Why is SRS "medically necessary," and not "cosmetic?"

[bxcellent2eo]

I am looking into electrolysis and other procedures for my transition, but it's a trend for these procedures to be denied as they are not medically necessary, and only cosmetic; while sexual reassignment surgery is medically necessary and not cosmetic. I'm trying to make a case to my insurance on why these procedures are medically necessary and not cosmetic, by comparing them to SRS.

What constitutes SRS as medically necessary? (Playing devil's advocate here:) Can't it be said that changing your genitals to look like something else is only cosmetic. We can live the rest of our lives with the current genitals we have, assuming they're not infected.

For me, I'd think electrolysis and facial feminization surgery are more necessary, as they affect the outward appearance seen by the general public, while genitals are only seen by you and your partner. In my opinion, it is more necessary for my mental health to pass in a public setting, than in a private setting.

What are your thoughts on any and all of this?

[tracy176]

Um I think your stretching it


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[Tysilio]

You may want to refer your insurance company to the WPATH Standards of Care. Here's what they have to say about these "other" surgeries:

Although most of these procedures are generally labeled "purely aesthetic," these same operations in an individual with severe gender dysphoria can be considered medically necessary, depending on the unique clinical situation of a given patient's condition and life situation.

So they get it, but it sucks that the rest of the health care industry hasn't caught up.

[Carrie Liz]

In England, they did a study on people who had had cosmetic surgery, and overall it actually has a 65% regret rate, with only 28% pleased with the results.

SRS actually on average improved the quality of life, self-image, mental happiness, bodily satisfaction, and self-reported levels of anxiety in trans people in just about every study done on it. Regret rates are almost always below 10%, and usually related to complications rather than actually feeling like the surgery was wrong for them, with people who are "satisfied" or "very satisfied" with it usually being around 80%. Clearly SRS is not just cosmetic, even though it basically is just changing the appearance of something. It really does correct an underlying feeling of wrongness in trans people, while normal cosmetic surgery does not generally "correct" anything in cis people.

[lovelessheart]

Ummm... obvious reasons? Srs is the most important step  t a lot. However it is all important, so I dont think we should start complaining.

I am looking into electrolysis and other procedures for my transition, but it's a trend for these procedures to be denied as they are not medically necessary, and only cosmetic; while sexual reassignment surgery is medically necessary and not cosmetic. I'm trying to make a case to my insurance on why these procedures are medically necessary and not cosmetic, by comparing them to SRS.

What constitutes SRS as medically necessary? (Playing devil's advocate here:) Can't it be said that changing your genitals to look like something else is only cosmetic. We can live the rest of our lives with the current genitals we have, assuming they're not infected.

For me, I'd think electrolysis and facial feminization surgery are more necessary, as they affect the outward appearance seen by the general public, while genitals are only seen by you and your partner. In my opinion, it is more necessary for my mental health to pass in a public setting, than in a private setting.

What are your thoughts on any and all of this.

[bxcellent2eo]

In England, they did a study on people who had had cosmetic surgery, and overall it actually has a 65% regret rate, with only 28% pleased with the results.

SRS actually on average improved the quality of life, self-image, mental happiness, bodily satisfaction, and self-reported levels of anxiety in trans people in just about every study done on it. Regret rates are almost always below 10%, and usually related to complications rather than actually feeling like the surgery was wrong for them, with people who are "satisfied" or "very satisfied" with it usually being around 80%. Clearly SRS is not just cosmetic, even though it basically is just changing the appearance of something. It really does correct an underlying feeling of wrongness in trans people, while normal cosmetic surgery does not generally "correct" anything in cis people.

Thank you for this. Numbers are good. Can you cite these sources for me, please?

[Carrie Liz]

Cosmetic Surgery Regrets Study: http://www.dailystar.co.uk/fashion-beauty/380887/Cosmetic-surgery-regrets

Just about every study ever done on SRS: http://transascity.org/quality-of-life-in-treated-transsexuals/
(pretty much every study which said that quality of life was lower was comparing post-SRS trans people to cisgender controls, rather than pre-op trans people.)

[Tysilio]

The problem with all the studies showing that a high percentage of people regret cosmetic surgery is that from our point of view, they're looking at the wrong group. Those studies are looking at people who are normal in appearance, but want to look better for reasons of vanity. This assumes, a priori, that the surgery is in fact cosmetic and not medically necessary.

I suspect that the results would be very different if they studied people on whom plastic surgery was done to correct a congenital defect or an abnormality resulting from an injury; I think a sample of people who had surgery to correct facial deformities would have far fewer regrets about it.

It seems to me that the latter group is more akin to MTFs who need facial feminization surgery, or FTMs who need liposuction around their hips and thighs. For many of us, these procedures are needed to correct things which are, in effect, congenital deformities.

It's a matter of a deep level of self- and social acceptance, not one of vanity.

[suzifrommd]

Same reason why surgery to correct a serious injury is medically necessary.

Everyone deserves to be whole.

[Carrie Liz]

That's exactly the point of showing the study of healthy people who have cosmetic surgery for complete reasons of vanity, and the regrets involved. It shows that SRS and FFS very clearly are NOT just cosmetic surgeries that people elect to have on a whim.

