California Bans Insurance Discrimination Against Transgender Patients

SAN FRANCISCO [April 9, 2013]: California’s Department of Managed Health Care (DMHC) has issued guidance clarifying the obligations of California’s health plans under the Insurance Gender Nondiscrimination Act (see below)  In a groundbreaking directive to health plans, the DMHC confirmed that California’s Insurance Non-Discrimination Act of 2006, authored by former Assemblymember Paul Koretz, guarantees all people the right to access coverage for medically necessary care regardless of their gender identity or gender expression. The directive also provides that patients who are denied coverage can appeal the decision for review by the Department.
Transgender Law Center applauds the DMHC, Governor Jerry Brown, Insurance Commissioner Dave Jones, the Assembly Speaker John A. Pérez, and the Legislative LGBT Caucus for their commitment to ending discriminatory insurance exclusions that limit access to medically necessary care for transgender patients.

Speaker Pérez said,“This is an important step in protecting the health of all Californians, including transgender individuals. No Californian should be denied care and treatment because of their gender identity or expression. Implementation of California’s Insurance Gender Nondiscrimination Act (IGNA) is a simple matter of fairness and equality in health care. I commend the Department of Managed Health Care for issuing its Director’s Letter reminding health care service plans of their obligation to comply with IGNA.”
“This one letter will save lives,” said Masen Davis, Executive Director of Transgender Law Center. “For years, transgender Californians have been denied coverage of basic care merely because of who we are. Discriminatory insurance exclusions put transgender people and our families at risk for health problems and financial hardship. Now we can finally get the care we need.”
The DMHC directive applies to HMOs and PPOs regulated by the Department of Managed Health Care. In 2012, the Department of Insurance issued non-discrimination regulations with similar protections for health insurance regulated by the Department of Insurance. Combined, this means that all California health plans and insurers cannot arbitrarily deny medically necessary services provided to other policy holders or members simply because the patient is transgender.
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.
A 2008 study conducted by Transgender Law Center found that an alarmingly high rate of transgender patients were denied coverage for essential health care. 15% were outright denied gender-specific care such as pap-smears or prostate exams just because they were transgender.
Individuals with questions about today’s announcement or other questions about their health coverage should contact the Department of Managed Health Care’s Help Center at 1-888-466-2219 /
The California Department of Insurance also offers consumer assistance at 800-927-HELP /
Transgender Californian’s who experience discrimination or have legal questions should contact Transgender Law Center at 417.865.0176 x306/
For more information or interview requests please contact Mark Snyder, Communications Manager, 415.865.0176 x310,
Transgender Law Center works to change law, policy, and attitudes so that all people can live safely, authentically, and free from discrimination regardless of their gender identity or expression.

I studied "girl tech"

This is a huge area covering everything from clothes and cosmetic application to social behaviors in the restroom. For example, what to do if someone looks at you in the ladies? Initially, I smiled at them momentarily and looked away to not challenge with a direct stare and proceed to a stall or stand in line. Now there is no issue, either because it is an unconscious behavior or that I look confident and friendly.

Very surprising to me, nobody cares about my voice which is not fully "transitioned" yet. So I suspect many know I am trans, but they like my presentation and social behaviors. I am happy more folks like me than before particularly among younger and middle-aged people.

Fortunately, I didn't need facial surgery because I generally fit within normal female variation. Some are very concerned about their face, but given normal variation, I suspect mine is "good enough". I discovered I could do things with cosmetics eliminating any need or desire for facial surgery. I often thought about making my chin a bit more triangular or less square, but it is basically OK, so I left it alone.

Articles I read suggested that women smile more than men. Perhaps its a way of dispelling tension, but as a guy, excessive smiling is suspect or perhaps a sign of weakness or intimidation. Years earlier I had been a trumpet player and with hours of practice, I developed different lip muscles. Some folks have an incision on the inside of the upper lip to slightly expose top teeth. Believe it or not, I prefer to avoid surgery when possible, but I've obviously had my share. So, I practiced exercising facial muscles and those in my upper lip and now I can smile with exposed upper teeth easily.

