Transgender Exclusion: Deeper than Health Insurance, Revisited

As Irma brings up in her first post, “according to the Transgender Law Center, many transgendered individuals are denied health insurance altogether solely because they are transgender” (TLC, 1). Both Irma and Leigh Ann mention the broken arm/leg incident in which transgendered individuals have been denied coverage for a non-transgender related issue. This is clearly an example of stark discrimination; however it is not what this debate is centered on.  

Before I continue, I would like to remind everyone that the question presented by this debate is not asking whether or not whether insurance companies should cover transgender and transsexual people overall, it’s asking whether or not insurance providers should be required to cover medical procedures related to being a transgender or transsexual (refer to my previous blog post’s definitions segment to see which procedures these are). There’s a difference between an insurance company being required to cover a certain procedure, versus an insurance provider deciding to cover transgender people. As stated in my previous post, by requiring insurance coverage for transsexual and transgender services, we are required to consider them as victims of a mental illness.

Irma mentions the Harry Benjamin Standards of Care which, “strictly outline the diagnosis and procedure that must be followed for a true, medically necessary transition” (TAW, 2). What Irma doesn’t acknowledge however, is that these standards, which Transgender at Work highlights as “the appropriate standard[s] of diagnosis and treatment,” reinforce a dichotomous and inflexible definition of gender.  The Harry Benjamin Standards of Care state that “Two Primary Populations with GID Exist–Biological Males and Biological Females” (Harry Benjamin International Gender Dysphoria Association). If all insurance companies were instructed to meet the Harry Benjamin Standards of Care, not only would this reiterate the need for a diagnosis for an identity presumably wrong, but also reinforces the confusion of sex with gender, and the incidence of black-and-white, harsh, and narrow definitions of gender.

In her first debate, Irma referred to a segment of the Transgender Health Benefits article produced by Transgender at Work that also struck me as quite interesting. The article states that the best way to see if health benefits are discriminatory is to “see if the same procedures would be covered for non-transsexuals by the same plan” (TAW, 1). This would seem to be a reasonable strategy, however it only further stresses how being transgendered or transsexual is equivalent to having a disease. By calling for the comparison of mastectomies or hysterectomies being covered in the case of cancer to being transsexual, there is clearly a preexisting assumption that those who are transgendered or transsexual are tormented by an illness. I would argue that this assumption isn’t safe to make because not all of those who identify as transgender express a need for surgeries, or as Susan Stryker highlights “some transgender people question why gender change needs to be medicalized in the first place” (Stryker, 14).

Irma calls for my attention to the National Coalition Article for LGBT Health in her second debate. She mentions “suicidal ideation rates as high as 64% and suicide attempt rates ranging from 16% to 37% with most attributing their ideation or attempts to their gender identity issues” (NCLGBTH, 2). These percentages are definitely concerning, and are not to be taken lightly. However in my opinion, the suicide rates mentioned do not solely reflect the fact that insurance doesn’t guarantee them surgeries and hormone treatments, but rather the stigmas they face, personal concerns, and society’s refusal to accept transgendered individuals as people as a whole. This refusal to accept transgender and transsexuals by society is echoed by another troubling statistic: “on average, one transperson [dies] from hate crimes every month” (Stryker, 148). And while I still feel troubled denying someone the right to have a surgical procedure they feel is necessary to align themselves with their understanding of gender, I have even more trouble with legitimizing the stigma that labels them as mentally disabled.

Many commenters raised questions of what forms of action I would recommend along with my argument. Meghan specifically asks “how, then can coverage for transgender procedures happen? Is it through the health care system but with different definitions? Or is there a separate entity that should be made to provide funds to cover these procedures?” First, I would encourage all of you to think about what you would recommend, too (I do not have all the answers). However, I will set forth a few propositions (bear in mind that I am no expert):

            >>  Change the DSM’s definition of Gender Identity Disorder. An organization called GID Reform Advocates calls for the DSM to include “diagnostic criteria that serve a clear therapeutic purpose, are appropriately inclusive, and define disorder on the basis of distress or impairment and not upon social nonconformity” (Winters, 2).  Health Insurance and health care providers utilize the Diagnostic and Statistical Manual of Mental Disorders (DSM) to direct their work, therefore changing its criteria would potentially lessen the discriminatory nature of GID. However, I would still be cautious with this action, because as Ashley points out in her comment, “the word “disease” is powerful. It is by definition harmful and abnormal.” Identifying transgendered and transsexual individuals as afflicted with disease has strong and negative connotations within society.  

