The whole thing about insurance companies paying for gender reassignment is a topic I find very interesting.

Because for it to be considered medically necessary, it would have to be considered a medical "defect" in a way, like a mental illness that needs a medical "cure." Yet I doubt many trans folk would want to see themselves as essentially suffering from a mental disorder, but would demand/want their surgeries to be covered.

But I have no idea what goes through the head of someone who feels they were born in the wrong type of physical body.

Oh, I never knew how nice it could be to click Paypal's "Pay Now" button while weeping happily. So great. THANK YOU.

@1 I am not trans nor do I purport to speak for the trans community but I think you're looking at this wrong. When the body doesn't match the brain the body has the disorder not the brain. Fixing that disconnect brings everything in line.

On another note clearly we have won, it's now just a waiting game.

@1 - Breast reduction surgeries are often covered for health reasons. So even the breasts in themselves are healthy or functional, in the ecology of the person's body and overall health (like back health), they are causing a problem. I don't see much difference here.

Another way to look at it could be men who develop excessive breast tissue and want it removed (see: German honor guard) - that would probably be considered acceptable and healthy/normal by most too.

today's youth are absolutely AMAZING

First Republicans supporting gay marriage and now frat brothers being cool and supportive? These guys are from Bizarro-universe, right? I hope they stay...

Kudos for them!

@1, have you read Far From the Tree by Andrew Solomon? It's a remarkably fascinating book about families whose children have some kind of difference from the parents -- deafness, dwarfism, transgenderism, genius, etc. Your question comes up a lot in the book. In communities that have differences, part of activism is to increase acceptance, which depends on people acknowledging that these are differences, not disabilities. The other part of activism is to procure better accommodation, which depends on the difference being construed as a disability. Anyway, awesome book.

I like what @3 says. I wonder, though...would insurance cover reduction for old guys with man-boobs? This is a devil's advocate question, I know, but I think it's relevant...what really are the differences between transgenderism and other ways of feeling that your body, or part of it, is not appropriate?

@1, I've had similar questions. If Body Dysmorphic Disorder is removed from the DSM-V (as I think it will be), then how will transfolks get insurance companies to pay for treatment? I understand not wanting to be labeled as broken or sick or wrong, but the practical reality is that one must be labeled as such in order to get treatment.

I want to ask a question here.

I am very pro lgtb and have devoted lots of time and money to the general cause, but the trans mindset really baffles me. I was reading a blog entry by a woman who wants to be a straight man, and how she bitterly hates her female parts and wants to utterly destroy them.

As a straight man myself, I was just dumbfounded as to how that was possible. As a straight man I absolutely love those parts and to wish their complete destruction seems horrible. How is this possible?

(Apologies if I cant use proper terminology, it's office computer policy.)

@10, as a straight man, you love vaginas bc you want to fuck them, and you love your dick because you want to fuck with it. If you woke up one morning with a vagina instead of a dick, you might start to hate it, right? Because its something you want to fuck, not fuck with.

Also, the trans man in the blog? His "parts" are not yours. Your opinion about them has no effect on his feelings.

@3: Problem is, you are making what accounts to a philosophical argument that, as far as I know, is unsupported by medical science (possibly unsupportable as far as medical evidence goes), and so will have no real basis when it comes to law making, or the medical policies of insurance companies.

While it is quite possible you are correct, it will unfortunately have little bearing on the situation. Especially considering how other similar dysmorphic type issues, such as anorexia, are often successfully treated by therapy, not physical means. I can see many doctors seeing gender dysmorphia as really no different from disorders like anorexia that also cause the mental image of the body to not match the physical reality.

@4: But breast reduction surgeries must be proven to be medically necessary to be covered. For example, my girlfriend got one years ago, and she had to prove that she had back pain caused by those big ol' breasts for insurance to cover part of it. So this would not be an option for the majority of FTM operations.

@8: Thanks, I will look into that one, and I think your last question, while it may be seen as somewhat rude to certain people, does need to be addressed.

@ 12, I think it's pretty well supported by medical science. It's just a hunch, but it's based on the fact that people have to go through lengthy psychological evaluations as well as physical examinations before a doctor will agree to hormone treatments and, eventually, gender reassignment surgery. It's not like breast implants, which can be had by any woman with the money and the desire to get them.

