A Pioneer in Gender-Affirming Care Caves to Anti-Transgender Panic
A love letter to UVA
In 1977, a young person in her early twenties, then living in a commune with fifteen other “homosexuals” in an overflowing house in Richmond, Virginia’s Fan District, was admitted for an operation at the University of Virginia Medical Center in Charlottesville. She received an innovative surgical treatment, the Richmond News Leader later reported, the effect of which was that she “became a woman.”
Around the same time, a nineteen-year-old from rural Farmville, Virginia, sixty miles south of Charlottesville, arrived at the university to pursue a similar treatment, yet in this case the goal was to become a man.
The treatment of young transgender people at UVA began, quietly, in 1970 under the leadership of Dr. Milton Edgerton, a pioneering plastic surgeon and co-founder, four years earlier, of the nation’s first center for transsexual medicine at Johns Hopkins University. After transferring to UVA, Edgerton and his team built Charlottesville into a major worldwide hub for the clinical practice and scientific study of transgender healthcare, attracting patients from as far away as Los Angeles and London.
On January 31, 2025, fifty-five years later, UVA shocked the Commonwealth by abruptly ending the practice of gender-affirming care for minors and young adults under the age of nineteen.
University administrators released a statement to the media explaining that they had terminated the transgender healthcare program for minors and young adults at UVA under pressure from Virginia Attorney General Jason Miyares, who, in turn, was emboldened by a new federal executive order seemingly outlawing these practices nationwide. Legal experts and advocates have pointed out, however, that there is no immediate legal mandate for hospitals or clinics in Virginia, or anywhere in the U.S., to end the practice of gender-affirming care for minors. There is only the threat of future investigations or the potential loss of federal funding.
In protest of UVA’s decision, over one hundred and fifty demonstrators flooded the entrance in front of UVA’s hospital on the evening of January 31, criticizing the university’s decision to abruptly end treatments for trans youth and young adults under their care.
Although Attorney General Miyares’ memo to UVA referred to gender-affirming care as “chemical and surgical mutilation,” it is notable that both the federal executive order and Miyares’ statewide guidance continues to allow the same treatments—puberty blockers, hormone therapies, and even some surgeries—for cisgender youth, just not for transgender youth.
Rather than caving to anti-transgender rhetoric and governmental threats, the University of Virginia can stand to learn from its own history—a history of advocacy for, and defense of, transgender healthcare.
That history is most apparent in the year 1979. In that year, anti-gay and anti-transgender backlash was at its height all across the United States. Many university hospitals that had previously practiced transgender medicine began to abruptly close their doors, and UVA’s Gender Identity Clinic was particularly embattled. Not only were some of the founding medical clinics, including the one at Johns Hopkins, curtailing treatment, but the Charlottesville clinic also faced a lawsuit from a disgruntled patient, and was the target of an intimidation campaign from a Virginia state senator.
When State Senator Frank W. Nolen of Augusta County heard about the “sex change” operations then happening at UVA, he sent off a heated letter to the University President, Frank L. Hereford, Jr., expressing outrage that any public hospital in Virginia would be engaged in the practice of changing a patient’s sex. Nolen called upon the Governor, John N. Dalton, to pass an executive order immediately to end all “sex change” operations in Virginia.
So, how did UVA’s president respond? In his reply to Nolen, Hereford offered a full-throated endorsement of UVA’s Gender Identity Clinic, praising the work of Dr. Edgerton and his team, and telling Nolen, politely, to back the heck off.
Dr. Edgerton himself wrote to Senator Nolen the following year, inviting the legislator to pay his clinic a visit. “Doctors and laymen alike become much more sympathetic,” Edgerton wrote, “when they know a few of these patients as individuals.” In other words, come meet an actual trans person and see how important this healthcare is for them.
I wish that the University of Virginia leadership would respond today, in this current crisis, with the same courage and tenacity. I wish they would forthrightly defend science-based medical practices and medical education in the Commonwealth of Virginia.
But that bravery is to be found elsewhere in Charlottesville today—in an altogether different corner. Over the weekend a coalition of medical students at UVA released an open letter to administrators and state officials. Speaking as the country’s “future physicians,” they called on the university to “reject all parts” of the federal government’s executive order and do what is necessary “to advocate for transgender and gender diverse patient populations.”
Within two days, nearly three hundred medical students had signed onto their letter, and students representing all six medical schools in Virginia had joined forces to create an umbrella organization to fight for the future of transgender healthcare in Virginia.
As I have watched these events unfold over the past week, I have felt acute anger at UVA’s abrupt capitulation to the Attorney General’s threats. And I have felt immense pride at the medical students fighting back, using their expertise as America’s “future physicians” to promote the legitimacy of transgender healthcare and the importance of receiving a holistic medical education that includes transgender medicine.
Over the past two years I have given several talks on the history of transgender healthcare at medical schools across Virginia. I know just how important this history is as a tool in the arsenal of a twenty-first-century medical education.
This is a love letter to UVA. For I am not just a historian of the institution, but also a patient.
When I walked through the former “Private Clinics” building for my first consult for surgery in 2023, I knew I was stepping in the footsteps of hundreds of other transgender people before me. Now I wonder if we might end up being some of the last trans people to do so.
