Out of Reach: Sex Reassignment Surgery Not ‘Medically Necessary’?

Cuba has approved
free sex change operations for transgender citizens
. What a stark contrast to the reality here in the United States.

June is LGBT Pride Month and,
along with the festivals and parades, we have an opportunity to
learn about the diversity within our community and the issues that
impact the lives of LGBT people. For many transgender people, the process
of transitioning is a long and expensive journey delayed due to the lack
of health insurance coverage for medically necessary procedures.

First, a quick primer. "Transgender" describes the state
of a person’s gender identity, which may match their
assigned at birth. Other words transgender people may use are female
to male (FTM), male to female (MTF), and genderqueer. After coming out, transgender
people may undergo psychological counseling for diagnosis, hormone
replacement therapy (HRT) to adjust their body to their new gender, medical visits to support that therapy, and sex reassignment
surgery (SRS) to change their genitals to match their new gender role.
Through sex reassignment surgery, transgender women may undergo a penectomy
and vaginaplasty. Transgender men may undergo bilateral mastectomy
and hysterectomy and, in some cases, they may also elect phalloplasty
(construction of a penis).

These procedures cost thousands
of dollars and they are not optional for many transgender people.
Most states require medical procedures before personal documentation,
like drivers licenses and birth certificates, can be updated to reflect
a person’s new gender. But, despite those requirements, many
insurance policies do not cover sex reassignment surgery, which is often considered cosmetic or not medically necessary.
Thus transgender people must pay thousands of dollars out of pocket
even if they have health insurance coverage that would cover the surgical
procedure for a medically recognized condition.

Transgender people may also
consider cosmetic surgery in order to adjust their appearance to their
new sex role. Cosmetic surgery procedures may include breast augmentation or
facial or torso surgery, and transgender women may require electrolysis
to remove hair. Many insurance companies do not cover these procedures
for any participant in their plan because they are considered elective
or not medically required.

Why would a health insurance
plan not cover a surgical procedure for a transgender person?
The American Psychological Association’s current classification of
gender identity disorder (the diagnosis given some transgender people
that may allow them to qualify for sex reassignment surgery) as a psychological
disorder does not clearly support medical treatment through sex reassignment
surgery. As a result of the
current lack of clarity, many insurance companies discriminate against
transgender people seeking coverage for the cost of surgery even if
the company through which they are insured approves coverage.

Transgender activists have been working to get an official
diagnosis and classification for Gender Identity Disorder from the American
Psychological Association to address the need for medical care and appropriate
mental health care for transgender people. In 2005, the American Psychological Association formed a task force
to study gender identity and they have been reviewing the scientific
research and American Psychological Association’s policies with the
goal of developing recommendations for education, training, practice
and additional research. The completed report is scheduled for
presentation to the American Psychological Association’s governing
Council of Representatives in August 2008.

Transgender activists
are divided
whether the classification of gender identity disorder from the American
Psychological Association as a mental disorder is positive or negative,
with some feeling that the classification stigmatizes transgender people
and others arguing that the classification is necessary to secure appropriate
health care and treatment. What is not in dispute is the need
to address lack of access to treatment options and the discrimination
many transgender people face within society and the medical community.

In 2007, the American Medical
Association amended their nondiscrimination policies to include transgender
. As
reported by the Windy City Times, the policy change "affects all aspects
of the functioning of the AMA, including relations with patients, employment
issues and insurance coverage." The report also noted that transgender
people face discrimination within the health care system and barriers
that prevent access to health care. In one section of the new policy
the American Medical Association clearly states its opposition to "the
denial of health insurance on the basis of sexual orientation or gender

As companies, health care insurers
and municipalities examine and revise their policies to ensure that
transgender people are not discriminated against or denied access to
medically necessary treatment, the cost of sex reassignment surgery
remains an obstacle for many transgender people seeking transition into
the sex role that better reflects their identity. As our community celebrates LGBT Pride Month
this June, we can celebrate the progress made within the medical and
psychological communities. But we must also note the progress
yet to be made and the impact of that lack of progress on the lives
of transgender people.

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  • invalid-0

    Thanks for the thoughtful, articulate view regarding medical needs for transgender people. Althought this is little understood by the general poplulation, there is a genuine need for these medical treatments for people who are transgender. It is as real as it is for someone who has a physical deformity that can be corrected to restore a reasonable quality of life.


  • invalid-0

    It’s great to see one of my favorite bloggers posting about this– awesome!

    A few other points to add:

    Insurance often doesn’t cover hormone replacement therapy, which is crucial for all transsexual people, regardless of their desire for any surgeries.

    Doctors frequently force transsexual people to obtain (sometimes repeatedly) psychiatric evaluations prior to treatment– something insurances companies again often don’t cover in this situation.

    Insurance companies rarely address the realities of transsexual bodies. Transsexual women need coverage for mammograms and prostate exams– insurance typically will cover one but not the other. Transsexual men typically need access to gynecological care, and this can be a problem insurance-wise as well.

    In other words, there’s a health care crisis for transsexual people in this country, which is largely a product of doctors and insurance companies not taking our needs seriously.

