The first modern transgender surgery is credited to Magnus Hirschfeld, a German physician who performed a vaginoplasty on a patient named Dora Richter in 1922 at his Institute for Sexual Science in Berlin. Hirschfeld is widely considered the father of transgender health care, and his clinic became the center of early gender-affirming medicine before the Nazis destroyed it in 1933. But transgender surgery wasn’t the work of a single inventor. It developed across decades through the contributions of endocrinologists, gynecologists, plastic surgeons, and psychologists working in different countries, often independently of one another.
Magnus Hirschfeld and the Berlin Institute
Hirschfeld opened his Institut für Sexualwissenschaft (Institute for Sexual Science) in Berlin during the Weimar Republic, a period of unusual social liberalism in Germany. The institute became the world’s first facility dedicated to studying gender and sexuality in a clinical setting. In 1922, Hirschfeld performed what is considered the first modern gender-confirming surgery on Dora Richter, making her the first known transgender woman to undergo vaginoplasty.
Richter’s case gained wider recognition through a 1931 publication documenting the successful outcome, which is often cited as the first published report of a completed sex reassignment surgery. The institute also treated Lili Elbe, a Danish painter who became one of the most famous early transgender patients. Elbe underwent multiple staged procedures including removal of the testes, removal of the penis, an attempted ovarian transplant, and vaginoplasty. She died from complications following one of these surgeries in 1931.
Hirschfeld’s work built on earlier research by Eugen Steinach, a Viennese physiologist whose animal experiments in the 1910s demonstrated that sexual development in mammals was not rigidly determined by genetics but shaped by hormones. Steinach’s gonad transplantation experiments, while crude and ethically troubling by modern standards, established the biological principle that hormones could alter sexual characteristics. This insight gave Hirschfeld a theoretical foundation for medical intervention.
In 1933, the Nazi government raided the institute and publicly burned its library and research archives. Some scholars believe Hirschfeld may have also performed one of the first gender-affirming mastectomies for a transmasculine patient in the early 1930s, but any records of that procedure were likely destroyed in the raid.
Georges Burou and the Technique That Became Standard
While Hirschfeld pioneered the concept, the surgical technique used in most modern vaginoplasties came from a French gynecologist working in Morocco. In 1956, Georges Burou independently developed the penile skin inversion vaginoplasty at his Clinique du Parc in Casablanca. This method, which uses existing tissue to line the newly created vaginal canal, became the gold standard for the procedure and remains the basis for techniques used today.
Burou deliberately kept a low profile. Performing transgender surgeries was controversial, and working in Casablanca gave him distance from European medical politics. Over his career, he performed more than 800 vaginoplasties for transgender patients who traveled to Morocco from around the world. Despite the scale of his practice, he avoided publicity so he could continue the work without interference. He practiced until his death in 1987.
Harry Benjamin and the Medical Framework
Surgery alone wasn’t enough to establish transgender medicine as a recognized field. That step required someone willing to build a clinical framework around it. Harry Benjamin, a German-American endocrinologist, became the most influential figure in that effort. Working primarily in New York from the 1950s onward, Benjamin treated transgender patients with hormone therapy and advocated for surgical options when other approaches failed to relieve distress.
Benjamin’s approach was cautious. He urged patients to proceed slowly and viewed altering the body as a last resort, partly because long-term outcomes were unknown. He also helped establish the first university-based gender clinics in the United States. His caution became codified in the first formal standards of care, though his framework also embedded assumptions about gender that later generations of clinicians would revise, including the expectation that patients should conform to a strict gender binary and be heterosexual in their affirmed gender.
The First US Gender Clinic
In 1965, psychologist John Money and endocrinologist Claude Migeon opened the Gender Identity Clinic at Johns Hopkins University, one of the first such clinics in the United States. The clinic served transgender patients for 14 years before closing in 1979. Its existence brought transgender health care into the American academic medical system for the first time, though the program remained small and access was tightly restricted.
That same year, 1979, marked two other milestones. The World Professional Association for Transgender Health (WPATH) was founded, and the organization published its first Standards of Care, creating the first formal international guidelines for treating transgender patients. Those guidelines have been revised multiple times since, with the most recent version (SOC-8) published in 2022. The eighth version significantly reduced barriers to care compared to earlier editions, reflecting both clinical advances and changing cultural understanding of gender diversity.
Expanding Beyond Vaginoplasty
The history of transgender surgery is often told through the lens of vaginoplasty, but other procedures developed on their own timelines. The next known gender-affirming mastectomy after Hirschfeld’s possible early cases took place in 1942 at the Bristol Royal Infirmary in England. The patient was Laurence Michael Dillon, a transgender man who had been taking testosterone pills for years. The surgeon’s name was not recorded. The technique used in that era eventually evolved into what is now called free nipple grafting, which remains common in chest masculinization procedures.
Facial feminization surgery came much later. In the 1980s, Douglas Ousterhout, an American craniofacial surgeon, adapted techniques originally developed for correcting congenital skull deformities to reshape the facial bones of transgender women. Ousterhout’s work created an entirely new surgical discipline. His colleagues described the procedures as having the potential to change someone’s life as profoundly as correcting a birth defect.
Why There’s No Single Creator
Transgender surgery doesn’t have an Edison or a Salk. It emerged from overlapping work in endocrinology, gynecology, plastic surgery, urology, and psychiatry across multiple countries and decades. Steinach provided the hormonal science. Hirschfeld performed the first surgeries and built the first clinic. Burou developed the technique that made vaginoplasty reliable and reproducible. Benjamin created the clinical framework. Money and Migeon brought it into the American university system. Ousterhout extended it to the face. Each built on or worked parallel to the others.
If forced to name one person, most historians point to Magnus Hirschfeld. He was performing gender-affirming surgeries decades before anyone else, and his institute housed the world’s first organized program for transgender health care. The destruction of his work by the Nazis set the field back by years, scattering knowledge that had to be rediscovered independently by later practitioners like Burou.