Along the way I read about all manner of facial surgery, along with top and bottom surgery. Now I am very happy with what I did and what I did not do. I read enough bibliographical articles and books to understand that many face similar concerns. "Know yourself" and understanding the choices is critical. Nobody understands you  better than you do regardless of certifications or pretense.

I hope all of this helps. People vote on me based on "the preponderance of evidence"
(LOL, I love that line) but it is true. If you miss a couple minor things they will ignore them based on other factors... ESPECIALLY if they personally like you or smile a lot.
Here is a fine example...


Stu doesn't pass that well, an understatement, but is well accepted in this rural community--in fact, she is the Mayor.On Election Day 2012, a transgender Oregonian drew national attention for the second time by winning a fifth term as Mayor of Silverton, Oregon.

Hormonal therapy for transsexualism safe and effective

Hormonal therapy for transsexual patients is safe and effective, a multicenter European study indicates. The results will be presented Saturday at The Endocrine Society's 95th Annual Meeting in San Francisco.

Transsexual individuals who seek treatment may feel as though they were born the wrong gender. Surgical and hormonal therapies are available to help these people change their external characteristics to match their internal image of themselves.

Hormonal therapy involves large doses of male or female sex hormones, which has led to concern about its health effects. This study found that short-term hormonal therapy for transsexualism is effective and safe, with few side effects.

"Although transsexualism remains a rare diagnosis, the number of trans persons seeking hormonal or surgical treatment has drastically increased in recent years, making a detailed multicenter description on the effects of cross-sex hormonal treatment timely," said study lead author Katrien Wierckx, MD, an endocrinologist at Ghent University Hospital in Belgium.

 "Our study gives valuable information about the effects of drastic changes in sex steroids on glucose and lipid metabolism, cardiovascular and bone health, so that we can inform our future clients, their families and other caregivers more accurately on the desired effects, side effects and adverse events of cross-sex hormonal treatment."

The effects reported by males transitioning to female in this study included breast tenderness, hot flashes, emotional behavior, and decreased interest in sexual activity. In addition, male-to-female transsexuals had significantly increased fat tissue, and decreases in lean tissue and muscle.

Among females who were transitioning to male gender, effects included increased interest in sexual desire, greater variation in tone of voice. This group also exhibited significantly more acne and body hair, as well as increases in lean tissue and muscle, and decreases in fat tissue. No serious complications occurred in either group.

This multicenter study included 45 transsexual men and 42 transsexual women at four European centers in Ghent, Oslo, Amsterdam and Florence that specialize in transgender treatment.

Female-to-male transsexuals received a form of the male sex hormone testosterone. Male-to-female transsexuals received anti-androgen treatment in combination with a form of estrogen, which is the principal female sex hormone. Treatment was for 12 months.

Throughout the study, investigators measured participants' waist-to-hip ratio, blood pressure, and the percentages of fat and lean tissue mass. Follow-up was one year.

In addition to demonstrating the safety of hormonal treatment for transgender people, these findings can also help clarify its safety for other indications, according to Wierckx.

"Studies in transsexual persons generate knowledge on the similarities and differences between men and women," she said. "This is why some of our findings can be extrapolated to other, more common conditions that are associated with changes in sex steroid hormones, such as hyperandrogenism in women, for example, polycystic ovarian syndrome; or androgen deprivation therapy in men, for example, when undergoing prostate cancer treatment, or treatment for sex offenders."

The Special Research Fund of the Ghent University, the Flemish Research Fund, and the European Society of Sexual Medicine funded the study.

Brain Mapping Gender Identity: What Makes A Boy A Girl?

study, published last year and conducted at the Laboratory of Neuro Imaging at UCLA School of Medicine, explored the extent to which brain anatomy is associated with gender identity. "The degree to which one identifies as male or female has a profound impact on one's life," the authors wrote. "Yet, there is a limited understanding of what contributes to this important characteristic termed gender identity."

