From the archives: Dr. Ira Pauly, pioneer in transgender health care

January 20, 2016

by Maija Anderson OHSU Historical Collections and Archives

Dr. Ira PaulyMany in the School of Medicine community are surprised to learn that a former faculty member, Ira Pauly, M.D., is a hero in the history of LGBTQ health care. Last year, I had the privilege of interviewing Dr. Pauly for the OHSU Oral History Program. The full transcript of his interview can be downloaded from OHSU Digital Commons.

Pauly was a star football player at University of California Los Angeles (UCLA), where he earned a bachelor's degree in 1954. He also attended UCLA for medical school. In his interview, he observed, "I was better at talking to people than I was with biochemical equations." His strong interpersonal skills, especially his easy rapport with patients, drew him to psychiatry.

He first met transgender patients during his residency at New York Hospital. As a heterosexual, cisgender psychiatrist, Pauly wanted to understand the psychological processes of patients who did not conform to their biological sex. While mainstream psychiatry stigmatized these patients and sought to "correct" how they perceived themselves, Pauly noticed, "As I got to know the patients, they uniformly described being happier in the gender role that they felt they were in from the very beginning." His curiosity led him to Harry Benjamin, an endocrinologist and sexologist who conducted groundbreaking clinical research on transgender patients. Benjamin allowed Pauly to see his patients and became a mentor.

George Saslow, M.D., Ph.D. recruited Pauly to the faculty of the University of Oregon Medical School's Department of Psychiatry, where he served from 1962-1978. At UOMS (a predecessor to today's OHSU School of Medicine), Pauly continued to focus on therapeutic treatment of patients with gender identity issues. Dr. Pauly joined a handful of psychiatrists who supported gender reassignment surgery. At the time, this position was far outside the mainstream and could negatively affect a practitioner's professional reputation. 

In 1965, Dr. Pauly published "Male psychosexual inversion: Transsexualism: A review of 100 cases" in the Archives of General Psychiatry. It was the first aggregated study of health outcomes of male-to-female transgender patients. The data supported the contention that gender reassignment surgery had positive outcomes, and that transgender patients should be supported in living as the gender with which they identified. Though he initially had trouble getting the article published, Pauly received over 1,000 requests for reprints from colleagues, many of whom were seeking solutions for their own transgender patients. This encouraged Pauly to continue researching and publishing on transgender health care. In 1975, Pauly and his student Thomas Lindgren published a body image scale to help evaluate candidates for gender reassignment surgery.

While Dr. Pauly retired from practice in the 1990s, he is still well ahead of his time in understanding and supporting LGBTQ health care issues. Dr. Pauly is now Professor Emeritus of Psychiatry and Behavioral Sciences at University of Nevada's School of Medicine. He and his wife split their time between homes in Phoenix and Reno.

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