Trans Scientist Spotlight: Dr. Alan L. Hart

In the early 20th century, the three leading causes of human death were all infectious diseases: tuberculosis, pneumonia, and gastroenteritis. In 1921 tuberculosis (TB) claimed the lives of 1 in 1,000 Americans. Similar levels of mortality were reported in other parts of the world.

At the time, one hurdle to preventing TB deaths was the inability to diagnose the disease in its asymptomatic stages. As a result, medical practitioners could not positively identify TB infections until patients began coughing up blood - a clear sign of TB.

Medical technology advanced greatly around the start of the 20th century after, in 1895, x-rays were discovered (by accident). This new technology slowly became integrated into Western medicine as a diagnostic tool for bone injuries.

As access to the x-ray became more widespread, doctors developed novel uses of the x-ray as a diagnostic tool. Dr. Alan L. Hart was among this group, demonstrating the utility of the x-ray in identifying asymptomatic TB.

At this time, there was no centralized public health agency, like the now-captured US Centers for Disease Control and Prevention (CDC), to disseminate best practices in treating infectious disease. So in the 1920’s, Hart traveled around the United States training doctors on using x-rays to diagnose early TB. Concomitant with Hart’s work, TB mortality dropped steadily, reflecting doctors’ ability to identify and treat TB earlier.

As a result of his work, Hart saved countless lives from a preventable death. He deserves recognition for his innovative use of chest x-rays and for his persistent advocacy for his patients who were battling a stigmatized disease.

What’s more, Hart accomplished all of this while living stealth - at a time when public outing (which he experienced on multiple occasions) would cost him his job and his community.

Alan Hart was born in 1892 in Halls Summit, Kansas, USA and assigned female at birth. As an adult, Hart told his psychoanalyst-turned-affirming-care-provider that he always considered himself to be a boy.

(N.B. Most accounts of Hart’s life use she/her pronouns when describing Alan Hart’s youth and education. It is impossible to know which pronouns Hart would prefer in telling this part of the story. However, given that Hart identified with boyhood as a child, I am using he/him pronouns to describe Hart throughout his whole life.)

At the age of two, Hart moved to an Oregon farm with his family. He delighted in doing work normally assigned to boys. He milked the cows and learned to drive the family’s horses. Boys’ clothes felt more natural, and Hart lobbied his family to let him wear pants (rather than dresses) and cut his hair short.

Education was important to Hart’s family, and they ensured that he could attend college at a time when most admissions spots were reserved for cis men. Hart initially attended Albany College (now Lewis & Clark College) in his hometown and transferred to Stanford University after two years. At Stanford, he founded the school’s first debate club for women and was a leader in the women’s glee and mandolin clubs. Life in the Bay Area suited Hart, and he became known for his masculine dress and hair style.

After Stanford, Hart pursued medical education at the University of Oregon Medical School (now Oregon Health Sciences University). All his classmates were cis men, so Hart threw himself into his studies. He graduated at the top of his class - the first non-cis man to do so at his institution.

Toward the end of his time in medical school, Hart began seeing a psychoanalyst, J. Allen Gilbert. As documented in Gilbert’s 1920 case study on Hart (“Homo-sexuality and its treatment”), Gilbert was quick to identify, pathologize, and obsess over Hart’s romantic and sexual attraction to women. (In the case study, the patient is referred to only as H. Years after his death, Hart was de-identified as H by queer historian Jonathan Ned Katz.)

Hart had initially hoped to keep his sexuality a secret, but Gilbert began pushing “treatments” such as hypnosis and other suggestive therapies with the intent of “curing” Hart’s sexuality. These conversion therapies failed however, and Hart eventually approached Gilbert with a request: approve his hysterectomy after which he would fully conform to a masculine appearance and live as a man. Hart’s ultimate goal was to “try and face life under conditions that might make life bearable.”

Gilbert was stunned by the request and considered it one of the most difficult medical decisions he had to make. But, he eventually did approve Hart’s 1917 hysterectomy. Hart’s procedure is considered one of the first documented gender-affirming surgeries in Western medicine.

