Transgender Lives in the Middle Ages through Art, Literature, and Medicine

Bagoas/Bagoe Pleads on Behalf of Nabarzanesin The Book of the Deeds of Alexander the Great, about 1470–75, Master of the Jardin de vertueuse consolation and assistant, made in Lille and Bruges. The J. Paul Getty Museum, Ms. Ludwig XV 8 (83.MR.178), fol. 133v. Digital image courtesy of the Getty’s Open Content Program

In primary texts, figures are addressed by medieval authors using both male and female pronouns interchangeably and by how they present.

By Dr. Roland Betancourt
Associate Professor of Art History
University of California Irvine


The exhibition Outcasts: Prejudice and Persecution in the Medieval World drew our attention to the story of Alexander the Great’s lover, the eunuch Bagoas (Bagoe). Bagoas’s gender was changed from male to female in a version of the story written in Latin in the first century CE and translated into French in the late fifteenth century. While this change appears to have been motivated by a desire to straight-wash the story of Alexander the Great—“to avoid a bad example,” as the author tells us—narratives of transgender and gender-fluid persons are well attested across late antique and medieval literature.

After nine years, they saw that the young girl was beardless and they called her “Hilarion the Eunuch”since there were many such [eunuchs] wearing the habit. For her breasts, too, they were not as those of all women. Above all, she was shrunken with ascetic practices and even her menstrual period had stopped because of the deprivation…Besides all this she was wearing a man’s garb.[1]

The Life of Hilaria/Hilarion

From the fifth to the ninth century, a series of saints’ lives composed in the Greek-speaking Mediterranean detail the lives of individuals assigned female at birth, who for a variety of reasons chose to live most their lives as monks, usually presenting and passing as eunuchs within male monastic communities.[2] Throughout the ninth, tenth, and eleventh centuries, these stories gained in popularity as evidenced by their increased presence in the manuscript tradition. They were also translated into Coptic, Syriac, Ethiopic, Armenian, and Arabic, as well as Latin and other European languages, leading to the eventual popularity of similar stories in the West.[3] While there are thirteen of these narratives from the late-antique Mediterranean that establish the tradition, scholars have identified no less than thirty-four instances in literature from across the medieval world that note stories of women who dressed as men in some capacity.[4]

In the primary texts, these figures are addressed by medieval authors using both male and female pronouns interchangeably,and depending on how they are presenting to others. Further work is necessary to ascertain the history of the usage of pronouns and the saints’ male and female names—the desire to misgender these figures as female at times appears to be a later insertion into the texts through their copying and transmission in the manuscript tradition, the compilation of critical editions, and the work of modern translators. In the context of this article, I will use the singular “they” to refer to these figures in order to stress that they did not simply identify as males, but rather invariably passed as eunuchs, who existed as a third gender in the Byzantine world. As readers today, it is necessary to understand that the term transgender encompasses a wide spectrum of gender variation and to acknowledge as transgender these figures who were assigned a female sex at birth, but lived their lives as males, often passing as male-gendered eunuchs.

The Life of Mary/Marinos

One such story that found popularity across the medieval Christian world is the life of Mary/Marinos. This story gives us a typical narrative for a transgender monk, in which there is some form of family crisis;entry into monastery;conflict; accusation or outing of their birth-assigned sex;and eventual resolution, usually after their death.[5]

In this case, there is young child, named Mary, who is raised by their father after the mother dies. Once the child has come of age, the father decides that he wishes to join a monastery. Wishing not to be separated from their father, the child asks to have their hair shorn, be clothed as a man, and their name changed to Marinos so that they may continue to share a life with their father. Here, as is always the case, the male-clothed female body is understood as being that of a eunuch. Marinos lives their life in the monastery, their beardless face and delicate voice interpreted by others as evidence of their status as a eunuch. Like many of these figures, Marinos is heralded for their great asceticism, eating only once every other day—a practice that, as we shall see,might have been aimed at stopping menstruation and lessening the appearance of breasts. Eventually, Marinos’s father passes away, and they are left to bear their secret alone.

One day, Marinos is accused of defiling a nearby innkeeper’s daughter who had copulated with a soldier. Upon conceiving a child, she blames “the young monk…the attractive one called Marinos.”[6] Marinos accepts the charges, saying: “I have sinned as a man.”[7] Marinos embraces the shame of the crime that they did not commit, and lives immediately outside the monastery gates after they are cast out, enduring the temperaments of the seasons. The child is handed over to Marinos after he is born, and seeking out milk from some shepherds, Marinos nurses the child “as its father.”[8] After three years, Marinos and the child are let back into the monastery. After some time, Marinos is found dead in their cell, and the brothers realize while preparing to wash the corpse that Marinos is female-bodied. The innkeeper is told to repent upon the revelation of this news, and his daughter becomes possessed by a demon.

