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Transgender people (including non-binary and third gender individuals) have existed in cultures worldwide since ancient times. The modern terms and meanings of "transgender", "gender", "gender identity", and "gender role" only emerged in the 1950s and 1960s. As a result, opinions of how to categorize historical accounts of gender-variant people and identities vary.

Sumerian and Akkadian texts from 4500 years ago document transgender or transvestite priests known as gala. Likely depictions occur in art around the Mediterranean from 9000 to 3700 years ago. In Ancient Greece, Phrygia, and Rome, there were galli priests that some scholars believe to have been trans women. Roman emperor Elagabalus (d. 222 AD) preferred to be called a lady (rather than a lord) and sought sex reassignment surgery, and in the modern day has been seen as a trans figure. Hijras on the Indian subcontinent and kathoeys in Thailand have formed trans-feminine third gender social and spiritual communities since ancient times, with their presence documented for thousands of years in texts which also mention trans male figures. Today, at least half a million hijras live in India and another half million in Bangladesh, legally recognized as a third gender, and many trans people are accepted in Thailand. In Arabia, khanith today (like earlier mukhannathun) fulfill a third gender role attested since the AD 600s. In Africa, many societies have traditional roles for trans women and trans men, some of which survive in the modern era. In the Americas prior to European colonization, as well as in some contemporary North American Indigenous cultures, there are social and ceremonial roles for third gender people, or those whose gender expression transforms, such as the Navajo nádleehi or the Zuni lhamana.

In the Middle Ages, accounts around Europe document trans men. Kalonymus ben Kalonymus's lament for being born a man instead of a woman has been seen as an early account of gender dysphoria. Eleanor Rykener, a male-bodied Briton arrested in 1394 while living and doing sex work dressed as a woman, has been seen as a trans woman. In the Balkans since the 1400s, female-assigned people have transitioned to live as men called sworn virgins. In Japan, accounts of trans people go back to the Edo period. In Indonesia, there are millions of trans-/third-gender waria, and the bugis of Sulawesi recognize five genders. In Oceania, trans-/third-gender roles like the akava'ine, fa'afafine and fakaleiti exist among the Cook Island Maori, Samoans, and Tongans.

In colonial America, Thomas(ine) Hall in the 1600s adopted clothes and roles of both men and women, while in 1776 the genderless Public Universal Friend arose. During the 1800s, some people began new lives as men and served in the military, including Albert Cashier and James Barry, or otherwise transitioned, like Joseph Lobdell; trans women like Frances Thompson also transitioned. In 1895, trans autobiographer Jennie June and others organized the Cercle Hermaphroditos; in the 1900s, musician Billy Tipton lived as a man, while Lucy Hicks Anderson was supported by her parents and community in being a woman.

Karl M. Baer (in 1906) and Alan L. Hart (1917) underwent early female-to-male reassignment surgeries, while in 1930 and 1931 Dora Richter and Lili Elbe had early male-to-female surgeries including (for Elbe) an ovary and uterus transplant. Baer, Richter and Elbe were aided by Magnus Hirschfeld, whose pioneering work at the Institut für Sexualwissenschaft for trans medicine and rights was destroyed by the Nazis in 1933. In 1952, American trans woman Christine Jorgensen's transition brought wide awareness to sex reassignment surgery. The grassroots fight for trans rights became more visible with trans and gay people fighting back against police in the 1959 Cooper Donuts Riot, 1966 Compton's Cafeteria Riot, and multi-day Stonewall Riots of 1969. In the 1970s, Lou Sullivan pioneered visibility for gay trans men and organized what became FTM International. At the same time, some feminists opposed the inclusion of trans women, creating what was later known as trans-exclusionary radical feminism. In the 1990s and 2000s, the Transgender Day of Remembrance was started and trans marches became more common; trans people were elected to public offices; and legislative and court actions began recognizing trans people's rights in some countries (especially in the West, India, and southern Africa). At the same time, other countries (especially in the rest of Africa, Central Asia, and Arabia) abridge trans people's rights due to transphobia.

Historiography
Transgender people are known to have existed since ancient times. A wide range of societies had traditional third gender roles, or otherwise accepted trans people in some form. However, a precise history is difficult because the modern concept of being transgender, and gender in general, did not develop until the mid-1900s. Historical understandings are thus inherently filtered through modern principles, and were largely viewed through a medical lens until the late 1900s. Writer Genny Beeman points out: "Can there be said to be a “transgender history,” when “transgender” is a contemporary term and when individuals in past centuries who would perhaps appear to be transgender from our vantage point might not have conceptualized their lives in such a way? And what about individuals today who have the ability to describe themselves as transgender, but choose not to for a variety of reasons, including the perception that it is a White, middle-class Western term and the belief that it implies transitioning from one gender to another? Should they be left out of “transgender history” because they do not specifically identify as transgender?"

Ancient Egypt
Ancient Egypt had third gender categories, including for eunuchs. In the Tale of Two Brothers (from 3200 years ago), Bata removes his penis and tells his wife "I am a woman just like you"; one modern scholar called him temporarily (before his body is restored) "transgendered". Mut, Sekhmet and other goddesses are sometimes represented androgynously, with erect penises, and Anat wears clothes of both men and women.

North Africa
Trans people face stigma and are not able to change gender markers or access hormone therapy or reassignment surgery in Morocco, but in 2018 some founded a group to oppose discrimination. In Algeria, trans people mostly live in the shadows, or seek refuge in France; in 2014 the first LGBT magazine in the country, El Shad, launched and profiled several. In Tunisia, trans people have been arrested, jailed, and tortured; some seek asylum in Greece. Egypt today is also hostile to transgender people, who are subject to arrest.

The Nuba peoples of Sudan (including the Otoro Nuba, Nyima, Tira, Krongo, and Mesakin), have traditional roles for male-assigned people who dress and live as women and may marry men, which have been seen as transgender roles. However, trans people face discrimination in the modern Sudanese state, and cross-dressing is illegal.

For the history of Roman and Byzantine Africa, see § Rome and Byzantium; for Ottoman Africa, see § Ottoman Empire.

West Africa
By the modern period, the Igbo, like many other peoples, had gender and transgender roles, including for females who take on male status and marry women, a practice which also exists among the Dahomey (Fon) of Benin and has been viewed through both transgender and homosexual lenses. Anthropologist John McCall documented a female-assigned Ohafia Igbo named Nne Uko Uma Awa, who dressed and behaved as a boy since childhood, joined men's groups, and was a husband to two wives; in 1991, Awa stated "by creation I was meant to be a man. But as it happened, when coming into this world I came with a woman's body. That is why I dressed [as a man]." However, trans people in Nigeria face harassment and violence.

In the modern Ghanaian state, trans people face violence and discrimination in accessing healthcare, work, education and housing, as they also do in a number of other western African states like the Gambia.

