The Trans Women's Anti-Violence Project

NEW YORK — A New York City transgender woman has won insurance coverage for her sex change operation.

The Transgender Legal Defense & Education Fund said Wednesday MVP Health Care agreed to cover the doctor-recommended procedure for Ida Hammer.

It had originally denied her claim on the grounds it was “cosmetic,” and therefore not covered under her policy.

The 34-year-old patient had applied for pre-authorization for her male-to-female sex reassignment surgery in July 2011.

TLDEF said that after denying two appeals, MVP reversed its decision and deemed the surgery medically necessary.

MVP didn’t immediately respond to a call and email seeking comment.

The American Medical Association recommends insurance coverage for sex reassignment. But only a small number of companies actually provide it.

(Associated Press via Wall Street Journal)

KASSEL, Germany - Male-to-female transsexuals have a legal right to breast enlargement operations when hormone therapy fails to give them a feminine shape, a German federal court ruled Tuesday.

A transsexual may receive implants if her new breasts have not yet reached the size of a bra’s A-cup, the Federal Social Court in the central city of Kassel said.

“Transsexual insurance policy-holders can make a claim to treatment measures to allow them to adapt their gender, including surgical procedures on healthy organs to minimise their psychological suffering, so as to approach the appearance of the other sex that is desired,” the court said.

It said such a procedure was justified even if the patient had not yet had a sex-change operation.

The court ruled in the case of a 62-year-old whose health insurance plan paid for hormone treatment and a sex change but whose breasts failed to grow to female proportions.

The insurance company declined to pay for an operation for larger breasts. In a second case before the court, the insurance company paid for hormone treatments, cosmetic surgery to make the face more feminine and two operations to make the voice of a transsexual patient more womanly.

It had also approved a sex-change operation, which the patient had not yet undergone.

The company argued that hormonal changes could result from the genital operation and lead the breasts to grow and thus rejected a claim for breast augmentation.

The court rejected the insurance companies’ stance in both cases, stating that only when a patient’s breasts “completely fill” an A-cup could they be considered to have reached an “undoubtedly gender-specific range”.

The judges said that this right to breast-enlargement surgery applied even before a sex change, basing its ruling on a recent decision by Germany’s top court which found that such a procedure was not a requirement for a legal name change.

Over the course of the past few months, TransActive has been working behind the scenes with organizational allies and officials in Germany to facilitate a positive outcome with regard to the treatment of an adolescent transgender girl.

Jul 09, 2012 -
Alexandra (Alex) Kaminski (a pseudonym) socially transitioned from her assigned male birth gender to her female gender identity several years ago with the full-support of her mother and with the full-knowledge of her father, who no longer lived with the family. When the time came for Alex to begin puberty blockers to prevent the development of secondary male sex characteristics (deeper voice, facial hair, muscular/skeletal bone structure, etc.) her father filed a complaint with the Berlin Youth Welfare Office (YWO). He claimed that Alex’s mother was coercing Alex’s gender transition.

As a result, the YWO revoked the mother’s right to make medical decisions for her daughter and refused to authorize the start of therapist and physician recommended pubertal suppression treatment. The YWO was also threatening to have Alex committed to a closed-ward psychiatric facility for extended counseling treatment targeted at making her ‘more comfortable’

with her assigned birth gender. All of these developments caused Alex and her mother great emotional and psychological trauma.

TransActive is now able to report that as the result of our efforts and the tireless and invaluable assistance of Dr. Amelie Zapf, Ph.D. in Berlin – a positive outcome appears to be on the horizon for Alex and her mother.

Included below is an email we received on July 9, 2012 from Dr. Zapf, along with an image from the current issue of the internationally known German magazine “Der Spiegel” which recently published letters from Dr. Zapf and TransActive Executive Director Jenn Burleton. (The magazine had featured a story about the Alex Kaminski case a few weeks ago.)

Translations of the magazine letters are provided below Dr. Zapf’s letter.

