CT deemed too restrictive on patients seeking gender-affirming surgery
Based on a 2022 study from the Williams Institute at UCLA, more than 1.6 million people in the U.S. over the age of 13 identify as transgender. Transgender individuals may feel conflicted between their sex at birth and the gender with which they identify.
This conflict can become such a source of anxiety and distress that it is termed “gender dysphoria.” While not every transgender individual experiences it, many people seek gender-affirming treatments from hormone replacements to surgery, genital or non-genital. With these treatments, they can finally feel on the outside how they feel on the inside.
“People I know who have gone through medical transition experience relief, feeling like themselves for the first time, even a desire to live that wasn’t previously present,” explained Alex Solomon, MSW, a clinical social worker in Glastonbury. “Hormones and surgeries are truly lifesaving.”
Christy Olezeski, PhD, associate professor at the Yale School of Medicine and director of the Yale Gender Program, reflected a similar point of view.
“When someone reports that they need a specific intervention to feel like their body and/or physical appearance is congruent with their gender identity, it is medically necessary to provide such care.” she said in an email. “When providers discuss this care as lifesaving, they mean that gender-affirming care results in less depression and lowered odds of suicidal ideation and suicidal attempts. Therefore, such care can indeed be lifesaving.”
She said gender affirming care is endorsed by every major medical organization including the American Medical Association, American Academy of Pediatrics, American Psychological Association and the American Academy for Child and Adolescent Psychiatry.
Some states, including Connecticut, have placed restrictions on gender-affirming surgery that have been criticized as too harsh and unnecessary.
A coalition of at least 20 mental health care providers, including Solomon who organized it, are less than thrilled with these restrictions. The state’s Department of Social Services (DSS) placed such requirements as proof of being transgender for at least a year (with the allowance of a legal name change as proof) and letters from multiple mental health providers, which initially had to include a provider with a doctorate. (The state has since dropped the doctorate requirement).
Connecticut also requires a mental health letter from a prescriber saying any mental health or substance abuse conditions are stable before any surgery is to be covered. The state still has a blanket denial of coverage on minors under 18 being allowed to undergo gender-affirming treatments.
Solomon, who prefers the pronouns of they/them, verbalized her frustration after a client was denied last minute for scheduled surgery in April. Solomon reached out to other providers to see if that group was also having the same experience. Collectively, the group wrote and distributed a letter this past May, got a reply, and returned that reply. Since then, they said the DSS has refused further contact.
Connecticut is not unique in these healthcare restrictions. Last year, more than two dozen states sought to restrict or ban gender-affirming health care in transgender youths. And this year, about 20 separate bills targeting transgender medical care were pre-filed in at least nine states—New Hampshire, Missouri, Montana, Oklahoma, South Carolina, Tennessee, Texas, Utah, and Virginia—for the legislative session.
(New Hampshire seeks to prohibit gender transition procedures in minors and reclassify conversion therapy, which is a practice that has been widely discredited).
The Associated Press reported in mid-January that South Dakota introduced a bill to outlaw gender-affirming healthcare—banning access to puberty blocking drugs and surgeries—for transgender youths under age 18.
“Just because states are banning care does not mean transgender individuals will ‘go away,’” Olezeski noted. “People will have to find providers who will follow the guidelines put forth by major medical organizations and may be forced to move to states that offer care or find alternative avenues for treatment, including Connecticut.”
Olezeski said banning healthcare for transgender and nonbinary individuals is political in nature and not reflective of the peer-reviewed research that shows the positive effects of treatment.
She noted that many bills are based solely on outdated research or research that has many methodological flaws and do not recognize or follow the guidelines and recommendations of all major medical institutions on this subject.
But what about “detransitioning?”
A Fox News report published in late December 2022 highlighted individuals who had some form of gender-affirming surgery, regretted the decision, and have attempted to revert to their birth sex.
The article cited a 2021 study from the Institute for Comprehensive Gender Dysphoria Research showing over half the individuals who detransitioned did not receive adequate mental health evaluations before their gender-affirming surgery. The argument that gender-affirming surgery was necessary to offset suicidality was countered—no evidence suggested there hadn’t been suicidality in transgender individuals before, during and after their surgery.
Solomon had this response: “There are people who detransition. The percentage of people who do so is incredibly small, and more than half report doing so because of societal discrimination and not because [of] their identity. The statistics also show that feelings of regret for gender surgery are far lower than for other surgeries generally. So, the issue of detransitioning is really a red herring.”
Ace Ricker, a trans man, vocal advocate for the LGBTQ community, and the founder of his consulting firm Awareness through Communication & Education, agreed with Solomon.
“I know very few people who have transitioned. Maybe three, and all of them did so because of a lack of resources,” he said. “For many people, they may not have the financial means to continue and that brings about a whole rollercoaster of emotions. It may not have been their choice to detransition and that brings a lot of anguish.”
Olezeski contrasted detransitioning with the following data. “Statistically, the number of individuals who regret having knee surgery (17.1%), chest reconstruction following a mastectomy due to cancer (19.5%) and hip replacement (4.8%) are much higher,” she explained. “Would lawmakers also choose to ban hip replacements, knee surgeries or breast augmentations because of these much higher regret rates? If the answer is no, then we should not be banning gender affirming surgeries.”
Ricker mentioned there are people who come to Connecticut because of the anti-discrimination laws in areas like employment and housing set at least a decade ago. But while people may be seeking a more accepting environment, there are still people that aren’t aware of the laws and that’s frustrating.
“You come to a state thinking they have the resources you need,” he said, “and then there are hurdles to getting those resources. [It’s] like having a carrot dangled in front of you.”
February 5th, 2023 at 12:41 pm Jessica posted:
I feel it’s dishonest/inappropriate to conflate the elective cosmetic surgeries/appearance-altering hormones involved in transitioning with knee/hip replacement and cancer-related mastectomies. A patient with cancer gets a mastectomy as a desperate measure with the hopes of preventing a potentially terminal reoccurrence and metastasis. Joint replacement surgeries are procedures in which the patient is likely experiencing serious PHYSICAL impairments/pain from failing joints – regret likely stems from the surgeries not improving their pain/physical functioning.
Gender-affirming care, as the Doctor quoted in the article states, is ‘necessary’ to address ‘internal feelings’ stemming from the patient’s battle with their body image, the patient desires to look different than they are and feel distressed because they do not look how they want to look. The doctor in the article states these procedures are necessary because the patient cannot avoid depression or suicidal feelings without them. The necessity for these procedures does not arise from a physical issue, but rather an emotional/feeling need – a psychological need. I think it would be more appropriate to compare plastic surgery regret stats (which have higher regret rates than the examples listed), as the reason a patient seeks out plastic surgery aligns more closely with why a patient seeks out hormones/bottom/top surgery (dissatisfaction with appearance, desire to alter appearance to make oneself feel more comfortable with their body) than the reason for cancer-related mastectomies or joint replacement (avoiding dying of cancer, avoiding pain and loss of functioning from a physically failing joint). I’m wondering if the author of the article seeks to avoid implying gender-affirming care-related procedures are at all optional, or perhaps the comparison, in general, is a can of worms to avoid opening.