Not Enough Resources!

The recent directive disallowing exclusions in California healthcare plans for care related to gender transition is significant progress! I continue to be excited by what this may mean for transgender CA residents with health insurance.  The next obstacle to overcome? The absolute dearth of trans-friendly/trans-competent resources in many parts of the country.

I get emails from people from all over the US, seeking gender transition and not living near any well-known resources in order to be assisted therapeutically or medically. I often go immediately to Google after receiving such an email, for which I always chide myself. My peeps know how to Google, and Google well. Do I really think I can Google resources in their area, and something is magically going to appear for me that did not for them? No. If a resource was available on the internet, it would have been found. “Did you try Laura’s Playground?”. Yes, they have usually looked for resources on Laura’s Playground. Then I’m stumped. I start reaching out to people who may happen to know of something that is not easily accessed on the web.

(A special shout out to Zander Keig, an incredible advocate for the trans* community and someone who is always willing to help me look for resources when I hit a brick wall.)

It would be one thing if this were just about logistics; it’s not. These are not just emails looking for resources; they are pleas for help. Pleas for help peppered with “I don’t know how much longer I can do this” and “I can’t remember the last time I was happy.” There’s an urgency inherent in these emails that cannot be ignored, and makes finding no resources in their area all the more frustrating.

I may not be able to see them in person, but I can still picture the look in their eyes, and on their faces. It’s a look I’ve seen countless times before in many of the clients I’ve had the honor of meeting with face-to-face.  It’s a look that tells me the internal obstacles they’ve overcome were overwhelming enough; obstacles to resources are sometimes more than they can bear.

There needs to be MORE gender therapists, gender clinics, and endocrinologists/doctors willing to treat this population.  Every major medical center and hospital should have doctors employed who are knowledgeable and equipped to medically prescribe hormones to the transgender citizens of this country.  I think back to my first transgender client; I knew next to nothing about the therapeutic and medical needs of this community.  This first client gave me a chance and the rest, as they say, is history.

If you are a transgender person or a loved one, seek resources where you think there are none. Talk to therapists and doctors to see if they are willing to get educated and begin working with this population. There are excellent sources of information to guide professionals new to this arena, such as the World Professional Association for Transgender Health (WPATH) Standards of Care and the Center for Excellence Primary Care Protocol.  Somehow we’ve got to make this circle bigger so that care is readily available to ALL.

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Insurance Victory

An issue that has caused frustration, sadness, and exasperation (and that is just for me- imagine how my clients must feel!) is the issue of exclusions for transition-related services for transgender individuals. Most healthcare plans have specific exclusions for anything related to gender transition. This includes but is not limited to hormone blockers, hormones, and needed surgery for transgender individuals.  In my opinion, this is as outrageous as healthcare plans excluding other major medical conditions. These exclusions leave me feeling very helpless, as I can see so clearly what my clients need: medical transition. And I cannot provide this!

As important as being able to access medical transition is being able to access EARLY medical transition when clinically necessary. However, even with the support and assistance of their parents, many transgender youth run into roadblocks when trying to get hormone suppressors. They are outrageously expensive, and most health insurances have exclusions that state they will not pay for anything related to gender transition. (Can you imagine, being one of these preteens/teens who are right on the doorstep of getting the treatment they so desperately need to survive, but they cannot afford it?)

Such is the same for many of my transgender adult clients. Surgery is an important part of the transition for most of my adult transgender clients, and yet most insurances will not cover it. This is a major power problem for those who cannot afford to pay for such surgeries out-of-pocket. It is my opinion that they shouldn’t have to.

On April 9, 2013, a ground-breaking ruling was made on this issue:

“California’s Department of Managed Health Care (DMHC) has ordered California’s health plans to remove exclusions of coverage based on gender identity and expression…The newly issued DMHC letter instructs health plans to revise current plan documents to remove exclusions and limitations related to gender transition.  For transgender people, how and when they transition is typically a private decision made with their doctor. The American Medical Association, American Psychological Association, American Psychiatric Association, and the American Academy of Family Physicians have all deemed transition-related care to be medically necessary for transgender patients.” Read more about it here.

I am truly curious to see how this plays out with all of my clients, and hope it is in reality as good as it sounds! To progress!

Honored! Recipient of 2013 Media Award

Honestly it was quite the honor to be nominated, but I am thrilled to announce this gender blog won “Best Single Topic Blog” for the 2013 National Association of Social Workers Media Awards! Thank you to everyone who voted, and to those of you who read and enjoy this blog. I am intensely passionate about this topic, and hope this blog helps educate, advocate, and raise awareness about this issue.

Published in: on April 11, 2013 at 2:21 pm  Comments (12)