Many who live at variance to their birth gender as well as many in the scientific field would heartily agree.
Historical Background
In 1910, German physician Magnus Hirschfeld coined the term "transvestites" to describe individuals who are more comfortable in clothing of the opposite gender. Hirschfeld's interest in this study population was not purely professional; he himself identified as a transvestite in addition to being gay. He believed that sexual orientation was a naturally occurring trait worthy of scientific inquiry, and in his many studies he found that transvestites could be men or women and could identify as any sexual orientation. In fact, most of his participants were heterosexual. Meanwhile, many psychoanalysts during the same period, including Wilhelm Stekel, characterized transvestites as "latent homosexuals" or men who consistently denied their attraction to other men.
Years later in 1948, endocrinologist Harry Benjamin was asked by Alfred Kinsey, the biologist and most famously sexologist who in 1947 founded the Institute for Sex Research, to examine a boy who "assured to be a girl." The mother of the boy had come to him wishing for help that would assist rather than thwart her child, and Kinsey had never encountered such a case. Upon his own examination, Benjamin understood that the boy's condition was markedly different than that of transvestism.
He immediately involved psychiatrists, but they were unable to agree on a strategy for treating the boy. Eventually, Benjamin decided to administer estrogen to the boy; he used Premarin, which had been introduced in 1941. This treatment, he noted, had a calming effect. Next, he helped arrange for the mother and child to go to Germany where surgery could be performed. Hirschfeld supervised the first recorded sex reassignment surgery in Berlin sometime during 1930-1931. The earliest surgeries primarily consisted of the removal of the male sex organs, though unsuccessful uterine transplants were attempted. Although the mother of the boy ceased contact after her departure for Germany, Benjamin continued to refine his understanding of her boy's condition, and in 1954 he reprised the term "transsexualism," which had been coined by Hirschfeld in 1923. Benjamin went on to treat several hundred similar patients in a similar manner, often without accepting payment.
From early on, then, scientists have identified separate communities of people — those who wished to dress as the opposite sex and those who wished to become the opposite sex. Although a much wider spectrum of gender identities currently exists, only now can the original ideas of transvestism and transsexualism be fully explored in a scientific way. And such is the case with the researchers at the UCLA School of Medicine who hoped to pinpoint more concrete factors influencing gender identity.

Transgender-Inclusive Benefits for Employees and Dependents

Medically necessary treatments and procedures, such as those defined by the World Professional Association for Transgender Health's Standards of Care for Gender Identity Disorders, should be included in employer-provided healthcare and short-term disability coverage.
Transgender people face many forms of discrimination in the provision of health insurance. Employers, as consumers of group health insurance products, can advocate on behalf of the transgender people insured on their group health insurance plans. Employers should work with their insurance carriers or administrators to remove transgender exclusions and provide comprehensive transgender-inclusive insurance coverage.
The American Medical Association  joined the movement to end discrimination in health insurance for transgender people by passing the following resolution at their annual meeting in June 2008:
"RESOLVED, That our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder as recommended by a physician."

Thinking about transitioning?

This is a major life altering step and of course you want to be sure. There are many articles available and more psychologists are becoming familiar with gender dysphoria. Know yourself is the best advise I can give. This step can affect your ability to earn a living and that is critical to having a pleasant life.

Make sure you have the money to finance yourself and any surgery you need. Some insurance companies are beginning to include surgery, doctor visits and hormones in their plan, but the majority do not at this time. I went to Bangkok where there are skilled surgeons a a more affordable price.

The first step is to make sure you have a trade, skill  or college degrees that will assure your income. These make you more marketable and assures your income. It also improves social acceptance. Nobody wants to be a social outcast or resort to the sex trade to survive. First things first.
Best wishes to all... Plan this with care.

What can I do about this? Is there hope for me?