In the Menologion of Basil II in the Vatican Library, this climactic moment in the story is illustrated.A brother is depicted at the far left, speaking to the innkeeper at the center, who holds a staff and judgingly glances over at his possessed daughter. The daughter rushes into the scene, her right leg and thigh in full display to the viewer as she approaches the recumbent Marinos. Her hair stands on end, electrified, indicating her demonic possession.

The scene dramatizes the moment before the innkeeper’s daughter repents before the deceased Marinos, the act of confession through which this narrative reaches its final outing. At the center of the image, Marinos is on a bier upon the ground in solemn rest, being buried in a female habit, and forcibly returned to her birth-assigned sex by the artist and narrative alike: the miracle all along being Marinos’s ability to pass as male.

In sketching out the bodily practices of such figures’transgender identity, it becomes necessary to consider the role that medical knowledge played in contouring notions of sex and gender, and conversely the transgression or reassignment of one’s sex and gender. For example, in the case of Hilarion, the text states that they had managed to stop menstruating and that after nine years their breasts were “not as those of all women.”

This matter is repeated in the story of another transgender monk, Anastasius, which explicitly tells us that as a brother was dressing them after their death, the brother “saw that on his chest he had women’s breasts, looking like two shriveled up leaves,” a detail preserved in both the Syriac and Greek versions of the text.[9] This repeats once again the evidence that these figures were able to transform the secondary sex characteristics of their bodies through ascetic practices.

Emperor Elagabalus

At the end of antiquity, we are provided with one of the most well-fleshed-out narratives of a figure who not only identified as female, but also actively sought out gender affirmation surgery. This striking evidence is found in the figure of Roman emperor Elagabalus, who lived in the early third century. In Roman History, Elagabalus’s contemporary Dio Cassius slanders the emperor’s life and deeds. Of key importance here is the manner in which Elagabalus is depicted,quite explicitly,as a transgender woman. Repeatedly, he is said to behave in the manner in of female prostitutes, standing naked in the doorway of the palace while in a “soft and melting voice”[10] soliciting all who went by. Also he took on a lover whom he referred to as his “husband” and wished to make a co-emperor,[11] and chose for himself the titles of “wife, mistress, and queen.”[12] Elagabalus would shave his own face and pluck his hairs out “so as to look more like a woman,” and he worked wool, wore a hair-net, and painted his eyes.[13]

Tetradrachm of Elagabalus, 1st–3rdcentury CE, Roman, made in Syria. Billon. The J. Paul Getty Museum, 79.NF.192.100. Gift of Morton Scribner, M.D.Digital image courtesy of the Getty’s Open Content Program

In a potent yet passing comment, Dio Cassius states that Elagabalus “carried his lewdness to such a point that he asked the physicians to contrive a woman’s vagina in his body by means of an incision, promising them large sums for doing so.”[14] Elagabalus’s request for what today we would refer to as gender affirmation surgery stresses their desire to have female genitalia.[15] Details about Elagabalus’s surgery request captured the imagination of several Byzantine writers well into the Middle Ages.

The notion that surgical procedures could be deployed to affirm or reassign a person’s gender was not at all foreign to late-antique and Byzantine doctors. The most obvious of these, of course, are the surgical and non-surgical procedures for the castration of eunuchs in which the testicles were either cut-out through incisions in the scrotum, crushed, or even dissolved in young children through friction and pressure in a hot bath.[16]

In the medieval world, a nuanced interplay between categories of sex and gender is evident in the manner that the medical guidebooks handle physical characteristics in a person of one sex that could be ascribed to the other: namely, in instances of women with an enlarged clitoris or of men with gynecomastia, that is, enlarged breasts that resemble those of females. Surgical procedures were recommended to correct these so-called deformities or improprieties because they were said to cause shame in those who have them, precisely because they did not adhere totheir assigned gender. In the case of gynecomastia, the justification of seventh-century physician Paul of Aegina for this surgical procedure was that: “Since this carries the unseemly disgrace of effeminacy, it is proper to operate upon it.”[17] Thus, the problem was staged as challenging the gender identity of the person, and the operation served to affirm the man’s gender identity, which had been challenged by his enlarged breasts.

In the case of an enlarged clitoris, we observe the same logic by these medical writers in justifying what today we recognize as female genital mutilation. Here, we get the sense that these operations are geared toward affirming a person’s gender by surgically altering characteristics of their bodies because they are associated with the opposite sex. The idea of shame here appears to be a stand-in for a sort of gender dysphoria.

