Restrictions on medical care for transgender youth assume that without the ability to medically transition, trans people will vanish.
As of 2024, 26 U.S. states have banned gender-affirming care for young people. Less than a month into office, President Donald Trump issued numerous executive orders targeting transgender people, including a mandate to use “sex” instead of “gender” on passports, visas and global entry cards, as well as a ban on gender-affirming care for young people. These actions foreground the upcoming Supreme Court case of U.S. vs. Skrmetti which promises to shape the future of gender-affirming health care in the U.S., including restrictions or bans.
History, however, shows that withholding health care does not make transgender people go away. Scholarship of medieval literature and historical records reveals how transgender people transitioned even without a robust medical system – instead, they changed their clothes, name and social position.
Surgery in medieval times
Surgery was not a widespread practice in the medieval period. While it gained some traction in the 1300s, surgery was limited to southern France and northern Italy. Even there, surgery was dangerous and the risk of infection high.
Cutting off fleshy bits is an old practice and, potential dangers aside, removing a penis or breasts wasn’t impossible. But amputating functioning limbs was nearly always a form of punishment. Medieval people, including surgeons and patients, likely would not have had positive views of surgery that involved removing working body parts.
Illustration from a Latin translation of Albucasis’ Chirurgia, depicting surgical instruments.
Wellcome Collection
Surgeons in the 14th century were increasingly thinking about how to perform surgery on those with both male and female genitalia – people now called intersex. But they thought about this in terms of “correcting” genitalia to make it more apparently male or female – an attitude still present today. Historically, the procedure was probably performed on adults, but today it is usually performed on children. Both then and now, the surgery often disregards the patient’s wishes and is not medically necessary, at times leading to complications later. For patients deemed female, excess flesh could be cut away, and for patients deemed male, the vulva could be cauterized to close it.
There is, however, at least one historical example of a transgender individual receiving surgery. In 1300, near Bern, Switzerland, an unnamed woman was legally separated from her husband because she was unable to have sex with him. Soon after, the woman headed to Bologna, which was the surgery capital of Europe at the time. There, a surgeon cut open the woman’s vulva, revealing a penis and testicles. The account ends, “Back home, he took a wife, did rural work, and had legitimate and sufficient intercourse with his wife.”
The story…
