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In 1976, a  received a prescription for two drugs: estrogen and progestin. Twelve months later, a local reporter noted Rhoda鈥檚 surprisingly soft skin and visible breasts. He wrote that the drugs had made her 鈥渟o completely female.鈥�

Indeed, that was the point. The University of Virginia Medical Center in nearby Charlottesville had a clinic specifically for women like Rhoda. In fact, doctors there had been prescribing hormones and performing surgeries鈥攚hat today we would call gender-affirming care鈥攆or years.

The founder of that clinic, , had cut his teeth caring for transgender people at Johns Hopkins University in the 1960s. There, he was part of a team that established the nation鈥檚 first university-based Gender Identity Clinic in 1966.

When politicians today refer to gender-affirming care as new, 鈥�,鈥� or 鈥�,鈥� they ignore the long history of transgender medicine in the United States.

It鈥檚 been nearly 60 years since the first transgender medical clinic , and 47 years since Rhoda started her hormone therapy. Understanding the history of these treatments in the U.S. can be a helpful guide for citizens and legislators in a year when  in statehouses target the rights of transgender people.

Treating Gender in Every Population

As a trans woman and a , I have spent much of the past decade . I also take several pills each morning to maintain the proper hormonal balance in my body: spironolactone to suppress testosterone and estradiol to increase estrogen.

When I began HRT, or hormone replacement therapy, like many Americans, I wasn鈥檛 aware that this treatment had been around for generations. What I was even more surprised to learn was that HRT is often prescribed to cisgender women鈥攚omen who were assigned female at birth and raised their whole lives as women. In fact, many providers in my region already had a long record of prescribing hormones to cis women, primarily women experiencing menopause.

I also learned that gender-affirming hormone therapies have been prescribed to cisgender youths for generations鈥攄espite what contemporary politicians may think. Disability scholar Eli Clare has written of the history and continued practice of  to boys who are too short and girls who are too tall for what is considered a 鈥渘ormal鈥� range for their gender. Because of binary gender norms that celebrate height in men and smallness in women, doctors, parents, and ethicists have approved the use of hormonal therapies to make children conform to these gender stereotypes .

Clare describes a severely disabled young woman whose parents鈥攚ith the approval of doctors and ethicists from their local children鈥檚 hospital鈥攁dministered puberty blockers so that she would never grow into an adult. They deemed her mentally incapable of becoming a 鈥渞eal鈥� woman.

The history of these treatments demonstrates that hormone therapies and puberty blockers have been used on cisgender children in this country鈥攆or better or for worse鈥攚ith the goal of regulating the passage from girlhood to womanhood and from boyhood to manhood. Gender stereotypes concerning the presence or absence of secondary sex characteristics鈥攖oo tall, too short, too much body hair鈥攈ave all led parents and doctors to perform gender-affirming care on cisgender children.

For over half a century, legal and medical authorities in the U.S. have also approved and administered surgeries and hormone therapies to force the bodies of intersex children to conform to binary gender stereotypes. I myself had genital surgery in infancy to bring my anatomy into alignment with expectations for what a 鈥渕ale鈥� body should look like. In most cases, intersex surgeries are  for the  of a child.

Historians such as Jules Gill-Peterson have shown that  in this country are deeply interwoven with the . Doctors at Johns Hopkins and the University of Virginia practiced reconstructing the genitalia of intersex people before applying those same treatments on transgender patients.

Given these intertwined histories, I contend that the current political focus on prohibiting gender-affirming care for transgender people is evidence that opposition to these treatments is not about the safety of any specific medications or procedures, but rather their use specifically by transgender people.

How Transgender People Access Care

Many transgender people in the U.S. have deeply complicated feelings about gender-affirming care. This complexity is a result of over half a century of transgender medicine and patient experiences in the U.S.

In Rhoda鈥檚 time, medical gatekeeping meant she had to live 鈥渇ull time鈥� as a woman and prove her suitability for gender-affirming care to a team of primarily white, cis male doctors before they would give her treatment. She had to mimic language about being 鈥溾�濃�攍anguage invented by cis doctors studying trans people, not by trans people themselves. She  she would be heterosexual and seek marriage and monogamy with a man. She could not be a lesbian or bisexual or promiscuous.

Many trans people still need to jump through similar hoops today to receive gender-affirming care. For example, a diagnosis of 鈥�,鈥� a designated mental disorder, is sometimes required before treatment. Many trans people argue that these preconditions for access to care should be removed because being trans is an identity and a lived experience, not a disorder.

Feminist activists in the 1970s also critiqued the role of medical authority in gender-affirming care. Writer Janice Raymond decried 鈥�,鈥� her term for the physicians, psychologists, and other professionals who practice transgender medicine. Raymond argued that cis male doctors were making an army of trans women to satisfy the male gaze: promoting iterations of womanhood that reinforced sexist gender stereotypes, ultimately ushering in the displacement and eradication of the world鈥檚 鈥渂iological鈥� women. The origins of today鈥檚 gender-critical, or , movement are visible in Raymond鈥檚 words. But as trans scholar Sandy Stone wrote in her , it鈥檚 not that trans women are unwilling dupes of cis male medical authority, but rather that we have to strategically perform our womanhood in certain ways to access the care and treatments we need.

The Future of Gender-Affirming Care

In many states, especially in the South, where I live, governors and legislatures are introducing bills to ban gender-affirming care鈥斺�攊n ignorance of history. The consequences of hurried legislation extend beyond trans people, because access to hormones and surgeries is a basic medical service many people may need to feel better in their body.

Prohibitions on hormone therapy and gender-related surgeries for minors could mean ending the same treatment options . The  may directly clash with  in several states that aims to codify 鈥渕ale鈥� and 鈥渇emale鈥� as discrete biological sexes with certain anatomical features.

Prohibitions on hormone replacement therapy for adults could affect access to the same treatments for menopausal women or limit access to hormonal birth control. Prohibitions of gender-affirming surgeries could affect anyone鈥檚 ability to . So-called cosmetic surgeries, such as breast implants or reductions, and even facial feminization procedures, such as lip fillers or Botox, could also come under question.

These are all different types of gender-affirming procedures. Are most Americans willing to live with this level of government intrusion into their bodily autonomy?

Almost every  in the U.S. has come out against new government restrictions on gender-affirming care because, as doctors and professionals, they know these treatments are . These treatments have histories reaching back over 50 years.

Trans and intersex people are important voices in this debate, because our bodies are the ones politicians who oppose gender-affirming care most frequently . Legislators are developing policies about us despite the fact that most Americans say they .

But trans and intersex people  to have to fight to access the care and treatment we need. And we know the joy of finally feeling comfortable in our own skin and being able to affirm our gender on our own terms.

This article was originally published by . It has been published here under a Creative Commons license.