Mary of Egypt

To think more about how these matters manifested themselves in the work of artists, let us look more closely at depictions of Mary of Egypt, a female saint who is not explicitly understood as being transgender, but who is often depicted in a more masculine form in Byzantine art.While the transgender saints discussed herein are invariably commemorated in art as women in the Byzantine world, the figure of Mary of Egypt is often depicted in art with masculine features.[18]

In the seventh-century story of her life, at times attributed to Sophronius, Mary is depicted as a reformed prostitute from Alexandria who escapes into the Egyptian desert to find salvation. She emerges in the story when the monk Zosimas catches a glance of her ghostly, almost demonic, figure in the desert, described as a black body.[19] As Zosimas pursues her she attempts to flee, but is eventually overrun and asks him to toss her his cloak,for she is a woman and should not turn around and reveal her nudity.[20]

In depicting her great asceticism in painting, artists often produced a body for Mary of Egypt that was visually synonymous with that of her male counterparts. Compare the image of Mary of Egypt in the sanctuary of the Church of the Panagia Phorbiotissa at Asinou in Cyprus with that of John the Baptist just outside the sanctuary of the same church. The similarity between the two figures in these frescoes is striking. Both wear a scrappy tan-colored garment over their emaciated bodies: John’s tunic is shredded at the hems, while Mary’s is haphazardly tossed over her flesh, wrapped as a himation, but without the chiton underneath. Her garment, which Zosimas has tossed to her to cover herself up, is much finer than John’s, neither tattered nor torn, with subtle instances of visible embroidery at the hems. Mary’s white hair is voluminous, twisting and turning over her profile in a shaggy manner, with what can only be described as a disheveled pompadour on top that echoes that of John. And while John’s body is just as thin and petite as that of Mary, her denuded chest and back reveal a gruesomely famished body, her ribs are prominently visible,and thick blobs of paint mark every single one of her vertebrae over a pronounced hunchback.

Looking at these two images, we are left with the nagging realization that John’s body is more feminine by Byzantine standards than Mary’s, or rather that Mary’s is more masculine than John’s. John’s own hair is longer than Mary’s, reaching well past his shoulders, and it falls into locks of thick glossy curls. Mary’s body shows no indication of breasts, her tunic falling flatly over her chest as it does with John, and there even seems to be a thin swirl of color beside her armpit that might allude to the semblance of withered breasts, a feature recounted in some of the trans-saints’ lives. On her face, the weight of her excess flesh and wrinkles pulls down her jawline. Compare the soft and rounded face of the Virgin Mary, standing next to John, with Mary of Egypt’s own. The ascetic has no roundness to her. The streams of paint that contour her drooping and wrinkled face flow down from between the utmost tip of her ear and eye, coming down at a soft right angle at her jawline, thus giving her a rigidly square jaw. This jaw culminates in a strong and prominent chin, unlike the Virgin’s soft and rounded features. Her brow is furrowed with contours and shadows, unlike the serenely plastic brow of the Virgin. In every manner, the artist has sought to make Mary male.

John’s legs, arms, and feet are covered with body hair, indicated by thin long strips of black paint. Mary’s body is lacerated with similar lines: thicker and shorter brownish-red stripes of paint that even cover her back, yet notably not the palms of her hands. Seemingly, then, her flesh is also covered in body hair. In this ambiguity between scar and hair, the lacerations of asceticism transmute into the secondary sex characteristics of the male body. Symbolically and spiritually, of course, the two are one and the same.

Mary of Egypt and Zosimasin the Theodore Psalter, 1066, unknown illuminator, made in Greece. Pigment and gold on parchment 23 x 22 cm. The British Library, London, Add. Ms. 19352, fol. 68r

In the Theodore Psalter, glossing Psalm 54 is the encounter between Zosimas and Mary. The exchange is captured precisely at the moment when he has tossed the garment toward her, the cloth having just left his hands. Zosimas looks away, while Mary turns back to catch his himation, thus exposing her denuded chest to the viewer while her right thigh preserves the modesty of her loins. A close inspection of her chest demonstrates that there is again no indication of breasts, neither full nor wither. Instead, a reddish,undulating, thick brush stroke crosses over her chest, armpit to armpit, like a pronounced wound. Instead of breasts, it looks more like the mottled dark-red of cauterized scar tissue.

