1. 1849–1918

   Names, extracts, and the first clinics

   Gonads are shown to secrete chemical messengers. Homosexuality is named as a legal and medical category. Crude ovarian and testicular extracts appear as medicines.

   1849

   1849Science

   Berthold proves the testes secrete something

   A Göttingen zoologist castrates roosters, transplants the testes into the abdomen, and watches the comb grow back.

2. 1869

   1869Rights

   “Homosexual” is coined

   Karl Maria Kertbeny, a Hungarian-German writer, invents the word in a pamphlet arguing against Prussia’s sodomy statute.

3. 1871

   1871Rights

   Paragraph 175 criminalizes sex between men in Germany

   The new German Empire writes male homosexuality into the penal code. The statute will last, in some form, until 1994.

4. 1889

   1889ScienceMale HRT

   Brown-Séquard injects himself with testicular extract

   A 72-year-old physiologist tells Paris he has rejuvenated himself with injections of crushed animal testes.

5. 1895

   1895Rights

   Oscar Wilde is convicted of gross indecency

   The most famous writer in London is sentenced to two years’ hard labour for sex with men.

6. 1896

   c. 1896Female HRT

   Ovariin: the first menopause “hormone” product

   Merck markets a powder of dried cow ovaries for “climacteric” symptoms — HRT before anyone has isolated a hormone.

7. 1897

   1897Rights

   Hirschfeld founds the first gay rights organization

   The Scientific-Humanitarian Committee in Berlin petitions to repeal Paragraph 175. Its motto: “Justice through science.”

8. 1905

   1905Science

   Starling coins the word “hormone”

   In the Croonian Lecture, Ernest Starling names the chemical messengers that travel in the blood.

9. 1910

   1910RightsFemale HRTMale HRT

   Hirschfeld separates gender from desire

   Die Transvestiten argues that people who live in another sex’s clothes are not simply homosexuals.

10. 1919–1939

    The laboratories

    Sex steroids are isolated and synthesized. Berlin becomes the world center of sexology — then the Nazis burn it. The first documented medical transitions take place.

    1919

    1919RightsFemale HRTMale HRT

    Institute for Sexual Science opens in Berlin

    Hirschfeld buys a villa and founds the world’s first clinic and archive devoted to sex, gender, and homosexuality.

11. 1923

    1923Science

    Allen and Doisy identify the ovarian hormone

    Follicular extract makes a spayed rodent go into heat. The Allen–Doisy test becomes the assay that will isolate estrogen.

12. 1924

    1924Rights

    First U.S. gay rights group is founded — and crushed

    Henry Gerber, a German immigrant inspired by Hirschfeld, starts the Society for Human Rights in Chicago.

13. 1929

    1929Science

    Estrone is crystallized

    Doisy in St. Louis and Butenandt in Göttingen independently isolate the first pure sex steroid from pregnancy urine.

14. 1931

    1931Science

    Androsterone, the first male sex hormone isolated

    Butenandt processes some 15,000 litres of police-barracks urine to obtain 50 milligrams of crystals.

    1930–31Female HRT

    Lili Elbe and Dora Richter undergo staged surgeries

    Two patients of Hirschfeld’s institute receive the most complete male-to-female operations yet attempted.

15. 1933

    1933Female HRT

    Emmenin, the first commercial oral estrogen

    Ayerst sells an extract of pregnant-women’s urine for menopausal symptoms. It works — and is too expensive to scale.

    May 1933Rights

    Nazis loot Hirschfeld’s institute and burn the library

    Students sack the villa on Beethovenstraße. Irreplaceable case files and books go onto the Opernplatz pyre.

16. 1934

    1934Science

    Four teams isolate progesterone in the same year

    Butenandt, Slotta, Hartmann, and Allen–Wintersteiner all announce the corpus-luteum hormone.

17. 1935

    1935ScienceMale HRT

    Testosterone is isolated and synthesized

    Ernst Laqueur crystallizes it from bull testes. Butenandt and Leopold Ružička make it from cholesterol the same year.

18. 1936

    1936Science

    Doisy isolates estradiol, the potent ovarian estrogen

    From four tons of sow ovaries, the St. Louis lab obtains the hormone the ovary actually secretes.

19. 1938

    1938ScienceFemale HRT

    Dodds publishes diethylstilbestrol (DES)

    A cheap, oral, non-steroidal estrogen is synthesized in London. It will be used for menopause, miscarriage prevention — and disaster.

20. 1939

    1939–44Male HRT

    Michael Dillon becomes the first trans man on testosterone

    A British medical student takes newly available testosterone and later undergoes phalloplasty with Sir Harold Gillies.