*****

Dear Jenn,

How are you? I hope all is well. Please find attached our letters to the editor, as printed in this week’s edition of “Der Spiegel”. Though much abbreviated, they did print them. Nice teamwork there!

Meanwhile, Alex’s first meeting with the new counselor went well and everything appears to be rolling along smoothly now. I expect her to be on blockers by the end of summer break (that is, early August).

Sincerely,

Dr. Amelie Zapf

*****
[TransActive Letter to Der Spiegel]

Alex’s gender is not open for debate by other individuals, including her parents. Those things have been prenatally determined, expressed by the only person capable of knowing such things: Alex Kaminski. Taking a “wait and see” approach will result in unnecessary negative outcomes. This young lady is a victim of ill-informed institutional interference and the kind of professional arrogance that would allow someone to think that a child or adolescent’s gender identity can be changed by parental, psychological or administrative pressure. What is happening to Alex Kaminski is nothing short of child abuse.

Jenn Burleton, Portland (USA)
TransActive Education & Advocacy

*****
[Dr. Amelie Zapf Letter to Der Spiegel]

Enforcing a male puberty by witholding medication would be tantamount to coercing the child into a physical gender change. However, the psyche would remain unchanged. Ostracism would be the consequence, not to mention the physical pubertal changes perceived as disfiguration. These factors are leading to suicide attempts for roughly 30% of the victims.

Dr. Amelie Zapf, Berlin

Photo:
http://www.prlog.org/11919840/1

—- end —-

A transsexual [woman] may return to prostitution to pay for gender reassignment surgery because the Government waiting list is too long.

The Health Ministry has provided funding for gender reassignment surgery under its High Cost Treatment Pool since 2004.

Jasmine Eastall, 28, is so desperate for the surgery - which she said is the final piece “to being the woman you really are” - she was considering returning to prostitution to fund it herself.

…

Although the cost of male to female surgery costs an average of $45,000 in New Zealand, the price in Thailand is about a third of that, said Racheal McGonigal, who recently wrote to Health Minister Tony Ryall urging him to consider alternatives to the current funding, including funding for surgery overseas.

The 12 operations funded by the ministry in the past eight years were all performed by a team of three Christchurch-based surgeons.

It has funded three people to travel overseas for female to male surgery, as there are no surgeons in New Zealand who can perform the operation.

“As NZ has specialists who can perform the male-to-female surgery we do not send people overseas for that surgery. This is policy in line with all other funding by the High Cost Treatment Pool,” the ministry said in a statement.

The ministry said there are 53 people on the waiting list and an average seven-year-wait - but McGonigal said most people will have to wait much longer than that, considering only 12 surgeries have been performed in the last eight years.

“At this level of surgeries New Zealand transsexuals [people] are being strongly disadvantaged and marginalised by our health system,” she says.

…

Similar calls are being made overseas with the Parents and Friends of Lesbians and Gays in Australia calling on their government to make the surgery a priority.

Adults who want sex-change surgery or hormone therapy in Argentina will be able to get it as part of their public or private health care plans under a gender rights law approved Wednesday.

The measure also gives people the right to specify how their gender is listed at the civil registry when their physical characteristics don’t match how they see themselves.

Senators approved the Gender Identity law by a vote of 55-0, with one abstention and more than a dozen senators declaring themselves absent — the same margin that approved a “death with dignity” law earlier in the day.

President Cristina Fernandez threw her support behind the law and is expected to sign it. She has often said how proud she is that Argentina became Latin America’s first nation to legalize gay marriage two years ago, enabling thousands of same-sex couples to wed and enjoy the same legal rights as married heterosexual couples.

For many, gender rights were the next step.

Any adult will now be able to officially change his or her gender, image and birth name without having to get approval from doctors or judges — and without having to undergo physical changes beforehand, as many U.S. jurisdictions require.

“It’s saying you can change your gender legally without having to change your body at all. That’s unheard of,” said Katrina Karkazis, a Stanford University medical anthropologist and bioethicst who wrote a book, “Fixing Sex,” about the medical and legal treatment of people whose physical characteristics don’t fully match their gender identity.

