CHICAGO — TRANSGENDER Americans scored a major victory for equality last month, when the Department of Health and Human Services overturned a decades-old ban on Medicare coverage for gender-confirming surgeries.
But the decision is hardly a final triumph. Though thousands of people will now receive insurance coverage, many, many more will continue to be denied because of state-level restrictions on coverage. Indeed, only five states and the District of Columbia require that private insurance companies cover transition-specific care. Pushing the other 45 states to extend coverage is the next front in the struggle for insurance equality for transgender individuals.
The federal decision was based on more than just a moral case: A growing number of medical organizations have concluded that treatment of gender dysphoria — a psychological condition in which patients identify with a gender other than the one they were born with — is a medically necessary step toward helping transgender individuals lead healthy and happy lives.
The five states that have a similar requirement — California, Colorado, Connecticut, Oregon, Vermont — and the District of Columbia likewise relied on statements by health organizations, including the American Medical Association, the American Psychiatric Association and the World Professional Association of Transgender Health.
The remaining states, however, l argely argued that such procedures — including genital reconstructive surgeries, mastectomies and facial contouring procedures — are cosmetic in nature and therefore not eligible for coverage. In those states, transgender individuals have to pay out of their own pockets for these procedures, which can cost tens of thousands of dollars.
A big part of the problem is a lack of public understanding, accompanied by a heavy dose of prejudice against transgender individuals. After Rochester, N.Y., announced that it would be offering transgender-inclusive health insurance options to city employees, two popular local radio hosts, Kimberly Ray and Barry Beck, launched into a 12-minute tirade, referring to transgender people as "nut jobs." (To the station's credit, they were quickly fired.) Even sympathetic liberals often wonder, quietly, why genital reconstructive surgery , hormone replacement therapy or a host of other procedures commonly sought by transgender individuals should be considered medically necessary rather than cosmetic.
Consensus in the medical community aside, those forms of treatment do so much more than alter one's appearance. In early 2012, just before I came out as transgender, I found myself struggling to keep suicidal thoughts away. I'd attempted to end my life by overdosing on pills years earlier, and I felt that uncontrollable depression beginning to seep back into my life.
At the time, I was regularly meeting with a psychiatrist and had been prescribed a small pharmacy's worth of antidepressants. None of it helped. I knew I had two choices: stop denying who I was or put an end to my life.
I came out as transgender shortly after, and while I felt a certain sense of relief in accepting my inner self, the thoughts of self-harm and desperation wouldn't let up. I began to worry that I'd never be able to shake those feelings, and so that October, I began hormone replacement therapy — reducing my body's testosterone output, increasing my body's estrogen levels.
Within weeks, the urges to harm myself began to be replaced by a sense of calm comfort. A lifetime of emotional problems that I tried to treat using every form of therapy and medication I could imagine had changed with a simple switch of hormone levels.
For some transgender people, just hormone replacement therapy is enough. Others need surgery to align their bodies with their brains. What it comes down to, though, is that these treatments are, without question, lifesaving.
Untreated gender dysphoria has been linked with depression, suicidal ideation, anxiety and other forms of psychological distress. Without transition care — for which I initially had to pay out of pocket, draining my savings — those symptoms, all of which I suffered regularly, would have continued to become more and more dominant in my life, having disastrous effects on my physical and mental well-being.
According to researchers at the University of California, Los Angeles, an estimated 41 percent of transgender individuals attempt s uicide at some point in their lives, compared with the estimated 4.6 percent of people among the general population. It's inarguable that as a culture, our unwillingness to provide medically necessary treatment is partly to blame for this largely ignored epidemic.
In order to properly care for transgender individuals, surgical options must be made affordable and available. We need to stop fearing what we don't understand, and push to end the anti-transgender stigma that empowers politicians and insurance companies to deny relatively inexpensive, lifesaving medical treatment. Medical science must trump public opinion, and we have both the knowledge and the power to help transgender people live happy and healthy lives.
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