    Yes, there is. Indeed, there are a multitude of options open to you, and in certain ways you can consider yourself spoilt for choices. The real issue is making certain you truly know what you want. Once you know that, I assure you that you can actually, truly achieve it....depending on a few factors which I will explain.For the classic, 'true' transsexual, such as your author, the future is very clean cut and straightforward. If you are less defined, if you are unsure or unclear, if your issues are not beyond question, then the multitude of choices become worth examination. Let us take this step by step.
    A classic, or 'true' transsexual follows a fairly predictable pattern, with a rather predictable and common life story. The basic cookie cutter version is easily summarized.

    The classic transsexual is aware of gender conflict at a very early stage in life, usually somewhere around the age of five. The gender issue causes problems throughout life, because the transsexual  cannot entirely suppress or deny the truth of their identity altogether, despite social pressure to do so. As time goes on, the agony of gender dysphoria, and a life of misery and self-denial, becomes unendurable and something must be done about it, either to correct it, or to permanently stop the suffering. For the latter group, the answer is too commonly suicide, but for the former, the answer is very standardized: hormones, followed usually by surgery.

How Gender Reassignment Works

As you were growing up, how did you know you were a girl or a boy? Was it because you had a vagina or a penis? Or was it something more than your physiology? Some people feel that their minds and bodies don’t quite match up. This feeling is commonly known as transsexualism — a type of gender identity disorder. Transsexuals are dissatisfied with their sexual identity, body characteristics or gender role. They wish to live as the opposite gender and may transform their bodies through gender reassignment surgery — a collection of procedures commonly known as a “sex change.”
Gender identity struggles usually begin in early childhood but have been identified in people of all ages. A biologically born man who identifies as a woman is known as transwoman, or transsexual woman. Labels like cross-dresser, transvestite, drag queen or drag king are not interchangeable with transsexual. However, transgender is used as a general, non-medical term to describe anyone with any type of gender identity issue.
It’s estimated that one in 11,900 males are transsexual adults [source: WPATH Standards of Care]. Lynn Conway, a professor emerita at the University of Michigan, estimates that one in 2,500 United States citizens has undergone male-to-female gender reassignment surgery [source: Advocate]. — at Chris Tina Bruce Fitness.

Your Transsexual Road Map

So you have decided to transition from one gender to another.
 What next?
 Have you decided how far you are going to go? Do you want hormones?

 Are you going to get gender reassignment surgery and if so, where can you get the proper services? You need to plan out your transsexual road map, a plan of who, what, where, when and how. A plan that will help guide you through the days to come. Have patience, persistence and proper preparation and you will glide through your transition to become the beautiful butterfly we all know you are!


Billie Rene: my advise... KNOW YOURSELF... REALLY WELL!!!!!

I just read this interesting viewpoint..
"Being trans* is kind of like a crayon coming out of the factory with the wrong wrapper. It's a blue (or pink) crayon, and it's wrapper says pink (or blue), but it's true colors are on the inside. When someone opens the box, some will return it to the box as if it were wrong to use, some will break it in half, and some will cherish it because it's "one-of-a-kind". But it's those who choose to remove the wrong wrapper and replace it with the correct one, that truly make a difference. Be true to your colors..."

 "It isn't easy being green", Kermit the Frog, but green we are so understand yourself because if you don't nobody else will regardless of professional certifications. You are the only one who knows, hopefully, and it is your job to sort it out because others can only contribute ideas.

 If you need surgery, you will need a psychiatrist to give you a letter. Make sure you get someone who actually knows about transgender issues, because many do not. A knowledgeable, understanding person can actually help you understand yourself, but again this is mostly based on what they learned elsewhere.

 MY SUGGESTION.. read a lot about everything as many experiences are similar. On the other hand, it isn't easy distinguishing the various influences that affect one's life. Know about the various medical options and surgeries... and if you choose surgery, pick someone with an excellent reputation.

 There are many internet resources including mine...
 Very best wishes, I wish you well!!!


