Should health insurance companies help pay for HRT, top, and/or bottom surgery?

"A lot of Medical personal already think of being trans* as a medical condition or disorder. As if there is something wrong with the trans* person that needs to be fixed."

Counter: The person doesn't need fixing, the body does, which is why you have surgery rather than corrective therapy.

It IS a medical thing, it's not something done for purely cosmetic reasons, it's not different really than a prosthesis or a transplant. It's something that you get ONLY if you need it in order to live - and by 'live' I mean in the same way a guy with one leg can 'suck it up and get over it' but you wouldn't in a million years tell that to his face. When I say live I mean continue to exist like a normal human being.

 

In a sense it is a disorder: it's a mismatch between the mind and body. For many, the"cure" is srs. However, insurance paying for it doesn't reinforce that everyone must transition. Depression is a well known issue and many choose not to go on medication or have therapy because they can manage fine on their own.

 

You know, I've wondered the same thing, but you bring up some good points against it. Sure, it would be awesome if insurance would cover my top surgery. Then I might actually get it!

Also, the truth is that GID isn't a real thing anymore. Being trans is no longer a medical condition. And I agree with that. There is nothing wrong with us. However, there are ways around this. For instance, for FtM's, binding can cause cysts of the breast, which can make it easier for us to get insurance to pay for top surgery. But coming from someone who already has fibrocystic breasts, cysts are very painful. There's also the fact that no matter what your sex, you can ask your doctor to write your prescription for HRT as being for a hormone disorder. I actually have a trans guy friend whom I met through one of my classmates whose insurance, when he had it, paid for his T.

 

Personally, I think gender dysphoria is a psychiatric disability (condition involving the mind, which causes distress or impaired functioning), with the effective treatment being medical interventions to change the body to match the mind. Just because a condition is centered in the mind doesn't mean we should direct our treatments at the mind - just like cerebral palsy is a neurological condition, but is often treated by surgery to the joints and tendons.

Being trans without dysphoria, however, is not a disability, because the person doesn't need any medical or psychiatric help to be happy with their body and appearance. All they need is to not be discriminated against, which is something everyone needs.

I suspect a lot of trans people object to it being seen as a psychiatric disability because of the assumption that this view necessarily means using psychiatric treatments designed to make the person more comfortable with their birth gender. But the simple fact is that clinicians are supposed to use effective treatments, and there is no evidence that there is any effective way to make a gender dysphoric person comfortable identifying as their birth gender. If you help them transition, you typically end up with a happy person whose only real 'problems' are that they're infertile and need to take hormones. If you try to get them comfortable with their birth gender, they typically get worse rather than better. The right choice is clear, even if you approach it solely through an 'illness' perspective.

For an analogy, imagine a woman with estrogen-sensitive inoperable breast cancer. If they did surgery on her breasts, they'd do a bunch of tissue damage, but are unlikely to completely remove the tumors, so they'll just grow back. But if they remove her (healthy, functional) ovaries, then the breast tumors will stop growing, and she'll have traded a dangerous cancer for a hormone imbalance. The choice is pretty clear.

 

A lot of this argument is really aimed at transsexuals. And more specifically, operative transsexuals. Non-ops (that are not non-op out of necessity) and the rest of the trans* community have different needs. Sometimes the "there is nothing wrong with us" arguments are coming from the rest of the trans* community, because they were lumped together with people like me. What's good for me is not good for them and vice-versa. There are some people whose problems would disappear in a world where trans people were not discriminated against and there were either no gender roles or more flexible gender roles. I am not one of those people, and many of those people would be miserable if they were on either the hormones I was born with or the ones I am taking.

However these debates go, I think it is very important that "saving lives" not be a standard. People should not feel like they have to be suicidal already before it's "okay" or "worth it" to get medical help. I personally would not have made it through my last semester of college if I did not start coming out to people and start making progress toward transition. That's enough negative impact on my life by itself. If you are transsexual, you do not have to wait to let it ruin your life, and it is okay to try to change your physical sex just because you are transsexual and for no better reason.

The other boundary I would like to see in these discussions is when we talk about gender identity in terms of sex. I can't have a fulfilling romantic relationship with anyone, at all, until I transition. My gender identity is much, much more than sex. In fact, I am very glad that my hormones have really decreased my libido, it feels amazing However, the fact is that my sexuality is very feminine, and part of that is my having to be comfortable with my body and appearance in order to enjoy sex.

The trouble is, less so now, but people sometimes get messages like "it's just about sex", or compare being transsexual to a fetish. And it can make things really confusing for people, like me, that are honestly turned on by the idea of being in a body opposite their birth sex.

If that were the only reason, I would not transition, because my hormones would not make me feel the way they do now, and I would not feel more comfortable being a woman around accepting people. But being able to have sex at all, while not the ONLY reason, is definitely A reason.

All that said I think the way Ettina put it is really good as far as the ethics. So I won't elaborate. She really hit the nail on the head.

As far as practicality, hormones are safe in the short term. In the long term though, especially for male-to-female transitioners, it's really important to get rid of the hormones the body produces naturally. Hormones also don't require a special doctor just for transsexuals. There are people that go to school just for endocrinology, but these doctors can train other kinds of patients. You have to stay on hormones for life. So put it all together, and it means that hormones are inexpensive - BUT - once you are on them you have more expensive obligations later.

