Cock Talk (Part 2)

March 27, 2013 in inQueery

In the first part of this article we laid out some of the options available for transgender individuals in pursuing varying methods to express their gender identity. This second part provides a more detailed and intricate discussion of the kinds of access, resources available to, and challenges transgender people face when pursuing medical procedures to physically change their bodies to match their gender identity, as well as Zander Keig’s positive experiences of these surgeries.

Insurance Challenges and Access
When Keig underwent his procedures, he was guaranteed coverage up to $75,000. Yet, this isn’t always the case. Since his wife worked for The City & County of San Francisco, his insurance provider paid $65,000, covering most of the expenses. For those wishing to pursue a medical procedure as part of their embodied experience, insurance is not necessarily guaranteed. It is also complicated by the fact that most insurance companies participate in a medicalized structure, wherein “‘multiple genders’ often remain dependent on a morphological notion of ‘sex’” (Hird). In a clinical policy bulletin that was last reviewed in January of 2013, Aetna noted that most of their plans “exclude coverage of sex change surgery” (Aetna). Though if the procedure is deemed medically necessary by the satisfaction of seventeen criteria, then coverage is provided. Aetna is not alone in this exclusive policy (Human Rights Campaign Foundation).

Meanwhile, the American Medical Association, the National Association of Social Workers, and the American Psychological Association all have implored the inclusion of all individuals to relevant health insurance coverage, particularly noting the need to provide coverage for transgender individuals (Am. Med. Assoc. House Delegates; Social Work Speaks; Am. Psych. Assoc. Council of Rep.). Though medical procedures may reflect a rigidity in the conceptualization of transgender embodiment with respect to a strict gender binary, the availability of insurance coverage could provide for some individuals the resources necessary to pursue their gender identity more fully.

As is often the case with healthcare, having the insurance coverage is just one piece of the puzzle. Learning how to navigate the system to access potential coverage requires a certain set of skills: assertiveness to locate individuals who will assist in the paperwork processing, confidence to interact with various medical care providers who must “approve” the surgeries, inquisitiveness to ascertain who all of the individuals are that make arrangements for travel, lodging and medical procedures, and discernment to be able to weigh all of the options being made available. For Keig, being a social worker made this advocacy and bureaucracy maneuvering rather easy!

Satisfaction in a New Context
“I am more comfortable in my body, I have fewer concerns regarding interactions with medical care providers, and I have experienced a shift in identity from feeling male to being a man,” shares Keig. With all of the medical procedures and social stigma, most individuals who elect to participate in and successfully complete a transgender-related procedure feel markedly happy, noting positive shifts in their social and personal life (Rehman). With regard to procedures, there are many misconceptions surrounding their efficacy. Nevertheless, these concerns can be better explored through several resources.

Anthologies and individual experiences can provide accurate and detailed accounts of some of these medical procedures. Keig contributed his personal account of being a transgender patient to the anthology, Hung Jury: Testimonies of Genital Reconstruction by Transsexual Men (Transgress Press, 2012). Hung Jury provides the reader with several first-person narratives concerning the “bottom” surgery journey. The community pursuing this particular anatomical change too often hears negative stories that are not necessarily first-hand accounts. This anthology is creating a paradigm shift in the social and intimate conceptualization of phalloplasty (i.e. (re)construction of a penis).

For some, the transgender experience may never result in a visit to the doctor’s office. While, for others being transgender results in the pursuit of the surgeries discussed above as a part of their overall journey. The paradigm is shifting for those who wish to pursue medical support and it includes this refocus on varying procedures’ potential efficacies and abilities to bring about a positive shift in some lives.

Resources & The Pacific Center
For individuals who wish to pursue a greater understanding of the medical portion of the transgender experience, several publications and support groups exist. The Pacific Center hosts an FTM Support Group, wherein individuals identifying with various genders and sexual orientations can meet on Wednesday evenings. Keig himself periodically attends this group and “really enjoys the camaraderie” and speaks to its social, economic, racial, and age diversity. When there, you could also pick up a wide range of books at the Pacific Center library, including Keig’s anthology, the Lambda Literary Finalist, Letters for my Brothers: Transitional Wisdom in Retrospect (Wilgefortis, 2011).

Through the experiences of Keig and the prevalence of relevant medical and social literature, exploring transgender procedures should be an enlightening and hopeful process. Begin by speaking with your primary care provider about your health readiness, says Keig, and develop a network of individuals who have completed their journey toward their own understanding of their gender. Become familiar with the WPATH Standards of Care (Coleman et al.), and “build a support network of family and friends who will be available for you post-surgery.”


    References

  • Aetna. 2013. Clinical Policy Bulletin: Gender Reassignment Surgery (Number: 0615). www.aetna.com/cpb/medical/data/600_699/0615.html
  • American Medical Association House of Delegates. 2008. Removing Financial Barriers to Care for Transgendered Patients. Washington, DC. http://www.tgender.net/taw/ama_resolutions.pdf
  • American Psychological Association Council of Representatives. 2008. Transgender, Gender Identity, & Gender Expression Non-Discrimination. Washington, DC. http://www.apa.org/about/policy/transgender.aspx
  • Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., Fraser, L., Green, J., Knudson, G., Meyer, W. J., Monstrey, S., Adler, R. K., Brown, G. R., Devor, A. H., Ehrbar, R., Ettner, R., Eyler, E., Garofalo, R., Karasic, D. H., Lev, A. I., Mayer, G., Meyer-Bahlburg, H., Hall, B. P., Pfaefflin, F., Rachlin, K., Robinson, B., Schechter, L. S., Tangpricha, V., van Trotsenburg, M., Vitale, A., Winter, S., Whittle, S., Wylie, K. R., & Zucker, K.. 2011. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Intl. J. Transgenderism. 13: 165-232.
  • Heyes, C.J. 2003. Feminist Solidarity After Queer Theory: The Case of Transgender. Signs 28(4): 1093-1120. doi: 10.1086/343132
  • Hird, M.J. 2000. Gender’s nature: Intersexuality, transsexualism and the ‘sex’/’gender’ binary. Feminist Theory 1(3): 347-364. doi: 10.1177/146470010000100305
  • Horton, M.A.. 2008. The Incidence and Prevalence of SRS among US Residents. Transgender at Work.
  • Human Rights Campaign Foundation. 2012. Transgender-Inclusive Health Care Coverage and the Corporate Equality Index. Washington, DC. www.hrc.org/transbenefits
  • Rehman, J., Lazer, S., Benet, A.E., Schaefer, L.C. & Melman, A.. 1999. The Reported Sex and Surgery Satisfactions of 28 Postoperative Male-to-Female Transsexual Patients. Arch. Sex. Behav. 28(1): 71-89.
  • Social Work Speaks. 2009. Transgender and Gender Identity Issues. NASW Press; Washington DC.