Institute transgender inclusive healthcare or clear guidelines for all policies
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What is transgenderism and why should I care?
Most people in the world are born with two arms, two legs, working organs, and generally no birth defects. Most of the time, when a child is born with a defect like a cleft lip or worse, we endeavor to correct it immediately. This is not generally considered optional or cosmetic.
Now imagine if a child was born with a life-altering birth defect, but the defect was undetectable until that child was an adult. This is still something we see in society from time to time, and health insurance generally covers it without incident.
But what if a child is born the wrong sex? What if a boy, with all the psychological elements of masculinity, was born with a girl's body? He would be forced by society to try to live as a girl for his developmental years. Then, when he reaches a point when he realizes that this discrepancy is present, 9 times out of 10, he'd want it corrected. Just as anyone with any birth defect would. This is where he runs into problems.
He is an example of a transgender man. A transgender woman is the same in reverse (i.e. a girl born into a boy's body.)
Now, let's look at his life in today's society. What if he discovered a way he can correct his gender, and that through a transitional period, he can make his body and lifestyle fit with what he internally believes to be his true identity? Up until this point, all of this is true and possible.
Unfortunately, unless he happens to be priviledged enough to live in a state where acceptance support is strong, he has a hard and very expensive journey ahead of him. Even if he never seeks surgical correction and just wants to change his life and his hormones to match his identity, he still can expect little to no support from society.
This is what I want to change.
The (abridged) state of affairs:
Transgender healthcare and health insurance is a mess.
The necessary services are effectively the same as yearly checkups for the rest of us.
The World Professional Association for Transgender Health says that the following services are medically necessary:
Hormone Replacement Therapy:
-This includes Estrogens, Testosterone, and the necessary blockers to suppress native hormones.
-Also includes Growth Hormones
Mental Health Services
- Breast/Chest reconstruction
- Facial reconstruction
- Gonadal surgery (Removing reproductive organs)
- Genital reconstruction (Often referred to as 'The Surgery')
- Hair Removal such as electrolysis (This is necessary for most surgeries)
- Speech Therapy
Currently, none of these procedures are covered by most insurance policies. They regard the entire subject as cosmetic and unnecessary.
One of the founding principles of America is that everyone deserves equal protection under the law. That's all I'm trying to achieve.
If we're all going to be required to pay for health insurance coverage, then it doesn't make sense for anyone to pay a policy that doesn't cover something that they medically need.
Please help me make a difference.
What is possible and what is already in place:
Most of the insurance companies in the United States have a view that anything trans related is cosmetic in nature. Some have at least one policy somewhere on their books that covers trans people's needs, but that policy is either unavailable to the individual or only available to very specific individuals. Very few providers transparently cover these services openly and universally.
There's not even an easy and clear way to see if most providers even cover trans services. Most of the time, an awkward and unnecessarily embarassing phone call is required, which usually only ends in disappointment and frustration.
There are a few places in the country (i.e. California, New York) where coverage and support for trans individuals exists. Although a select few trans individuals have the opportunity to move to a place like that, most of us are rooted to somewhere that hasn't quite caught up yet.
Here is my personal experience and journey:
Warning: I go into very personal detail several times after this.
To my friends and family: Please get in touch with me if anything here raises concerns, and we'll talk about it, okay?
This story is the story of my transition and part of the story of my life.
When I was about 7 years old, I realized that my life would be a lot better if I were a girl. I didn't think that I had a choice, so I decided to make the best of it. Since then it's been sitting in my mind, and I would come back to it from time to time.
When I was 11, I saw my first psychotherapist. I had been having a hard time adjusting. She at some point had me take a test called the MMPI. It's a personality index that determines all sorts of things about you. There was a question about desire to be the opposite gender, which, remembering what I had thought about years prior and ever since then, I marked as Yes. When we reviewed the information from the personality index, my therapist decided to do it with my mother in the room. When that question came up, and I saw the look of shock on my mother's face, I dismissed it as something that had happened in the past but no longer. I felt a bit crushed by my therapist's lack of reverence for such a personal topic, and I never completely trusted that therapist after that incident.
Middle school was complicated. I couldn't identify with the boys because I didn't feel like I belonged with them, and I couldn't identify with the girls because they didn't feel like I belonged with them. This was when I really started to realize how different I was. I thought that maybe I had a social disorder or something, and I knew it would affect my parents so I kept it to myself. Eventually I made a few friends who I could identify with on intellectual subjects and entertainment, but I always felt awkward around my male friends. As though they were judging me, or I couldn't really let my guard down around them. My female friends were a different story, but I became aware that I often wished I could be one of them. I was jealous of their lifestyles and I wanted to understand things from their perspectives. Unfortunately this also created awkwardness.
Everyone loses a few friends when entering highschool. I know that's pretty normal, even if most of the kids you knew ended up going to your highschool. People change. I came out to a few friends about the fact that I thought I was bisexual, because of my gender confusion. After that I sort of ended up being slowly phased out of the group. Although people would occasionally include me, I never really felt like I was accepted for who I was. I always felt like they were including me because they felt guilty or uncomfortable, and because I was aware of it, I couldn't relax and be myself.