21. 1940–1968

    Institutions and the closet

    Premarin industrializes estrogen. Homophile groups organize in secret. Psychiatry lists homosexuality as illness. Christine Jorgensen makes transition front-page news.

    1941

    1941Male HRTScience

    Huggins links testosterone to prostate cancer

    Charles Huggins shows that cutting androgen supply shrinks metastatic prostate cancer. The finding saves lives — and scares doctors off testosterone for decades.

22. 1942

    1941–42Female HRT

    Premarin is approved

    Conjugated estrogens from pregnant-mare urine become the first scalable oral menopause drug. The name: PREgnant MARes’ urINe.

23. 1944

    1944Male HRT

    The “male climacteric” is treated with testosterone

    Heller and Myers describe aging men with hot flushes, fatigue, and low 17-ketosteroids — and report that testosterone injections reverse the picture.

24. 1948

    1948Rights

    Kinsey reports that homosexual behavior is common

    Sexual Behavior in the Human Male claims 37% of men have had at least some same-sex experience.

25. 1950

    1950Rights

    The Mattachine Society is founded

    Harry Hay and a handful of Communist and left organizers start a secret homophile society in Los Angeles.

26. 1952

    Dec 1952Female HRTRights

    Christine Jorgensen makes transition world news

    The New York Daily News headline: “Ex-GI Becomes Blonde Beauty.” An American who took estrogen in Denmark becomes a celebrity.

    1952Rights

    DSM-I lists homosexuality as a sociopathic disturbance

    The American Psychiatric Association’s first diagnostic manual medicalizes same-sex desire as mental illness.

27. 1953

    1953Rights

    Eisenhower bans “sexual perversion” in federal employment

    Executive Order 10450 makes homosexuality a security risk. The Lavender Scare outruns even McCarthy’s red one.

28. 1955

    1955Rights

    Daughters of Bilitis, the first lesbian rights group

    Del Martin and Phyllis Lyon start a social club in San Francisco that becomes a political organization.

29. 1959

    1959 (sample)HIV

    The earliest known HIV-1 sample is drawn in Léopoldville

    A 1959 blood sample from Kinshasa, sequenced decades later, contains HIV-1. The virus had already been circulating in Central Africa.

30. 1960

    1960Female HRTScience

    The FDA approves Enovid, the first oral contraceptive

    A pill of mestranol and norethynodrel puts estrogen-plus-progestin in millions of younger women’s mouths.

31. 1961

    1961Rights

    Illinois becomes the first U.S. state to repeal sodomy law

    Following the Model Penal Code, private consensual sex between adults is no longer a crime — in one state.

32. 1966

    1966Female HRTMale HRT

    Benjamin publishes; Johns Hopkins opens a gender clinic

    The Transsexual Phenomenon gives American doctors a protocol. Hopkins becomes the first U.S. university gender-identity clinic.

    Aug 1966Rights

    Compton’s Cafeteria riot

    Trans women and hustlers in San Francisco’s Tenderloin fight back against police harassment — three years before Stonewall.

    1966Female HRT

    Feminine Forever sells estrogen as youth

    Gynecologist Robert A. Wilson’s bestseller tells women that menopause is a deficiency disease estrogen can cure.

33. 1967

    1967Rights

    England and Wales partially decriminalize male homosexuality

    The Sexual Offences Act legalizes sex between two men, in private, over 21 — a narrow door, but a door.

34. 1969–1980

    Liberation

    Stonewall, Pride, and the APA vote. Estrogen’s first cancer scare. Gender clinics open, then some close. A rainbow flag is sewn.

    1969

    28 June 1969Rights

    The Stonewall uprising

    Patrons of a Greenwich Village gay bar fight a police raid. Six days of unrest become the origin myth of a mass movement.

35. 1970

    28 June 1970Rights

    The first Pride marches

    Christopher Street Liberation Day in New York, and twin marches in Los Angeles and Chicago, mark Stonewall’s anniversary.

36. 1973

    Dec 1973Rights

    The APA declassifies homosexuality

    After years of gay protest inside psychiatry’s own meetings, the Board of Trustees votes to remove homosexuality from the DSM.

37. 1975

    1975Female HRT

    Unopposed estrogen is linked to endometrial cancer

    Two New England Journal of Medicine papers show menopausal estrogen without a progestin raises uterine cancer risk.

38. 1977

    1977–78Rights

    Harvey Milk is elected — and assassinated

    San Francisco’s first openly gay supervisor wins office in 1977 and is shot, with Mayor George Moscone, in November 1978.

