Christine Jorgensen was a transgender woman and activist in the United States who lived during the twentieth century. She was one of the first US citizens to publicly disclose her gender transition from male to female through gender-affirming surgery and hormone replacement therapy. By 1949, when Jorgensen began her transition, few individuals had undergone gender transition. Various popular media outlets reported on Jorgensen’s gender transition and surgery, which allowed Jorgensen to educate the American public on topics such as gender identity and sexual orientation. Jorgensen authored an autobiography in 1967, which detailed the journey of her life from early childhood to the end of her forties. Although many transgender people continue to fight for acceptance and equality in the US as of 2024, Jorgensen’s advocacy and activism increased transgender awareness for the general public at a time when existing and living openly as a transgender person received little recognition and support.

In 1989, physicians Henk Asscheman, Louis J. G. Gooren, and P.L.E. Eklund published the article “Mortality and Morbidity in Transsexual Patients with Cross-Gender Hormone Treatment,” hereafter “Mortality and Morbidity,” in the journal Metabolism. The authors presented clinical data regarding patients with gender dysphoria who were actively undergoing gender-affirming hormone replacement therapy. The data highlighted frequencies of various side effects of the treatment, including high blood pressure, blood clots, mood changes, as well as varying risk percentages of osteoporosis and cardiovascular disease, as those side effects are typically common in conventional hormone replacement therapy. According to “Mortality and Morbidity,” few scientists were studying the long-term effects of estrogen and androgen treatment for transgender people at the time of publication. The retrospective study was one of the first to research the long-term effects of hormone treatments on transgender individuals and found health concerns, such as more frequent blood clots and weight gain, in those undergoing gender-affirming hormone treatment.