In early 2022, looking around at an increasingly hostile and transphobic public space, and seeking a research topic that mattered, I decided to research the history of transgender medicine.1 I was interested in how the field developed, how research was (and is) entangled in the provision of care, how policymaking does (or does not) take up this research, and the consequences of all of this for patients.
Almost two years later, I found myself looking around a train station in Seattle, trying to spot a stranger called Gary whom I had met online. When we finally saw each other, he handed over an unmarked plastic bag containing a single VHS tape, which I carried home as if it were my child. Slotting it into a video player, I saw the latest breadcrumb in my medical research: a grainy stand-up comedy set from the mid-’90s.
What follows is a reflection on how I arrived at this moment—that is to say, on how a journey deep into the archive unearthed an unlikely, yet potent connection between transgender medicine and stand-up comedy.
Histories of Medicine and Histories of Histories
To understand the connection, it helps to understand a little bit of the history that I’m studying. Between the mid-1960s and the early 1980s, the United States was home to a whole host of gender identity clinics (GICs): “one-stop shops” for transgender healthcare that provided access to psychiatric screening, hormones, and surgery. GICs represented the first effort toward the institutionalization of trans healthcare, in contrast to the patchy and somewhat-underground private practices that had existed previously,2 and their influence continues to be felt in everything from narratives of the “acceptable” timeline for care to the standards of care themselves.
Many of the GICs were hosted at university hospitals, and this was not a coincidence: early GICs were not only (or even primarily) centers for medicine but centers for research. Their aim, in a time when trans healthcare was seen as experimental and disreputable, was to conduct studies that demonstrated whether or not medical interventions helped trans people. The clinical researchers who ran them, and the studies they produced, were both the subjects of and interveners in public policy and culture debates on whether medical transition should be supported, for whom, and under what conditions. Answering these questions was done using medical data, using science. What this meant in practice was the extensive recording of aggregable, quantitative data—reducing the complexities of trans lives into numbers that could be represented by doctors, rather than patients. The centers sought to provide care to trans people, but in a way that retained medical control over the forms that care took, as well as its goals.
If this sounds resonant with the present, it’s because it is: once again, we are in a time when trans healthcare is coming under the microscope, and once again, expertise on the topic derives not from the unmediated experiences and desires of trans people, but predominantly from cisgender clinicians and debates over the quantitative data they have gathered. Unsurprisingly, the resonance means that scholars are increasingly turning to the history of the first wave of GICs to understand the state we’re in, and how we might get out of it.3
This creates two problems: one practical, and one ethical. The practical issue is simply that most of the clinics’ records have not survived the intervening years.4 There is a reason that—apart from a couple of researchers, particularly Emmett Harsin-Drager—most historians have studied the Johns Hopkins clinic,5 which is (in part) that the Hopkins clinic has the most accessible medical records and clinical paperwork. The ethical issue, though, is that reliance on these records—limiting ourselves to what has been already archived—means overwhelming reliance on records that display trans autonomy or direct patient opinions only incidentally.
What would it look like to focus instead on histories that weren’t already archived—on building the archive? How would such an approach change the records to which we have access and the information patients could present us? I decided to find out by investigating a different GIC: one that was housed at the University of Washington.
Trans Medicine at the University of Washington
When I started my research, very little was known about the University of Washington (UW) GIC. Founded in 1968, as the third GIC in the United States, it operated only briefly, closing in 1972. The closure is usually attributed to the departure of the surgeon; the truth is more complicated—a tale of legal intrigue that deserves an essay all its own. As with many of the other clinics, it was established as a research project,6 which heavily structured patient experiences and expectations, and involved extensive testing both before and after treatment.
One might expect all these tests and treatments to leave archival traces. But initially, despite everything I tried, I uncovered none of it. In fact, the UW archives, on the surface, do not even mention the clinic (let alone the clinicians). A bit of digging revealed some mentions that the clinicians’ research interests included “transsexualism,” but still no mention of the patient or clinic files. So I reached out to one of the surviving clinicians, and he confirmed there were records: extensive records. Four giant green filing cabinets were chock full of everything from correspondence to interview transcripts to postcards sent by patients a decade or two after treatment. The problem was that I was not the only researcher interested in their contents; he had taken them home to write a research paper, following up on patients’ long-term outcomes. Specifically, he’d taken them to Northern California, where they were almost immediately placed in the path of the 2014 Tubbs wildfire and completely incinerated.