Trans people face abuse from society, government, media and doctors in Senegal, and are harassed (including by police) in Sierra Leone, but have built some underground community spaces. Transphobia is rampant in modern Mali and trans women are often beaten in the streets. In Liberia, sexual minorities have long been part of society, and founded the Transgender Network of Liberia in 2014, hold an annual pageant, and mark the Trans Day of Remembrance, but also face harassment. They benefited from US backing under Obama and were harmed by Trump administration cuts, and by Liberians who wrongly believe transness was introduced to the country by the West.

In the Ivory Coast, trans women (especially sex workers) face harassment and violence, especially since the 2011 election; since 2009, there has been an annual drag pageant, but it focuses more on gay men than trans women or travestis. In modern Benin, one trans woman was supported by her mother and the French in organizing other trans Beninese, but abused by other relatives, threatened by police, and forced to flee abroad. In Cape Verde, activist Tchinda Andrade came out in 1998, becoming so well known that trans people are locally called tchindas; in 2015, the documentary Tchindas followed her preparation for the annual carnival. Trans people still face intolerance, but São Vicente, Cape Verde is today among the more tolerant places in Africa, which locals attribute to its small size requiring people to work together.

Central Africa
In Cameroon, trans people face violence and discrimination in accessing healthcare, work, education and housing, and trans women have been attacked and jailed. Trans people in the Democratic Republic of the Congo today also face harassment. Trans and gay people in Rwanda live more openly and face less violence than in neighboring states, but face some stigma. In Angola, in the 2010s, trans singer Titica initially faced violence but has become popular, especially with young Angolans.

East Africa
Among Swahili-speaking people in Kenya, male-assigned mashoga may take feminine names, marry men, and do womanly household work (while mabasha marry women). Among some other Kenyan peoples, male-assigned priests (called mugawe among the Meru and Kikuyu) dress and style their hair like women and may marry men, and have been compared to trans women.

Among the Nuer people (in what is now South Sudan and Ethiopia), female-assigned people who have borne no children may adopt a male status, marry a woman, and be regarded as the father of any children they bear (a practice which has been viewed as transgender or homosexual); the Nuer are also reported to have a male-to-female role. The Maale people of Ethiopia also have a traditional role for male-assigned ashtime who take on feminine roles; traditionally, they served as sexual partners for the king on days he was ritually barred from sex with women; with the introduction of modern transphobia, ashtime came to be viewed as abnormal by the 1970s. The Amhara people of Ethiopia stigmatize male-assigned people in their communities who adopt feminine dress.

In Uganda today, transphobia and homophobia is increasing, introduced in the 1800s and 1900s by Christian missionaries and stoked in the 2000s by conservative evangelicals; trans people are now often kicked out by their families and denied work, and face discrimination in accessing healthcare, though trans men are trying to challenge such transphobia and sexist gender roles. Traditionally, Ugandan peoples were largely accepting of trans and gay people; the Lango people accepted trans women—male-assigned people called jo apele or jo aboich who were believed to have been transformed at conception into women by the androgynous deity Jok, and who adopted women's names, dress, and face-decorations, grew their hair long, simulated menstruation, and could marry men —as did the Karamojong and Teso, and the Lugbara people had roles for both trans women (okule) and trans men (agule).

In Madagascar, the U.S. State Department reported in 2011 that "sexual orientation and gender identity were not widely discussed" and attitudes ranged "from tacit acceptance to violent rejection, particularly of transgender sex workers". In the early 2000s, Balou Chabart Rasoana became one of the first publicly out trans women, and faced discrimination but was supported by her mother and, over time, her neighborhood; much of the LGBT community remains underground.

Traditional Bantu third genders
Various Bantu peoples in southern Africa, including the Zulu, Basotho, Mpondo and Tsonga, had a tradition of young men (inkotshane in Zulu, boukonchana in Sesotho, tinkonkana in Mpondo, and nkhonsthana in Tsonga; called "boy-wives" in English) who married or had intercrural or anal sex with older men, and sometimes dressed as women, wore breast prostheses, did not grow beards, and did women's work; these relationships became common among South African miners and continued into the 1950s, and while often interpreted as homosexual, boy-wives are sometimes seen as transgender.

Botswana
In two cases in 2017, Botswana's High Court ruled trans men and trans women have the right to have their gender identity recognized by the government and to change gender markers; the court said the registrar's refusal to change a marker was unreasonable and violated the person's "rights to dignity, privacy, freedom of expression, equal protection of the law, freedom from discrimination and freedom from inhumane and degrading treatment".

South Africa
From the 1960s to 1980s, the South African Defence Force forced some white gay and lesbian soldiers to have sex reassignment surgery.

Since March 2004, trans and intersex people are allowed to change their legal sex after medical treatment such as hormone replacement therapy. Several Labour Court rulings have found against employers that mistreated employees who transitioned.

Early history
Prior to western contact, some Native American tribes had third-gender roles, like the Diné (Navajo) nádleehi and the Zuni lhamana. European anthropologists usually referred to these people as berdaches, which Indigenous people have always considered an offensive slur. In 1990, some Indigenous North Americans, largely in academia, adopted the pan-Indian neologism two-spirit, as an attempt to organize inter-tribally. Though acceptance of this term in traditional Native communities which already have their own terms for such people has been limited, it has generally met with more acceptance than the slur it replaced.

One of the first European accounts of Iroquois practices of gender was made by missionary Joseph-François Lafitau who spent six years among the Iroquois starting in 1711, and observed "women with manly courage who prided themselves upon the profession of warrior, [and seemed] to become men alone", and people he called "men cowardly enough to live as women."

There is archaeological evidence that trans- or third-gender individuals existed in California 2500 years ago at rates comparable to those at which they exist among indigenous peoples there in the modern era, and archaeological and ethnographic evidence suggests third-gender categories may be of great antiquity in North America overall; Barbara Voss suggests they may go back to the first migrations of people from eastern Asia and Siberia over 10,000 years ago.

Canada


During the colonial period a European system of beliefs and values was imposed on the First Nations and enforced among the colonists.

In 1970, Dianna Boileau underwent sex reassignment surgery at Toronto General Hospital, becoming possibly the first in Canada to do so. Over the following two years, Boileau shared her story with a number of press outlets and published a 1972 memoir, Behold, I Am a Woman, before retreating from the public eye.

In 2002, sexual orientation and gender identity were included in the Northwest Territories Human Rights Act.

In June 2012, gender identity and expression were added to the Ontario Human Rights Code, and gender identity was added to the Manitoba Human Rights Code. In December 2012 Nova Scotia added gender identity and expression to the list of things explicitly protected from harassment in that province's Human Rights Act. In May 2012, after a legal battle to reverse her disqualification for not being a "naturally born female", Vancouver resident Jenna Talackova became the first trans woman to compete in a Miss Universe pageant, and was one of four contestants to win "Miss Congeniality".

In March 2013, the House of Commons passed Bill C-279 to officially extend human rights protections to trans people in Canada. In February 2015, the Senate of Canada amended the bill in ways that were criticized as transphobic.

