And the Healthcare System TRANSGENDER And the Healthcare System

Introduction Transgender? Umbrella term used to define different groups Included, but not limited to: Cross Dressers Genderqueer (identifies as both genders or neither) Transsexual (older term used to describe one taking hormones or one going through SRS)

Know The Rights What laws protect? Affordable Care Act: Prevents sex discrimination HIPAA: Protects the privacy of patients Joint Commission: Prevents hospitals from discriminating against gender identity and sexual orientation. The Nursing Home Reform Act: Protects privacy as well as maltreatment of patients. State/local nondiscrimination laws: Varies from state to state, but overall protects against and my even explicitly prohibit discrimination against gender identity and sexual orientation.

Programs and Facilities Under the Affordable Care Act, it is illegal for the following healthcare programs/facilities to discriminate against you for being transgender or not conforming to gender stereotypes: Physicians’ offices, Hospitals, Community health clinics, Drug rehabilitation programs, Rape crisis centers, Nursing homes/assisted living facilities, School- based clinics, Medical residency programs, Home health providers, Veterans' health centers, Health services within prison/detention facilities.

Types of Discrimination It is illegal for healthcare providers that receive federal money to do any of the following: Refuse to admit or treat you, Subject you to intrusive and medically unnecessary examinations, Refuse to provide you services that they provide to other patients, Harass you or refuse to respond to harassment by staff or other patients, Refuse to provide counseling, medical advocacy or referrals, or other support services, Isolate you or deprive you of human contact, or limit your participation in social or recreational activities offered to others, Require you to participate in “conversion therapy” for the purpose of changing your gender identity, Harass, coerce, intimidate, or interfere with your ability to freely exercise your health care rights.

Primary Care Transgender patients come in all shapes, sizes, ages, races, sexual orientations, socioeconomic levels, and educational backgrounds General healthcare for transgender patients is much the same as it is for other patients. However, one important rule to remember is that patient’s body may not match the gender they choose to identify with. They also may have had (or want to have) medical treatments such as SRS and hormone therapy, both of which will be discussed later.

Primary Care (continued) Today, many patient intake forms ask questions about sex assigned at birth, and current gender identity. It is crucial to honor the person’s preferred gender identity by using pronouns and terminology that is appropriate. This is important so the physician knows how to care for the patient in a non-discriminatory way. It is then important to provide the correct anatomical care to the patient, regardless if the anatomy matches the current gender identity PAP smears, Prostate exams, etc.

Insurance Quick Facts 51% of transgender individuals do not have any form of private health insurance whatsoever. Over 95% of all transgender persons are denied insurance when applying by themselves, as most receive coverage through group plans or through their employers. The average SRS surgery can cost anywhere between $34,00 and $75,000 (not including any “optional” procedures). Many well-known mental health clinics have around $100-upcharges for “non-procedural” visits – which are often applied to transgender individuals.

Insurance Insurance companies who cover mental therapy and other general practices include: Aetna, Amerigroup, Blue Cross Blue Shield, Cigna, Health Net, and United Healthcare. However, full coverage is very expensive and will often only be allotted to individuals who meet the following criteria: A letter of recommendation from a qualified mental health professional, Persistent, well-documented, long-time gender dysphoria, Be well-informed of all procedures and treatments (and, in some cases, over the age of 18), And, all other mental illnesses be well controlled and documented for over a year

Insurance (continued) The requirements for sexual reassignment surgery (SRS) are much more rigorous than those for mental and general therapy and often do not cover all procedures (i.e. implants, cosmetics) SRS surgeries are also covered by much fewer insurance companies and are limited to: Aetna, Amerigroup, Blue Cross Blue Shield (some states only), and Health Net The requirements include (though many more roadblocks exist): Two letters of recommendation from qualified healthcare providers, several more evaluations, A history of at least 12 months of hormone therapy, Be well-informed of all procedures, treatments, and over the age of 18, 12 months of living as the desired gender in all social roles, AND, all other illnesses be controlled and closely monitored for over a year

Sexual Reassignment Surgery Sexual Reassignment Surgery (SRS) has two different types – MTF and FTM Male-to-Female/Female-to-Male Female-to-Male (FTM) surgery requires over 10 more surgeries, such as hysterectomies, vaginectomies, urethroplasties, metoidioplasties, phalloplasties, scrotoplasties, and placement of a testicular and erectile prostheses. Male-to-Female (MTF) surgery requires enectomies, vaginoplasties, labiaplasties, clitoroplasties, and many dilation treatments. The mentioned surgeries are simply genital-based. Often FTM surgeries often include the removal of the breasts and liposuction to redistribute fat from the hips. MTF surgeries often include the addition of breasts and implants on the hips, buttocks, and thighs.

Transgender Mental Illness Gender Dysphoria – This is a fundamental unease and dissatisfaction with the biological sex one is born with which results in anxiety, depression, restlessness, and other symptoms. The dysphoria often acts as a catalyst to change one’s body and gender expression (how one presents to the world) to be more in keeping with what is felt to be one’s gender identity (the gender that one feels oneself to be). Problems associated with growing up with Gender Dysphoria – The main problem of growing up with gender Dysphoria, aside from the body dysphoria itself is the social predicament. Essentially everyone expects the individual to be and act like a boy/girl, when they feel inside to be a girl/boy.

Hormone Therapy Hormone replacement therapy for transgender or gender variant individuals, also sometimes called cross-sex hormone therapy, is a form of hormone replacement therapy (HRT) in which sex hormones (namely androgens for trans men and estrogens for trans women) are administered for the purpose of bringing one's secondary sexual characteristics more in line with their gender identity. Some intersex people may also undergo HRT, either starting in childhood to confirm the gender they were assigned at birth, or later in order to change the gender they were assigned at birth. This form of HRT is given as one of two types, based on whether the goal of treatment is feminization or masculinization: hormone replacement therapy (male-to-female) and hormone replacement therapy (female-to-male).

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