The Legend of Barbara Dayton
The story might have ended there, if not for a realization: doctors aren’t the only ones who keep copies of records; patients do, too. So even if I couldn’t get hold of the entire clinic record, I might be able to obtain a patient’s copy of their file: something to give me a sense of what questions patients were asked, how they were treated and evaluated, and who was involved. All I needed was to find one known and recorded patient among the twenty who were treated. In the end, I found one. Barbara Dayton, though deceased, has had her life extensively and publicly discussed by her friends Ron and Pat. Why? Because it's their theory (and, having talked to them about it, I can’t discount it) that Barb was the legendary and mysterious D. B. Cooper, famous for hijacking and ransoming a commercial airliner before parachuting from it in mid-air, vanishing somewhere between Seattle and Reno.
After Facebook messages (and letters, emails, and phone calls) to Ron and Pat, I finally managed to get in touch. They confirmed that they indeed had a copy of Barb’s medical records. So in a detour on the way to a friend’s wedding, I found myself in a lovely house in Tacoma, Washington, where for years a perfect duplicate of a UW GIC patient record had been sitting innocuously in a Tupperware container.
Ron and Pat were kind enough to let me copy the records. But their generosity went a lot further. Barb had met Ron and Pat through their shared interest in flying—an interest the latter still held. And so, with clear fondness, they told me about Barb’s life and their time with her; they showed me the hangar they’d shared with her, where her plane—and ashes—remain to this day. Sometimes when Ron takes a flight, he’ll bring Barbara’s ashes with him, strapped into the passenger seat. She’s been dead since 2011. Where does such profound love, overflowing with significance, appear in formalized, statistical data indexing what people’s post-treatment lives mean to the world? What does it mean, to medical history or analysis, to begin with people’s relations rather than their records?
Excitingly, and mysteriously, Barb’s patient records came with another clue: a receipt indicating they had been copied in 2016—two years after the wildfire destroyed the originals. I had another thread to follow.
Patient Records, Court Records
As I eventually learned, the University of Washington has, since its founding, been meticulous about keeping patient records; starting in 1969, the university began storing them on microfilms.7 What this means is that every patient record ever made is still preserved, and lives not only in the relevant hospital or department but (as a matter of protocol) in a central storage facility. To put it another way: not only had I found a copy of a UW patient’s records; I’d found proof that every other UW patient’s records had been preserved after all. Their final resting place was an office at Harborview Medical Center, east of downtown Seattle—meaning I’d spent almost a year of my life hunting for paperwork that was two blocks from my house.
But there was a catch—a big one—which showed up the moment I approached the records office. The interaction went something like this:
“Hi! I’d like to see the records for the patients for the UW Gender Identity Clinic?”
“What’s that?”
I explained, and they replied that even though there were records for every GIC patient, there were no aggregated “GIC patient records.” The problem is simple—and, in retrospect, obvious. Patient records were indexed not by clinic but by patient name. So gaining access to the patient records I was interested in was in fact impossible without the very information I had come to retrieve: their names.8
This, then, seems like it should have been the real end of the story; and perhaps it should have been. But (as all this digging probably suggests), I’m not very good at letting things go, which is how I found myself still worrying at it a month later as I battled jetlag in Northern Ireland, and why I ended up having a realization that broke the whole thing open. The problem was the structure of the UW School of Medicine; the solution was the structure of the clinic.
The early clinics were hyperfocused on two things: fear of patient regret and the desire for research data. Arguably, clinics still focus on those two things. The UW GIC was no exception, and this combination of fear and desire surfaced in the form of very specific requirements and restrictions for patients. These conditions offered a path to unraveling the tangle of identifying clinic records.
Not only did the clinic require patients to pass psychological tests or interviews; it also required particular changes to the way patients live. Specifically, the clinic required patients to live within 300 miles of the hospital (for ease of research follow-up) and, prior to treatment, to change their names to something stereotypically gendered.9 Pretty much anywhere in the US, such conditions would threaten to make searches like mine impossible. This is because name-change petitions, which are treated as generic court cases, end up in a massive archival pile with every other noncriminal case in a given area. Thus, finding the name-change petitions would mean wading through the microfilms of every single proceeding from that era, a process that would take literal years. Fortunately, I was saved by the very same restriction that had been so cynically imposed on trans individuals seeking care: geography.