How to develop a female voice

Truth be told... I can't pass on the phone and guess what, it doesn't matter, But I have raised the pitch and reduced resonance with practice so some cisgendered women are deeper than me and I speak more quietly. As women get older their voices deepen some because of smoking.  Some cisgender girls tell me they are "Sir'd" too. When people see me they may recognize the obvious depending on their "transdar".  I was a guy and now I am not. No problem. It may actually promotes understanding of transpeople.

When I go to the store, I am very well received. The other day one person gave me a big hug. WOW, I have so many friends now. I never expected this.  SOooo, I guess voice is one more thing I don't need to think about. Friendly attitude and presentation are important for me.

  You can be very passable in your appearance, but if you speak in a masculine voice you've just outed yourself . . .

 It amazes me how many transsexual women speak in a masculine-sounding voice, even post-ops. They'll spend thousands on hormones, electrolysis, surgery, etc. but won't make the effort to retrain their voices.  If you don't mind getting sir'd on the phone, or even in public, go ahead and talk like a man. But if you want to pass as a woman your voice is important.

Another reason to speak in a female voice is, whether we like it or not, we're all ambassadors for the trans community. People will often base their opinions of us on first impressions. If you speak in a male voice, not only will there be incongruity between your voice and appearance, but it will tend to make people relate to us more as drag queens and crossdressers—an image we need to get away from.

 Any male voice can be retrained. Don't be discouraged if you're starting with a baritone! For proof that your voice can be changed, try talking in falsetto. Obviously, it sounds silly and I don't recommend talking in falsetto, but it shows even the deepest voice can be raised.

Just like your walk, you're unlearning years of doing something in a masculine way. You're retraining your throat muscles. It was two-and-half months before I started getting ma'am on the phone and it may take a year, or more, before your voice sounds good in all situations, like yelling.

Will hormones make your voice higher? Unless you started HRT at the onset of, or early, puberty before your voice changed, hormones will have no effect on pitch, though estrogen will tend to soften the voice.

What about vocal surgery? That's an option and can take the worry out of whether you'll get clocked when you speak. I know three trans women who've had vocal surgery. Two sounded good and one didn't, she sounded raspy (I guess two out of three ain't bad). As with most surgery, the outcome of voice surgery isn't certain. Explore your options and educate yourself about vocal surgery before deciding. If you don't want surgery some voice training is usually required.

Vocal Feminization: Surgery - Experimental and risky

Some have said it is better this way.  I am accepted and have more friends than before.
manners, attitude and presentation seem more important

ARTICLE: There are several surgical methods of vocal cord alterations being performed.
I do not recommend existing voice surgery techniques based on results I've heard. To date, I have met or spoken to 14 people in person who have had vocal cord surgery. Of these, 12 have what I consider poor results. Two have acceptable results, and of these two, one has very good results.
How unacceptable?
One woman I know sounds like slightly deeper version Minnie Mouse, or maybe Michael Jackson. On the other end of the spectrum are two women who sound like a hoarse Bea Arthur, or Marge Simpson's sisters Selma and Patty. Most don't sound much different than before surgery.
Katherine writes:
I, too, looked into "voice surgery", just before my SRS two years ago.  After speaking on the phone to about 6 people who had had it done, I was scared off it forever. They all had the weirdest, squeakiest voices, and one said that after about half the day, her voice would give out altogether. AND all told me that they could no longer sing -- the end of the subject for me! I'd as soon give up singing as most men would give up their penises.
JulieAnne is an ENT (ear, nose and, throat) surgeon who writes:
Differences in the way people heal will affect the eventual outcome and this is something the surgeon often has no control over. I hope any surgeon would discuss this with their patient so they can make an intelligent decision about proceeding with this type of surgery.
A reader sent this comment in June 2005:
Hello again, I wanted to send you a short note to "follow-up" with my experience with voice surgery, as you had an entire page dedicated to it.  After having the CTA surgery July 2004 in Portland, I can confidently say it isn't in any way a cure-all procedure.  My voice was not masculine to begin with, but it was at a level (I thought) sounded like a 16 year old feminine gay guy.  CTA helped me a very small bit, especially being able to raise my voice to someone across the room or laugh, but it wasn't a miracle.  Along with changing my speech patterns I was able to improve a great deal on my voice.  So what many people have said about voice surgery still remains true ;^). Hopefully someday they'll come out with something better surgery-wise!

