In continuing the discussion on gender-affirming care, I wanted to take this opportunity to speak about my personal experience this Transgender Awareness Week, Nov. 13-19, 2023. I was lucky enough to get top surgery this past September. Going through this experience and recounting the process to get this procedure opened my eyes to the disparities in our healthcare system when it comes to these lifesaving treatments. I would be remiss not to recognize my experience came with a great deal of privilege; I was able to afford the procedure, take the time off to recover risk-free, and I had support from people in my life. I also recognize this is not the case for the majority of people seeking this same procedure.
I hope by sharing my experience and some of my gained knowledge, I can help normalize these procedures, as well as highlight the disparities people face when it comes to transgender healthcare access.
Gender-affirming medical procedures, such as top surgery, are generally not a last-minute decision. In my case, it feels particularly delayed. Having gone most of my life never hearing the words “nonbinary” or “gender dysphoria,” I spent a large portion of my life assuming if I had no words to describe how I felt, then I just needed to learn to accept what I was given. Had I learned this terminology at a younger age I would have come out and been able to assess my need for this surgery much sooner. So anti-LGBTQIA+ legislation hits particularly hard for someone who wishes they had seen better representation growing up. According to the Center for American Progress more than 300 bills targeting the rights of LGBTQI+ people were introduced by state lawmakers in 2022 alone.
Once I decided I needed this procedure, the next step was finding a doctor. I was grateful to receive a solid recommendation for a local surgeon from someone close to me who had the procedure and a positive experience. Most folks aren’t that lucky. Finding a doctor you trust is already an intimidating task, but finding a surgeon you feel confident in and safe around means looking at out-of-state options. According to studies done in 2022, more than 50% of people needing gender-affirming surgeries went out of state, which means they had to pay up to 50% more out-of-pocket costs than instate patients.
This doesn’t even address the financial barriers that exist for trans and gender-nonconforming (GNC) folks. Prohibitive healthcare costs — due to no insurance, discriminatory health insurance policies with large out-of-pocket costs or other economic insecurities — can lead to healthcare delays or avoidance for some LGBTQI+ people.
For my procedure, I decided not to go through my insurance. Again, I recognize this is a privilege. While the company I work for does an excellent job ensuring we have proper coverage and support for our medical needs, it is not able to control what policies the insurance companies have in place for access to gender-affirming care. In order to get insurance coverage for these procedures, patients need to provide proof that the procedure is medically necessary, including referral letters from a psychologist or psychiatrist (and often both), persistent and well documented gender dysphoria from a healthcare professional and more.
For most of my adult life, I avoided going to a doctor. Without having a name for how I felt, I was convinced I would be seen as crazy — so I believed I was untreatable. This meant I didn’t have persistently documented gender dysphoria from a doctor. Avoiding medical care is an unfortunate reality for many trans and gender-nonconforming folks. More than 1 in 5 LGBTQI+ adults reported postponing or avoiding medical care in 2022 due to disrespect or discrimination by providers.
As I continue my smooth recovery from top surgery — and rejoice in my newfound ability to comfortably button up a shirt — I am going into Transgender Awareness Week with a newfound appreciation of everything transgender and GNC folks have to endure to access this transformative and lifesaving healthcare.
Personally, this has been one of the most positive changes I have made for myself. Trying on clothing feels right for the first time since childhood, and I can smile at myself in the mirror.
If you are inspired to do more, please consider donating to organizations such as Trans Youth Equality Organization. They provide education, advocacy and support for transgender, nonbinary and gender-nonconforming youth and their families. Or if you want to take a local approach, check out this list from Them on how you can get involved with organizations supporting trans people in your state.