“There’s a whole set of medical criteria that people have to meet to change their gender in the U.S., and meanwhile this gives the individual an extraordinary amount of authority for how they want to live. It’s really incredible,” she said.

When Argentines want to change their bodies, health care companies will have to provide them with surgery or hormone therapy on demand. Such treatments will be included in the “Obligatory Medical Plan,” which means both private and public providers will not be able to charge extra for the services.

“This law is going to enable many of us to have light, to come out of the darkness, to appear,” said Sen. Osvaldo Lopez of Tierra del Fuego, the only openly gay national lawmaker in Argentina.

“There are many people in our country who also deserve the power to exist,” Lopez said.

Children also get a voice under the law: Youths under 18 who want to change their genders gain the right to do so with the approval of their legal guardians. But if parents or guardians want a gender identity change and don’t have the child’s consent, then a judge must intervene to ensure the child’s rights are protected.

Argentina need not worry about vast numbers of people demanding sex changes, Karkazis predicted.

“This isn’t going to create a huge demand on the national health system for these procedures. They’re difficult, painful, irreversible. And this is why many people don’t do it,” she said.

But because the law says people can legally change their identities without having to undergo genital surgery or hormone therapy, these changes can be more benign and even reversible, if some day the person’s self-image changes.

Other countries, including neighboring Uruguay, have passed gender rights laws, but Argentina’s “is in the forefront of the world” because of these benefits it guarantees, said Cesar Cigliutti, president of the Homosexual Community of Argentina.

“This is truly a human right: the right to happiness,” Sen. Miguel Pichetto said during the debate.

View this image ›

Source: GWImages  /  via: shutterstock.com

Last week, Beth Scott won her battle to get her insurance carrier to cover her mammogram, after they refused to because she’s transgender. Scott’s doctor had recommended the screening, but when it comes to figuring out their actual risk of breast cancer, transgender women (and men) face a frustrating lack of information.

According to Dr. Maddie Deutsch, director of the transgender health program at the LA Gay & Lesbian Center the risk of breast cancer for trans women like Scott is relatively low. It’s likely “much lower,” she says, than the risk for cisgender (that is, non-trans) women. And trans men have surgery to remove their breasts, a small amount of breast tissue can remain, but the reduced amount translates to a significant reduction in risk.

However, she also noted that there’s a serious lack of research in this area. It’s not clear, for instance, whether developing breasts as part of gender transition actually raises a person’s cancer risk — that is, whether transgender women are more likely to get breast cancer than men who never grow breasts. Most funding for trans-related health issues has focused on HIV, mental health, or substance abuse — there’s been almost no research into general health concerns like breast cancer.

View this image ›

Beth Scott.

Via: upi.com

The reason, according to JoAnne Keatley, director of the Center of Excellence for Transgender Health at UCSF, is that people who control research money still think of transgender health as a political hot potato. So federal grants for trans health research aren’t available, and private donors shy away too. Keatley says, “there’s no private foundation that I’m aware of that is willing to provide money” to study breast cancer in trans women. A 1988 case study looked at one trans woman who developed cancer 10 years after her transition, and mentioned two previous cases, but according to Keatley, no large-scale research whatsoever into the incidence of breast cancer in transgender people has been done.

When trans men have surgery to remove their breasts, a small amount of breast tissue can remain, but the reduced amount translates to a significant reduction in risk. And Deutsch says there’s some evidence that the testosterone some trans men take can cause remaining breast tissue to “involute,” becoming smaller and less functional. This, she says, could further reduce the risk of cancer.

So while Beth Scott will get her mammogram, it may be some time before she and other transgender women know their true risk of contracting breast cancer.

“The fact is that in Canada or Japan or elsewhere in the industrialized world Perla would not have needed to commit fraud just to get basic healthcare (which is apparently what she obtained). And that is the real story in this news piece, not her trans status.”