[jeni]

I think the GRS is considered necessary because it produces a functional change that gives you the, er, apparatus of the other gender. Your body is then physically aligned with your gender identity, so you can therefore no longer be suffering gender dysphoria. Your condition has been fully treated, so you're in the same boat as a cis person who finds themselves unattractive.

That first paragraph is in the perspective of those who make the rule, I am not saying that is a reasonable view by any means! However, I am not sure how the difference between necessary and cosmetic can be defined. I don't know where the line should be. So there's a certain logic to the distinction.

[Muffinheart]

BA/FFS = vanity

GRS/SRS/GCS = sanity

[Tysilio]

I think the GRS is considered necessary because it produces a functional change that gives you the, er, apparatus of the other gender. Your body is then physically aligned with your gender identity, so you can therefore no longer be suffering gender dysphoria. Your condition has been fully treated, so you're in the same boat as a cis person who finds themselves unattractive.

The difficulty with this is that gender dysphoria doesn't only relate to primary sexual characteristics, i.e. genitals. Top surgery for FTMs makes this very clear; breasts are a secondary sexual characteristic, yet for many FTMs, they, rather than our genitals, can be the major focus of our dysphoria. Top surgery is now generally accepted as medically necessary for many FTMs -- it's just as much gender reassignment surgery as is bottom surgery. As I understand it, for many MTFs, the masculinization of the face which takes place during puberty (also a secondary sexual characteristic) can also be a major trigger for dysphoria. By this logic, it should be (and is, by the WPATH standards) treated as medically necessary GRS for those individuals.

[kelly_aus]

BA/FFS = vanity

GRS/SRS/GCS = sanity

As someone with little issues with my genitals, I could say that SRS is for vanity.. But I acknowledge that I'm not everyone, for some it is very needed. A BA, on the other hand, would be beneficial to me due to the poor natural ones I've acquired from hormones, both in terms of my mental health and peoples perceptions of me.

[Zumbagirl]

If you have FFS you are still you, you just look more girly in the face. If you have electrolysis you are still you, you just don't shave. If you have SRS you give up the ability to reproduce for the rest of your life and nearly all government agencies (as well as society in general) will recognize the new genitals for the purposes of identification, marriage, etc. There is a huge difference between that one operation and anything else one can do to alter their physical body.

[jeni]

The difficulty with this is that gender dysphoria doesn't only relate to primary sexual characteristics, i.e. genitals. Top surgery for FTMs makes this very clear; breasts are a secondary sexual characteristic, yet for many FTMs, they, rather than our genitals, can be the major focus of our dysphoria. Top surgery is now generally accepted as medically necessary for many FTMs -- it's just as much gender reassignment surgery as is bottom surgery. As I understand it, for many MTFs, the masculinization of the face which takes place during puberty (also a secondary sexual characteristic) can also be a major trigger for dysphoria. By this logic, it should be (and is, by the WPATH standards) treated as medically necessary GRS for those individuals.

Oh, I agree that it's problematic. I'm not arguing that the rules are the way it should be. I just don't know where the line between cosmetic and medically necessary needs to lie. For cis people, there's a fairly clear difference between cosmetic and reconstructive. There's not a great analog for trans people, though, because you're not restoring something to its original state.

I think a better solution would be for the insurance companies to at least respect the standards for what is needed and get rid of trans exclusions. Medically necessary should be the end of it: if it's necessary, it needs to be covered. That doesn't solve the problem, because it's a quagmire to define necessary, but we could do without the insurers unilaterally deciding to disregard what the medical communities come up with.

[LordKAT]

Part of that could be because most mtf gain breasts from hormones. If they didn't then BA would be just as medically necessary IMO.

[Carrie Liz]

Oh, I agree that it's problematic. I'm not arguing that the rules are the way it should be. I just don't know where the line between cosmetic and medically necessary needs to lie. For cis people, there's a fairly clear difference between cosmetic and reconstructive. There's not a great analog for trans people, though, because you're not restoring something to its original state.

Actually, with FFS, yes you are. Unlike boobs or hips, the face's bone structure isn't feminine because it's been affected by estrogen, it's feminine because it hasn't been affected by testosterone. Testosterone causes the brow ridge, causes the bigger chin, causes the angularity and the Adam's Apple, while estrogen really doesn't do anything to the face's bone structure. So in a way, FFS actually is reconstructive surgery. It's taking your face and trying to revert it to the state it was previously in before testosterone un-feminized it.

[ImagineKate]

Ummm... obvious reasons? Srs is the most important step  t a lot.

I disagree.

SRS is at the very bottom of my list, and a lot of trans women do not have SRS.

In my opinion, HRT is the most important to most that medically transition.

[Muffinheart]

I disagree.

SRS is at the very bottom of my list, and a lot of trans women do not have SRS.

In my opinion, HRT is the most important to most that medically transition.

Respectfully, I disagree.
I know of a few trans living full time, great jobs, great life, but never started HRT. One, because of a bad liver, the other because her doctor suggested she might have a few extra pounds. I also know of another who's been an airline stewardess for years with a major airline, never been on hormones.
I am also of the belief, from someone who's been on hormones six full years, hormones do not make me a woman. They did not mold me into who I am. They didn't define my character or magically make me more sensitive. Hormones were a nice addition to my transition, but had i for some reason been denied access to them, I still would have transitioned.
Hormones, In opinion are not the magic ingredient to transition, but they don't hurt for some.