The earliest known gender reassignment surgeries took place in the early 1930s at Magnus Hirschfeld’s Institute for Sexual Science in Berlin, Germany. But the groundwork began even earlier. In 1922, a patient named Dora Richter had her testicles removed at the institute, making her the first known person to begin what would become a complete male-to-female surgical transition.
The First Surgeries in Weimar-Era Berlin
Dora Richter completed her transition in 1931 with a penectomy and vaginoplasty, becoming the first person in recorded history to undergo full male-to-female gender-affirming surgery. This happened during Germany’s Weimar Republic (1918–1933), a period of unusual social openness that allowed Hirschfeld’s institute to operate freely and publish its findings.
Around the same time, Danish painter Lili Elbe began a series of five highly experimental surgeries starting in 1930. She was examined by Hirschfeld and then operated on by German gynecologist Kurt Warnekros. The procedures removed her testicles and penis and attempted to transplant ovaries and a uterus. Elbe died of complications shortly after the fifth procedure in 1931. Both Richter’s and Elbe’s cases took place in the same narrow window of medical experimentation, and both ended abruptly when the Nazis rose to power and destroyed Hirschfeld’s institute in 1933.
Christine Jorgensen and the 1952 Headlines
For most of the public, gender reassignment surgery entered awareness on December 1, 1952, when the New York Daily News ran the front-page headline “Ex-GI Becomes Blonde Beauty.” Christine Jorgensen, an American World War II veteran, had traveled to Copenhagen in 1950 to seek treatment. She met Danish physician Christian Hamburger, who supervised her hormone therapy and referred her for surgery. Jorgensen received an orchiectomy at Gentofte Hospital in 1951, followed by a penectomy at Copenhagen University Hospital in 1952.
Jorgensen was not the first person to have these procedures, but her story made her a household name overnight. The intense media coverage, a mix of curiosity and hostility, brought transgender existence into mainstream conversation for the first time. Jorgensen spent the rest of her life as a public figure and advocate, giving lectures and interviews until her death in 1989.
The First Female-to-Male Surgery
The first known female-to-male surgical transition happened in Britain. In 1946, physician Michael Dillon (born Laura Maude Dillon) consulted Sir Harold Gillies, a pioneering plastic surgeon best known for reconstructing the faces of World War I soldiers. Gillies performed a series of thirteen operations over four years to construct male genitalia for Dillon. The procedure drew ethical protests and media attention, but it laid the foundation for modern reconstructive urology and phalloplasty techniques still refined today.
A Key Surgical Breakthrough in 1956
Early vaginoplasty techniques were crude by modern standards, and outcomes varied widely. A major turning point came in 1956, when French gynecologist Georges Burou independently developed a new approach at his clinic in Casablanca, Morocco. His technique used inverted penile skin to line the vaginal canal. It produced more consistent, functional results than anything before it and eventually became the gold standard for vaginoplasty in transgender women. Variations of Burou’s method remain the basis of most vaginoplasty procedures performed today.
Gender Surgery Comes to the United States
Johns Hopkins Hospital established the first gender-affirming surgery clinic in the United States in 1966. Before this, Americans seeking surgery typically had to travel to Europe or North Africa. The Hopkins clinic operated for more than 13 years, treating patients and publishing research that shaped how the American medical establishment understood gender identity. The clinic closed abruptly in 1979 amid internal controversy, setting back institutional support for gender-affirming care in the U.S. for years.
That same year, 1979, the Harry Benjamin International Gender Dysphoria Association published its first Standards of Care, creating the first formal clinical guidelines for evaluating and treating patients seeking gender transition. The organization later renamed itself the World Professional Association for Transgender Health (WPATH) and has published seven editions of those standards, each reflecting evolving medical knowledge and shifting terminology.
From “Sex Change” to “Gender-Affirming Surgery”
The language around these procedures has changed significantly over the decades. Early media coverage used terms like “sex change.” The medical field adopted “sex reassignment surgery” through much of the late 20th century. More recently, major organizations including WPATH and the American Medical Association have shifted to “gender-affirming surgery,” a term that frames the procedure as aligning a person’s body with their existing identity rather than switching from one sex to another. This shift happened gradually across the seven editions of WPATH’s Standards of Care published between 1979 and 2012, alongside changes in how transgender identities themselves were classified and discussed.
How Common These Surgeries Are Today
Gender-affirming surgeries have become far more accessible, though they remain a relatively small share of all surgical procedures. In the United States, the number of these surgeries rose from roughly 4,550 in 2016 to a peak of about 13,000 in 2019, according to national estimates published in JAMA Network Open. The numbers dipped slightly to around 12,800 in 2020, likely influenced by the pandemic’s effect on elective procedures. Insurance coverage has expanded considerably: regulations now require many health insurance companies to cover surgical treatments for gender incongruence, a stark change from even a decade earlier.
The field has come a long way from the experimental operations at Hirschfeld’s Berlin institute nearly a century ago. What began as a handful of secretive, high-risk procedures in the 1920s and 1930s has grown into a recognized surgical specialty practiced at major medical centers worldwide.