Cover treatments for gender dysphoria

Pennsylvania legislators seem poised to deny critical care to transgender citizens

The Pennsylvania General Assembly is considering firstin-the-nation legislation that could dramatically affect the wellbeing of low- and middle-income transgender citizens of the commonwealth. House Bill 1933 would bar insurance coverage for gender-affirmative treatments such as counseling, hormone therapy and sex-reassignment surgery under Medicaid and the Children’s Health Insurance Program.

I recently spent a day in Harrisburg talking to legislators about this bill and found many of them unaware of the professional medical consensus regarding gender-affirmative treatments and the careful deliberation that goes into decisions to undergo them.

Making a life-changing medical decision requires an understanding of the risks and benefits of available treatments and of evidence regarding their effectiveness. Transgender individuals who come to a medical professional typically seek treatment for gender dysphoria — the distress an individual experiences when an assigned sex at birth does not match the person’s gender identity. Transgender individuals suffering from gender dysphoria experience depression and anxiety, and many commit, attempt or contemplate suicide.

Recommended treatments for gender dysphoria include counseling, crosssex hormones and surgery. These noncontroversial approaches have the backing of major mainstream medical organizations, including the American Academy of Pediatrics, the American Medical Association, the American Academy of Family Physicians, the American Psychiatric Association and the American Psychological Association. Additionally, treatment is standardized under guidelines from the World Professional Association for Transgender Health (WPATH) and the Endocrine Society.

These treatments are transformative. Transgender individuals who receive gender-affirming treatments have improved psychological and social functioning. Without such treatments, more than 40 percent will attempt suicide.

I have personally witnessed such transformations. One of my 18-year-old patients came to me severely depressed a year ago because of gender dysphoria. Medicaid covered his gender-affirmative treatments. After receiving counseling and cross-sex hormones, he was transformed from a person isolated from friends and family to someone passionately pursuing an architecture degree at a prestigious university.

Many transgender individuals with gender dysphoria improve with counseling and cross-sex hormones. But some need surgery. The decision to undergo surgery is made with careful consideration. WPATH and Endocrine Society guidelines recommend a comprehensive assessment with a mental health therapist to determine a patient’s developmental stage, understanding of the risks and benefits of surgery, and ability to make a decision about an irreversible procedure. Also assessed is whether a patient has a support system needed for recovery. Surgical decisions for young people are made by a team that includes their families, physicians and mental health therapists.This process usually takes several months, which is far longer than the time House Bill 1933 spent in committee.

If the Legislature passes H.B. 1933, it would be disregarding accepted medical practice, leading to poor health outcomes for lowand middle-income transgender individuals who already struggle obtaining necessary health care. There would be serious consequences for thousands of Pennsylvania’s citizens. The Legislature also would be encouraging other states to follow suit.

I urge members of the General Assembly to listen to the voices of transgender individuals, their families and their health care providers. Before voting for H.B. 1933, legislators must understand that gender-affirmative treatment is therapeutic and even lifesaving for transgender people and that passing such a bill would seriously harm them.