Tom Waddell Health Center Transgender Protocals

The Tom Waddell Health Center is a center in San Francisco operated by the Department of Health. They have a clinic specializing in transgender care.
The Transgender Clinic of Tom Waddell Health Center has been in operation since November of 1993 and is committed to providing quality, integrated health care in an atmosphere of trust and respect. We are a multidisciplinary primary care clinic focusing primarily on the needs of underserved populations of inner city San Francisco. Primary care means we treat your whole body, not just your gender issues. Being multidisciplinary means we address all your concerns, not just your medical problems. We have nutritional, mental health and social services, and we work closely with community organizations.

Read the Tom Waddell Protocals

Finding Insurance for Transgender-Related Healthcare

This is a partial-list of insurance options. Some carriers, employers and states may additional options, but exclusion of transsexual coverage should be banned as it is caused by hormonal conditions in the womb prior to birth. This is not expensive because demographics and experience indicates that only a few with to receive surgical services.

ARTICLE: The following insurance carriers have available plans without blanket exclusions for transgender-related healthcare. Below is a list of direct links to the carriers’ websites where major guidelines for transgender-related treatments are openly available. Please feel free to consult these resources as you evaluate your employer’s health plan and determine whether or not it covers medically necessary treatments associated with a healthy gender transition.

Study: Castration Adds Years to Men's Lives

It's suspected that there is a biological trade-off between reproduction and longevity, the theory being that our mechanisms of repairing damaged genetic material are limited and thus relegated to the most evolutionarily advantageous repair work. Propagating our genes, it would follow, trumps living to see/attempting to control the lives of proceeding generations. The male sex hormone is implicated in this theory, and taking into account that fact that women tend to live significantly longer than men, may be responsible for limiting men's lifespan.

METHODOLOGY: Because sometimes you can't offer enough cash or college credit to put together a randomized control experiment, researchers did a (very) retrospective study of Korean eunuchs from the Chosun dynasty, which stretched from the late 14th to the early 20th century. The eunuchs, a class of nobles employed as guards at the royal palace, preserved their lineage through the adoption of castrated sons and kept detailed genealogical records, which the researchers cross-verified with other historical accounts. 

RESULTS: Averaging a lifespan of 70 years, the eunuchs lived about 14 to 19 years longer than cohorts from a similar socio-economic background. The group of 81 eunuchs included three centenarians among their ranks -- making them 130 times more likely to celebrate their 100th birthday than, for example, men in the present-day U.S.


1.  PURPOSE:  This Veterans Health Administration (VHA) Directive establishes policy
regarding the respectful delivery of health care to transgender and intersex Veterans who are
enrolled in the Department of Veterans Affairs (VA) health care system or are otherwise eligible
for VA care.

2.  BACKGROUND:  In accordance with the medical benefits package (title 38 Code of Federal
Regulations (CFR) section 17.38), VA provides care and treatment to Veterans that is compatible
with generally accepted standards of medical practice and determined by appropriate health care
professionals to promote, preserve, or restore the health of the individual.

a.  VA provides health care for transgender patients, including those who present at various
points on their transition from one gender to the next.  This applies to all Veterans who are
enrolled in VA’s health care system or are otherwise eligible for VA care, including those who
have had sex reassignment surgery outside of VHA, those who might be considering such
surgical intervention, and those who do not wish to undergo sex reassignment surgery but selfidentify as transgender. Intersex individuals may or may not have interest in changing gender or
in acting in ways that are discordant with their assigned gender.

b.  VA does not provide sex reassignment surgery or plastic reconstructive surgery for
strictly cosmetic purposes.

