Queer Health: Standards of Care

As a transgirl smack-dab in the middle of her transition, I have a vested interest in transgender rights developments around the world. Often times I’m left disappointed, but some news coming out of South America earlier this month has me all aflutter; Argentina has passed a transgender rights law light-years ahead of any other. But what does that mean? Well, any adult who feels the need can change their legal sex/gender without the need for medical treatments or procedures. However, if somebody wants medical interventions then all insurance companies, public and private, must cover those treatments or surgeries. In other words, Argentina’s government has done something unheard of, and has decided to treat their transgender citizens like responsible, competent adults equal with their cisgender peers.

For most people reading this who come from countries still in the Stone Age of transrights (in other words, most countries), this law seems an impossible achievement. I for one live in the U.S., where there are 56 different laws on changing your legal sex, depending on the state you live in, and every single one requiring either hormone replacement therapy or gender confirmation surgery. Not only is this ridiculous, but also expensive; these treatments often require a medical and/or psychological professional’s approval, and insurance often covers neither medical nor psychological treatment in these cases. These laws are because the Harry Benjamin Standards of Care lays out a process that someone seeking to change their gender must follow:

1. See a psychologist for a number of months
2. Convince them you have had gender identity dysphoria for the majority of your life
3. Obtain a referral letter for hormone replacement therapy
4. See an endocrinologist (which is typical, but other medical professionals will suffice)
5. Get a prescription for hormones
6. Wait for hormones to take their desired effects. This is a looooooooooooooooooong process.
7. Go full time
8. Change your legal name (if needed/wanted)
9. Get top surgery/facial feminization surgery (if needed/wanted)
10. After 1 year of being full time, see a psychologist (with a PhD) to get permission for gender confirmation surgery
11. Find a doctor to perform the surgery
12. After GCS you may apply to get your gender marker changed on your license/birth certificate

Yes, you read that right. In order to get your driver’s license changed you must first undergo an invasive medical procedure (in most U.S. states at least, other countries may have different qualifications). This leads to an interesting dilemma for some. As I said before, most insurance companies won’t cover these treatments (this is slowly changing, but still follows that trend), meaning that much of these treatments must be paid for out of pocket. And this is assuming you even have insurance, which an increasing number of Americans simply don’t. So, once you go full time, you must find a job to pay for these treatments, which can be incredibly difficult seeing as how your actual gender will not match up with what’s on your legal records. And this is assuming you even want gender confirmation surgery (many trans people choose not to operate, meaning they will never be able to change their legal documentation).  There are many implications of getting stuck in this negative spiral of gatekeeping that I’m not even going to get into here. Suffice it to say though, many people turn to illegal activities which can be incredibly dangerous and life threatening, and could easily be avoided if the right laws were passed.

Obviously the situation shown above is not the norm. It is a reality for more people than you’d realize, but there are millions of people in America, and worldwide, who have successfully transitioned with or without GCS. I for one have been incredibly lucky so far; I’ve found therapists and endocrinologists who were not gatekeepers, and have managed thus far to hide my transition from my employers. I’m coming up on the point of having to go full time and change my legal documentation, and I have no idea how that will turn out. But the point is, transition is hard no matter if you have insurance or not. We don’t need politicians making it more difficult when a simple change of insurance laws will ease the struggles of so many. Not every country has to go as far as Argentina, but right now they are a shining example of what can happen if a government listens to and respects its citizens. Thank you Argentina, for doing your part to make your citizens healthier, happier people; we could all learn a lesson from you.

Queer Health is a bi-monthly feature that shares information about important health issues. Look for Queer Health every 2nd and 4th Saturday of the month.