In December 2015, legislator Estefania Cortes-Vargas came out as non-binary in the Legislative Assembly of Alberta during a debate over the inclusion of transgender rights in the provincial human rights code. While the provincial Hansard normally reports members' speeches under the gender honorifics "Mr." or "Ms.", Cortes-Vargas is recorded as "Member Cortes-Vargas". On December 17, 2015, Kael McKenzie was appointed to the Provincial Court of Manitoba, becoming Canada's first openly transgender judge.

In 2016, gender identity or expression was added to the Quebec Charter of Rights and Freedoms. The same year, Jennifer Pritzker gave a $2 million donation to create the world's first endowed academic chair of transgender studies, at the University of Victoria in British Columbia; Aaron Devor was chosen as the inaugural chair. In May 2016, Bill C-16 was introduced aiming to update the Canadian Human Rights Act and Criminal Code to include gender identity and expression as protected grounds from discrimination, hate publication and advocacy of genocide, and to add targeting of victims on the basis of gender identity and expression to the list of aggravating factors in sentencing, the first time such a bill was put forward by the governing party in the House of Commons. Since June 2017, all places within Canada explicitly within the Canadian Human Rights Act or equal opportunity or anti-discrimination legislation do prohibit discrimination against gender identity or expression.

Since August 2017, Canadians can indicate that they are neither male nor female on their passports, using an 'x' marker.

In January 2018, Canadian Women's Hockey League player Jessica Platt came out, the first trans woman to come out in North American professional hockey.

Haiti
In 1791, early in the Haitian Revolution, a black planter who had been raised as a boy led an uprising in southern Haiti under the name Romaine-la-Prophétesse ("Romaine the Prophetess"). Romaine dressed like a woman and spoke of being possessed by a female spirit, may have been transgender or genderfluid, and has been compared to the transgender feminine religious figures of West Africa, the area many black Haitians descended from. Mary Grace Albanese and Hourya Bentouhami list Romaine among the women who led the Haitian Revolution, while Terry Rey argues calling Romaine transgender could be anachronistic. Romaine has been compared to Kimpa Vita, who professed to be the incarnation of a male Catholic saint.

In the modern era, discrimination and violence against transgender people is common in Haitian society, though many LGBT people find it easier to be open about their gender within the Vodou subculture, in which it is believed, for example, that people may be possessed by divinities of the opposite sex. Haiti's criminal code prohibits vagrancy, with a specific mention of transvestites.

Mexico


In several pre-Columbian communities across Mexico, anthropologists and colonial accounts document acceptance of third-gender categories. Transvestitism was an accepted practice in the native cultures of Central (and South) America, including among the Aztecs and Mayans (as reflected in their mythologies). Spanish colonizers were hostile to it.

The Zapotec people of Oaxaca have a third gender role for muxes, people who dress, behave and perform work otherwise associated with the other binary gender; vestidas wear feminine clothes, while pintadas wear masculine clothes but also makeup and jewellery. They may marry women, men, or other muxes. It has been suggested that while the three gender system predates Spanish colonization, the phenomenon of muxes dressing as women may be more recent. Juchitán de Zaragoza, an indigenous community on the Isthmus of Tehuantepec, has so many well-accepted muxes there is a myth attributing their numbers to a bag of third-genders carried by Saint Vicent ripping and accidentally spilling many out over the town; one study estimated 6% of males in the community in the 1970s were muxes.

During the Mexican Revolution, Amelio Robles Ávila began to dress and demand to be treated as a man and, gaining respect as a capable leader, was promoted to colonel. Robles' maleness was accepted by family, society, and the Mexican government, and he lived as a man from age 24 until death; a neighbor said that if anyone called Robles a woman, Robles would threaten them with a pistol, and he killed two men who attacked him and tried to reveal his anatomy.

United States


Thomas(ine) Hall, an indentured servant in Virginia, reported being both a man and a woman and adopted clothes and roles of each at different times until ordered by a court in 1629 to wear both men's breeches and a woman's apron; Hall is thought to have been intersex and is cited as an early example of "a gender nonconforming individual in colonial America".

In 1776, the Public Universal Friend reported being genderless, dressed androgynously, and asked followers gained while preaching throughout New England over the next four decades not to use their birth name or gendered pronouns; some scholars have called the Friend a chapter in trans history "before [the word] 'transgender'". There were also cases of people living as the opposite gender in the early years of the Republic, such as Joseph Lobdell, who was assigned female at birth in 1829, lived as a man for sixty years, and married a woman.

During the Civil War, over 200 people who had been assigned female at birth donned men's clothing and fought as soldiers; some lived the rest of their lives as men and are thought by some to have been transgender, such as Albert Cashier. After the war, Frances Thompson, a formerly enslaved black trans woman, testified before Congress's investigation of the Memphis Riots of 1866; ten years later, she was arrested for "being a man dressed in women's clothing".

In the late 1800s, We'wha, a Zuni lhamana fiber artist and potter, became a prominent cultural ambassador, visiting Washington, D.C. in 1896 and meeting President Grover Cleveland. The lhamana are male-bodied people who may at times take on the social and ceremonial roles usually performed by women in their culture, and at other times the roles more traditionally associated with men.

In 1895 a group of self-described androgynes in New York organized a club called the Cercle Hermaphroditos, "to unite for defense against the world's bitter persecution". They included Jennie June (assigned male at birth in 1874), whose The Autobiography of an Androgyne (1918) was one of a few first-person accounts in the early years of the 20th century which cast light on what life for a transgender person was like then.

In some cases, immigrants would change their gender identity upon arrival in the United States, especially those assigned female at birth, ostensibly for social mobility, like Frank Woodhull, a Canadian immigrant who lived for about 15 years as a man in California and in 1908 was forced to disclose this during processing at Ellis Island.

American jazz musician and bandleader Billy Tipton (assigned female at birth in 1914) lived as a man from the 1940s until his death, while socialite and chef Lucy Hicks Anderson insisted as a child that she was a girl and was supported by her parents and doctors and later by the Oxnard, California community in which she was a popular hostess from the 1920s to 1940s. In 1917, Alan L. Hart was one of the first trans men to undergo a hysterectomy and gonadectomy, and later became a pioneering physician and radiologist.

The possibility of someone changing sex became widely known when Christine Jorgensen in 1952 became the first person widely publicized as undergoing sex reassignment surgery. Around the same time, organizations and clubs began to form, such as Virginia Prince's Transvestia publication for an international organization of cross-dressers, but this operated in the same shadows as the still forming gay subculture. In the late 1950s and 1960s, modern transgender and gay activism began with the 1959 Cooper Donuts Riot in Los Angeles, 1966 Compton's Cafeteria riot in San Francisco, and a defining event in gay and transgender activism, the 1969 Stonewall Riots in New York; prominent activists included Sylvia Rivera.

The 1970s and 1980s saw organizations devoted to transgender social activities or activism come and go, including activist Lou Sullivan's FTM support group that grew into FTM International, the leading advocacy group for trans men. Some feminist and lesbian organizations and individuals began to debate whether transgender women should be accepted into women's groups and events, such as the women's music collective Olivia Records where trans woman Sandy Stone had long been employed, or the Michigan Womyn's Music Festival which had a "women-born-women" in policy.

