Johns Hopkins to resume gender-affirming surgeries after nearly 40 years

The prestigious school is finally distancing itself from its anti-trans reputation.

CREDIT: AP Photo/Patrick Semansky
CREDIT: AP Photo/Patrick Semansky

Johns Hopkins University is setting itself up to reclaim a reputation it once had as the leading academic medical institution when it comes to providing affirming care for transgender people, but it has nearly four decades of damage to repair.

Earlier this month, the heads of Johns Hopkins Medicine issued a letter to their colleagues addressing increasing scrutiny on the institution. One of its faculty members, Paul McHugh, has become the face of anti-transgender advocacy, propping up junk science to justify rejecting transgender identities. McHugh’s latest “special report” in The New Atlantis, co-authored with Lawrence Mayer, another Johns Hopkins professor, challenged basic premises about the nature of LGBT identities by cherry-picking studies and sounding anti-LGBT dogwhistles. This prompted the Human Rights Campaign and other LGBT advocates to call upon Johns Hopkins to disavow the report and abandon the legacy established by McHugh’s leadership.

The letter confirmed that the medical school intends to do just that. First, it addresses the controversy of the professors’ scholarship, defending their academic freedom, but sternly noting, “When individuals associated with Johns Hopkins exercise the right of expression, they do not speak on behalf of the institution.”

Though it doesn’t specifically reference McHugh or Mayer, the letter then outlines an institutional commitment to LGBT nondiscrimination and affirmation that directly contradicts the doubts they raised in their report. The list includes expanding benefits to cover transgender health services (“including surgical procedures”) and a plan to develop “new paths for our institutions to further approaches to evidence-based, patient-centered care for LGBT individuals.”

Then there was this bombshell:

We have committed to and will soon begin providing gender-affirming surgery as another important element of our overall care program, reflecting careful consideration over the past year of best practices and the appropriate provision of care for transgender individuals.

In 1965, Johns Hopkins made history as the first academic institution to offer gender-affirming surgical procedures. Though the surgeries were experimental and geared toward research, they served as a model for teaching surgeons about the procedures that other schools then adopted.

In 1979, the school made history again. Under the leadership of McHugh, the school shut down its sex reassignment surgery clinic. As he explained in 2004, “I concluded that Hopkins was fundamentally cooperating with a mental illness. We psychiatrists, I thought, would do better to concentrate on trying to fix their minds and not their genitalia.”

It was that same year that the World Professional Association for Transgender Health (WPATH) standards of care for trans people were first drafted, drawing the very opposite conclusions. Those WPATH standards have been revised several times in the decades since to incorporate new research, making it increasingly easier for transgender people to access the quality care they need and deserve as they transition.

But since 1979, McHugh’s opposition to affirming transgender identities has defined Johns Hopkins’ approach to transgender patients. Not only could they not find treatments there that may have been medically necessary, but many have reported over the years various forms of mistreatment by McHugh and other doctors on the staff. And as McHugh became a more vocal and visible opponent of transgender rights — opposing the consensus of mainstream medicine to do so — the prestige of the institution lent credence to his harmful rhetoric.

That’s why the announcement that it will soon begin offering transition surgeries again could be quite revolutionary. Not only will Johns Hopkins no longer be tacitly endorsing McHugh’s debunked views, but it will actually train generations of doctors in providing affirming care to transgender patients. A four-decade reputation of rejection might not be changed overnight, but the shift could very well save lives in the years to come.