I take this on faith (but one based on what little I do know, both about gender reassignment and also how good doctors practice), so I have little personal interest in researching it further. But others have suggested resources, so if I were you, I'd read up and learn.

@1, insurance does often cover medical needs that are not necessarily defects, such as pregnancy and childbirth.
@10, there's a big difference between female parts on a happy woman and female parts on an unhappy man.

Also, I meant to post that this is a beautiful story. Sometimes you think people just suck, and then they come along and do something like this...

@9 Body Dysmorphic Disorder was not removed from the DSM V, but Trans folks were never diagnosed with that condition (right now it only applies to people who are compelled to amputate a body part - completely distinct from their gender identity). They used to be diagnosed with GID, Gender Identity Disorder, which diagnosed their desire to identify with the gender opposite of their assigned sex as a disorder. In the DSM V, this was replaced with Gender Dysphoria, which identifies the emotional and psychological stress of being assigned a sex that is the opposite of one's perceived/experienced gender identity as the disorder, which can only be corrected by medically assigning someone a sex that is congruent with their internal gender identity. It has moved the root of the disorder from identifying with the gender opposite to the sex assigned at birth to the distress caused by being assigned the wrong sex.

@11: Please don't be hostile, I only asked a question in order to better understand. I guess that kind of makes sense. I think the answer is that I was too self-referenced in regard to my own ___uality. My point of view is that I am extremely attracted to v___s and I couldn't care less whether I have a d___ or not. I guess some males (ie male spirits) are more defined by pride in having a d___ than any other defining factor? Or something like that.

@10 Not a "mindset". A biological, fundamental fact.

The brain and body are connected. Being born transgendered is not a psychological issue..it is a physical one. But of course each part of the equation (mind and body) need care.

Therapy and then hormones are a huge part of it but some things simply can not be addressed without surgery.

@10, I don't understand it either, but you know what? I don't have to.

I'm gay and there are a lot of straight people who just will never understand what being gay is about. That's fine too.

I don't have to understand trans people. I just have to support their right to live in a way that will make them happy. Straight people don't have to understand my being gay. All I ask is that they not fuck with my pursuit of happiness.

I don't understand trans folks, but I fully support their rights, equality, and think they deserve all the protections the law can afford. I don't understand them, but as humans I have to grant them the same baseline of respect I would for anyone else. I don't understand them, but as a fellow human being I have the minimum obligation to not screw with their lives and choices, and a greater obligation to do what I can to make the world a place where they, and all people, can have fair opportunity for happiness.

Understanding is never a necessity. Support, caring, kindness. These are the only things necessary no matter who you are dealing with. If you can provide these then don't worry about understanding. That will either come or it won't, but it is far less important.

@16, you're right--I had an inkling I was wrong when I typed it, and was too lazy to look it up. Thank you for the clarifications.

He's fucking adorable! Hats off to these guys. Warms my heart.

@19 Two points:
1. It can be very difficult to be kind if you are unsure whether or not you will offend someone because you lack understanding.
2. Understanding is not necessary, but it is an irrepressible urge for extremely curious pseudo-intellectuals like me :)

@17 - It does appear that you genuinely want to understand, but it's possible that you may not be able to internalize the feelings of a trans person in this because, as you mention, you are attracted to vaginas and could not feel otherwise. You also could be fairly secure in your masculinity, so a FtM's obstacles to being accepted as male might not be something you'd be able to empathize with.

One perspective I've heard is that when the presence/absence of body parts are used as justification to deny your gender identity, it adds to the distress. So being able to remove breasts makes it easier to walk down the street and not be automatically treated like a female.

And when being with a sexual partner, the presence/absence of plumbing could lead to rejection or even violence. Imagine how you'd feel if you met a beautiful woman at a bar, went to bed with her, and it turned out she had a penis. It would be surprising at the very least, and a lot of men would not go through with sex.

@22 - Being kind is never offensive. Being kind doesn't require understanding. It requires listening. I don't have to understand a person to learn from them what they want and need from me.

And sure, if you really want to understand something go for it, but some things are going to be beyond your ability to understand. When you don't understand accept it and just be kind.

I just want to say how impressed I am at the level of discourse here. As an insurance lawyer, I am used to everyone assuming the insurance companies are always the bad guys. Whether the decision in this case was right or wrong, I appreciate the implicit understanding I see here that there is a genuine dilemma over what should be covered. Personally, I think it should be covered as much as any other physical, genetic disorder, but I can appreciate the reasoned debate over whether it is necessary or correcting a physical or psychological ailment.