Patients at the UW GIC had to be within 300 miles of Seattle—a space that, in terms of other major metropolitan areas, includes Portland, Oregon, to the south and Vancouver, British Columbia, to the north, and nothing else. In practice, if one had to come in for interviews irregularly and vitally (and during the evaluation process, this was certainly the case), travelling 299 miles was highly impractical. So most of the patients lived in Seattle proper—and for many of them, that was where they got their name changed. The city is located in King County, which is unique—among all the counties in all the states in the US—in that from 1947 to 1973, it maintained a single, centralized, standalone index of every single petition for a change of name.
The index is housed at the Puget Sound branch of the Washington State Archives, watched over by some incredibly lovely people who were only too happy to help me in my odyssey. I suspect they, too, were excited by the premise: a detective story involving queer history and D. B. Cooper is a hell of a lot more interesting than “Can you give me grandpa’s tax records.” They lent me the book for an afternoon, although calling it a book is sort of like calling the Titanic “a boat”; the thing is the size of a table, held together not with a spine but by metal hinges and ropes. A couple of hours of iPhone photography later, I walked out with copies of about 150 pages of court index. After another twenty hours of trying to understand some of the worst handwriting I’ve ever seen, I was left with twenty-two court cases—twenty-two name changes reflecting the applicant’s (now legal) gender.
To double-check, I took those pairs down to the superior court. As expected, a lot were false positives—either people whose parents had given them incredibly unfortunate names (who calls a baby girl Randy Rogerson?) and were trying to fix it after the fact, or court-clerk-handwriting-induced transcription errors (“Jan” turning out to be “Ian”). But twelve passed muster. And their public records, in turn, turned up yet more. As I followed the traces left by these individuals, seeking to confirm things like their date of birth, I encountered a multitude of fascinating stories that were not captured by the records.
One that still lives with me is told by a pair of numbers—specifically, a pair of court case numbers. As I pored over the files, I noticed that two patients’ name-change records appear sequentially; the cases, filed immediately after each other, were heard the same day. The reason for this became clear when I kept digging, and managed to find (and talk to one of) the two women, who by then must have been in their seventies. They were friends. Having met in another state, they’d traveled together up to Seattle to become patients at the clinic. They’d lived together; gotten their names changed together; seen each other through treatment, marriages, divorces, and marriages again; and moved to yet another state together. Fifty years later, they’re still friends and still describe each other as “like sisters.”
Also deeply captivating were the trajectories patients followed after the clinic. Some settled down into the kinds of lives that clinicians often idealize in their formal evaluations of outcomes; they became housewives or working husbands, adopted children, lived quietly. Others lived in ways more out of the ordinary; they became prize racehorse breeders, or held together the drag community in an out-of-the-way Canadian city, or spent their spare time—yes—as a stand-up comedian.
Archival Imperatives
Why does any of this matter? Well, I’d argue it matters for two (interlinked) reasons. The first relates to the archive—that thing I spent this entire story missing (or avoiding). For decades, academics have sought to problematize archives, with a central criticism revolving around two questions: Whose materials are preserved? And on whose terms? Much of the time, the answer to both is “people with the structural power to be taken seriously and as important.” Trans medicine provides a great case study of this: those few archives that do exist are predominantly the materials not of patients but of doctors.10 This creates two sets of absences: only the lives of trans people who “fit” as patients are included, and even then, only through the lens of what about their lives matters from the perspective of the medical gaze. In practice, this means that most of the lives of archival subjects are excluded from consideration, and that the fragments that remain are largely those of patients with privilege: white, with the wealth to afford treatment, and normative enough in their desires to be “worth treating.”11
But despite these limits, academia’s obsession with “the archive” remains—particularly in the humanities, where many trans studies scholars operate. Julietta Singh, for one, recalls in her book No Archive Will Restore You:
If you are like me and you didn’t roll into graduate school knowing the highfalutin importance of the archive, you learn it the moment you step into the seminar room. There, everyone is required to pretend to have one, and everyone wants to know yours. “What’s your archive?” you’ll be asked repeatedly, and your answer will reveal how seriously you should be taken.
The result is that while the archive is inherently limited, it remains to many scholars “an elusive hope of our individual salvation.” So we end up with researchers in a love–hate relationship, going back and forth to the same (inadequate) archives of the same (limited) people time and time again, with new techniques for wringing information out of collections never designed for our lives or the questions we care about.
Surgery, Satisfaction, and Statistics
That mismatch—between trans people and the medical gaze, between trans lives and the archival focus—is the other reason this story matters. As mentioned earlier, the question of whether trans medicine makes for better lives is today a hot topic, and much of the conversation revolves around data with the same limits as the archives—data gathered by (predominantly cisgender) doctors with a normative (and normalizing) imperative. But trans lives—as is true of all lives—cannot be circumscribed by such data.