Given the almost unprecedented nature of Hart’s hysterectomy, I want to consider Gilbert’s rationale for approving it because his reasoning illuminates persistent medical biases around trans health care. First, Gilbert justified the procedure because Hart could “pass as a man” (Gilbert’s words) - the false suggestion that passing as cisgender is the ultimate medical goal of a gender transition. Even if passing was unlikely or undesirable for Hart, he still would have deserved care.

Further, Gilbert approved Hart’s hysterectomy to alleviate the appearance of homosexuality in his patient. Presenting as a man, Hart could (and did) pursue relationships with cis women without arousing society’s homophobia. Yet, sexuality is not something to be treated, and forced gender transition (which one could read as the logical conclusion of Gilbert’s case study) is never ethical. Both same-sex attraction and gender non-conformity should simply be accepted by medical practitioners and by society.

Despite these biases, Gilbert advanced a model of what we now call trans health care to the medical field. Anticipating criticism, Gilbert ended his study with a defense of his actions:

Gilbert doesn’t admit it, but it is probable that Hart’s medical expertise (and proximity to the medical establishment) also helped sway Gilbert’s decision to approve Hart’s hysterectomy. Still today (when trans health care is not novel), self-advocacy in the doctor’s office is met with condescension.

Regardless, Hart remained confident in the approach, later telling the Albany Daily Democrat:

After his hysterectomy in 1917, Hart exclusively presented as male and was hired as an intern at San Francisco Hospital. Hart was completely stealth at work, but after less than a year, one of Hart’s former Stanford classmates recognized and outed him to the hospital superintendent. The news spread from there, appearing on the front page of the San Francisco Examiner and local papers across the country. Hart immediately resigned from the hospital.

Days after his public outing in February 1918, Hart legally married his girlfriend, Inez Stark. They moved back to Oregon where Hart continued to practice medicine. Upon returning to Oregon, Hart obtained documentation signed by Gilbert as a testament to his male identity. The local newspaper also affirmed Hart’s identity by publishing part of Gilbert’s attestation and allowing Hart to address the purported scandal. In the interview, Hart remained defiant: “I came home to show my friends that I am ashamed of nothing.”

Hart continued to be forcibly outed at work whenever someone recognized him from the headlines. Most times, he and his wife would to move to a new town and start over in a new community. The couple divorced in 1925, and Hart quickly remarried. Over the course of his life, Hart settled and resettled in at least seven states.

It was in this period of his life that Hart started using x-rays to diagnose early stage TB and showing other physicians how to apply the technique to their practice. In this way, Hart’s frequent and forced moves may have unwittingly helped to disseminate his x-ray diagnostics to a greater number of hospitals across the United States, allowing better identification of asymptomatic TB carriers.

In his spare time, Hart was a writer who used his craft to explore his own experiences. His fiction was reviewed in leading literary publications and contained overt social critiques (including critiques of American medicine), and his non-fiction work explaining x-rays to the general public is infused with an ideology of non-conformity filtered through the x-ray technology itself. In 1935, Hart wrote to one of his reviewers:

Hart died in 1962 at the age of 71 in the Connecticut home where he lived with his second wife, Edna. Per his wish, Hart’s personal papers were destroyed after his death. Upon Edna’s death, the Harts’ assets were bequeathed to the Medical Research Foundation of Oregon.

Hart’s life is remarkable in its impact (the countless lives saved through his x-ray diagnoses of asymptomatic TB) and its distinctiveness (as one of the first people to receive a gender-affirming surgery). Hart was undeniably resilient, intent on continuing to serve his patients despite the frequent outings which forced him to relocate.

In the archive of his life, there is little evidence that Hart ever wavered on his identity as a man or in his mission as a medical doctor. I imagine that Hart still got discouraged occasionally and that his moves took a toll on him and his relationships. This seems to be a basic human response to which Hart must have developed his own ways of coping.

To me, much of Hart’s life remains legible through the lens of contemporary trans identity. Today, trans people are largely able to come out on our own terms, yet the price remains steep: workplace discrimination, excessive pathologizing from medical providers, navigating the sexual politics of an intolerant society, the hypervisibility of gender non-conformity, and (of course) just wanting to be left the fuck alone.