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."