Associations Between Transgender Exclusion Prohibitions and Insurance Coverage of Gender-Affirming Surgery

Dermatologic Care of Hair in Transgender Patients: A Systematic Review of Literature

“…Thirty-five studies met the inclusion criteria [2,. Broadly, 14 evaluated hair changes of patients on masculinizing and feminizing hormonal therapy [7, 9, 17-19, 21, 22, 26, 31-36], 4 articles related to insurance coverage of gender-affirming procedures [2,12,15,20], 6 assessed patient's quality of life and/or mental wellbeing [16, 23-25, 28, 29], 6 articles discussed hair treatments [6,11,13,14,27,37], 3 assessed patient demand for minimally invasive genderaffirming procedures [8,10,30], and 2 assessed patient/physician understanding of gender-affirming procedures [4,5]. Table 1 summarizes the study findings.…”

“…Numerous studies have shown a significant correlation with the amount and density of hair growth with more symptoms of gender dysphoria in transgender woman and less in transgender men [16, 23-25, 28, 29]. However, obtaining these procedures can be financially difficult, as only 16-40% insurances provide some degree of coverage for these procedures, most of which only permit coverage preoperatively for genderaffirming surgery [2,12,15,20]. For those that wish to undergo these procedures, patients should be fully educated on treatment expectations, as many are unaware that procedures such as laser hair removal require multiple treatments [4].…”

Barriers to Gender-affirming Surgery Consultations in a Sample of Transmasculine Patients in Boston, Mass.

“…Issues with surgery cost and lack of coverage for gender-affirming care have been reported by other studies with adult samples of both transfeminine and transmasculine adults seeking any type of gender-affirming care, 34 and these barriers point to persisting structural issues with US health insurers. For instance, although a 2014 mandate 44 required both public and private insurance providers in the state of Massachusetts to cover medically necessary gender-affirming care, insurers have flexibility in deciding what procedures are medically necessary, 23 , 45 and self-insured plans are exempt from this mandate. 44 In addition, accessing qualified surgical care is likely to be a major barrier to many transmasculine people at rates higher than those of our sample (who did ultimately access qualified care); another community sample of transmasculine adults found that difficulty accessing a qualified provider was a frequently reported reason for not pursuing a gender-affirming surgery.…”

Medicine as constraint: Assessing the barriers to gender-affirming care

“…This pattern in differential funding exists even though the latter procedures are ones that many transgender individuals view as necessary for expression, comfort, and safety. 13,14 Designating genital-modification surgeries as more ''medically necessary'' for transgender patients is reminiscent of the now discredited sexology theories from the twentieth century that prioritized genitals as the major marker of gender identity. Healthcare payers preferentially categorize surgeries as ''medically necessary'' because historical models have advocated the view that they will remedy the psychological conditions transgender people experience.…”