In fact, this type of scaring would be in keeping with Byzantine mastectomies that involved a process of alternative cutting and cauterizing according to medical and surgical handbooks, such as is prescribed in Aetios of Amida’s sixth-century text in the chapters describing the removal of breast cancer. There is no evidence to corroborate that this was the artist’s explicit intention, and we have no illuminations in these surgical manuscripts. However, we can compare the scar-like trace on Mary’s body to an earlier image of Saint Agatha’s torture in the Menologion of Basil II. There we see two men torturing the saint by cutting off her breasts, not with pincers as it is often shown, but with a striking half-moon knife. This knife is a lunellum, associated with the scraping and cleaning of animal skin in the making of parchment, thus a tool connected with the working of flesh for a scribe and illuminator.

In the miniature, Agatha’s recently cut-off breast has fallen to the ground to the left of the figure, while a man approaches her with a torch that is about to be pressed against the wound where her right breast was,seemingly in order to cauterize the open lesion. However, an open torch is not hot enough to cauterize such a wound,and we have no plausible evidence that such a lunate knife would have been used as a surgical tool. In other words, we are seeing here the manner in which painters conceptualize this surgical process through the types of tools and methods with which they would have been most familiar for the working and manufacturing of animal skins for parchment. (See A Parchmenter Scraping Parchment with a Lunellum in Various Works by Saint Ambrose of Milan, mid-1300s, from Kloster Michelsberg;Bamberg, Staatsbibliothek, Misc. Patr. 5, fol. 1v.)

But, I would like to suggest that a familiarity with medical knowledge isat work here, given that Paul of Aegina’s instruction for breast reductions indicate the need for “a lunate incision,” leading the artist to articulate this “crescent-shaped cut” either through the shape of the cutting tool, or, as in this other case on the screen, through the stressed oval shape of the gash. The depiction of Agatha’s wound and its height right at her armpit are comparable to what we observed in Mary of Egypt’s curious depiction in the Theodore Psalter.

Certainly, whether out of cruelty, modesty, or a desire to stress the breasts’ negation, these painted figures have had the breasts removed, evidencing even the scars to match. They poignantly intimate that the visual language of excision and cauterization associated with mastectomies could be deployed to manifest the transformation of Mary of Egypt. This here is just a miniscule history of the narratives that I have been attempting to articulate.


Rather than struggling with how to allow for modern categories to represent medieval realities, we can confront here how the figures discussed throughout this article push against our own expectations of gender identity in the early Christian and medieval world, rubbing against our own anachronistic notions of a binary gender construct. If we accept that transgender subjects are not a modern phenomenon—a reality which,if we choose not to accept it,also denies the lives of transgender people today—then we must recognize that these saints and other related figures could have been people that did not identify with the gender they were assigned at birth. Or, at the very least, we must acknowledge and build upon the fact that these stories would have offered up effective models with which transgender audiences could have found ways for contouring their own subjectivity.

These recalibrations in our perspectives of what transgender means in the Middle Ages reveal a range of sites in which premodern non-cis-gender persons could find potent sites for self-identification: not as queer, abject, and aberrant social figures, but often within the central practices of Christian worship, asceticism, and empire. The notion that to be a transgender man in the Early Christian world would not have been a radical queer practice is a deeply powerful thought, as is the simultaneous existence of deeply queer transgender women, whose stories come down to us only through screeds of trans-misogyny. As historians, our work now is to perceive these subjectivities, give them articulation, and go on to look at how other intersections of identity, like sexuality and race, have contributed to the erasure and preservation of these various lives.


