosexual transsexuals--early onset desire to transition due to attraction to men--or autogynephilic transsexuals--later onset desire to transition due to sexual arousal at the fantasy of seeing oneself as a female.^[13] This theory drove ongoing debates around the legitimacy of gender transition, even though the theory has been critiqued as being reductive and unfalsifiable.

In 2018, researcher Lisa Littman published a study on "rapid-onset gender dysphoria" (RODG), positing that some adolescents identify as transgender and experience gender dysphoria due to peer influence and social contagion, especially those assigned female at birth.^[14] The publication faced wide criticism due to methodological issues, including the recruitment of parents from mostly anti-transgender forums who believed their children had RODG, although some of these claims have since been countered.^[15]