Dating was also a bit awkward. I learned over time that I had a lot more success dating girls who were bisexual because of the way my personality tends to be. I have always been attracted to strong, intellectual, and emotionally complex people. I was attracted to a few guys through high school, but I never actually tried dating any men until recently because as it turns out, most if not all of the guys I was attracted to were straight.
College of course was complicated as well. Not certain of what to do with myself emotionally, and desperate for validation of my attractiveness and desirability, I slept around a lot. Over the course of two years, I slept with something like 40 different people. Males and females. Most of the men were one night affairs because I didn't know how to handle them emotionally, and most of the females were either short term relationships of around a month or two, or intimate friendships.
This became a serious problem after awhile. I spent a solid year avoiding sex completely, and then dated someone with whom sex was not a choice for a few months after that.
That's when I really became aware of the possibility of transition. That maybe I could do this after all.
When I started dating someone who I had known for a few years and trusted enough to be myself with, I revealed to her that I was considering gender transition. She was somewhat experienced with transgenderism and warned me against it. She seemed extremely concerned that I wasn't emotionally stable enough to handle it. So I responded to her concern with diversion. Instead of pursuing the appropriate avenues for transition, I started taking herbal supplements. By combining certain plants and nutrients, I was able to force my body's estrogen levels higher than normal. I developed a little bit of breast tissue as a result, and I had extremely strong mood swings. This created serious tension and eventually ended my relationship with her. I tried dating someone else and being open about this, but I received zero support for this lifestyle choice, and as a result, abandoned the concept of transition.
A short while after that, my relationship with my current partner started. Although we were only casually dating to begin with, I knew she had dated people of indeterminate gender before, and was interested in that lifestyle. She supported me in trying to use herbals to modify my body for awhlie, but expressed similar concern for my health. When we separated, I had come to terms with the fact that I wanted to transition properly. When we eventually reunited, she supported me completely in my desire to transition legitimately. I started seeing a therapist specializing in transgenderism. He helped me to work out exactly what it was that I wanted, and to get in touch with a medical professional. When I saw my doctor for the first time, it was filed as a general consult, and my insurance provider covered it. When she prescribed me a low dose of hormone replacement therapy for the first time, my insurance provider covered it (Even though their policy says they don't.) But when we had our next and subsequent checkups and filed them as hormone replacement therapy, we ran into issues. The insurance provider wanted nothing to do with it. I ended up paying for the visit completely out of pocket. About 250 dollars. This was something I could look forward to doing every 4 months or so for the rest of my life.
But I had no choice, so I paid it and hoped that maybe someday it would be covered by insurance as it should be.
Several months ago, I started looking for a new job for after college. This was after I had been on hormones for nearly half a year, and my status was becoming impossible to hide. I interviewed as my old male self since I couldn't possibly pass as female yet, but since my breasts had developed significantly at that point, I had little choice in the matter of visibility.
Interview requests came in. Potential employers would ask me to do remote interviews and aptitute tests. I passed most of them with flying colors. If nothing else I am a competent software engineer. But the companies which I did manage to get all the way to the personal interview with all declined me. The only reason they were willing to provide was that I wasn't a good fit. I agree that sometimes this is the case for anyone, but if I had come in as 100% male or 100% female and no question had to be raised about my gender at any point, I sincerely doubt I would have faced the same issue.
Fortunately, one employer decided to keep me. They never did a face to face interview and asked very few questions on the remote interview.
Two months ago, I started at the new job. The HR department had assured me that my being trans would not be a problem and that everyone was culturally diverse at this company. So, with my hopes up, I asked the question of insurance. Would it cover transgender related services, or would I be excluded? The answer took two weeks and was disappointing. Although the health insurance provider that my employer does business with does have some plans that cover trans individuals, the health plan my employer has with them does not. It should not have taken two weeks to determine this. I am not blaming my employer of course. They are victims here as much as the rest of us. I have already requested that they look into modifying their policy to be more inclusive, and an investigation is underway.
Meanwhile, I decided to shop around. I live in Michigan. Michigan is one of about half of the United States that does not protect trans individuals from discrimination. Although most people here are pretty accepting of trans, every different insurance provider I have looked at, including those that have at least one plan for at least one set of customers that covers trans inclusive benefits, have all told me that they do not cover anything relating to trans services as far as the individual plans are concerned. Every time I have had this conversation, I am crying when I get off of the phone. And I'm not crying for me. I'm crying because our society is so archaic that companies will take advantage of any opportunity to exclude a minority for financial benefit if it is legal to do so. I have even had a few tell me plainly that transgenderism is cosmetic and the associated services are not medically necessary. When I presented the argument that the medical community disagrees, the response was that Insurance companies choose the services that they cover, and there's nothing to be done about this.
I sincerely doubt it. Let's make a difference.
Please help me challenge the american government and the insurance industry to reevaluate their policies and coverage. Every insurance policy available should have some form of coverage, or at the very least clearly and visibly state whether trans services are covered with a clear yes or no so that we can continue searching.
For further information about trans and healthcare, please consult the following:
The HRC's white paper on trans healthcare:
Trans healthcare examples- ** (These providers have AT LEAST ONE plan that covers trans services)
Information for contacting me with video responses:
Email me with a link to your video uploaded to youtube or similar: firstname.lastname@example.org
If you'd rather send me the file directly, let me know and we'll work something out.
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