Coming out as transgender (trans) is a big deal. There are a lot of things to think about — like when and how to tell people, how to dress and present yourself, what pronouns you prefer, and what name to use.
Getting medical support for gender transition can be a long journey, with lots of decisions to be made. Here is a short primer that will hopefully help guide the way.
Why Pursue Gender-Affirming Health Care?
Not all trans people pursue hormone therapy, surgery, or any other kind of medical treatment. For some, it’s enough just to embrace their gender identity and express it in whatever way they choose.
But many trans people experience gender dysphoria — distress about the disconnect between their physical body and their gender identity. It can be incredibly severe. In this case, trans people may choose to have medical and surgical treatments, otherwise known as gender-affirming health care. These treatments can literally save lives.
Gender Hormone Therapy
Gender hormone therapy can help your body look and feel more aligned with your gender identity. It used to be harder to get this treatment, but now many providers offer it on an informed consent model.
This means that as long as you fully understand and accept the consequences of being on treatment, they’ll work with you to prescribe appropriate hormones and hormone blockers. You will need regular checkups and blood work to make sure your hormone levels are where they need to be and your body is tolerating treatment well.
You should also tell your other health care providers that you’re on hormone therapy because the hormones may affect other systems in your body and other medicines you may be taking.
There are a handful of gender hormone therapy providers in our area. It’s a good idea to check patient reviews when choosing one. Also, it’s important to note that most providers have a waiting list.
Gender Confirmation Surgery
Gender confirmation surgery, also known as sexual reassignment surgery, involves modifying your body to be more consistent with your gender identity. There are a variety of procedures for this, mostly performed by plastic surgeons.
Like all surgeries, these procedures carry some level of risk. It’s important to understand the risks and complications and to find a surgeon you trust.
Look for a surgeon who performs many of these operations each year, has gotten good patient reviews, makes you feel comfortable, and inspires your confidence.
A good place to start is by talking to your hormone therapy provider, who may be able to recommend a surgeon based on other patients’ experiences.
Standards of Care
Before performing gender confirmation surgery, a surgeon should require you to meet standards of care established by the World Professional Association for Transgender Health (WPATH). These standards are designed to make sure treatment is ethical and appropriate.
They include having “letters of support” from two different mental/behavioral health providers with experience treating trans people. Basically, the letters confirm that:
- You’ve been on hormone therapy for at least a year.
- You’ve been dressing, behaving, and presenting yourself consistently with your gender identity for at least a year.
- The surgery is needed for your mental health.
- You’re mentally competent to choose surgery.
Usually, your hormone therapy provider can supply one letter, but you’ll need a separate therapist to write the other one.
Other Kinds of Gender-Affirming Care
In addition to hormone therapy and surgery, many trans people get:
- Electrolysis and/or laser hair removal
- Voice therapy (to make their speech more consistent with their gender identity)
- Mental health treatment, because going through gender transition can be confusing and scary — especially if a person’s family, friends, coworkers, and community aren’t supportive
Your hormone therapy provider may be able to help you find resources for these treatments.
Health Insurance Coverage
The Affordable Care Act requires health insurance companies to cover gender-affirming health care exactly like any other kind of health care, with the same cost-sharing. You should check with your health insurer regarding coverage of hormone therapy, hair removal, and voice therapy services.
Most surgeons who offer gender confirmation surgeries don’t accept health insurance, i.e. they aren’t in network. This means:
- You’ll probably have to pay your surgeon in advance, then apply for reimbursement.
- Reimbursement is only possible if you’ve gotten prior authorization from your health insurer.
- If your health plan is an HMO, i.e. it only covers in-network providers, you may not be able to get any reimbursement at all.
If your health plan lets you use out-of-network providers, then:
- Your insurer will reimburse you for a certain percentage of surgical costs … if they cover that procedure. For instance, some insurers don’t cover breast augmentation for trans women.
- Different insurers reimburse different percentages for out-of-network surgery. But those are fixed percentages of what they’ve determined the procedures should cost — no matter what the surgeon is actually charging.
Gender confirmation surgery still tends to be very expensive. If this is something you are planning to pursue, you’ll have to think about how you’re going to finance it.
“To Thine Own Self Be True”
This Shakespeare quote is as good a piece of advice today as it was in 1611. If your body doesn’t match your gender identity, and that causes you distress, gender-affirming treatments may help you feel more at home in your own skin. I hope this article helps you chart your way forward.
And if you’re in major distress about your gender or gender identity, or need some emotional support, please seek help. You deserve to be happy. And you deserve to be exactly who you are.