Elmer Belt, Harry Benjamin, and the Birth of Gender-Affirming Surgery in the United States

Abstract Introduction Gender Affirming Surgery (GAS) originated in early 20th century Europe and innovators there established some of the first surgical and social principles of GAS. GAS in the United States, however, lagged behind in practice and acceptance. Two American pioneers in the care of patients undergoing gender-affirmation therapies were Elmer Belt and Harry Benjamin. How they became dedicated to GAS and establishing a new standard of care for GAS in the United States is less clear. Our goal was to describe how Belt and Benjamin created GAS in the US, in the context of their time, and how their work influenced our current approach to transgender care. Sources and Methods We accessed the private papers, correspondences, and memos of Belt and Benjamin from their private libraries, donated collections to local archives or libraries including the University of California at Los Angeles, the National Library of France (Paris), and the National Library of Medicine (Bethesda). We used secondary sources as cited. Results The first documented GAS was performed in Berlin at the Charité Hospital in collaboration with Magnus Hirschfield’s Institut für Sexualwissenschaft in 1922. Thirty years later, the sensational story of Christine Jorgensen, an American GI who underwent transgender surgery in Denmark, sparked US interest in transgenderism. By the early 1950s, US endocrinologist and transgender activist, Harry Benjamin, sought a surgical partnership with Elmer Belt, a Los Angeles urologist. Belt became the first surgeon in the US to perform gender affirming surgery, though he did so in secrecy. His surgical interventions included penectomy, vaginoplasty, and abdominal transposition of the testicles. Despite the safeguards that Belt and Benjamin created, Belt ultimately discontinued gender affirming surgeries as he feared patient regret might lead to either legal or personal retribution. These unofficial safeguards ultimately influenced the World Professional Association of Transgender Health (WPATH) standards of care, leaving a lasting impact on the field of gender affirming medicine. Conclusions Benjamin and Belt were extremely influential in the birth of gender affirming surgical care in the US Key Words Elmer Belt, Harry Benjamin, Gender Affirming Surgery, Transgender Medicine