@23 Thanks, that helps
@24 Thanks, @11 and @23 made me understand.

However...Look at dan's recent email with the catholic lady. She was sure trying to be kind, but she failed because she didn't understand his point of view. If she did, she would have tried a diferent tack or not tried to convert him at all.

@10 I don't get it either. I can't imagine it.

As someone who likes both male and female genitalia on other people, I can't imagine hating my own, whichever they happened to be. I don't feel defined by my sex organs; I'm pretty confident I'd be basically the same person if I had been born with a penis that I am with a clit.

I especially don't understand the strict lines sometimes drawn between genders. It is like they want to be male so they can do "masculine" things, or female so they can do "feminine" things, and I want to just ask "what is holding you back?!"

So, I don't understand or empathize with their problem.

However, I sympathize with their need to change what they can to make themselves who they want to be, and who am I to say what they need and what will work?

Why are people now chiming in that understanding isn't important? It's always important. Saying "I don't have to understand" is how you end up w people who think gays are pedophiles or that vaccinations cause autism, and no evidence will ever change their mind because "they don't have to understand."

By all means, be kind and respectful, but a crucial part of that is an open-hearted desire to understand more about what it is that you are accepting.

@12, it is not dysmorphia, it is a difference is brain structure.

@13: The original point was that when the body and brain do not match up, the body is the problem. While this is very PC, it is not how the medical community operates in anything close to a universal fashion.

I brought up anorexia before, and it is a good example here: the anorexic has a normal body, but the brain sees it as horribly overweight. It is foolish and wrong to say the body is wrong, and the mind is right. Or even phantom limb syndrome. The body is missing an arm, and the brain is wrong that it is still there and in pain. The brain is the problem, not the body.

The fact that there are seperate tests for physical and mental issues is irrelevant. I never claimed that there is not a differenct between the two, and one was more "important" than the other. The sticking point is in regard to insurance anyway, not if gender dysmorphia is a real thing, or if trans people have mental illnesses.

Also, your last sentance is incredibly condescending. I do not know if you intended it, but I do not need you to pat my head and send me to the library.

@19 That was the most moving testimony to Love Thy Neighbor as I've read in a long, long time. This needs to be shouted from pulpits.

@Drusilla: thanks for the reading recommendation; that book looks good.

@Indighost: Happy to help.

@28 Frost

Some of it is probably just that "understand" is often used where "empathize" should be used.

I understand that gender identity is very important to many people, and that some people want to change genders.

I don't understand why it is important, or why they want to change. I can hear the arguments, but they make no sense to me, because the arguments are based on emotions and feelings I do not share. More correctly, I don't empathize with the desire to change gender.

I do sympathize with it, because I empathize with the desire to change oneself and I understand that the changing of someone else's gender has no relevance on my life and potentially will make that person happier, which I think is a good thing.

@28 "Why are people now chiming in that understanding isn't important? It's always important. Saying "I don't have to understand" is how you end up w people who think gays are pedophiles or that vaccinations cause autism, and no evidence will ever change their mind because "they don't have to understand.""

Not, that's not "not understanding". That's using "not understanding" as an excuse for bigotry.

Not understanding doesn't inherently lead to being a bigot.

I will never understand what goes on for a trans person. I don't understand how they feel about their bodies. I can barely understand straight people.

But I still fully support them, their decisions about their bodies and lives, and genuinely want to see them protected and given equal opportunity in all walks of life.

Sorry, but understanding isn't necessary. Just because some people use their lack of understanding as an excuse to be jerks doesn't mean the problem lies with their understanding. It lies with their personality and choices.

Lacking understanding of what a person experiences doesn't mean, however, not caring or listening to them. I don't need to understand because I can still listen. I don't understand what they experience, how they see themselves and others, or what it feels like to be them.

But I can listen to what they say they want from me. That, combined with a desire to see them happy is all I, or anyone really, needs. Be that a desire to be called by a certain pronouns, to sign a petition to get legislators to protect their rights, to simply treat them like any other man or woman... what ever. I don't have to understand their experience to do these things.

Also, what fortunate said @34.