39. 1978

    June 1978Rights

    Gilbert Baker sews the rainbow flag

    Eight colored stripes fly at San Francisco Pride. The flag becomes the most recognized gay symbol on earth.

40. 1979

    1979Female HRTMale HRT

    Standards of Care — and Johns Hopkins closes its clinic

    Harry Benjamin’s colleagues found a professional society with treatment guidelines. The same year, Hopkins shuts its gender program.

41. 1981–1995

    The plague years

    A new immunodeficiency is reported in gay men, then named, then given a virus. AZT, ACT UP, and a generation of funerals. Premarin becomes America’s most prescribed drug.

    1981

    5 June 1981HIV

    CDC reports five cases of Pneumocystis in gay men

    The MMWR describes a rare pneumonia in previously healthy Los Angeles men. By year’s end there are hundreds of cases.

42. 1982

    1982HIV

    GRID is dropped; the disease is named AIDS

    “Gay-related immune deficiency” is abandoned as cases appear in hemophiliacs, Haitian immigrants, and people who inject drugs.

43. 1983

    1983HIV

    A retrovirus is isolated at the Pasteur Institute

    Françoise Barré-Sinoussi and Luc Montagnier find lymphadenopathy-associated virus (LAV) in a patient with swollen lymph nodes.

44. 1985

    1985HIV

    An antibody test, a blood-supply screen, and Rock Hudson

    ELISA is licensed. Donated blood begins to be tested. A movie star’s death forces the American public to say the word AIDS.

45. 1986

    1986Rights

    Bowers v. Hardwick upholds sodomy laws

    The Supreme Court rules that the Constitution does not protect private consensual sex between men. AIDS is the background radiation.

46. 1987

    March 1987HIVRights

    ACT UP is founded in New York

    Larry Kramer’s speech at the Lesbian and Gay Community Services Center births the AIDS Coalition to Unleash Power. Silence = Death.

    March 1987HIV

    AZT becomes the first approved AIDS drug

    Zidovudine, a failed cancer compound from 1964, is rushed through the FDA. It is toxic, expensive, and only briefly effective alone.

47. 1988

    1988Rights

    Britain’s Section 28 forbids “promotion” of homosexuality

    Thatcher’s government bars local authorities from presenting gay relationships as acceptable. Schools go quiet for 15 years.

    1 Dec 1988HIV

    The first World AIDS Day

    WHO organizes a global day of attention. The same year, the CDC mails Understanding AIDS to every U.S. household.

48. 1990

    1990HIV

    Ryan White dies; the CARE Act is signed

    The Indiana teenager who had been the epidemic’s most famous hemophiliac child dies at 18. Congress names the major U.S. HIV care law after him.

    1990Rights

    WHO removes homosexuality from the ICD

    The World Health Organization’s ICD-10 drops “homosexuality” as a mental disorder. The APA had done so 17 years earlier.

49. 1991

    1991HIV

    Red ribbons, Magic Johnson, Freddie Mercury

    Visual AIDS debuts the red ribbon. A basketball star and a rock star make HIV inescapably famous in the same autumn.

50. 1992

    1992Female HRT

    Premarin is the most prescribed drug in America

    Observational studies have convinced a generation of doctors that estrogen prevents heart disease and keeps bones. Fifteen million women will be on HRT by decade’s end.

51. 1993

    1993Rights

    Don’t Ask, Don’t Tell

    Clinton’s compromise lets gay people serve in the U.S. military if they stay silent. Discharges continue.

52. 1995

    Dec 1995HIV

    The first protease inhibitor is approved

    Saquinavir opens a new drug class. Combined with two older antivirals, it can drive virus in the blood below detection.

53. 1996–2011

    Treatment and recognition

    Triple therapy turns HIV from a death sentence into a chronic illness for those who can get it. Marriage fights go to court. The Women’s Health Initiative upends menopause HRT.

    1996

    1996HIV

    HAART: HIV becomes a chronic disease — for some

    The Vancouver International AIDS Conference presents triple therapy. U.S. AIDS deaths drop within two years. The global majority cannot afford the drugs.

    1996Rights

    The Defense of Marriage Act

    Congress defines marriage as one man and one woman for federal purposes and lets states ignore out-of-state same-sex marriages.

54. 1998

    1998Female HRT

    HERS: estrogen does not prevent second heart attacks

    A randomized trial in women with existing coronary disease finds no overall cardiovascular benefit from Premarin plus progestin.