The 1990s saw the establishment of Transgender Day of Remembrance to honor those lost to violence, Paris is Burning documenting gay and trans New York ball culture, transgender marches and parades around the time of Pride celebrations, and—increasingly in the 2000s and after—the visibility of transgender people rose, with Monica Roberts starting TransGriot in the mid-2000s to model accurate media coverage of the trans community, actress Laverne Cox being on the cover of TIME in 2014 and Caitlyn Jenner coming out in 2015. Early trans officials like Joanne Conte (elected in 1991 to Arvada, Colorado's city Council) and Althea Garrison (elected to the Massachusetts house in 1992, serving from 1993 to 1995) were not out when elected in the 1990s; while Kim Coco Iwamoto became the first openly trans person elected to statewide office when she won election to the Hawaii Board of Education in 2006 (and later to the Hawaii Civil Rights Commission in 2012), and Danica Roem became the first openly trans person to serve in a state legislature when she won a seat in the Virginia house in 2017.

Organizations such as the Girl Scouts and the Episcopal Church announced acceptance of transgender members in the 2010s. In 2016, the Obama administration issued guidance that clarified Title IX protections for transgender students, the most well-known being allowing trans students to use bathrooms and locker rooms matching their gender identity. However, some legislative bodies passed discriminatory bills, such as North Carolina's HB 2 (in 2016), and beginning 2017 the Trump administration rescinded the Obama-era protections of trans students, rescinded rules against healthcare providers discriminating against trans patients, and issued a series of orders against employment of trans people by the department of defense. In 2020, the Supreme Court ruled in Bostock v. Clayton County that Title VII of the Civil Rights Act protects employees against discrimination because of gender identity (or sexual orientation).

Bolivia
In 2016, Bolivia passed the Gender Identity Law, which allowed people over 18 to change their name, gender, and picture on legal documents.

Chile
In March 1973, the first sexual reassignment surgery in Latin America took place in Chile, when Marcia Torres underwent it in a Santiago hospital. This took place just months before the 1973 Chilean coup d'état, and the new dictatorship under Augusto Pinochet began adopting policies which criminalized and marginalized the activities of gay and trans people. Torres, however, was able to acquire the changed identity documents she sought from the courts after her surgery.

In 2018, President Sebastián Piñera signed the Gender Identity Law, which allows transgender people over age 14 "to update their names on legal documents and guarantees their right to be officially addressed according to their true gender."

Colombia
In December 2018, Davinson Stiven Erazo Sánchez was charged with the murder of Anyela Ramos Claros, a transgender woman, as a gender-based hate crime. Under the Rosa Elvira Cely law, feminicide, defined as "the killing of a woman because of her gender, or where there were previous instances of violence between the victim and the accused, including sexual violence," was made punishable by a prison sentence of 20 to 50 years. Claros was only the second transgender woman to have her murderer punished under this law.

Peru
Prior to the 16th century arrival of Spanish conquistadors, the Inca Empire and their Moche predecessors revered third-gender persons and organized their society around an Andean cosmovision that made room for masculine and feminine ambiguity based in "complementary dualism." Third-gender shamans as ritual practitioners were subject to violence as the Spanish suppressed pre-colonial worldviews.

In 2014, the Peruvian Constitutional Court ruled against a transgender woman changing her gender on her national identity document, but in October 2016 the court reversed the earlier decision, acknowledging "people are not only defined by their biological sex, but one must also take into consideration their psychic and social reality." Following this, trans people in Peru can apply to a judge for a gender change without undergoing sex reassignment surgery.

Uruguay
In 2018, Uruguay passed a law granting rights to transgender people, giving them the right to sex reassignment surgery and hormones paid for by the Uruguayan state. The law also mandates that a minimum number of transgender people be given public jobs. Transgender people can now self-identify and change their legal names without needing approval from a judge. In addition, transgender people who faced persecution during the 1973 to 1985 military dictatorship will receive compensation. The law also lets people under 18 legally change names without the previous requirement of parents' or a court's approval.

Ancient Sumer and Assyria


In Sumer, androgynous trans priests known as gala used a women's-speech dialect called eme-sal and sometimes took female names. During the Akkadian period, similar people known as kurgarrū and assinnu served Ishtar wearing feminine clothing and performing dances in her temples; the goddess was believed to transform them from masculine to feminine.

In ancient Assyria, transgender cult prostitutes took part in public processions, singing, dancing, wearing costumes and sometimes women's clothes, carrying feminine symbols, and even at times performing the act of giving birth.

West Asia (the Middle East)
For the history of Roman and Byzantine Asia, see § Rome and Byzantium.

Arabian peninsula
Khanith are a gender category in Oman and Arabia who function in some sexual and social ways as women, and are variously considered to fill an "alternative gender role", to be transgender, or (as they are still considered men by Omani standards and laws) to be transvestites. Discussing the (male-assigned) khanith, older mukhannathun and Egyptian khawalat, and the (female-assigned) ghulamiyat, Everett Rowson writes there is "considerable evidence for institutionalized cross-dressing and other cross-gender behavior in pre-modern Muslim societies, among both men and to some extent women" which existed from Muhammad's day and continued into the Umayyad and Abbasid periods and, in the khanith, into the present.

Iran
Under Mohammad Reza Pahlavi, transsexuals and crossdressers were classed with gays and lesbians and faced lashing or death.

Beginning in the 1970s, trans woman Maryam Khatoon Molkara wrote to Ruhollah Khomeini asking for support to live as a woman, and building on a 1963 decision that corrective surgery for intersex people was not against Islamic law, he agreed. After the Islamic Revolution, Molkara was institutionalized and forced to detransition, but later released, and in 1985 personally convinced Ahmad Khomeini to decree transition and sex reassignment surgery allowed in Islamic law; she advocated for transgender rights until her death in 2012.

As of 2008, Iran carries out more sex change operations than any other nation except Thailand; the government pays up to half the cost for those needing financial assistance, and a sex change is recognized on one's birth certificate. However, trans people in Iran still face widespread harassment. Some gay people are also pressured into sex reassignment. Transgender director Saman Arastoo directs plays about and starring trans people in Iran.

Israel and Palestine


In 1998, Israeli pop singer Dana International became the first trans person to enter and win the Eurovision Song Contest. In 2008, singer and trans woman Aderet became popular in Israel and neighboring Lebanon.

The second week of June is the Tel Aviv Pride Parade, during international LGBT Pride month. In 2008 it coincided with the building of an LGBT Centre in Tel Aviv. In 2015, the parade was led by Gila Goldstein, who in the 1960s became one of the first Israelis to receive sex reassignment surgery. The festival is popular, with over 200,000 participants in 2016.

Israel is sometimes accused, including by transgender Palestinians, of pinkwashing—projecting a gay and trans-friendly image to appear more progressive or distract from mistreatment of Palestinians—while others argue its actions on trans issues should be regarded as sincere. Trans people in Israel face widespread harassment and difficulty in accessing employment and healthcare; half have been physically attacked.