@4,

I challenge you to find a health insurance plan that would cover breast reduction for men with man boobs. That is and always will be considered cosmetic, and insurance doesn't cover elective cosmetic surgery.

It's going to be a challenge for transpeople going forward to figure out what insurance should realistically cover for their transition. Hormone therapy? Yes. Bottom surgery (so to speak)? Probably. Anything that comes across as cosmetic? It'll be a cold day in hell frankly.

The transgendered man in this story shouldn't have had to pay for his hormone treatment, but his own top surgery? I'm going to say yes. Health care is about making people healthy (to the best of its ability), not about making us perfectly happy with our appearance.

@37, actually when male breast reduction surgery has been found to be psychologically nessessary it is often covered. Also, it is more accurate to consider it reconstructive surgery.

@37: This is in Germany, but is an example of a very valid case of male breast reduction coverage: German Wachbataillon soldiers develop br…

The majority of the public simply does not understand Trans* issues. This is not their fault, no one talks about trans issues, no one educates about them. People have to go by "what they feel about it" or "what they heard in church" or often at best "what I read on the interent".

Most of the people on here who are saying the surgery shouldn't be covered simply do not understand that this is the single most successful treatment for the health and well being of this person involved and is recognized as such by the medical establishment.

Trans people have been left by the wayside for way way too long, and ignored simply because their issues are not "attractive" or "easy". I'm so glad to see that this year will be Seattle VERY FIRST Trans* pride march and event. The future is coming and Trans* people will be there.

If you wish to help the Trans* People in your community to obtain the rights and resources that are due, visit www.genderjusticeleague.com and give them a hand or a donation.

Dear 25, please allow me to harsh your mellow regarding what you perceive to be a general happy happy towards insurance companies. Those goddamn soulsucking anal warts who reap billions in profits by denying medical care to as many as they can get away with by ripping off their customers are always to blame. If they could figure out how to get corpses to pay premiums they would gladly let everyone die a miserable death. I'm so tickled that you work in Satan's own favorite form of capital enterprise. I hope you live in a nice house and drive a nice car and send your kids to nice schools with the wages you make from for profit medical care. Blood money spends just as well as other forms of income, I guess.

This gives me hope for the younger generation. Such wonderful guys.

Why can't the circus start its own Chicks with Dicks insurance company? Oh, right. We all have to suffer with the modern day Elephant Men.

41,

I'm not saying that there aren't sleazy insurance companies out there, or that most wouldn't love to avoid paying claims, but it wouldn't be a good business model. Who would buy insurance from a company that never pays claims.

The reason for a lot of the vilification is that people buy insurance for one type of thing, but expect it to pay for everything. The wind/flood distinction in Katrina was a particularly heinous example, but more common disputes are akin to someone who buys only fire insurance and demands coverage when his house floods. Insurance companies usually pay up right away when it's clear they owe on a claim (they suffer huge penalties in bad faith claims and lose customers otherwise), but they'd all go out of business if they paid on claims they didn't owe.

As for my nefarious role, most often it involves explaining to insurance companies that they do in fact have to pay on a claim that they think they can avoid (or that they don't, but the chance of an u favorable judgment is high enough that they should just pay anyway). Other times it involves telling them not to pay for a claim where an insured clearly violated the contract, or generally telling them how courts in a given state have interpretted a relevant provision.

The blood money / satan's den stuff sounds pretty cool, but the truth is a bit banal.

@44, I would prefer insurance for health was not a thing and we had universal coverage like north European countries or that it was strictly non-profit, like Germany. There have been some pretty terrible rejected claims for Trans people, like rejecting blood transfusions because they had "transgender blood" and the company doesn't cover Trans claims. Insurance companies only cover what they are legally required to and nothing else. Which is why the law of what needs to be covered should be changed. I don't blame you personally for any of this btw.

@45,

I'd actually agree with you on that. The free market isn't always better, and like any business, health insurers put profit ahead of the well-being of their customers. To the extent we want to put access to healthcare first, the free market is an inferior mechanism. To the extent that we are resigned to leaving it in the hands of the free market, we have to accept that they won't pay any more than they are legally obligated to.

It is a very heartening story.

As for understanding, life isn't long enough. Being unable to understand human beings (and being convinced I'm quite inhuman), I make do with listening. Most people are quite capable of telling one what's necessary.