55. 2000

    Feb 2000Male HRT

    AndroGel creates a mass market for male HRT

    A once-daily testosterone gel is FDA-approved for men with confirmed hypogonadism. Direct-to-consumer ads will soon sell “Low T” to middle age.

56. 2001

    1 April 2001Rights

    The Netherlands opens marriage to same-sex couples

    The first legal same-sex marriages on earth are performed in Amsterdam. A global legal cascade begins.

57. 2002

    July 2002Female HRT

    The Women’s Health Initiative stops the combined-HRT arm

    In women averaging 63 years old, estrogen plus progestin increased breast cancer, stroke, and blood clots. Heart-disease prevention failed.

58. 2003

    26 June 2003Rights

    Lawrence v. Texas strikes down sodomy laws

    Justice Kennedy overrules Bowers. Private consensual sex between adults is no longer a crime anywhere in the United States.

    2003HIV

    PEPFAR begins the largest HIV treatment rollout in history

    George W. Bush’s emergency plan commits billions to antiretroviral therapy in Africa and the Caribbean.

59. 2004

    17 May 2004Rights

    Massachusetts begins issuing same-sex marriage licenses

    Goodridge v. Department of Public Health made Massachusetts the first U.S. state with marriage equality.

60. 2008

    2008HIV

    The Swiss Statement: no virus, no sexual transmission

    Switzerland’s HIV commission says that people on effective therapy, with an undetectable viral load and no STIs, do not transmit HIV sexually.

61. 2010

    2010HIV

    iPrEx shows a daily pill can prevent HIV

    Among men who have sex with men, tenofovir/emtricitabine reduced infections by 44% overall — and far more when people actually took it.

62. 2012–present

    Prevention, equality, and unfinished fights

    PrEP, U=U, nationwide marriage, and workplace protections. Hormone therapy is both more precise and more contested — in menopause clinics and in gender care.

    2012

    16 July 2012HIV

    FDA approves Truvada for PrEP

    A combination once used only as treatment is licensed to keep HIV-negative people negative.

63. 2013

    26 June 2013Rights

    Windsor knocks out the heart of DOMA

    Edith Windsor had been billed $363,000 in federal estate tax that a straight widow would not have paid. The Court agrees that is unconstitutional.

64. 2015

    2014–15Male HRT

    FDA reins in “Low T” testosterone

    After observational studies hint at heart attack and stroke, the agency warns that testosterone is not approved for aging, and orders a cardiovascular outcomes trial.

    26 June 2015Rights

    Obergefell v. Hodges: marriage is a nationwide right

    Five to four, the Supreme Court holds that same-sex couples may marry in every U.S. state.

65. 2016

    2016HIV

    U=U becomes a global campaign

    Undetectable = Untransmittable. People on effective ART with suppressed virus do not pass HIV through sex.

66. 2017

    2017Female HRTMale HRT

    Endocrine Society updates gender-dysphoria guidelines

    A clinical practice guideline endorses hormones for carefully assessed adolescents and adults, with puberty blockers as a fully reversible pause.

67. 2019

    2019RightsFemale HRTMale HRT

    ICD-11 moves gender incongruence out of mental disorders

    WHO reclassifies trans health under sexual health, not psychiatry. The revision takes effect in 2022.

68. 2020

    15 June 2020Rights

    Bostock: firing someone for being gay or trans is sex discrimination

    Neil Gorsuch, writing for a 6–3 Court, holds that Title VII already covers sexual orientation and gender identity.

69. 2021

    2021HIV

    Long-acting injectable PrEP is approved

    Cabotegravir (Apretude), given every two months, outperformed daily Truvada in trials — especially where pills are hard to take.

70. 2022

    2022RightsFemale HRTMale HRT

    Respect for Marriage Act and WPATH SOC-8

    Congress writes a statutory backup for same-sex (and interracial) marriage. WPATH releases a more individualized, and more contested, Standards of Care.

71. 2023

    June 2023Male HRT

    TRAVERSE: testosterone does not raise major cardiac events

    A 5,246-man randomized trial, ordered by the FDA after the “Low T” scare, finds gel testosterone non-inferior to placebo for heart attack, stroke, and cardiovascular death.

72. 2024

    April 2024Female HRTMale HRT

    The Cass Review overhauls youth gender services in England

    Paediatrician Hilary Cass’s independent report finds weak evidence for puberty blockers and routine hormones in minors. NHS England restricts them to trials.

73. 2025

    2025HIV

    HIV is treatable, preventable, and still killing

    A person diagnosed today and treated early can expect a near-normal lifespan. About 40 million people live with HIV. A million still die each year, mostly where pills do not reliably arrive.