Transgender Health Coverage: California & Oregon Direct Insurance Companies To Provide It

 Regulators in Oregon and California have quietly directed some health insurance companies to stop denying coverage for transgender patients because of their gender identity.
The states aren't requiring coverage of specific medical treatments. But they told some private insurance companies they must pay for a transgender person's hormone therapy, breast reduction, cancer screening or any other procedure deemed medically necessary if they cover it for patients who aren't transgender.
The changes apply to companies insuring about a third of Oregonians and about 7 percent of Californians, but not to people on Medicare and Medicaid or to the majority of Californians who are insured through a health management organization, or HMO.
Advocacy groups said the action is a major step forward in their long battle to win better health care coverage for transgender Americans.
"It's just a matter of fairness," said Ray Crider, a 28-year-old transgender man from Portland. "I just never felt that I was like anybody else. I see everybody else being taken care of without having to fight the system."
Officials in both states said the new regulations aren't new policies but merely a clarification of anti-discrimination laws passed in California in 2005 and in Oregon two years later.
Many health insurance policies broadly exclude coverage of gender identity disorder or classify it as a pre-existing condition. Transgender patients are often denied coverage for medical procedures unrelated to a gender transition, advocacy groups said, because insurance companies deem the condition to be related to their sex reassignment.
Some transgender patients also have trouble getting access to gender-specific care. A person who identifies as a man might be denied coverage for ovarian cancer screening or a hysterectomy. A transgender woman might be denied a prostate screening.
The state insurance regulators said those procedures, if covered for anybody, must be covered for all patients regardless of their gender. Masen Davis, director of the Transgender Law Center in San Francisco, said he's unaware of insurance regulators in any other state taking similar action.
The California regulations took effect in September and apply only to insurance products regulated by the California Department of Insurance. The agency primarily regulates preferred provider plans, or PPOs, that covered about 7 percent of the population in 2010, according to data from the California Health Care Foundation.
The agency that regulates California HMOs has discussed transgender care with consumer groups and health plans, "but no regulations have yet been proposed or adopted," said Marta Bortner Green, a spokeswoman for the Department of Managed Health Care.

Re: How to tell the doctor I'm transsexual. Any tips?

Here are a couple messages that I received in an email...
Many are apprehensive in telling their doctor, but doctors already know about transgenderism although many do not have a lot of experience. 

ARTICLE: Isn't it cool when we find out we were putting ourselves thru a hell because we were afraid to tell someone about us and when we do we find out it's really no big deal..Its called self torture, lack of confidence in other people to understand, especially our Doctors..I personally want my doctor to know everything, if I'm screwed up or not, it gives them a better perspective of you as a patient and makes asking for help a lot easier...

> I know exactly what you are going through. I was self medicating on and off for 4 years and full regime since last April. I have developed pretty fairly considering that I have been taking hormones for 5 years but almost a third of that time I was off of HRT and only full time for 9 months. I was very nervous about coming out to my doctor but I just couldn't pretend I was a male any longer and decided that I would tell my doctor as well as my employer I was trans. I was very surprised that my employer was so understanding and supportive and my doctor wasn't upset at all. My doctor took lab tests and suggested I get involved with a support group and counseling. She (my doctor) wants to see me again in 3 months to do another set of labs and adjust my hormones if necessary.

> I was so scared to come out to her that I started crying when telling her and she comforted me. What was supposed to be a 15 minute office visit lasted almost 2 hours because she was so supportive and listened to me for a long time. I am happy that I decided to inform her of my HRT and that I was transsexual and wish I had done it earlier. Perhaps I wouldn't have stopped taking the hormones on and off so often because my medical insurance will pay for all of the hormones. I quite several times because I was faced with food and housing or hormones, not a good choice. Now i can have both without worry.