            >> Remove GID from the DSM altogether, just as homosexuality was removed in 1973.

            >>  Develop other organizations. As the National Coalition for LGBT Health reports, “ a few urban, community-based health care organizations have developed their own local Trans Health protocols that do not require a prior GID diagnosis” (NCLGBTH, 3).

            >>  Expand the overall definitions of depression-like illness to include transgendered or transsexual people who are feeling “unfit” in their own skin. Treat them accordingly as people, who happen to choose not to conform to a stereotypical gender identity.

Ashley asks a revealing question in her comment: “is it fair to make them wait if they could gain access to insurance coverage under the umbrella of ‘disease treatment?” The answer to this question is a catch-22. As Stryker writes, “some people resent having their sense of gender labeled as a sickness, while others take great comfort from believing they have a condition that can be cured with proper treatment” (Stryker, 13). No matter what position you take on this debate, not everyone is going to be happy. It touches on a theme we discuss in class: being willing to face the consequences of the decisions you make. As Jaime writes, “treating Gender Identity Disorder as a “condition” or “disease” [is inevitable] in order [for them to gain access to] needed medical care.” I argue that this is not going to solve the issue at large, and therefore should not be required of health insurance companies.  

Jaime also brings up the incrementalist approach, stating that “the best way…is for change to take place incrementally; I am not necessarily saying that I think it is okay for us to continue to marginalize transgender individuals and deny them equal medical coverage, but I do think that the best approach to changing society’s view as a whole is by taking baby steps.” Considering the erosion metaphor brought up in class, the incrementalist approach is extremely time consuming. By supporting the incrementalist approach you are essentially patting the metaphorical rock on transgendered and transseuxals’ heads and saying “you can have the surgery, but you’re still diseased and mentally ill in our books.”

Meghan stated, “I do see some flaws in Rachel’s argument, though. I feel as if she did not tackle the question head on, rather she created a new argument in itself.” However, in my opinion, if a new argument can be made it’s not that the problem isn’t being tackled head on; it is showing that the original argument is missing something.

Just as the Transgender Law Center advocates, I am all for urging health insurance companies to stop discriminating against transgendered people or all people in general, but I am arguing they should not discriminate by mischaracterizing people as mentally disabled.  Discrimination, as we have discussed in class, is being selective based off of irrelevant facts or characteristics.  Being stigmatized as “diseased” in my opinion goes even farther than irrelevant categorization and is offensive at deeper, more fundamental levels.  Perhaps a new definition of “effective treatment” of transgendered and transsexual people would be: not only medically necessary “sexual reassignment surgery, hormone therapy, and real-life experience” but socially necessary actions that aim to remove the stigmatization of those who are choosing to challenge societal accepted gender roles (TAW, 2).  However in order to act accordingly, we must for the time being refrain from requiring insurance companies to broaden their discriminatory and “diseased” ways.


Harry Benjamin International Gender Dysphoria Association. The Standards of Care for Gender Identity Disorders (5th Version).

Stryker, Susan. “An Introduction to Transgender Terms and Concepts” and “The Current Wave”

TAW: Transgender At Work. “Transgender Health Benefits.”

TLC: Transgender Law Center. “Recommendations for Transgender Health Care”

NCLGBTH: National Coalition for LGBT Health. “An Overview of U.S. Trans Health Priorities.”

Winters, Kelley. “GID Reform Advocates.”

3 Responses to “Transgender Exclusion: Deeper than Health Insurance, Revisited”

  1. Leigh Ann Mason says:

    After reading this next portion of Rachel’s debate a lot of my previous questions were clarified. I believe that Rachel makes an even stronger argument for her side of the debate in “Revisited”. One of the most influential statements makes is, “no matter what position you take on this debate, not everyone is going to be happy. It touches on a theme we discuss in class: being willing to face the consequences of the decisions you make”. While this is entirely true, the question remains, are we willing to accept the consequence of categorizing transgender people as “diseased?”

