Gender Confirmation Surgery

The first reported gender confirmation surgery (GCS) was performed in Berlin in 1931 (Luther Z Arztl Fortbild (Jena) 84(19):1005–1008, 1990 [1]). Prior to that only ablative procedures such as hysterectomy and gonadectomy were reported for gender dysphoria, notably the case of Alan L. Hart, an American physician born Alberta Lucille Hart who underwent hysterectomy and gonadectomy in 1917, at the age of 27 [2]. After a setback due to World War II, GCS in the United States resumed, notably with the creation of the Johns Hopkins Gender Identity Clinic in 1965. Led by plastic surgeon Milton Edgerton, this was the first multidisciplinary center for the care of transgendered patients and was composed of psychiatrists, psychologists, plastic surgeons, gynecologists, urologists, and endocrinologists. The center was closed in 1979 but reopened in 2017. Significant change occurred in 2014 when the United States Department of Health and Human Services review board ruled that Medicare would pay for GCS.