Dr Alan Hart, a personal reflection to mark LGBT+ History Month

by Jim Austin, co-chair Proud Alliance - LGBTQIA+ Network

This article references transphobia and conversion therapy.

It is not exaggeration to say that Dr Alan Hart is responsible for saving the lives of millions of patients with tuberculosis, and the prevention of an even larger number of infections. His ground-breaking work established the basis for many screening tests that are still used today. An intellectual powerhouse, a successful published fiction author and a tireless activist for public health.

Born in Kansas, USA in 1890, Dr Alan Hart’s father died when he was two. He moved to Oregon with his mother to live with his maternal grandparents at their farm. He was a happy and active child and formed a close bond with his grandfather. Although assigned female at birth, Dr Hart was much more comfortable dressing as a boy and playing with them. He was a typical boisterous boy, preferring to do farm work with the ‘menfolk’ and for all intents and purposes was able to socially transition with his family’s support.

This changed when he was 12 as the family moved to Albany and he was forced to detransition and present himself as female to attend school. Although he was forced to attend school under his birth name, he continued to write stories, articles and essays under a male name. His summers were still spent at his grandparent’s farm, where he was free to dress and refer to himself appropriately. He attended college and was again forced to enrol under his birth name. Apart from a year studying in San Fransisco with his girlfriend, he completed his medical degree at Albany College. He dated several women during this period and was a dedicated and talented student. When he graduated, he was awarded the Saylor medal, an accolade given to the student with the highest grades at Albany College each year. At the time he was reported as the first woman to receive this award. Due to his forced detransition, it would be more accurate to refer to him as the first trans man to receive the Saylor medal.

Upon graduation Dr Hart was extremely disappointed to have his degree issued in his birth name, forcing him to practise medicine in this way. Conflicted by his attraction to women and his desire to live authentically as a man he contacted a former professor and practicing doctor, Dr J. Allen Gilbert. Dr Hart explained his history, gender identity and sexuality and asked Dr Gilbert to help cure him. They attempted talking therapy and hypnosis but to no effect. Although this conversion therapy was performed at his own request, it was doomed to failure. Dr Gilbert helped as Dr Hart was suicidal, and they agreed to take a break for Dr Hart to reflect on himself. During this break, he had a profound realisation; if the treatment was successful then he would no longer feel like a man and be attracted to women. This idea appalled him, and he contacted Dr Gilbert with a new goal. Inspired by the successful medical transition of Karl Baer, he wished to become the first man in America to received gender affirming surgery.

Dr Gilbert recognised that this was the only possibility for Dr Hart to live a happy life and performed the procedure in 1917. Dr Gilbert wrote his experience as an anonymised publication in a medical journal, saying ‘from a sociological and psychological standpoint he is a man, and that living as one is his only chance for a happy existence’. This statement, and another from the article are as relevant today as they were over a hundred years ago and a firm reminder that trans people have always been here. Dr Gilbert also said ‘let him who finds in himself a tendency to criticise to offer some constructive method of dealing with the problem at hand. He will not want for difficulties. The patient and I have done our best with it’.

Dr Hart was able to legally change his name and married his first wife, Inez Stark. He took a position but was quickly recognised and outed by a former medical school classmate. The local newspaper reported on this, and the couple were forced to move for their privacy and safety. This pattern repeated itself over the years, and Dr Hart was forced to take temporary and unstable positions. The strain of these experiences led the couple to separate in 1923, before divorcing in 1925. During the separation Dr Hart met Edna Ruddick, who he entered a relationship with. They married after his divorce and remained together for the remainder of their lives.

Seeking greater privacy, he then spent the next five years working with patients with tuberculosis and studying for master's degree in radiology. At the time one in four patients in urban areas were infected with tuberculosis in the USA, and the mortality rate was high to a lack of treatment options. Patients would be admitted to sanitoriums when symptomatic, leading to many additional infections. Dr Hart spent until 1948 exploring screening methods for diagnosing tuberculosis earlier. He also gained his second master’s degree in public health.

Although synthetic testosterone was approved for human use in 1939, it was not widely available to patients. Confident in the work he had done in using X-rays to screen patients for the characteristics of tuberculosis infection, Dr Hart began taking testosterone as soon as he could. His voice deepened and he grew a beard giving him greater confidence to be more publicly active. He began public speaking and advocating his ideas and was successful in his appointment as the Director for Hospitalisation and Treatment for the Connecticut state tuberculosis commission. In this role his ideas and techniques were performed to immediate success. As his techniques were implemented nationwide, rates of new tuberculosis infections were reduced by a factor of 50. With the discovery of streptomycin, an early screening technique and effective treatment were available for the first time.

Dr Hart spent the remainder of his life working in public health and advocating for tuberculosis patients. He worked with charities to raise money for those who couldn’t afford treatment. He continued to write and publish fiction novels and was the long-time vice-president of his Unitarian church. He was a remarkable man, both as a scientist and doctor.

Dr Alan Hart is best remembered in his own words: “I am happier since I made this change than I have ever been in my life and I will continue this way for as long as I live … I am ashamed of nothing.”