There are about 1,700 inmates at Auburn Correctional Facility, of whom 1,698 or so are indisputably men.

Then there are Jessica Marie Brooks and Leslieann Marie Manning.

They are part of the small population of transgender inmates in New York prisons. Both say they’re receiving hormone therapy, and the physical changes are subtle but apparent.

…

Brooks and Manning say there is at least one other transgender person at Auburn, and more in other state prisons. That leads to two pertinent questions for New York state taxpayers: is gender dysphoria, or gender identity disorder, an actual affliction? And if so, is the state obligated to pay for treatment?

On the first question, experts agree that transgender people do indeed have a legitimate medical condition.

Gender dysphoria is recognized by the American Medical Association and the American Psychological Association and is listed in the Diagnostic and Statistical Manual of Mental Disorders, an authoritative resource published by the American Psychiatric Association.

“Gender dysphoria is a medical condition, not a lifestyle choice. … It’s not something anybody would choose,” said Randi Ettner, chairwoman of World Professional Association for Transgender Health’s committee on incarcerated persons. “I think the layperson doesn’t understand this is a lifelong medical condition, most likely something the individual is born with, and that there is no cure for it.”

…

For Ettner and other transgender advocates, the legal implication for inmates is clear: the state has an obligation to pay to treat all medical diagnoses, including hormone therapy, electrolysis and sexual reassignment surgery for people who require them.

“The principle has to be that to the extent that we pay for health care for people in incarceration, then everyone who’s incarcerated should be treated the same way and all medically necessary care should be provided,” said Michael Silverman, executive director of the Transgender Legal Defense and Education Fund in New York City. “We shouldn’t be targeting one small subset of incarcerated individuals and saying, ‘We don’t want to provide you care because we don’t like who you are.’”

State Sen. Michael Nozzolio, chairman of the Crime Victims, Crime and Corrections committee, disagreed, calling hormone therapy and other accommodations for transgender inmates “optional medical care.”

“I’ve long believed this is an inappropriate expenditure of taxpayers’ dollars,” he said. Hormone therapy costs about $100 a month and gender reassignment surgery is much more expensive.

Nozzolio annually sponsors a bill that would require inmates to make a co-pay for all medical care. It has never passed the Democrat-controlled state Assembly.

States have taken different approaches to treating transgender inmates. Most allow for some medical care with a proper diagnosis; the only complete ban, in Wisconsin, was struck down in federal court last August.

The New York Department of Corrections and Community Services formally recognizes gender identity disorder as a legitimate affliction and has a policy of maintaining hormone therapy for inmates who were diagnosed prior to their entry into custody.

Inmates who were diagnosed after their entry into custody can also begin hormone therapy with a diagnosis from a specialist and the approval of the department’s chief medical officer.

Both Brooks and Manning accused the prison administration of throwing up barriers to treatment, and both had to sue for the hormones they now receive.

Manning first requested hormones in 2002, then sued the state in 2005 and eventually received treatment starting in 2009. In the meantime, she stopped taking her anti-HIV medication and attempted to remove her testicles with a rubber band, according to court papers.

In 2004, Brooks challenged the state’s former policy that barred hormone therapy for new diagnoses and briefly gained national notoriety after a U.S. District Court judge sided with her. That decision was later overturned, and it was not until last June — more than a decade after her first request — that she started on treatment.

“You’ve got to fight for everything in here,” she said.

Both Brooks and Manning say they are currently receiving estrogen boosters and androgen blockers after having been diagnosed as gender dysphoric by an outside specialist.

Manning had to wait seven years, Brooks 11, and both said they are not receiving the dosage their doctors recommended, but the medications are having an effect.

…

Beyond access to medical care, the two transgender inmates both complained of verbal harassment and abuse from correctional officers at Auburn and elsewhere in the prison system. They gave specific examples of homophobic slurs and destruction of property like feminine undergarments.

