Out of Reach_ Sex Reassignment Surgery Not 'Medically Necessary'

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					Out of Reach: Sex Reassignment Surgery Not 'Medically Necessary'?                                       http://www.rhrealitycheck.org/print/7540

          Published on Reproductive Health | RHRealityCheck.org (http://www.rhrealitycheck.org)

          Out of Reach: Sex Reassignment Surgery Not
          'Medically Necessary'?
          By Pamela Merritt
          Created Jun 16 2008 - 8:00am

          Sexuality Education Women’s Rights LGBT issues medical care transgender issues

          Cuba has approved free sex change operations for transgender citizens [1]. 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 [2] over whether the classification of gender identity disorder from the American

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Out of Reach: Sex Reassignment Surgery Not 'Medically Necessary'?                                       http://www.rhrealitycheck.org/print/7540

          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 people [3].
          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 identity."

          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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Out of Reach: Sex Reassignment Surgery Not 'Medically Necessary'?                                  http://www.rhrealitycheck.org/print/7540

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          Source URL (retrieved on Jul 18 2008 - 11:00am):

          [1] http://news.yahoo.com/s/ap/20080607/ap_on_re_la_am_ca/cuba_sex_changes;_ylt=AiTllFQHgOyuJEezauasfO_VJRIF
          [2] http://www.washingtonblade.com/2008/5-30/news/national/12682.cfm
          [3] http://www.windycitymediagroup.com/gay/lesbian/news/ARTICLE/php?AID=15413

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