  • invalid-0

    Thank you, thank you, thank you for this! It really made my morning. I wish the public understood that most trans people really do suffer significantly from this condition, and treatment improves our lives tremendously. The research is out there, but the public only sees the Jerry Springer-esque distortion of what we actually deal with.

    I wanted to add a point that is very relevant to this year’s frequent health care debates: covering trans care would not cost employers and consumers a significant amount of money. There are many recorded examples of this fact among employers that already cover this care, including the City and County of San Francisco, the American Friends Service Committee, and all Unitarian Universalist congregations (see here for more on the affordability of covering necessary trans care: http://www.afsc.org/lgbt/trans-health-care.htm )

    Also, there is no question in my mind that removing the GID diagnosis from the DSM would negatively impact the most vulnerable trans people: those who are in the prison system, the juvenile justice system, youth in out-of-home care, and those in other institutions. In such a setting, the ONLY way to get treatment is to have a diagnosis, and even then these folks face discrimination. This is not like removing homosexuality from the DSM, because you don’t need -treatment- for sexual orientation. Anyhow, a mental health diagnosis is not, in and of itself, stigmatizing. It is not ideal, but right now it is the only way- and I care a lot more about the real trans people who would suffer if they had no diagnosis to point to, then the symbolic significance that might go with removing GID from the DSM.

    Anyhow I very much agree with you, and thank you again for this. God bless!

  • http://transgendered-personals.com/blog/ invalid-0

    This is a wonderful article. Some would say that with the millions of American presently without any form of insurance the dilemma faced by the transgender community looking to transition is minor.

    What most fail to realize is that many have health insurance that simply will not cover the huge expenses involved in the transitioning process. I’m with the previous comment – if you had a physical deformity the insurance companies would cover the cost to enable someone to have a full and rewarding life.

    Hopefully someday the doctors and insurance companies will take a more serious attitude towards the transgendered community

  • invalid-0

    I’m not at all reactionary or a neocon or anything like that. I’m prochoice. I’m even pro same-gender marriage for gosh sakes. But I’m sorry but I don’t agree that society should be required to pay for someone’s gender reassignment surgery. If you think it should be funded, start a voluntary charity to pay for it. Don’t extort my money, via taxes or higher insurance rates, to pay for it.

    • invalid-0

      OK Anonymous, if you come down with cancer, I don’t feel like paying for you either. That’s not the point. I’m paying a SIGNIFICANT amount in taxes and health insurance costs, and I’m a very healthy person except for this persistent, overwhelming need to live as myself. Insurance pays for EVERY trans procedure, including vaginoplasty, as long as you’re not transsexual. This policy clearly discriminates against people like me.
      Please take your blinders off and allow me to enjoy the same rights that you enjoy. I’m not taking your money.

  • invalid-0

    First off I’d like to clear up a popular misunderstanding.

    Transgender, the term, includes anyone society feels does not fit into their typical “normal” gender behaviour. This can include people who have sex with the same sex, to effeminate straight males, butch women, drag performers and people who are transexual as well as a great deal many other communities.

    It’s an umbrella term just like queer.
    People who are transexual, a medical term or definition speaks to people who have minds or brains of one gender/sex and the body of the other.
    These people work hard to bring their bodies inline with their core gender.

    Since science has yet come up with a way to know which gender the child really is, they rely on sight in order to define or label them male or female.

    If not for this predetermined label given to the person who is transexed that begins the problems in their lives.
    I’m happy to see more parents beginning to listen to their young children and are willing to accept and give their child a chance to be happy by allowing them to live as their felt/core gender.

    As for funding, I too find it funny that a country to spouts to be for all , and speaks of equality still treats this segment of their society as if they are mentally ill and indeed deviants. They are neither.


    These people are only trying to fix a medical problem, much the same as we do for children born with cleft pallets.

    Those who are so against funding need to answer the question about just how far they are willing to limit funding for medical procedures.

    Should we also refuse to pay for that person who ends up with cancer after years of smoking? How about those who end up with liver disease?
    How about those who break bones playing sports, even as children?

    I ask that because these are things that happen in life because of what people choose to do, not because they were born with that smoking caused cancer or sports caused broken limb.

    We, in society, pay for many people in many cases for self inflicted injuries and diseases. Yet no screaming to cease funding happens, and rightfully not.

    So rather then shun that person born with the medical issue, transexualism, how about thinking of how you want to be treated next time you find yourself at your doctor’s office or in emergency in need of urgent care. Because for people who are transexed this is urgent care they are seeking.

    Surgery allow people that are transexed, and above all else they are people first, them to live a better life and more able to be self reliant members of the tax paying society. And in many cases these people are active paying members of the taxing society and they are only asking for the same rights as so many other receive. The treatment they need.

  • http://beema.wordpress.com invalid-0

    As with all things a sense of humor is important. For a light-hearted take on the matter go to,

    Beema Blog | Cuba Sex Policy

  • http://etransgender.com invalid-0

    Hopefully with a National Health Care System under the Obama administration, such things as this will be a thing of the past.

  • http://www.bunnywunny.com invalid-0