Friday, March 12, 2010

Let's Talk about Surgery and Hormones

When I told my hiring manager, I had changed my name, she asked, "When's your surgery?" When I explained how long I had to wait, she was relieved. She assumed that I had it scheduled for the next six months.

When I updated another co-worker who I trust on my transition, that I had just changed my name, he asked if I was going to be done in August (that was my initial target for transitioning on the job). After we talked a bit, I found out he assumed I was going to have Gender Reassignment Surgery, what most outside of the transgendered community and he called "the sex change", at that time.

I wish.

The price from surgery runs from just over a 1,000 dollars (3,000 dollars, because I would have buy two round tickets to Thailand) to about 20,000 dollars in Trinidad, Colorado by a world-renowned surgeon. Reputable surgeons start about 8,000 dollars in Thailand, so barring changes in insurance policy, that would be my choice, and I already have a surgeon picked out. The problem is raising the money, when I have so much debt and am sliding deeper into it month by month. Overall, this is something pretty depressing to think about.

The other issue, which for me is reasonable, is the requirement by WPATH to live full-time with the name change for 12 months. Technically, upon rereading the definition, as of February 24th, I am full-time, since I was volunteering strictly as a woman in my church shortly before that. I am also interacting as such with the contracting company. And if something happens to this job, I'll be interviewing under my legal name, Sophia.

The 12-month time requirement is meant to test your commitment to the surgery, but I find it more of a time to settle my life as much as possible as a woman, and a time to prepare myself for what I can realistically expect.

Now the AMA and the Tax Court have deemed that GRS for severe GID is medically necessary, which puts the prevalence of insurance exclusions for it on shaky grounds. Not only do they exclude GRS, they exclude hormone therapy for transitioning, and therapy.

Estradiol in pill form is pretty inexpensive, but is taxing on the liver and my endocrynologist refused to continue my prescription in pill form, and wrote her prescription instead for the patch. It turns out that a box of patches for a woman going through menopause is 36 dollars for a months supply. When insurance pays, it usually costs her around 10 dollars. Given that I have to use twice as much, my bill is exhorbitant at 72 dollars per month when you do the math. The insurance doesn't want to pay the 52 dollars because of the exclusion, and is even denying prior authorizations from the treating physician. Do you smell discrimination? I do.

What makes the discrimination blatant is that my insurance company actually has guidelines for when GRS is medically necessary. Included in the guidelines is the requirement that the individual be on medically and emotionally supervised hormone treatment for 12 continuous months. But the exclusion again specifically denies that.

Someone from my church just this Sunday asked if I was done with the hormones, because of my redistributed body fat. The reality is, I'll be on them for life. Until I can have surgery, I need to continue the antiandrogens, which keep me from going bald, having hair sprout all over my body, and other effects, including the persistent anxiety and inability to deal with extreme emotions when the testosterone hits my brain. It's up to the doctor when I stop taking progestins, the hormone released during pregnancy, because there is a debate on how long to take them and everyone has their own opinions. And estrogen, the patch I am required to take is necessary because I don't have ovaries, and while the dosage will be reduced if I am able to have the surgery, it is necessary to help prevent osteoporosis, or to at least slow it down, if I have surgery. Meanwhile, going off the medication after two years would send me into depression.

I had a discussion with my insurance company's member services, and that's when I found out about the exclusions that go with the option that my employer selected. Providing options that are discriminatory is just plain wrong. The insurance company is sending me an appeal form, to which I am going to attach the AMA recommendations.

Meanwhile, I contacted my contract company and found out that the Human Resources department did not go through the exclusions when they were pricing the insurance. Because their EEO policy includes gender identity, they were shocked to discover that they had selected an option with such exlusions. They just happen to be doing their annual evaluation of insurance plan for coverage starting in April. Asked what they could do for me, I suggested that they check the exclusion policies for the keywords "cross-sex" and "cross-gender". Hopefully they willl select a plan and option this time that's at least a little less discriminatory.

Hugs and God Bless,


  1. I hope that you can get the help of the insurance company. It would make a huge difference to things for you.

  2. Even if a little dim on the insurance details, it sounds like your employer wants to do right by you. Not a small thing by any means, certainly not expected in Kentucky.

    It's interesting the assumptions that the general public have about the transgendered. I suppose if Oprah is your only source of info, you might be a tad misinformed!