Whatever the specifics, every story—every life—I ran into had something in common: they were not, and could not be, captured by medical records. What people’s lives mean to them, or what people mean to each other, always overflows, whatever version of a person (or a community) medical records record. And, partly in consequence, they quickly and clearly overflow attempts by medical data alone to neatly gauge the goodness of someone’s life or their experiences of medicine.
But these stories and experiences are not to be encountered in either the trans medical literature or the judicial debates over its acceptability. Instead, matters are often reduced to statistics: to whether, in the eyes of (predominantly cisgender) doctors, patients are “better.” Not only does this constrain how we can understand the purposes and justifications for trans medicine; it also constrains who can speak in that debate, and how. A focus on how doctors define “better” often leads to evaluations that only ask about what the doctor perceives as the markers of a good life: Is someone employed? Do they have a family? But what forms of life does this leave out, and what modes of measuring a life’s value? How can such questions contain the feeling of being loved so much that your friends would take your ashes to the skies, or of having a chosen sister you’ve held tight for fifty years?
These questions—and the responses they inspire—do not fit into standardized evaluations, a life reduced to medical records, or a conventional archive. Thus, their appearance is rare—not only in medical literature but in expert testimony in the various court cases around the world over the provision of trans care. In both contexts, simple answers, backed by the imprimatur of a medical doctor, are valued more than treating trans people as people—as capable of leading complex lives that cannot be captured simply.12 The result is that, just as archival practices risk reinforcing the importance of the archive even as we bemoan its limitations, common approaches to understanding the worth of transition risk reinforcing simple, conventional definitions of a life worth living, and the power of professionals to act as the ultimate arbiters of whether such a life has come to pass.
On Being Trans and Feeling However We Want
If we are to break through these limits—in public discourse, in how we approach each other, and in the shape of medical evaluations—we need to see (and be seen) in all of our lives, not just those that fit in a standardized form or patient record. We need to be allowed to be happy in ways that work for us; to be sad, too, and imperfect, in ways that work for us, as Hil Malatino writes so beautifully in Side Affects. And researchers need to take just as expansive a view to archival and historical research, if we are to do the people we are researching and researching with justice.
The materials I collected do, after all, live in an archive. It’s named after Barbara Dayton and Dan Hunt—the first patient, and the last doctor—and comprises far more than medical records. There are marriages and self-authored autobiographies; go-go dancing photographs and the testimonies of friends; shitty, low-quality VHS tapes of stand-up comedy routines that wouldn’t be worth a second look if they didn’t signify a trans woman smiling and laughing, after decades of insistence that such a thing was impossible. This archive is not complete, and the lives it contains are not perfect. But it does not have to be, and neither do they.
1. Os Keyes, “Trans Science: Research, Medicine, and the Politics of Proof,” PhD diss., University of Washington, 2024.
2. See Beans Velocci, “Standards of Care: Uncertainty and Risk in Harry Benjamin’s Transsexual Classifications,” Transgender Studies Quarterly 8, no. 4 (2021): 462–80.
3. See, for example, Elliot Marrow, “Breaking Cycles of Harm: Lessons from Transgender History for Today’s Clinicians,” Behavior Therapist 45, no. 6 (September 2022).
4. Keyes, “Trans Science.”
5. See, for example, Jules Gill-Peterson, Histories of the Transgender Child (Minneapolis: University of Minnesota Press, 2018); and Sandra Eder, How the Clinic Made Gender: The Medical History of a Transformative Idea (Chicago: University of Chicago Press, 2022).
6. D. Daniel Hunt and John L. Hampson, “Follow-Up of 17 Biologic Male Transsexuals after Sex-Reassignment Surgery,” American Journal of Psychiatry 137, no. 4 (1980): 432–38.
7. Records of Robert Hardin Williams, Accession 2933-001, University of Washington Special Collections, Box 11, Folder 10.
8. Os Keyes, “ ‘Legally, We’re Alright, but Ethically, I Don’t Know’: Research, Regret, and Trans Medicine at the University of Washington, 1968–1972” (forthcoming, 2024).
9. Keyes, “Legally, We’re Alright.”
10. Keyes, “Trans Science.”
11. See Gill-Peterson, Histories of the Transgender Child.
12. For exhibits, see “Reply Memorandum in Support of Plaintiffs’ Motion for Preliminary Injunction,” Document No. 51.