Ottoman Empire
Eunuchs, who served in the Ottoman Empire from the 16th to late 19th century (and were commonly exiled to Egypt after their terms, where black eunuchs had served pre-Ottoman rulers as civil servants since the 10th century) have sometimes been viewed as a kind of third gender or an alternative male gender.

Central Asia
In Kazakhstan, since 2009, trans people who undergo sterilizing sex reassignment surgery can change gender on legal documents, but have few other rights.

In Kyrgyzstan, especially since the drafting of discriminatory legislation in 2014, trans people face widespread discrimination in access to work, and such severe and widespread violence that many move to Russia. In Uzbekistan, too, trans people are often beaten, raped, or murdered, though laws adopted by the Soviets in the 1980s under Western pressure enable a few Uzbeks to transition.

Trans people also face harassment in Tajikistan, where reportedly just three reassignment surgeries were performed between 2006 and 2016, and Turkmenistan, a repressive state notorious for violating human rights.

China
Eunuchs (who existed in China since 4000 years ago, were imperial servants by 3000 years ago, and were common as civil servants by the time of the Qin dynasty until a century ago) have sometimes been viewed as a third sex,  or a transgender practice, and Chinese histories have often expressed the relationship of a ruler to his officials in the terms of a male relationship to females.

Cross-gender behavior has long been common in Chinese theatre, especially in dan roles, since at least the Ming and Qing dynasties. Today, Jin Xing is a well-known entertainer and trans woman.

In the mid-1930s, after Yao Jinping's father went missing during the war with Japan, the 19-year-old reported having lost all feminine traits and become a man (and was said to have an Adam's apple and flattened breasts) and left to find him; the event was widely reported on by the press. Du He, who wrote an account of it, insisted Yao did become a man, and Yao has been compared to both Lili Elbe (who underwent sex reassignment in the same decade) and Hua Mulan (a mythical wartime crossdresser).

In the 1950s, doctors in Taiwan forced Xie Jianshun, an intersex man, to undergo male-to-female sex reassignment surgery; Taiwanese press compared the former soldier to Christine Jorgensen, who had sought out surgery, and the decade-long media frenzy over Xie led to increased coverage of intersex and transgender people in general.

In the 1990s, transgender studies was established as an academic discipline. Transgender people are considered a "sexual minority" in China, where widespread transphobia means trans people face discrimination in accessing housing, education, work, and healthcare. China requires trans people to get the consent of their families before sex reassignment surgery, leading many to buy hormones on the black market and attempt surgeries on themselves.

Japan


Historical documentation of male- and female-assigned transgender people is extensive, especially in the Edo period. Trans-masculine people were found especially in Yoshiwara, Edo's red-light district, and in the modern era have worked in onabe bars since the 1960s. At the start of the Edo period in 1603, Izumo no Okuni founded kabuki (dressing as a handsome man to tryst with a woman in one popular performance, and being honored with a statue near where she performed which depicts her as a cross-dressing samurai with a sword and fan); in 1629, when the Tokugawa shogunate banned women from acting, male performers took on the roles of women. Some, such as onnagata actor Yoshizawa Ayame I (1673-1729) dressed, behaved and ate like women even outside the theatre.

Outside the entertainment industry, however, trans people face stigma, and in 2004 Japan passed a law requiring trans people who want to change their gender marker to have sex reassignment surgery and be sterilized, be single, and have no children under age 20, which the supreme court upheld in 2019. In 2017, Japan became one of the first countries in the modern world to elect an openly trans man to office, electing Tomoya Hosoda as a city councillor in Iruma.

Cambodia
Under the Khmer Rouge, Phnom Penh's trans community was expelled or killed, and trans women and men were raped, jailed, or killed. Some escaped and live as refugees in the US. In Cambodia today, trans or traditional third-gender people are often harassed and denied employment; some do sex work.

Indian subcontinent


Indian texts from as early as 3000 years ago document a third gender, which has been connected to the hijras who have formed a category of third-gender or trans-feminine people on the Indian subcontinent since ancient times. In the Rigveda (from roughly 3500 years ago), it is said that before creation the world lacked all distinctions, including of sex and gender, a state ancient poets expressed with images like men with wombs or breasts. The Mahabharata (from 2–3000 years ago) tells of a trans man, Shikhandi. In the Ramayana (from roughly 2000 years ago), when Rama asks "men and women" not to follow him, hijras remain and he blesses them. Most hijras are assigned male at birth (and may or may not castrate themselves), but some are intersex and a few are assigned female. Hijras wear feminine clothing and usually adopt feminine names, often live together in households (often regardless of differences in caste or religion) and relate to each other as female fictive kin (sisters, daughters, etc.), and perform at events such as births and weddings.

The Buddhist Tipitaka, composed about 2100 years ago, documents four gender categories: female, male, pandaka, and ubhatobyanjanaka. It says the Buddha was tolerant of monks transitioning to nuns, at least initially, though trans people did face some stigma, and the possibility of monastic transition was later curtailed when the tradition of female monasticism was extinguished in Theravada Buddhism, and between the third to fifth century, Indian Buddhists were hostile to transgender people. These trans- and third-gender categories have been connected to the § kathoeys who exist in Thailand.

Beginning in the 1870s, the colonial authorities attempted to eliminate hijras, prohibiting their performances and transvestism. In India, since independence, several state governments have introduced specific welfare programs to redress historical discrimination against hijras and transgender people. Today, there are at least 490,000 hijras in India, and an estimated 10,000 to 500,000 in Bangladesh, and they are legally recognized as a third gender in Bangladesh, India, Nepal, and Pakistan. In 1999, Kamla Jaan became the first hijra elected mayor of an Indian city, Katni, and around the same time Shabnam Mausi was elected as a legislator from Gorakhpur. In Bangladesh, in 2019, several trans people filed to run for parliament, which currently has no trans or hijra members.

In Hinduism, Ardhanarishvara, a half-male, half-female fusion of Shiva and Shakti, is one of several deities important to many hijras and transgender Hindus, and has been called an androgynous and transgender deity.

Indonesia


Indonesia has a trans-/third-gender category of people called waria. It has been estimated that there are over 7 million waria in the Indonesian population of 240-260 million people.

The Bugis of Sulawesi recognize three sexes (male, female, intersex) and five genders: makkunrai, comparable to cisgender women; oroané, to cisgender men; calabai, to trans women; calalai, to trans men; and bissu, an androgynous gender.

An all-transgender netball team from Indonesia competed at the 1994 Gay Games in New York City. The team had been the Indonesian national champions.

Philippines
Today, male-assigned people who adopt a feminine gender expression and are transgender or gay are termed bakla and sometimes considered a third gender. Historically, cross-gender babaylan shamans were respected and termed bayog or bayoc in Luzon and asog in the Visayan Islands until outlawed in 1625 and suppressed by Spanish colonial authorities. The Teduray people in Mindanao accepted two trans identities, mentefuwaley lagey ("one who became a man") and mentefuwaley libun ("one who became a woman") into at least the 1960s. Crossdressing was practiced during American colonial rule. Singer and actress Helen Cruz was a prominent trans figure, especially in the 1960s, and pioneer of Swardspeak.