“Some of (the officers) are more tolerant or accepting, and some of them might not like me, but they’re professional in their job,” Brooks said. “And some of them …are biased, prejudiced, everything’s just piling down on you and they don’t care. They just hate, and they’re comfortable with it.”

Their claims are corroborated by a 2007 report from the Sylvia Rivera Law Project, an advocacy and legal center for transgendered people that represented both Brooks and Manning in their lawsuits. It lists numerous complaints by transgendered inmates including multiple daily strip searches and having persistent reports of rape go ignored.

Brooks and Manning have filed only one formal complaint, according to DOCCS records. That came in 2002 when Manning accused an officer of calling her a homosexual.

Manning also has a grievance pending now after DOCCS’ chief medical officer in Albany denied her endocrinologist’s prescription for a bra, saying her breasts weren’t full enough to warrant one.

“They try to do everything they can to deny that you’re trying to be female,” Manning said. “There’s a couple of officers up there that will call you a fag, call you homosexual, say other nasty things. It’s just continual harassment.”

DOCCS does not have targeted transgender sensitivity training for its officers, but spokesman Peter Cutler said there are behavioral standards for all staff.

“We expect all of our staff, security and civilian, to perform their duties in a professional manner, which includes the fair and appropriate treatment of inmates,” he wrote in an email. “We have a variety of training programs for staff where sensitivity to inmates’ needs is emphasized.”

Morgan Hook, a spokesman for the New York State Correctional Officers and Police Benevolent Association, assailed the Sylvia Rivera report as “unsubstantiated” because the inmates quoted in it did not give their names.

As for the specific claims from Brooks and Manning, he said NYSCOPBA and DOCCS take them seriously.

“Inmates are absolutely entitled to their rights - and NYSCOPBA members swear an oath to protect those rights,” Hook wrote in an email “Further, inmates should never be subjected to violence or harassment. … (But) this depiction of Auburn is uninformed at best, and dangerously misleading at worst.”

…

[Read the full article]

A transgender New Jersey woman has reached a settlement with her health insurance company that had declined to cover a sex-specific procedure that had been deemed medically necessary.

Beth Scott underwent a mammogram in June 2010 at her doctor’s recommendation. Aetna declined to cover the procedure because Scott’s policy had a “Sex Reassignment Exclusion” that did not include treatments, drugs, services or supplies “related to changing sex or sexual characteristics.” Scott subsequently appealed the decision, but the company denied it.

In the settlement that the Transgender Legal Defense and Education Fund announced on Monday, Aetna agreed to cover the mammogram and any future procedures that Scott may have to undergo. The company agreed that the Sex-Reassignment Exclusion clause in her policy only applies to treatments, drugs, services or supplies specifically used to change a patient’s sex or sex characteristics.

Aetna also formally apologized to Scott.

“In reviewing [Scott’s] mammogram claim and plan documents, we have determined that the eligibility of the claim and the plan benefits were misinterpreted,” wrote Shelly Ferensic, vice president of Aetna Service Operations, in a March 13 letter to Scott’s lawyer, Carmine D. Boccuzzi, Jr. “We also verified that routine and medically necessary mammograms are not automatically excluded just because a plan excludes transgender surgery. Therefore, based upon clinical information, the claim should have been paid according to her plan benefits, as we consider this to be a routine test that is covered under the plan.”

Scott said that the settlement is about fairness.

“While I’m hopeful that my employer will soon eliminate the transgender health exclusion altogether, I’m relieved to know that the existing exclusion can no longer be used to unfairly deny me other needed health care like a cancer screening just because I’m transgender,” she said in a TLDEF press release.

This settlement underscores the challenges many trans people face when they submit claims for sex-specific procedures to their health insurance companies.

Lina Kok, a trans woman from North Carolina, reached a settlement with Prudential last fall after it denied a short-term disability claim she filed in Nov. 2010 after she underwent reconstructive facial feminization surgery.

