Maurice Garcia, MD
The Program in the History of Medicine at Cedars-Sinai chronicled transgender and non-binary identities and their intersections with medicine, from the Middle Ages to today, during its latest seminar Monday, Dec. 3.
The seminar is one of several in a series presented by the program, which explores the body and its cultural contexts from the early modern period to the present.
"It is such as pleasure to have a program like this at Cedars-Sinai," said Melissa Lo, PhD, an assistant professor of Biomedical Sciences, who organized the event. "The more we can stipulate connections between the past and present, I think the better situated we are to make decisions about what our role can look like, and how we can include as many people as possible in that vision of our role."
Roland Betancourt, PhD, associate professor of Art History at the University of California, Irvine, was the first to take the stage, discussing the extensive history of gender transition throughout the Greek-speaking areas of the Mediterranean from the fourth to 15th centuries.
During his presentation, Betancourt highlighted a number of historical figures associated with gender variance, including the Roman emperor Elagabalus, who was reported to have sought out physicians who could perform gender-affirming surgery, as well as eunuchs who were assigned female identities at birth but chose to present themselves as males in monastic communities.
Bentancourt also discussed the interactions between surgeons and the transgender communities of the time, in which procedures were grisly and attitudes were often underscored by prejudice.
Picking up more than 500 years later, Victoria Steele, PhD, curator of the public art collection at the University of California, Los Angeles, brought the discussion closer to home—but not farther from society's biases. In her presentation, Steele recounted the work and times of urologist Elmer Belt, MD, and his pioneering yet controversial role in transgender surgeries.
Belt, who helped found the medical school at UCLA during the 1940s, is believed to have performed the first gender-affirming surgeries in the United States. After Belt began performing the surgeries in the early 1950s, he was pressured by both his medical peers and his family to cease the then-taboo work. Belt pushed back against this pressure until 1962, at which point he stopped—instead referring transgender patients to supportive surgeons elsewhere.
Steele, who met Belt prior to his death in 1980, shared that the details around these early procedures remain veiled in mystery after a 1958 fire turned Belt's office—and his records—to ash. But the urologist's role and impact on the progress of transgender healthcare has not been extinguished.
To conclude the seminar, Maurice Garcia, MD, MAS, director of the Transgender Surgery and Health Program at Cedars-Sinai, shared the current state of transgender and non-binary healthcare, saying that while advancements have been made in recent years, there is still work to be done.
"There isn’t much new under the sun. Go back to Byzantine times; the same themes, the same people, the way that people manage their differences relative to their societies, is very similar," Garcia said, stressing that the transgender and non-binary communities continue to suffer disproportionate rates of suicide and depression as a result of gender dysphoria, a term for the discomfort and distress caused by a person's body not reflecting who they are on the inside.
The Transgender Surgery and Health Program, an interdisciplinary program that provides comprehensive medical and surgical care for transgender people, is just one step—but an impactful one—toward resolving the marginalization of the transgender and non-binary communities in today's healthcare environment, Garcia said.
"As doctors, nurses, people in healthcare, one of the things we profess to do in our professions is to alleviate human suffering with treatment. There is an ethical mandate to offer and participate in this care," Garcia said in closing. "It is the right thing to do."