A Brief History of Transgender Care in the United States

1949: In one of the first known written recordings of trans individuals in medical literature, American sexologist David Cauldwell stated that a “poor hereditary background” and a “highly unfavorable childhood environment” caused this “condition.” Cauldwell also implied that these individuals were a “burden to society.” (1) 
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1966: Credited as the first physician to offer care to transgender patients, Harry Benjamin distinguished sex from gender in his publication, “The Transsexual Phenomenon.” Benjamin was focused on identifying “true transsexuals” and proposed that they must express desire for genital surgery and report feeling as though they were “trapped in the wrong body.” These conditions had to be present in order to access hormones or surgery. (1) 
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1966: The Johns Hopkins Gender Identity Clinic opens, and was the first of over 40 gender clinics that opened in the late 60s and early 70s. Many of these gender clinics relied on Benjamin’s conceptualization of a “true transsexual” as a basis for treatment criteria, which ultimately led to restricted access to these services. People of color were explicitly excluded from receiving care, and treatment was focused on individuals identifying as trans-feminine. (1) 
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1979: The Johns Hopkins’ gender clinic closes, reporting little evidence that surgery was effective in treating trans people, a conclusion based on the fact that after having surgery, many trans people still reported problems, such as distress related to their gender or their bodies. The Harry Benjamin International Gender Dysphoria Association was founded and set out to create and approve standards of care for trans individuals. As transgender health care was privatized, these standards would assist independent practitioners in making decisions about eligibility for trans health care services. These standards are now known as the WPATH Standards of Care, though there have been many updates to these standards since that time. (1) 
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1989: Medicare officially excluded “transsexual surgery” from its coverage and this exclusion remained until 2014. This exclusion prevented trans individuals from seeking surgery for over 25 years. All other gender clinics followed the Johns Hopkins gender clinic are closed. 
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2013: Some insurance companies start to include gender-affirming health care services in their coverage plans. As a result of the Department of Managed Health Care in California lifting exclusions on trans health, many health insurance plans in California started to include gender-affirmation services under their coverage plans. However, this expansion has not occurred in every state, and coverage for gender-affirmation care still does not exist in many insurance plans. (1) 

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Source: 

1. Chang, S.C., Singh, A.A., & dickey, l.m. (2018). A clinician’s guide to gender-affirming care: Working with transgender and gender nonconforming clients. Oakland, CA: Context Press.