  1. Anonymous, The Life of Hilaria/Hilarion, modified trans. James Drescher, “Hilaria,” Three Coptic Legends (Cairo: Institut Français d’Archéologie Orientale, 1947), 69-82, at 75 and 77.
  2. See Patricia Cox Miller, “Is There a Harlot in This Text? Hagiography and the Grotesque,” Journal of Medieval and Early Modern Studies 33:3 (2003): 419-435; Stephen J. Davis, “Crossed Texts, Crossed Sex: Intertextuality and Gender in Early Christian Legends of Holy Women Disguised as Men,” Journal of Early Christian Studies 10:1 (2002): 1-36; Evelyne Patlagean, “L’histoire de la femme déguisée en moine et l’évolution de la sainteté féminine a Byzance,” Studi Medievali, series 3, 17 (1976): 597-623; John Anson, “The Female Transvestite in Early Monasticism: The Origin and Development of a Motif,” Viator (1974): 1-32; Kari Vogt, “‘The Woman Monk:’ A Theme in Byzantine Hagiography,” Greece and Gender, eds. Brit Berggreen and Nanno Marinatos (Bergen: Norweigian Institute at Athens, 1995), 141-148; Crystal Lynn Lubinsky, Removing Masculine Layers to Reveal a Holy Womanhood: The Female Transvestite Monks of Late Antique Eastern Christianity (Turnhout: Brepols, 2013); Valerie R. Hotchkiss, Clothes Make the Man: Female Cross Dressing in Medieval Europe(New York: Garland Publishing, 1996); Stavroula Constantinou, “Holy Actors and Actresses: Fools and Cross-Dressers as the Protagonists of Saints’ Lives,” The Ashgate Research Companion to Byzantine Hagiography, vol. 2, ed. Stephanos Efthymiadis (Burlington, VT: Ashgate, 2014), 343-362; Vern L. Bullough, “Transvestites in the Middle Ages,” American Journal of Sociology79:6 (1974): 1381-1394; cf. Vern L. Bullough, “Transvestivism in the Middle Ages,” Sexual Practices and the Medieval Church, eds. Vern L. Bullough and James Brundage (Buffalo, NY: Prometheus Books, 1982), 43-54.
  3. On transmission see, Patlagean, “L’histoire de la femme déguisée,” 597-623. For more about the individual transmission and translations of particular lives, see their respective editions and translations.
  4. Hotchkiss, Clothes Make the Man, 131-142.
  5. Life of Mary/Marinos, 5, trans. Nicholas Constas, “Life of St. Mary/Marinos,” Holy Women of Byzantium: Ten Saints’ Lives in English Translation, ed. Alice-Mary Talbot (Washington, DC: Dumbarton Oaks, 1996), 1-12.
  6. Life of Mary/Marinos, 9, trans. Constas, “Life of St. Mary/Marinos,” 9.
  7. Life of Mary/Marinos, 12, trans. Constas, “Life of St. Mary/Marinos,” 9.
  8. Life of Mary/Marinos, 14, trans. Constas, “Life of St. Mary/Marinos,” 10.
  9. Life of Anastasia/Anastasius, 7, trans. Harvey and Brock, Holy Women, 147.
  10. Dio Cassius, Roman History, 80.13, ed. and trans. Cary and Foster, Roman History, 462–463.
  11. Dio Cassius, Roman History, 80.14, ed. and trans. Cary and Foster, Roman History, 464–465.
  12. iDio Cassius, Roman History, 80.14, ed. and trans. Cary and Foster, Roman History, 464–465.
  13. Dio Cassius, Roman History, 80.14, ed. and trans. Cary and Foster, Roman History, 464–465.
  14. Dio Cassius, Roman History, 80.16, ed. and trans. Cary and Foster, Roman History, 470–471.
  15. See also the comment that follows soon thereafter that: “Avitus, according to Dio, besought his physician to employ his skill to make him bisexual (diphuē) by means of an anterior incision.” Dio Cassius, Roman History, 80.16, ed. and trans. Cary and Foster, Roman History, 470-471.
  16. See Sean Tougher, The Eunuchin Byzantine History and Society(London: Routledge, 2008), esp. 26–35. See also Kathryn M. Ringrose, The Perfect Servant: Eunuchs and the Social Construction of Gender in Byzantium (Chicago: University of Chicago Press, 2003), esp. 15.
  17. Paul of Aegina,Medical Compendium,6.46, trans. Adam, The Seven Books, 334.
  18. By contrast, western depictions of these saints offer a much greater deal of variety. For a survey of these depictions in the later Middle Ages, see Andrea-Bianka Znorovzky, “Between Mary and Christ: Depicting Cross-Dressed Saints in the Middle Ages (c. 1200-1600),” unpublished PhD thesis, Central European University (2016). See also Andrea-Bianka Znorovzky, “Marinus Unveiled: A Transvestite Saint in Western Art and Literature,” unpublished MA thesis, Central European University (2011); Andrea-Bianka Znorovzky, “Holy Female Monks-Patterns of Purity: A Comparative Approach of the Visual Representations of Saint Marina the Monk, Saint Eugenia of Rome, and Saint Euphrosyne,” Il Genere Nella RicercaStorica, vol. 1, eds. S. Chemotti and C. La Rocca (Padua: Il Poligrafo, 2015), 151-170; Kirk Ambrose, “Two Cases of Female Cross-Undressing in Medieval Art and Literature,” Source: Notes in the History of Art23:3 (2004): 7-14.
  19. Life of Mary of Egypt, 10, trans. Maria Kouli, “The Life of St. Mary of Egypt,” Holy Women of Byzantium: Ten Saints’ Lives in English Translation, ed. Alice-Mary Talbot (Washington, DC: Dumbarton Oaks, 1996), 65-93, at 76.
  20. Life of Mary of Egypt, 12, trans. Kouli, “The Life of St. Mary of Egypt,” 77.

Originally published by The Iris under a Creative Commons Attribution 4.0 International license.



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