Lili Elbe: a pioneer of medical transition

Lili Elbe was one of the first known people to undergo gender-affirming surgical procedures, becoming a pioneering symbol in the history of transgender people [1]. Born as Einar Magnus Andreas Wegener in 1882 in Denmark, Lili lived an extraordinary life that challenged the social and medical conventions of her time, paving the way for future generations.

Early years and artistic career

Einar Wegener was born on December 28, 1882, in Vejle, Denmark [1]. From a young age, he showed exceptional talent for painting, which he cultivated by studying at the Royal Danish Academy of Fine Arts in Copenhagen. During his studies, in 1904, he met Gerda Gottlieb, also a talented painter, whom he married that same year [1].

The artist couple moved to Paris, where both developed their artistic careers. Einar specialized in landscapes, while Gerda became known for her portraits of elegant and sensual women, often in the Art Deco style [1]. Their life in Paris, a cosmopolitan and culturally open city, would play a fundamental role in Lili’s journey.

The birth of Lili

According to the autobiography “Man into Woman,” published posthumously in 1933, it all began when Gerda asked Einar to pose as a model for one of her paintings, wearing women’s clothing [2]. What might initially have seemed like a simple artistic device turned out to be a moment of profound revelation.

Einar began to feel increasingly comfortable in women’s clothing and started to develop the identity of Lili Elbe. The name “Lili” was chosen for its delicacy, while “Elbe” derived from the river that flows through Dresden, a city that would later play a crucial role in her life [1].

In the 1920s, Lili began living publicly as a woman in Paris, where the bohemian and artistic environment offered greater tolerance than other contexts [1][2]. She attended social events, frequented Parisian cafes and salons, gradually building an autonomous life distinct from that of Einar.

The medical journey

At the time, medicine had not yet developed established protocols for transgender people. Lili consulted several doctors, many of whom considered her condition a form of mental illness or perversion [4]. However, some enlightened professionals, particularly at the Institut fur Sexualwissenschaft founded by Magnus Hirschfeld in Berlin, were beginning to scientifically study gender identity and sexuality [5].

In 1930, Lili met Dr. Kurt Warnekros at the Frauenklinik in Dresden [1]. Warnekros, a progressive gynecologist, agreed to help her in her medical transition. With the theoretical and scientific support of Hirschfeld’s institute [5], Lili began a series of pioneering surgical procedures.

Between 1930 and 1931, Lili underwent four surgical procedures [1]. The initial operations included an orchiectomy (removal of the testicles) and a penectomy (removal of the penis), followed by attempts to construct a functional vagina. For the time, these procedures represented the absolute frontier of medicine.

Legal recognition

In an extraordinary gesture for the era, King Christian X of Denmark officially recognized Lili Elbe’s female identity, allowing her to legally change her name and gender on her documents [1]. This recognition also entailed the annulment of her marriage to Gerda, since same-sex unions were not legally recognized at the time.

Despite the legal separation, Gerda remained a fundamental source of support in Lili’s life, demonstrating an affection and understanding rare for that era. Their relationship represents a touching example of how love can transcend conventional categories.

The final tragedy

Encouraged by initial successes, Lili decided to undergo a fifth surgical procedure in 1931: a pioneering attempt at a uterine transplant [1][2]. The goal was to enable her to have children, a desire she expressed repeatedly in her letters and diary [4].

Unfortunately, the medicine of the time did not possess the immunological knowledge, advanced surgical techniques, or immunosuppressive drugs necessary for this type of transplant. Lili developed severe postoperative complications, likely related to organ rejection and infection [1].

On September 13, 1931, at only 48 years of age, Lili Elbe died in Dresden [1]. Her last words, according to accounts, were of gratitude for having been able to live, even if briefly, as the person she felt herself to be [2].

Posthumous legacy

After her death, her friend and collaborator Ernst Ludwig Hathorn Jacobson oversaw the publication of Lili’s autobiography, “Man into Woman,” in 1933 [2]. The book, based on diaries, letters, and conversations, became a fundamental historical document, offering one of the first direct testimonies of the transgender experience.

The work went through several editions and translations, helping to make Lili’s story known around the world. Although some passages were fictionalized or edited for editorial reasons, the text remains a valuable source for understanding not only Lili’s life but also the medical and social context of the era.

Lili Elbe in contemporary culture

In 2000, American writer David Ebershoff published “The Danish Girl,” a novel loosely inspired by the life of Lili Elbe [3]. The book was a great success, and in 2015 it was adapted into a film directed by Tom Hooper, with Eddie Redmayne in the role of Lili and Alicia Vikander as Gerda.

The film brought Lili’s story to a global audience, generating renewed interest in this pioneering figure. However, both the novel and the film take numerous artistic liberties with historical facts, fictionalizing and dramatizing many aspects of Lili’s life [4]. Transgender historians and activists have emphasized the importance of distinguishing the cinematic portrayal from documented reality.

Historical significance

Lili Elbe represents a crucial figure in the history of transgender people for several reasons:

Pioneering visibility: In an era when transgender identity was completely misunderstood and stigmatized, Lili lived openly as a woman, challenging social conventions [1][2].

Medical transition: She was one of the first known people to undergo gender-affirming surgical procedures, paving the way for subsequent medical developments [1][5].

Documentation: Thanks to her autobiography and preserved letters, we have a direct testimony of her experience, rare for that era [2][4].

Legal recognition: The fact that the King of Denmark recognized her female identity represented a significant precedent, even if limited to her specific case [1].

Personal courage: Lili’s determination to live authentically, despite the medical and social risks, continues to inspire transgender people today.

Critical reflections

It is important to contextualize Lili’s story within her time. Medicine in the 1930s was radically different from contemporary medicine. The procedures she underwent were experimental and risky, without the safety protocols, endocrinological knowledge, and modern surgical techniques available today.

Furthermore, the language and concepts used to describe Lili’s identity reflect the medical and social understandings of the era, often pathologizing in nature. Today we recognize that being transgender is not an illness but a natural variation of human experience.

Nevertheless, reading Lili’s words through her letters and diary [4], her profound self-awareness and her courage in pursuing her truth clearly emerge, despite everything.

Conclusion

Lili Elbe died nearly a century ago, but her story continues to resonate. In an era when transgender people still struggle for recognition, rights, and access to medical care, Lili’s life reminds us that this struggle is not new.

Her courage in living authentically, in facing risky medical procedures, and in seeking recognition of her identity paved the way for millions of transgender people who have come after her. Although she paid the ultimate price, her legacy lives on in every transgender person who today can live more freely.

Remembering Lili Elbe means honoring not only a pioneer but also recognizing that transgender people have always existed throughout human history, deserving dignity, respect, and the right to live as themselves.