Thailand


Some (especially Thai) scholars identify the third- and fourth genders documented in the Tipitaka with the kathoey, a third-gender category which was already a part of traditional Thai and Khmer culture by that the time that scripture was composed about 2100 years ago. Some (especially Thai) Buddhists say Ananda (Buddha's cousin and attendant) was born a kathoey/transgender in many previous lives, but that it was to expiate for a past misdeed.

The category of kathoey was historically open to male-assigned, female-assigned and intersex people. Since the 1970s, the term has come to be used (by others) to denote mainly male-assigned transvestites or trans women, the latter of whom usually refer to themselves simply as phuying ("women"); a minority refer to themselves as phuying praphet song ("second-type women") or sao praphet song ("second-type females"), and only very few refer to themselves as kathoey. Kathoey is often rendered into English as "ladyboy".

Thailand has become a center for performing sex reassignment surgery, and now performs more than any other country. In 2015, the government proposed recognizing third-gender people in the constitution, but instead only retained protections for individuals regardless of phet ("sex") which was interpreted to include trans people; a third gender is not recognized on identity documents.

Earliest history
Drawings and figures from around 9000 to 3700 years ago, depicting androgynous and genderless humans in domestic, religious and funerary settings, occur around the Mediterranean.

Near what is today Prague, a burial from 4900 to 4500 years ago was found of a biologically male skeleton in a woman's outfit with feminine grave goods, which some archaeologists consider an early transgender burial.

Ancient Greece, Ancient Rome, and Byzantium


In Ancient Greece, Phrygia, and the Roman Republic and Empire, Cybele and Attis were worshiped by galli priests (documented from around 200 BCE to around 300 CE) who wore feminine clothes, referred to themselves as women, and often castrated themselves, and have therefore been seen as early transgender figures.

In Rome, cross-dressing was also practiced during Saturnalia, which some argue reinforced established gender identities by making such practices unacceptable outside that rite. Romans also viewed cross-dressing negatively and imposed it as a punishment, as when Charondas of Catane decreed deserters wear female clothes for three days or when, after Crassus' defeat, the Persians hung a lookalike of the dead general clad as a woman.

Women who cross-dressed as men could have access to male opportunities, as depicted in the fictional story of an Athenian woman dressing as a man to vote in the ekklesia in Aristophane's Ekklesiazusae, or when Agnodice of Athens dressed as a man to get a degree in medicine, Axiothea from Philus cross-dressed to attend Plato's lectures, and the wife of Calvisius Sabinus dressed as a soldier to join a military camp.

Roman emperor Elagabalus (c. 204 – 222) is said by Roman historians to have depilated, worn makeup and wigs, rejected being called a lord and preferred being called a lady, and offered vast sums of money to any physician who could provide the imperial body with female genitalia. Despite marrying several women, the Syrian's most stable relationship was with chariot driver Hierocles, and Cassius Dio says Elagabalus delighted in being called Hierocles' mistress, wife, and queen. The Severan emperor has therefore been seen by some writers as transgender or transsexual. In the 500s, Anastasia the Patrician fled life in the court of Justinian I in Constantinople to spend twenty-eight years (until death) dressed as a male monk in Egypt, coming to be viewed by some today as a transgender saint. Coptic texts from that era (the fifth to ninth centuries), like texts from around Europe, tell of many female-assigned people transitioning to live as men; in one, a monastic named Hilaria (child of Zeno) dresses as a man, brings about a reduction in breast size and cessation of menstruation through asceticism, and comes to be accepted by fellow monks as a male, Hilarion, and by some modern scholars as trans; the story of Marinos (Marina), another Byzantine, who became a monk in Lebanon, is similar.

Other Byzantine hagiographies describe eunuchs, who occupied a kind of third-gender status, like Ignatios of Constantinople (who became patriarch of Constantinople and a saint).

Early Scandinavia, Viking-era Norse
Norse society stigmatized effeminacy (especially sexual passivity, but also—it is sometimes said—transgender and cross-dressing behavior), calling it ergi, At the same time, the characteristics the Norse revered in their gods were complicated; Odin was skilled in effeminate seiðr magic, and assumed the form of a woman in several myths, and Loki too changed gender on several occasions (for which reason some modern works label or depict the trickster deity as genderfluid).

In 2017, archaeologists found that the bones of a Viking buried in Birka with masculine grave goods were female; some suggested the burial could be a trans man, but the original archaeologists said they did not want to apply a "modern" term and preferred to see the person as a woman.

Middle Ages
A 2021 study concluded that a grave from 1050 to 1300 in Hattula, Finland, containing a body buried in feminine clothing with brooches, valuable furs and a hiltless sword (with a second sword later buried above the original grave), which earlier researchers speculated to be two bodies (a male and female) or a powerful woman, was one person with Klinefelter syndrome and that "the overall context of the grave indicates that it was a respected person whose gender identity may well have been non-binary".

In the 1322 book Even Boḥan, Kalonymus ben Kalonymus (from Provence, France) wrote a poem expressing lament at and cursing having been born a boy, calling a penis as a "defect" and wishing to have been created as a woman, which some writers see as an expression of gender dysphoria and identification as a trans woman.

In 1394, London authorities arrested a male-bodied sex worker in women's clothing who went by the name Eleanor Rykener. Rykener reported having first gotten women's clothing, and learned embroidery (perhaps completing an apprenticeship, as female apprentices did) and how to sleep with men for pay, from Elizabeth Brouderer; Rykener also slept with women. Rykener's testimony offers a glimpse into medieval sexual identities. Carolyn Dinshaw suggests Rykener's living and working in Oxford as a woman for some time indicates Rykener enjoyed doing so, and Cordelia Beattie says "it is evident [Rykener] could pass as a woman", and passing "in everyday life would have involved other gendered behaviour"; historian Ruth Mazo Karras argues Rykener was a trans woman, and could also be described as bisexual. Historian Judith Bennett argues people were familiar enough with hermaphroditism that "Rykener's repeated forays into the space between 'male' and 'female' might have been as unremarkable in the streets of fourteenth-century London as they would be in Soho today", while Robert Mills argues officials would have been even more concerned by Rykener's switching of gender roles than by sex work.

A few medieval works explore female-to-male transformation and trans figures. In the 13th century French Roman de Silence, Nature and Nurture personified try to sway a child born a girl but raised a boy, who longs to do some feminine things but also long enjoys life as a man before being put into a female identity and clothing at the end of the story; Silence has been viewed as (at least temporarily) transgender. Christine de Pizan's Livre de la mutacion de Fortune (1403) opens "I who was formerly a woman, am now in fact a man [...] my current self-description is the truth. But I shall describe by means of fiction the fact of my transformation" using the metaphor of Iphis and Ianthe (a myth John Gower's Iphis and Ianthe also took up), leading some modern scholars to also view Fortune's protagonist (and Gower's) as transgender.

