Jules Gill-Peterson: A Historian's Perspective on the Past, Present, and Future of Trans Healthcare
Jules Gill-Peterson speaks from a unique vantage point, not only as a preeminent historian of transgender life but also as someone navigating the complexities of medical transition in the present day. Reached via Zoom, she is 11 hours ahead, the bright Bangkok sun illuminating her space as she recovers from a significant surgical procedure. This personal experience, undergoing a vaginoplasty in Thailand after years of struggling to access the same care within the American healthcare system, deeply informs her academic and political perspectives. It highlights a critical disconnect between the theoretical discourse surrounding 'gender-affirming care' and the tangible, material realities of accessing necessary medical interventions like hormones and surgery.
Gill-Peterson, a Baltimore-based trans studies scholar, is renowned for her groundbreaking research into the history of medical transition, particularly focusing on how trans youth have sought and accessed healthcare over time. Her 2018 book, Histories of the Transgender Child, was published at a time when legislative attacks on gender-affirming care for minors were just beginning to gain momentum in the United States. This work proved eerily prescient, anticipating the wave of state-level bans and federal efforts that have since sought to restrict or eliminate access to puberty blockers, hormones, and surgery for young trans people. The book challenged the prevailing narrative that trans identity and medical transition in youth were entirely new phenomena, demonstrating a long, albeit often obscured, history of children seeking to medically alter their sex dating back to the early 20th century.
Seven years after the publication of her first book, the fight over access to trans youth healthcare has escalated dramatically, reaching the highest court in the land. The case, United States v. Skrmetti, challenges a Tennessee ban on gender-affirming care for transgender youth. The Supreme Court's ruling, expected soon, carries immense weight, potentially shaping the future of access to essential medical care for trans youth across the country and influencing broader aspects of trans American life.
Gill-Peterson, alongside other experts in the field, contributed an amicus brief to the Supreme Court for the Skrmetti case. This brief leveraged historical evidence to counter the arguments that trans youth and their medical needs are recent inventions or that the care they seek is experimental. It underscored that trans kids have existed and have been transitioning, through various means, for far longer than contemporary anti-trans rhetoric suggests. This historical grounding is crucial in a legal and political landscape where opponents of trans rights often rely on ahistorical claims to justify discriminatory policies.
Beyond her formal academic and legal contributions, Gill-Peterson offers a sharp critique of the language and priorities often adopted within mainstream trans advocacy. She expresses a preference for plain language, speaking directly about 'hormones' and 'surgery' rather than the more abstract 'gender-affirming care,' which she finds euphemistic. This linguistic choice is not merely semantic; it reflects her political conviction that the focus should be on meeting the concrete, material needs of trans people. In a climate of escalating attacks, she argues, prioritizing abstract concepts like 'trans joy' or 'gender euphoria' can distract from the urgent fight for resources, access to medical care, and economic security.
Her personal journey to Bangkok for surgery underscores this point. Despite being a prominent scholar in the field, holding a tenured position at Johns Hopkins University, and having health insurance that would nominally cover a significant portion of the cost, she spent five years trying unsuccessfully to obtain the surgery in the United States. Navigating the complexities of the American healthcare system, changing jobs, switching insurance, and moving states repeatedly created insurmountable barriers. Her experience, even within a system that was supposedly 'working' for her at its best, highlights the systemic difficulties trans people face in accessing necessary medical care in the US.
Reflecting on her experience in Bangkok, Gill-Peterson notes the stark contrast. Having a positive surgical experience with a skilled surgeon abroad led her to a powerful realization: if only the resources and systems were in place in the US, this level of accessible, effective care could be available to everyone. Instead, the US has moved in the opposite direction.
Approximately half of US states have enacted healthcare bans that prohibit minors from accessing medical transition, often pushing families and individuals towards underground or out-of-state options. Furthermore, legislative efforts at the national level threaten to restrict Medicaid coverage for gender-affirming care for people of all ages. According to a 2022 report from the Williams Institute, a quarter-million trans individuals rely on Medicaid. Proposed legislation, such as the "One Big, Beautiful Bill Act," which has passed the House and is moving through the Republican-controlled Senate, aims to prevent Medicaid from covering puberty blockers, hormones, or surgery, treatments currently permitted in many states. Should such a bill become law, it would erect significant new barriers to care for a vulnerable population.
In this challenging environment, Gill-Peterson calls for a reality check among those who rely on feel-good platitudes like "Love Is Love." She argues that acknowledging the material reality of healthcare as an urgent, lifesaving need is crucial for mounting an effective challenge to these attacks. "All of these push factors are impolite to acknowledge in progressive liberal circles," Gill-Peterson says. "They’d rather plug their ears than admit that health care is a material need. It’s not a slogan. It’s not, like, a thing you support in your heart. It’s an urgent, lifesaving need."