As far as surgeries go, both men and women have less expensive surgeries to remove the hormones their bodies provide naturally. These are called hysterectomies and orchiectomies. They can also be performed by doctors that don't specialize in transsexuals.

The most expensive surgeries are the ones where the cost is high because someone goes to school for years and years just to work on us. Even the people that make it all the way through are not always experts. So there are a tiny handful of surgeons who can do these surgeries at all, and they all invested a ton of money to get where they are. Unlike the cheaper surgeries, these ones also require a hospital stay and full anesthetics, which means more money.

These surgeries are breast removal, breast enhancement, facial feminization surgery, and sex affirmation "bottom" surgery.

And finally, for male-to-female transitioners, there is voice. There is a surgery called "femlar" that works for voice but, previously, since voice surgeries weren't that great the traditional route was for a woman to train her voice. This is possible even for someone that went through male puberty, although it is very, very difficult.

Soooo... with all that in mind, I personally am in favor of at the least hormones and either orchie or hysto being covered completely. I also flat out support breast removal for people transitioning either direction, although a male-to-female transitioner that opts for this for non-health reasons should have to wait six months before starting HRT again. This would be inexpensive overall and I think could treat a lot of trans people just by themselves with nothing else needed.

Past that, I think things should be covered but only if more reputable surgeons are willing to work with insurance companies to keep treatment as inexpensive as possible. But there are many surgeons that have bad reputations, and I would be worried that one of them would be a "go-to" for insurance companies to save money. I feel this way about both SAS and FFS. You really need a good doctor for these.

I hate to say it but I am not in favor of voice surgery being covered at all. If a voice coach is something that could be provided though I would be in favor if this.

I think all of the above is doable for any insurance company, because there are a small number of transitioners, and they are "one time" procedures. Once they are paid for, that's it. The exception being hormones, which are the cheapest part, and insurance companies already have an easy time covering drugs.

 

Insurance should definitely cover HRT because it's a health thing. Not so sure about top and bottom surgery though.

 

To continue what Cassie said, there are a handful of medical procedures. that I think are above and beyond the strictly necessary.

It reminds me of an argument I read once where someone was complaining that trans women shouldn't get any for of hair removal on the NHS because cis women couldn't. There is a specific condition that causes women to grow what would usually be considered abnormal body hair for a woman, and they can't get that removed. If they suddenly grew a moustache, apparently getting it removed is just cosmetic.

See that I think is a backwards argument, and it's one I hear SO damn often. "Trans women/men should have this because real women/men don't get it!" instead of asking WHY cis people can't have some of these treatments. Obviously a cis woman growing a god damn moustache is going to cause a hell of a lot more problems mentally than just being a cosmetic issue.

But then you have things like facial surgery, and then things start to bother me. I do not and will not look down on someone because they feel they need facial surgery just because I don't, BUT I do wonder how far things have to go before it does genuinely find its way in to the realms of 'beauty treatments' instead of actual medical treatments.

 

Alot of plans do infact cover some hormones, I have a blue cross plan and only pay like $5 for my estrogen, $20 for my doctor visits, and if I am still on this plan come time for my lower body, it will only be like $5k out of pocket.
Trick is to find a doctor first, call around, find out what Hormones they prescribe, what insurance they take & then find a plan with said doctor & drug in network

 

Actually, where I live, it is covered. Since 2006, bottom surgery for both MtFs and FtMs, top surgery and hysterectomy are covered. I don't know if hormones are though. The reason why they did this is because it really does help people a lot. The only thing with this is that sometimes they'll try to talk you out of transitioning because it's expensive, but usually they don't insist too much.

 

I'll keep it simple.

I believe in socialized health care of any kind and I'll leave it at that despite how unrealistic it is in today's economy and social evolutionary status as a whole.

 

It's not unrealistic, it works pretty well in my country and many others.

 

So is everything covered? Socialized doesn't mean equal and full coverage everywhere.

But that's not the point I guess. Since I believe in socialized health care (and it should be free but that's certainly not possible) I support the original sentiment that yea health care should cover it.

 

Kasey I am not going to lie...I've run across several statements you've made and thought "hmmm...I like Kasey"

This right here is absolutely my undying opinion

I want 100% socialized health care

To stay on topic and tie this together...yes I believe HRT and surgeries for transition should absolutely be covered by insurance.

 

Yes, it's covered.

 

This exactly for me. If it improves peoples lives it should be done, no matter how much it costs. People before money.

 

This is basically my opinion as well.

Anyway where I live, HRT is covered by insurance (only pay around $10 out of pocket), but not for top surgery. I actually did the calculations recently, spoke with the insurance company, and depending on the surgeon I may be able to have insurance cover anesthetics and the hospital stay. I'm unsure about SRS because I haven't looked into it, but I definitely think insurance should cover HRT and major surgeries (top, bottom, hysto) completely.

 

In Canada they don't cover prescriptions or dental care. (However, with prescriptions many doctors will give you free samples because they hate seeing people with easily treated conditions not filling their prescriptions because of the money.) But if you need to be examined or hospitalized, you won't get any bill from that, as long as you show them your health card.