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Costly Trans-Action - high cost of sex-change operations - includes related article on gender-reassignment surgeon Stanley Biber
Advocate, The, May 25, 1999 by Todd Savage, Lisa Neff
WITH REASSIGNMENT SURGERY EXPENSES AS HIGH AS $50,000 SOME TRANSSEXUALS MUST DECIDE BETWEEN WHAT THEY NEED AND WHAT THEY CAN AFFORD
Some people sock money away in a 401k to buy a home or save for retirement. Over the five years she worked for a Chicago-area electronics corporation, Rachael Zuniga amassed a nest egg of $20,000. Now she's used her savings to cover the bill for the gender-reassignment surgery she had scheduled for May 4.
Zuniga is one of the lucky ones. She's cleared one of the biggest hurdles in making a gender-related transition. "Otherwise, I couldn't afford it," says Zuniga, who now works as an administrative assistant at Howard Brown Health Center, a gay and lesbian community health agency in Chicago.
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But there have been some lean times. Zuniga, who was born a biological male, estimates that since she started making the transition a few years ago, her credit card bills have topped $15,000. She had 200 hours of electrolysis--costing from $30 to $65 per hour--to eliminate facial hair. Since her insurance didn't cover the cost, she says, she could afford the treatments only by putting gas, rent, and other living expenses on a credit card.
"There were times that I didn't eat properly for a few months [and times] I paid less money on bills than I should have," Zuniga says. "I ended up going a lot into debt because this was so important. I'm going to spend 20 years paying off what I've already spent."
Before they invest any money in health care, transsexuals such as Zuniga often spend years, even decades, of their lives sorting out the complex internal and social issues associated with their gender identification. But once they've grown to understand themselves, told their families and friends, and begun living as their self-identified gender, they also must be prepared to face enormous medical expenses.
"It's another thing that makes you feel way out there and isolated and alone," says Michael Munson, a female-to-male transsexual computer consultant living in Milwaukee. "It adds to that feeling of isolation."
For most, that means going it alone to pay for the treatments and surgeries themselves. That's because most insurers do not provide reimbursement for transsexual surgeries, which they consider elective--"even though you may be ready to blow your brains out because your body doesn't match your brains," says Alex Dionne, a female-to-male transsexual who lives in Cambridge, Mass., and who asked that his real last name not be used to protect his family's privacy.
The cost of transition-related health Care includes a wide range of services and treatments. Male-to-female transitions can cost anywhere from $18,000 to $35,000, while female-to-male reassignments are far more expensive since a phalloplasty (in which a phallus is created, typically from the patient's forearm tissues) alone can run up to $50,000. Other services include psychotherapy, hormone treatments, and a variety of surgeries. Add to that other incidental expenses for everything from legally changing one's name (about $200, depending on the state) to buying a new wardrobe (one female-to-male patient needed to replace $2,000 worth of boots when, according to him, his feet grew because of hormone therapy).
Insurers typically pick up the cost of psychotherapy, and doctors are usually able to get reimbursed for hormone treatments--but only because they are deliberately vague in reporting their purpose. One doctor who sees many patients for hormone therapy refuses press interviews because, according to an assistant, he fears his records may be scrutinized.
Activists are divided over the best way to proceed with lobbying for access to reimbursement for transsexuals' medical care. Some advocates would like to shift the debate from the psychiatric arena to the medical field by pushing for the American Psychiatric Association to end its classification of gender identity disorder as a psychiatric problem. While that may provide better footing in achieving broader civil rights for transgendered people, it also could undermine their ability to make progress with insurers, advocates say.
Alejandro Daviko Marcel, director of the Transgender Education Network, a state-funded agency in Boston, says he has never heard of an insurance company paying for reassignment surgery. In fact, he says, he would advise pre-op transsexuals to consider carefully the repercussions of asking an insurer to pay for anything related to their transition, even if their doctor doesn't specify the reason for the treatment.
"It really puts your health credentials on the line with insurance companies," Marcel says. "If the insurance company covers it, then from there on you're marked as someone who's had this surgery, and everything that follows, healthwise, will be under question [as to] whether it relates to sex-reassignment surgery."
In February the state of Oregon decided against adding sex-change procedures to the list of approved health services covered under the state's health plan for the poor. Transgender advocates had urged the Oregon health services commission to extend coverage to include the procedure, but the state panel ruled that there was no good evidence showing that sex-reassignment surgery improves patients' mental and emotional well-being or socioeconomic status or that it reduces the incidence of suicide attempts among transsexuals.