Transgender People and the Medieval Church
Trans figures and the embodiment of non-normative gender traits were acknowledged by the medieval church, and were often times interpreted as an expression of God’s plan, rather than a deviation from it. There are many examples of transgender saints and clergy members who are celebrated and uplifted by the medieval church. Trans people were canonized in the early days of Christianity on account of their “extraordinary lives” and the view that they were extraordinarily blessed by God. However, as the medieval church developed more concrete doctrine as well as stricter policies and procedures, the view of trans people and trans embodiments changed

Saint Marinos (alternatively translated as Marius) is often used as an example of the existence of transgender individuals within the clergy. Sources vary, but Saint Marinos likely lived somewhere between the fifth and eighth century near modern-day Syria. Marinos, despite being assigned female at birth, chose to enter a monastery as a monk, following in the footsteps of his father. In response to his father’s apprehension, he reasoned that the modesty and abstinence that came with the life of a monk would protect his identity. Ironically, he was expelled from the monastery after a woman accused him of impregnating her. He never refuted the claims made against him, as doing so would involve revealing his genitals. Instead, he fathered the child and was eventually allowed back into the monastery, along with his son. His identity as a trans man was only discovered after his death. Despite his identity, he was named a saint by both the Roman Catholic and Eastern Orthodox Churches.

Marinos’ story was not the only of its kind. The theme of “sexual disguise” was quite popular, especially in early monasticism. There are numerous examples of female hermits living alone in the desert dressing identical to male hermits. Saint Mary of Egypt, who was born in Alexandria in the early fifth century, is one popular example of what can be described as an “emasculated female saint.”   In depictions of her after her conversion to ascetic life, both in visual art and in personal accounts, Mary is portrayed as seemingly genderless. When she stripped herself of all aspects of her previous identity, she also seemed to have shed her gender. Saint Thelca, a contemporary of the Apostle Paul, shaved her head and adopted a man’s dress in order to prove her devotion and piety. She, like Mary of Egypt, shed her female identity in pursuit of a devoutly religious lifestyle.

Caroline Walker Bynum, a medieval historian, explored the idea of Jesus, the very center of Christianity, as an androgynous figure. In the 12th century, the idea of “mother Jesus” began showing up more and more in religious texts. In many Cistercian texts, Jesus is described as both the son of God, and the mother of all people. He is ascribed traits like nurturing and affectionate, which would not have been used to describe men at the time. Jesus, then, is caught somewhere between distinctly male and distinctly female.

Trans ideas continued to show up in religious writing throughout the Middle Ages. One story that bridged the gap between secular and religious ideas of transness is the tale of Blanchandin. Although he is an entirely fictional character, Blanchandin’s story gives insight into the attitudes towards transgender individuals during the Middle Ages. The fourteenth-century chanson de geste, Tristan de Nanteuil details how Blanchandin was physically transformed from woman to man in order to father St. Gilles. In the story Blanchandin is visited by an angel who gives him testicles and a penis. Rather than being portrayed as a transgression against the natural order of things, this transition is seen as a “radiant expression of God’s will”. Blanchandin was viewed as having a special relationship to God and to his mission on earth.

Around the turn of the thirteenth century, the church’s view of trans individuals began to change. The church had developed a firmer stance on issues, one of which being non-normative gender expressions. As tensions rose between Christianity and Judaism, so did the divide between who was a part of the church and who was not. Individuals who did not fit neatly into the gender binary did not fit into the church. Religious doctrine insisted that intersex individuals choose one sex organ or the other to perform sexual acts with, lest they be accused of engaging in sodomy. The Cathars, who erased all ideas of sex and gender from their belief system, were labeled as heretics. The church’s reaction to the Cathars exemplified a greater trend within the medieval church, one that did not accept the rejection of the traditional gender binary.

Balkans


Balkan sworn virgins such as Stana Cerović are people assigned female at birth who transition to live as men, out of personal desire or at the urging of family or necessity; they dress as men, socialize with men, do men's activities, and are usually referred to with masculine pronouns in and outside their presence. They take their name from the vow of celibacy they traditionally swore. The gender, found among several national and religious groups in the Balkans (including Muslims and Christians in Albania, Bosnia, Macedonia and Dalmatia), dates to at least the 15th century. It is thought to be the only traditional, formally socially defined trans-masculine gender role in Europe, but it has been suggested that it may be a survival of a more widespread pre-Christian European gender category.

In Serbia today, since 2019, trans people are able to change legal gender after approval from a psychiatrist and an endocrinologist, without undergoing surgery; one notable trans woman is Helena Vuković (military officer), a former army major.

Belgium
Since 2017, Belgians have the right to change legal gender without sterilization. Many Belgian hospitals specialize in sex reassignment surgery, attracting patients from other countries such as France. On 1 October 2020, Petra De Sutter was sworn in as a deputy prime minister of Belgium under Alexander De Croo, becoming the most senior trans politician in Europe; De Sutter was previously a Belgian senator and a Member of the European Parliament, and is a gynaecologist and the head of the department of reproductive medicine at Ghent University Hospital.

Denmark


Lili Elbe was a Danish trans woman and one of the first recipients of sex reassignment surgery. Elbe was assigned male at birth and was a successful painter before transitioning. She transitioned in 1930 and changed her legal name to Lili Ilse Elvenes, and died in 1931 from complications after overy and uterus transplants.

Denmark is also known for its role in the transition of American Christine Jorgensen, whose operations were performed in Copenhagen starting in 1951.

In 2017 Denmark became the first country in the world to remove transgender identities from its list of disorders of mental health.

France
Christine de Pisan makes one of the early accounts of gender transitioning in her autobiographical allegorical poem Le Livre de la mutation de fortune.

The Chevalier d'Éon (1728–1810) was a French diplomat and soldier who appeared publicly as a man and pursued masculine occupations for 49 years, but during that time successfully infiltrated the court of Empress Elizabeth of Russia by presenting as a woman, and later promoted (and may have engineered) rumours that d'Éon had been assigned female at birth, and thereafter agreed with the French government to dress in women's clothing, doing so from 1777 until death. Doctors who examined d'Éon's body after death discovered "male organs in every respect perfectly formed", but also feminine characteristics; modern scholars think d'Eon may have been a trans woman and/or intersex.

Herculine Barbin (1838–1868) was a French intersex individual assigned female at birth and raised as a girl. After a doctor's examination at age 22, Barbin was reassigned male, and legal papers followed declaring Barbin officially male. Barbin changed names to Abel Barbin, and wrote memoirs using female pronouns for the period before transition, and male pronouns thereafter, which were recovered (following Barbin's suicide at age 30) and published in France in 1872, and in English in 1980. Judith Butler refers to Michel Foucault's commentary on Barbin in their book Gender Trouble.

In March 2020, Tilloy-lez-Marchiennes elected—and in May, inaugurated—Marie Cau as mayor, making her the first openly transgender mayor in France.

