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Results | We included 158 464 041 combined views, with a mean of 660 267 views per video. The mean age of the videos was 4 years (range, 9 days to 11 years) and the mean length was 10.18 minutes (range, 0.50-51.18 minutes). The term nose job received the most views, totaling 56 251 991 views with a mean of 2 812 600 views per video. The mean DISCERN rating was 2.21 overall, and blepharoplasty had the highest mean rating of 2.75. The DISCERN rating for bias was 2.78 (Table 2). The correlation coefficient for videos scored by both reviewers was 0.74. Ninety-four videos did not include a medical professional. Seventy-two videos included US-board certified physicians and had a mean DISCERN score of 2.54. Fifty-seven of those physicians were board certified in ophthalmology, otolaryngology, or plastic surgery; their videos had a mean DISCERN score of 2.63. The difference between the mean DISCERN score of videos including a US board-certified physician and those without a medical professional was 0.69 (P < .001). We found no statistically significant difference (0.43; P = .08) between videos that included US board-certified plastic surgeons, ophthalmologists, or otolaryngologists and those that included US boardcertified physicians from other specialties (Table 1).

Objectives/Hypothesis To determine insurance coverage for gender‐affirming surgery and voice therapy for individuals who seek to align their voice with their gender identity, and to analyze differences based on state‐by‐state transgender equality. Study Design Cross‐sectional study. Methods Policies from the top three commercial insurers per state in 2019 were reviewed. Coverage status was determined by web‐based search, telephone interviews, and email inquiries. A state‐by‐state equality score was calculated based on the number of laws and policies relating to the transgender community. Correlation between number of preauthorized procedures and state equality scores was assessed. Results Of the 150 insurance companies reviewed, only four (2.7%) held favorable policies, whereas 113 (75.8%) provided no coverage. Endoscopic surgery, open surgery, individual voice therapy, and group voice therapy interventions were equally excluded (n = 93, 62.4%). Coverage was not correlated with laws driving transgender equality (P = .782). Conclusions Gender‐affirming voice interventions are seldom covered by commercial insurance companies. Despite established medical necessity and years of experience in practice, gender‐affirming interventions for voice have not yet been fully considered by third‐party payors. Further investigation regarding cost‐effectiveness and treatment efficacy is warranted to improve insurance coverage of voice‐related gender‐affirming care. Level of Evidence NA Laryngoscope, 131:E896–E902, 2021