The California Court of Appeals ruled in 1978 that the state’s Medicaid program must cover sex-reassignment surgery because it is not a cosmetic procedure. A New Jersey judge in 1992 ruled that the state’s Medicaid program must also cover the procedure.

The Minnesota Supreme Court in 1977 struck down their state Medicaid’s blanket exclusion for SRS, but lawmakers subsequently reinstated it in 2005. The program still covers hormones and therapies for trans recipients.

The World Professional Association for Transgender Health acknowledges facial plastic reconstruction and other sex-reassignment procedures are “medically necessary” to treat Gender Identity Disorder. The U.S. Tax Court upheld this standard in 2010 with its ruling that SRS and other trans-specific surgical procedures are tax deductible.

TLDEF staff attorney Noah Lewis noted to EDGE that insurance companies continue to move to cover sex-specific treatments and procedures that trans patients’ doctors deem medically necessary.

“As long as they are in place, they have to be interpreted narrowly and not be used to deny transgender people care that is provided to everyone else,” he said.

A gay San Francisco doctor who primarily provides care to low-income transgender women and people living with HIV/AIDS was honored last weekend by Equality California.

Dr. Royce Lin, 39, accepted the first-ever State Farm Good Neighbor Award at the statewide LGBT lobbying group’s Saturday, April 14 gala at the Fairmont Hotel.

Lin told attendees he’s felt lucky to be able to reach out to those “whose voices so often go unheard.”

“Our clients are among the bravest, most tenacious, and generous people I know,” he added.

Among other positions, Lin works at the Ward 86 HIV clinic at San Francisco General Hospital and for the Tom Waddell Health Center’s Transgender Clinic.

Equality California board President Clarissa Filgioun said in a statement that Lin “provides a lifeline for marginalized gay and transgender people who often lack access to basic health care or for whom a trip to the doctor can be a traumatic experience because of a lack of culturally competent health care providers who understand and empathize with the unique health care needs of LGBT people.”

Lin told the crowd, “It is not I who deserve this award,” saying there are many people doing similar work “day in and day out.”

A doctor since 2000, Lin said in a phone interview that he chose the profession because “as a gay man coming of age during the height of the AIDS epidemic, I was always drawn to the way that our community gathered” in response.

“It was not just for the science, but really the story, the heroism of people who are affected by HIV, and it was a great fit for me,” said Lin. “HIV is something that certainly has affected my life, as well, so to be able to help others is something that’s tremendously rewarding.”

Lin attended college in Boston in the early 1990s. He said that among the memories that stand out to him are volunteering at Fenway Health, which provides HIV care and other services.

He recalled “trying to navigate being a sexually active gay man during a time when there was a lot that was unknown, a lot of fear. It really made me feel that I had a duty and obligation to my community to really give back, and medicine was a route for me to do that.”

Lin has been a physician at Ward 86 since 2004, where the vast majority of patients either has no insurance or receives public safety net coverage through Medi-Cal or other forms.

Many of the ward’s patients are from communities of color, and many are monolingual Spanish or Chinese speakers, said Lin, who speaks both Mandarin Chinese and Spanish. Most of the clients are gay men, he said.

Lin has worked for the Waddell center since 2011 and sees patients in the Transgender Clinic. There, problems facing many people include HIV, poverty, and discrimination. He said a number of the clients are engaged in commercial sex work.

As a Waddell center employee, Lin also has provided medical care out of Tenderloin Health’s offices three days a week. He said many of those clients “suffer from a great deal of trauma and have a very difficult time navigating a conventional medical system.” Many of the patients there are homeless or marginally housed and struggle with substance abuse and mental health issues. The city has been working to ensure Tenderloin Health’s former clients continue to receive care in the aftermath of the agency’s closure.

Lin said there’s “absolutely” still a lot of stigma around HIV.

“I think stigma is really the big killer,” he said. “I think when I see people do poorly, oftentimes it’s stigma and the silence and the shame that really leads to a poor outcome.” He said that he and other care providers see many people “because of stigma not access care until very, very late in the course” of the disease.