Germany


In the early 1900s, transgender people became a subject of popular interest in Germany, covered by several biographies and the sympathetic liberal press in Berlin. In 1906, Karl M. Baer became one of the first known trans men to have sex reassignment surgery, and in 1907 gained full legal recognition of his gender with a new birth certificate, married his first wife, and published a semifictionalized autobiography, Aus eines Mannes Mädchenjahren ("Memoirs of a Man's Maiden Years"); in 1938, he emigrated to Palestine. The same year, Brazilian socialite Dina Alma de Paradeda moved to Breslau and became engaged to a male teacher, before committing suicide, after which a doctor revealed that her body was male. This made her one of the first trans women known by name in Central Europe or of South American origin. A biography published in 1907, Tagebuch einer männlichen Braut ("Diary of a male bride"), was supposedly based on her diary.

During the Weimar Republic, Berlin was a liberal city with one of the most active LGBT rights movements in the world. Magnus Hirschfeld co-founded the Scientific-Humanitarian Committee (WhK) in Berlin and sought social recognition of homosexual and transgender men and women; with branches in several countries, the committee was (on a small scale) the first international LGBT organization. In 1919, Hirschfeld co-founded the Institut für Sexualwissenschaft, a sexology research institute with a research library, a large archive, and a marriage and sex counseling office. The institute was a worldwide pioneer in the call for civil rights and social acceptance for homosexual and transgender people. Hirschfeld coined the word transvestite. In 1930 and 1931, with Hirschfeld's (and other doctors') help, Dora Richter became the first known trans woman to undergo vaginoplasty, along with removal of the penis (following removal of testicles several years earlier), and Lili Elbe underwent similar surgeries in Dresden, including an unsuccessful ovary and uterus transplant, complications from which resulted in her death. In 1933, the Nazis burned the institute's library.

On June 12, 2003, the European Court of Human Rights ruled in favor of Van Kück, a German trans woman whose insurance company denied her reimbursement for sex reassignment surgery and hormone replacement therapy, who sued under Article 6 and Article 8 of the European Convention on Human Rights.

Italy


Traditional Neapolitan culture recognized femminielli, a sort of third gender of male-assigned people with markedly feminine gender expression and an androphilic/homosexual orientation, who remain largely unstigmatized.

In 2006 Vladimir Luxuria became the first openly transgender woman elected to the Italian Parliament and the first transgender member of a parliament in Europe.

In 2015, the Court of Cassation ruled that sterilization and sex reassignment surgery was not required in order to obtain a legal gender change.

In 2017 Alex Hai came out as a trans man, becoming the first openly trans gondolier in Venice.

European Russia
The Soviet Union performed its first sex reassignment surgeries in the 1970s, but since 2013 —when the government passed a law against "promoting" "non-traditional relations" —Russia has become notoriously hostile, with trans people facing increasing harassment. Dmitri Isaev's clinic, which provided medical authorization for half the sex reassignment surgeries, was forced to operate in secret. In 2019, a court in Saint Petersburg, Russia's most liberal city, ordered a business which had fired a woman when she transitioned to reinstate her.

Indigenous peoples of the Far East
Among the Itelmens of Siberia, a third gender category of the koekchuch was recorded in the 18th and 19th centuries, individuals who were assigned male at birth but dressed as women did.

Spain
There are records of several individuals in Spain in the 1500s who were raised as girls subsequently adopting male identities under various circumstances who some historians think were transgender, including Eleno de Céspedes and Catalina de Erauso.

During the Franco era, thousands of trans women and gay men were jailed, and today fight for compensation. In 2007, a law took effect allowing trans people to change gender markers in documents such as birth certificates and passports without undergoing sterilization and sex reassignment surgery.

Turkey
Bülent Ersoy, a Turkish singer who was assigned male at birth, had a gender reassignment surgery in April 1981. Rüzgar Erkoçlar, a Turkish actor who was assigned female at birth, came out as a trans in February 2013.

United Kingdom


Irish-born surgeon James Barry had a long career as a surgeon and rose to the second highest medical office in the British Army, improving conditions for wounded soldiers and the inhabitants of Cape Town, South Africa, and performing one of the first caesarean sections in which both the mother and child survived.

In 1946, the first sex-reassignment phalloplasty was performed by one British surgeon on another, Harold Gillies on Michael Dillon (an earlier phalloplasty was done on a cisgender man in 1936 in Russia).

In 1961, English model April Ashley was outed as transgender; she is one of the earliest Britons known to have had sex reassignment surgery, and was made a Member of the Order of the British Empire (MBE) in 2012 for promoting trans equality.

In 2004, the Gender Recognition Act passed, giving transgender people legal recognition of their gender before the law subject to certain conditions.

Australia
The first reported case of an Australian undertaking a sex change operation was an ex-RAAF Staff Sergeant Robert James Brooks in February 1956.

The Gender Dysphoria Clinic at Queen Victoria Hospital, Melbourne was established by Dr Trudy Kennedy and Dr Herbert Bower in 1975. It moved to Monash Medical Centre in 1989 and closed in 2009.

Australia's first transgender rights and advocacy organizations were established in 1979: the Melbourne-based Victorian Transsexual Coalition and the Victorian Transsexual Association; followed in 1981 by the Sydney-based Australian Transsexual Association, which included prominent activist, academic and author Roberta Perkins.

New Zealand, the Cook Islands, Niue


In 1995, Georgina Beyer became the first openly trans mayor in the world when Carterton, New Zealand elected her, and in 1999, she became the first transgender member of a parliament, winning election to represent Wairarapa; in 2003, the former sex worker helped pass the Prostitution Reform Bill decriminalizing sex work.

Some Maori use the terms whakawahine ("like a woman"), tangata ira tane ("human man") to refer to trans-woman- and trans-man-like categories. The related term fakafifine denotes male-assigned people in Niue who fulfill a feminine third gender. Similarly, in the Cook Islands, akava'ine is a Cook Islands Māori (Rarotongan) word which, due to cross-cultural contact with other Polynesians living in New Zealand (especially the Samoan fa'afafine), has been used since the 2000s to refer to transgender people of Māori descent from the Cook Islands.

Samoa, Tonga, Fiji and Tahiti
In Samoa, the fa'afafine ("in the manner of women") are a third gender with uncertain origins which go back at least to the beginning of the twentieth century. Fa'afafine are assigned male at birth, and express both masculine and feminine gender traits, performing a role otherwise performed by women. The word fa'atamaloa is sometimes used for a trans-male or tomboyish gender category or role.

In Tonga, the related term fakafefine or more commonly fakaleiti ("in the manner of ladies") denotes male-assigned people who dress and work as women and may partner with men, and call themselves simply leiti ("ladies"). They are common—one of the children of former king Taufa'ahau Tupou IV (d. 2006) is a leiti—and still held in high regard, though colonization and westernization have introduced some transphobia.

In Fiji, vakasalewalewa (also written vaka sa lewa lewa) are male-assigned people who perform roles usually carried out by women. In Tahiti, the rae rae fulfil a similar role.