Gill-Peterson's academic journey began in Canada, leading her to a PhD in American Studies from Rutgers University. Her subsequent position at the University of Pittsburgh provided the foundation for Histories of the Transgender Child, a book that earned the Lambda Literary Award for best transgender nonfiction in 2019. The book's core argument—that transness is not a recent phenomenon and that youth have historically sought medical transition—directly counters the narrative used to justify current bans. As filmmaker and historian Morgan M. Page has noted, "Trans people are in a constant state of being discovered," a cycle Gill-Peterson's work seeks to break by providing deep historical context.
Her research has become increasingly vital as lawmakers criminalize the provision of gender-affirming care, often labeling it "experimental." As Charlie Markbreiter, an academic and organizer, states, Gill-Peterson has "paradigm-shifted the field of trans studies multiple times." He highlights that Histories of the Transgender Child "destroyed the myth that trans kids were ‘just invented,’" praising her scholarship for being "historically grounded, accessible to nonacademic audiences, and useful to movement struggles." Markbreiter considers her "easily the most important trans studies scholar working today. It’s not even close."
Gill-Peterson's intellectual and political development has been significantly shaped by her relationship with Kadji Amin, an associate professor at Emory University and author of Disturbing Attachments. Their relationship, which began during the isolating early days of the Covid-19 pandemic, fostered a collaborative working dynamic that helped them refine their political goals and critical perspectives. "My thinking owes a lot to our relationship," she says of Amin, who accompanied her to Bangkok and provided care during her recovery.
Despite her academic success, Gill-Peterson has faced harassment and bigotry, even within academia. She credits Amin's unwavering support and willingness to speak out against the mistreatment of transsexual women, particularly by those who claim to be allies, as instrumental in her ability to continue her work amidst a worsening political climate. Their shared experience during the pandemic led them to contemplate the practical value of academic research in times of crisis, concluding that academics must learn to articulate "urgent and basic truths" that the academy often avoids. This includes critiquing the "condescending elitism, anti-transsexualism, and misogyny of middle-class transgender thought and politics," perspectives they had long held but were discouraged from expressing.
These critiques are sharply articulated in her second book, A Short History of Trans Misogyny, published by Verso. This work builds upon the legacy of transfeminist scholars like Julia Serano and Viviane K. Namaste, examining how seemingly progressive neoliberal politics can create a space for certain trans individuals only by excluding others, particularly transsexual women who are poor, Black, brown, sex workers, or immigrants. Gill-Peterson's analysis demonstrates how this exclusion is rooted in centuries of Euro-American colonial violence, tracing these dynamics across continents and historical periods with extensive research, yet remaining remarkably concise and accessible.
A powerful example of the dynamic she analyzes is the 2015 protest by Jennicet Gutiérrez, an organizer for queer and trans immigrants' rights, at a White House Pride reception. Just two days before the Supreme Court's landmark ruling on same-sex marriage, Gutiérrez interrupted President Obama to demand action against the abuse of trans people in ICE detention centers and the release of LGBTQ+ detainees. The reaction from many attendees—a mix of activists, journalists, and community leaders—was telling: they shushed, booed, and applauded when Obama rebuked her, highlighting how the focus on mainstream, assimilable victories can overshadow the urgent needs of the most marginalized within the community. Gill-Peterson's book provides the historical and theoretical framework to understand such moments of internal conflict and exclusion within trans politics.
Gillian Branstetter, a communications strategist at the American Civil Liberties Union (ACLU), which is representing the trans teenagers and their families in the Skrmetti case, attests to the value of Gill-Peterson's perspective. "I’ve found Jules to have an essential perspective and one that challenges me and how I do this work of ‘trans activism,’” Branstetter says. She notes that Gill-Peterson's work illuminates the limitations of identity-first politics at a time when "we need solidarity across difference," adding that identity itself is often something shaped by the constraints and violence of existing systems.
Over the years, Gill-Peterson's work, which also includes her editorial role at Trans Studies Quarterly and cohosting the Death Panel podcast, has increasingly focused on constructing trans histories that exist outside the traditional archives of American medical institutions. Her forthcoming book, Transgender Liberalism, from Harvard University Press, will delve further into this, exploring the history of class differences among trans people and how state and medical institutions have exacerbated these disparities.
The project originated as a history of DIY transition practices but evolved as Gill-Peterson recognized the divergent histories of transition for trans women and trans men, which remained largely separate until recent decades. She notes that trans men historically experienced upward mobility even without hormones, while trans women did not. A central argument of Transgender Liberalism is that the US gender clinic system was initially developed, in part, to address the specific needs and circumstances of poor trans women, particularly those marginalized from the labor market and criminalized. The clinics, she argues, aimed to "coercively rehabilitate them... into working women and get them back into the economy." This historical context challenges simplistic narratives about the origins and purpose of medical transition access.