    Rachel is clear that she is willing to accept the consequence of not labeling transgender people as diseased. Again, that consequence is no healthcare for those transgender individuals. As Irma has pointed out, that consequence also includes an enormous number of injuries, botched surgeries and oftentimes, death. I for one am torn between labeling and discrimination that could eventually lead to coverage without the “diseased” label and the harm that is affecting transgender individuals. Rachel states, “the suicide rates mentioned do not solely reflect the fact that insurance doesn’t guarantee them surgeries and hormone treatments, but rather the stigmas they face, personal concerns, and society’s refusal to accept transgendered individuals as people as a whole”. While this may be true, if transgender people were considered to have a “sickness” and consequently covered by insurance, I think it is fair to assume that suicide rates and injuries would decrease. Isn’t saving those lives something we want to commit to? I think of the discussion we had about Warner’s “The Trouble with Normal” in class. If society could begin to throw away this idea of “normal” and be indifferent to those they disagree with then this problem of discrimination could begin to be tackled. Rachel has presented such a complex issue in this debate, and as I said before it is difficult for me to make a decision as to what needs to be done.

    Initially, I stood firm on the idea that health insurance must be required for transgender individuals. Am I still willing to believe in this stance at the expense of categorizing an entire group of human beings as “diseased?” At this point, this is something I am not willing to do, and I can only hope as Rachel has said that change and reform will take place and discrimination will end.

  2. Ashley Biermann says:

    Again, Rachel made a solid argument here. I’m just going to attempt to pull at one of the seams.

    She makes a point in reference to the question of whether it is better for transgendered individuals to be categorized as having a mental disorder and be covered by insurance now or if this would hurt them more in the long term. Rachel states that “No matter what position you take on this debate, not everyone is going to be happy. It touches on a theme we discuss in class: being willing to face the consequences of the decisions you make.” She argues that the long term affects of transgendered individuals not inherently being labeled as diseased would be more beneficial than insurance coverage. However is this true? Will there be a time when transsexual individuals truly fit into society? I hope there is but the question here is whether their staying on the list of mental disorders is causing more harm to them than insurance companies refusing to cover their procedures. Which would have the greater consequences to the lives of these people?

    If this is a disease and these procedures are covered transsexuals are given an economically feasible option. This could relinquish much of the potential physical, mental and emotional harm that could be inflicted on them without the surgery. (I would like to cite the movie based on the slaying of a male to female transgender individual “A Girl Like Me” for what I mean here.) These people would be able to go to the bathroom without worry. They would be able to have a driver’s license and passport in which their sex matched their photo. Their romantic relationships would have the potential for fewer speed bumps. Overall, transgendered individuals should be given this option, even if it means living with a medical label. Are they not already living with a label, in on top of everything listed above?

  3. Jaime Olsen says:

    Rachel’s second posting was very helpful in clarifying many of the questions I had when reading her initial argument, and when thinking further about how we would go about changing the view that transgender individuals are “diseased”. My biggest concern is the fact that it would be so difficult to change society’s views regarding transgender individuals. Rachel’s suggestion that we “remove GID from the DSM altogether, just as homosexuality was removed in 1973” is a great suggestion; however, I feel that removing homosexuals from the “diseased” category was much easier than removing transsexuals would be.

    I would like to point out that even though homosexuals are no longer considered “diseased”, they are still discriminated against in many ways, and I feel that societal views of gays and lesbians as a whole haven’t really changed all that much for the better. So why would removing transsexuals from the “diseased” list change society’s view of them any more?

    Also, while reading Rachel’s post, I kept thinking of our class discussion of Michael Warner’s The Trouble with Normal, and the idea that categories of “normal” and “abnormal” are exclusionary. Even if we were to remove the “diseased” label from transsexuals, they would still not be considered “in the norm”; the stigma of being an abnormal individual will stick with them even though they may no longer be medically classified as such.

    After discussing Warner’s book, I would like to revise my previous comment (which Rachel addresses) about an incrementalist approach being a step in the right direction. Requiring medical coverage of transsexuals who are considered to have a “condition”, while it may be a step in the right direction, is, as Rachel points out, reinforcing the idea that transsexuals are abnormal. Incrementalism excludes certain individuals as well. While I think it is great that transsexuals can receive medical coverage in this way, I agree with Rachel’s argument that majority views of transgender individuals need to change; as she concludes, “Perhaps a new definition of ‘effective treatment’ of transgendered and transsexual people would be…socially necessary actions that aim to remove the stigmatization of those who are choosing to challenge societal accepted gender roles”. For me, the question becomes about cost – at what cost do we choose to wait until society accepts transsexuals?