As the Supreme Court prepares to issue its ruling in United States v. Skrmetti, the stakes for trans youth healthcare are incredibly high. While a ruling striking down the Tennessee ban on the grounds of sex discrimination could provide legal precedent to challenge similar laws in other states, the conservative majority on the bench makes this outcome uncertain. The "worst-case scenario," as Branstetter told Dazed, is that things remain as they are, with trans kids and their families in states with bans continuing to face severe restrictions on lifesaving care. For them, "the world has already ended."
However, Gill-Peterson is not a defeatist. She emphasizes that legal victories, while important, are not the sole determinant of the struggle for trans liberation. The mere existence of a legal right to change sex, as Andrea Long Chu has termed it, does not guarantee the practical ability to do so. Therefore, the fight for medical transition access requires a broader, more comprehensive strategy focused on material conditions. "It demands a bread-and-butter approach," she says, prioritizing economic security and adequate resources for all trans people.
Her research for Transgender Liberalism has revealed a critical, often overlooked aspect of this struggle: the skyrocketing cost of medical transition. She notes that in the 1960s, the total cost for psychiatric evaluation, ancillary care, and surgeries at a gender clinic for transsexual women averaged around $3,500, equivalent to about $35,000 today. By the 1990s, this amount had doubled. The cost of procedures like phalloplasty for trans men saw an even more dramatic increase, reaching over $200,000 by the century's end when adjusted for inflation, making it practically inaccessible for most people. This historical data demonstrates that, contrary to popular narratives, accessing medical transition in the US has become empirically harder and more expensive over time, especially if one removes the gains made through recent healthcare reforms that lawmakers are now targeting.
This increasing difficulty and cost, Gill-Peterson argues, represent "the real political crisis—the real panic when it comes to transition, not the moral panic that we’re told exists." The American healthcare system has not made it too easy to transition; it has made it too hard, and her historical research provides the evidence to support this claim.
When invited to coauthor an amicus brief for the Skrmetti case, Gill-Peterson was prepared. Anticipating that the Supreme Court would eventually address trans kids' healthcare, she had for years maintained a separate file of historical evidence demonstrating the "longevity, the reality, and the banality of medical transition in this country." This meticulous approach, characteristic of a good historian, allowed her to contribute crucial empirical data to counter the state's claims that gender-affirming care is "novel" and "experimental." Her brief detailed the deep historical roots of "gender dysphoria and these treatments," providing a vital counter-narrative to the ahistorical framing often employed by opponents of trans rights.
While acknowledging that she is not a lawyer or legal scholar, Gill-Peterson emphasizes her role as an "empiricist," someone who grounds her arguments in historical evidence. This position makes her work a powerful counterpoint to legal frameworks like textual originalism, which the right has strategically used in its attacks on civil rights. She sees this moment as critical for historians to intervene, correcting the record against ahistorical legal arguments.
Despite the lack of optimism regarding the immediate outcome of the Supreme Court decision, Gill-Peterson remains resolute. She believes that every legal case, regardless of the ruling, creates new opportunities for political action both inside and outside the courtroom. Rather than succumbing to despair, she advocates for clarity about the diverse arenas where political work can be done and material change can be achieved. This includes engaging in state and local elections, workplace organizing, building mutual aid networks, and other forms of collective action. What happens *after* the ruling, she contends, is ultimately more important than the ruling itself.
"When the battle’s playing out on a hundred fronts at once, we have to remember that there’s no single court ruling, no existential moment, no single referendum on ‘transgender rights’ that’ll decide how this struggle will go," she asserts. The goal, she believes, must be to build momentum towards achieving "wonderful things" for trans people, including "unrestricted medical transition, sex changes, surgery."
Her vision for the future of trans healthcare is not limited to legal battles or academic discourse; it is deeply intertwined with the practical realities of access, cost, and material well-being. As she reaches off-screen for her drink, she adds a touch of personal joy to her powerful political statement: "—and iced coffee in Thailand! The girls love it." This small, human detail serves as a reminder that the fight for trans liberation is ultimately about enabling trans people to live full, healthy, and joyful lives, supported by the resources and care they need and deserve.
Jules Gill-Peterson's work provides a vital historical lens through which to understand the current political attacks on trans healthcare. By demonstrating the long history of trans people seeking medical transition and highlighting the material barriers to access, she challenges simplistic narratives and redirects the focus towards the concrete needs of the community. Her involvement in the Skrmetti case and her ongoing research into the class dynamics of trans life underscore her commitment to a politics that prioritizes resources, access, and economic security. As the fight for trans rights continues on multiple fronts, Gill-Peterson's voice, grounded in rigorous historical analysis and personal experience, offers a clear-eyed vision for a future where essential medical care is not a privilege but a readily available reality for all trans people.
This piece was published in partnership with Them.